Impact of Brief Patient Exposure on Pre-Clinical U.S. Medical Student Bias Towards Mental Health.

Abstract

Objective: Negative bias towards patients with mental illness contributes to worsened healthcare outcomes. However, few data exist on interventions to decrease bias. In this study, the authors examined the impact of brief patient exposure on first-year medical student perceptions of psychiatry.

Methods: In 2023, two townhalls were introduced to the psychiatry course for first-year medical students at Indiana University School of Medicine. Participants were surveyed before and after the course using the Mental Illness: Clinician's Attitudes version 2 (MICA-2), with higher scores indicating more negative bias. Pre- and post-course scores were compared with paired t-tests. Level of pre-course bias in years with townhalls (2023 and 2024) was compared to the year without townhalls (2022) with an unpaired t-test. Impact of townhalls was assessed by comparing 2022 data to 2023 and 2024 with repeated measures analysis of variance (ANOVA).

Results: Response rates ranged from 22.5 to 32.0%. The combined 2023 and 2024 pre- and post-course MICA-2 means were 36.5 (SE 0.6) and 34.8 (SE 0.6), respectively. The pre-course means were not significantly different from 2022's, indicating a consistent level of baseline bias (t(236) = 0.11, p = 0.92). Repeated measures ANOVA indicated change attributed to the course was significantly less in years with townhalls (2023 and 2024) compared to the year without (2022; F = 4.04, p = 0.045).

Conclusions: Contrary to the hypothesis, added patient volunteer exposure resulted in less reduction in bias compared to the year without such exposure. These findings suggest increased complexity in reducing bias; timing and context of patient exposures may be important determinants of effect on bias.