Secondary Logo

Medical Students’ Perceptions of and Responses to Health Care Disparities During Clinical Clerkships

Glaser, Johanna; Pfeffinger, Alana, MPH; Quan, Judy, PhD; Fernandez, Alicia, MD

doi: 10.1097/ACM.0000000000002582
Research Report: PDF Only
Free
SDC
PAP

Purpose: To measure the frequency and nature of student perceived clinician-driven health care disparities, and determine their impact on medical students’ professional development.

Method: Retrospective study of fourth-year medical students at the University of California, San Francisco School of Medicine, August 2016 to June 2017. Conducted via an electronic survey asking about frequency/nature of directly witnessed health care disparities and barriers/facilitators to action during third-year clerkships, and individual, semi-structured interviews focusing on clinical details and impact on students’ professional development.

Results: Students (103/159; 65%) responded. In internal medicine clerkships, a majority of students perceived disparities as occurring sometimes (2–7 times in 8-week clerkship) or often (at least once weekly or nearly daily) based on language barriers (89%), patients’ homelessness (76%), history of substance abuse (76%), obesity (76%), and race/ethnicity: Latino (72%), Black (71%), and Asian (56%). Results from other clerkships were similar. Barriers to student action to perceived disparities included fear of poor evaluations, hierarchy/powerlessness, a “don’t speak up” culture, the desire to be a team player, limited clinical experience, and perceiving doctors as “good people” who provide disparate care unintentionally. Impact on professional development varied, ranging from students’ normalization of disparities as stemming from clinical constraints to increased motivation to provide equitable care.

Conclusions: Medical students routinely witness health care disparities during clerkships and their observations spotlight specific clinical practices. For some students, these observations lead to a normalization of disparities; for others, they heighten commitment to equity. Clinical curricula should incorporate responding to health care disparities.

J. Glaser is medical student, School of Medicine, University of California, San Francisco, San Francisco, California.

A. Pfeffinger is research analyst, Department of Medicine, University of California, San Francisco, San Francisco, California.

J. Quan is biostatistician, Department of Medicine, University of California, San Francisco, San Francisco, California.

A. Fernandez is professor, Department of Medicine, University of California, San Francisco, San Francisco, California.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A627.

Acknowledgments: The authors wish to thank Dr. Catherine Lucey, Professor and Vice Dean for Education, University of California, San Francisco, School of Medicine and Eric Steinbrook, BA, in facilitating our student survey and in manuscript preparation, respectively.

Funding/Support: National Institute on Minority Health and Health Disparities, award R25MD006832; National Institute of Diabetes and Digestive and Kidney Diseases, award K24DK102057.

Other disclosures: None reported.

Ethical approval: University of California, San Francisco (UCSF) institutional review board approval, IRB # 16-19798.

Previous presentations: UCSF School of Medicine; multiple forums.

Correspondence should be addressed to Alicia Fernandez, UCSF Box 1364, DGIM Zuckerberg San Francisco General Hospital, San Francisco, CA 94143; telephone: (415) 206-5394; Email: alicia.fernandez@ucsf.edu; Twitter: @AliciaFMD and @ucsfcvp.

© 2019 by the Association of American Medical Colleges