Hello COMSEP!
This is our second annual COMSEP DEI Journal Club.
Thanks to our colleagues at the DEI Resource and Advisory Committee (DRAC) for their help in reviewing these important articles.
Karen, Jon and Amit
Social justice at the bedside
Hayes K, Szymusiak J, McCormick A. A clinical antiracism curriculum for third-year medical students to bring antiracist principles to the bedside. J Hosp Med. 2024 Jul;19(7):610-615. https://doi.org/10.1002/jhm.13327
Reviewed by Terry Kind
What was the study question?
What are medical students’ self-reported frequency and comfort with conversations regarding DEI topics after implementation of a social justice rounds (SJR)?
How was the study done?
Trained hospital medicine faculty implemented a Social Justice Rounds (SJR) curriculum to create space within daily clinical workflow for all team members (including students) to process and adjust to inequities in real time, at the bedside. Each SJR was limited to 15-30 minutes. Students spend 3 weeks on the inpatient teams anytime during the 8-week clerkship.
Authors used pre-post survey design (before and after clerkship) with one medical school’s pediatric clerkship students where SJR were implemented in 2021-22. The primary focus was the change in number of and comfort with conversations regarding racism in medicine and other health equity topics, with the team and patients. Mann-Whitney was used for Likert responses (self-reported abilities identifying and comfort) and unpaired t-tests were used for mean number of discussions.
What were the results?
Among students responding to the pre-test (62/125 students; 49.6%) and post-test (58/125 students; 46.4%), there was a statistically significant increase in the mean number of racism in medicine discussions in the past 2 months (beginning of clerkship) with the team (from 2.08 to 4.33; p=0.0001) and with patients directly (from 1.22 to 2.29, p=0.049). The number of health equity conversations also significantly increased (from 1.68 to 4.47 with team and from 1.14 to 3.19 with patients). Mean agreement with self-reported comfort having these discussions also increased significantly, while self-reported ability to identify and attitudinal questions were not statistically significantly increased.
How can I apply this to my work in education?
This study can also be an impetus to introduce conversations around social justice and health equity in clinical settings with learners and patients/families, augmenting other preclinical or classroom-based sessions. It would be interesting to see whether there is a sustained impact, and what impact if any there is on patient care.
Editor’s Note: This was an amazing study to show how a students incorporated essentially what was bedside teaching. It was also nice to see them ask how students incorporated it into patient care rather than just confidence. (AKP)
LGBQTIA+ curricula in medical school---where are we?
Macedo, A., Aurindo, M. & Febra, C. Effectiveness of undergraduate medical students training on LGBTQIA + people health: a systematic review and meta-analysis. BMC Med Educ 24, 63 (2024). https://doi.org/10.1186/s12909-024-05041-w
Reviewed by Molly F Wyman MD
What was the study question?
What is the current evidence on initiatives addressing medical students’ knowledge, attitudes, confidence, and discrimination perception towards LGBTQIA+ people?
How was the study done?
A systematic review of the literature (2013-2023) was conducted, using multiple databases using PRISMA guidelines and following Cochrane recommendations. Inclusion criteria focused on medical students, multiple aspects of knowledge and practice regarding LGBTQIA+ people’s health, and a variety of measurement outcomes. Quality and risk of bias was objectively evaluated by using the Medical Education Research Quality Instrument. The meta-analysis focused on student self-confidence/comfort with LGBTQIA+ patients and LGBTQIA+ patient unique/specific concerns in medicine. Statistical analysis was utilized to evaluate overall effect of group comparisons and attainment of learning objectives.
What are the results?
In total, 22 studies were included in the systematic review, involving 2164 medical students throughout all years of training in multiple countries. Interventions varied in duration (1-10+ hours) and format (lectures, videos, case discussions, role-play, discussions with individuals from LGBTQIA+ community). Studies showed consistent improvement of students’ self-confidence around LGBTQIA+ topics/interactions but had mixed results on knowledge outcomes. MERSQI scoring indicated good methodological quality for included studies. In the meta-analysis of 11 studies, a statistically significant improvement was found in students' self-confidence and comfort interacting with LGBTQIA+ individuals. Similarly, a statistically significant increase in student self-rating of understanding of unique/specific concerns for LGBTQIA+ patients on Likert scale was found.
How can this be applied to my work in education?
As we continue to improve educational content in alignment with best practices, accreditation requirements, and serving all our patient populations, this study is an excellent reminder that high quality content integration can be flexible in duration and format but still positively impact our students.
Editor’s Comments: While it is promising to see collective results demonstrating improvement in comfort and confidence in interacting with LGBTQIA+ individuals with various interventions, evidence on interventions regarding improved knowledge on unique and specific health concerns of LGBTQIA+ individuals was mixed. Ultimately, this needs to be addressed in undergraduate medical education to reduce health disparities and promote health equity for this population. (KFo)
Stress and academic performance in medical students --not necessarily a clear relationship
Eames D, Thomas S, Norman K, Simanton E, Weisman A. Sociodemographic disadvantage in the burden of stress and academic performance in medical school: implications for diversity in medicine. BMC Med Educ 2024; 24(1):348. https://dx.doi.org/10.1186/s12909-024-05263-y
Reviewed by: Veronica Gonzalez
What was the study question?
What are the relationships between sociodemographic characteristics, perceived stress, and academic performance among medical students?
How was it done?
This retrospective observational cohort study analyzed data from 358 students across six cohorts at a single institution between 2021-2026. Researchers examined preclinical, clinical, and USMLE exam scores alongside Perceived Stress Scale-4 (PSS-4) survey results. The PSS-4 survey was given at four educational milestones: prior to matriculation, at the end of the preclinical phase, at the end of third-year clerkships, and just before the match. The students were categorized into four different groups: first-generation college students (FGCS), underrepresented in medicine (URM), socioeconomically disadvantaged (SED), and students 30 or older at matriculation. Mean stress levels and academic performance were compared across these groups.
What were the results?
FGCS reported significantly higher stress levels at the end of third-year clerkships (mean 7.8 vs. 6.8, P=0.03).. URM students had lower scores on preclinical exams (mean 81.37 vs. 83.07, P=0.02). Students 30+ exhibited significantly lower exam scores across all academic performance measures. While SED students had slightly higher stress noted up until the end of third-year clerkships as well as lower academic performance and USMLE Step 1 exam scores, this was not statistically significant.
How can this be applied to my work in education?
Recognizing that nontraditional medical students encounter distinct challenges is essential. Their diverse backgrounds and experiences offer unique perspectives that enrich medical education. Educators should implement mentorship programs, provide tailored academic resources, and foster inclusive learning environments to reduce these disparities, enhance diversity, and ultimately advance health equity.
Editor’s Note: Interestingly, the findings were much less pronounced than anticipated based on previous studies. Either this institution (UNLV) is doing something right, or (as the authors posit) there is some resilience factor that protects these students. Older matriculants are a group that is worth further research as well. (JG)