Exploring Negative Behaviors and Biased Perceptions in the Clinical Environment: Students' Perspectives

• In Event: Equity in Assessment in the Health Professions

Abstract

Introduction
Professionalism is considered one of the core competencies in the training of professionals. In medical education, the Physician Competency Reference Set (PCRS) defines professionalism as a set of attributes and behaviors. 5 Professionalism entails creating workplaces that are physically and psychologically safe within the health care system.6 Role modeling from trainers is crucial to create a learning environment that fosters diversity, equity, and inclusiveness for medical students to grow academically and professionally. Therefore, it is important to investigate how un/professional attitudes and behaviors in treating patients, working with colleagues, and coaching students are demonstrated.
Previous research has shown the various unprofessionalism and bias issues that people of color face in the quality of health care and the behaviors and attitudes of health care providers.7 In medical education, research found that gender bias impacted faculty assessment of medical student learners.8 Brown et al. 9 used a qualitative, constructivist approach to investigate bias based on the experiences of medical students from multiple UK medical schools. We investigated negative behaviors and biased perceptions demonstrated by health professionals as perceived and experienced by medical students in the clinical rotation at one medical school.
Methods
We used a mixed-methods sequential design, first collecting and analyzing quantitative data through the items in the learning environment survey followed by focus groups. The survey items included two areas 1) disconnection and unprofessional behaviors demonstrated by faculty, residents, and nurses and 2) perceived biases in clinical assessment and learning opportunities based on ethnicity, gender, etc. Based on the quantitative findings and previous literature, a semi-structured interview protocol was designed asking students to provide their interpretations of survey results and their personal experiences.
Data sources
73 students out of 98 responded to the survey and responses were analyzed using SPSS.
Results
While only 1.4% reported unprofessional behaviors demonstrated by residents and 2.7% by nurses, 37% of students agreed or strongly agreed there were disconnects between the level of professionalism demonstrated by faculty and what they were taught about professionalism. Furthermore, 56% of students agreed or strongly agreed that their clinical assessments were solely based on their knowledge, not influenced by other factors. The participants reported various instances of explicit and implicit bias because of race, gender, religion, ethnicity, and socioeconomic status.
Implications
By investigating students’ perceptions, this study provides implications about the importance of bias training for clinical educators. To further explain our quantitative findings, focus groups to explore students’ perceptions in depth in Block 1/2 (July and August) are planned. Transcripts will be analyzed using a thematic inductive coding method. Being more aware of personal bias will help to improve educators’ ethical behaviors and foster a more inclusive learning environment.

Authors

• Xiaomei Song, Case Western Reserve University
  Presenting Author

• Mildred Willy, Central Michigan University
  Non-Presenting Author