When a patient's ethnicity is declared, medical students' decision-making processes are affected

Ewen, S.C, Barrett, J, Paul, D, Askew, D, Webb, G and Wilkin, A (2015) When a patient's ethnicity is declared, medical students' decision-making processes are affected. Internal Medicine Journal, 45 8: 805-812. doi:10.1111/imj.12800


Author Ewen, S.C
Barrett, J
Paul, D
Askew, D
Webb, G
Wilkin, A
Title When a patient's ethnicity is declared, medical students' decision-making processes are affected
Journal name Internal Medicine Journal   Check publisher's open access policy
ISSN 1445-5994
1444-0903
Publication date 2015-08-01
Year available 2015
Sub-type Article (original research)
DOI 10.1111/imj.12800
Open Access Status Not yet assessed
Volume 45
Issue 8
Start page 805
End page 812
Total pages 8
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Formatted abstract
Background
Disparity in health status and healthcare outcomes is widespread and well known. This holds true for Indigenous peoples in many settings including Australia and Hawaii. While multi-factorial, there is increasing evidence of health practitioner contribution to this disparity. This research explored senior medical students' clinical decision-making processes.

Methods
A qualitative study was conducted in 2014 with 30 final year medical students from The University of Melbourne, Australia, and The John Burns Medical School, Hawaii, USA. Each student responded to questions about a paper-based case, first in writing and elaborated further in an interview. Half the students were given a case of a patient whose ethnicity was not declared; the other half considered the patient who was Native Hawaiian or Australian Aboriginal. A systematic thematic analysis of the interview transcripts was conducted.

Results
The study detected subtle biases in students' ways of talking about the Indigenous person and their anticipation of interacting with her as a patient. Four main themes emerged from the interview transcripts: the patient as a person; constructions of the person as patient; patient–student/doctor interactions; and the value of various education settings. There was a strong commitment to the patient's agenda and to the element of trust in the doctor–patient interaction.

Conclusion
These findings will help to advance medical curricula so that institutions graduate physicians who are increasingly able to contribute to equitable outcomes for all patients in their care. The study also draws attention to subtle biases based on ethnicity that may be currently at play in physicians' practices.
Keyword Aboriginal health
Bias
Clinical decision-making
Health disparity
Indigenous health
Medical curriculum
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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