探索居民对种族在临床决策中的作用的信念:一项定性研究。

Journal of graduate medical education Pub Date : 2025-08-01 Epub Date: 2025-08-15 DOI:10.4300/JGME-D-24-00981.1
Elizabeth Selden, Julia Perry, Kahiau Cockett-Nagamine, Ritu Agarwal, Austin Bacon
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引用次数: 0

摘要

长期以来,种族一直被视为医学上的一个生物学决定因素,许多美国教师仍然在临床环境中引用它。随着这一领域逐渐远离这一模式,医学界面临的挑战是,如何在不强化有害做法的情况下,解决种族如何影响患者的经历和结果。在将种族纳入临床推理的相互矛盾的指导下,内科住院医生必须驾驭这种转变。了解居民目前如何概念化和应用种族在临床环境是必不可少的准备他们提供公平的,以病人为中心的护理。目的了解住院医师在临床决策中对种族的看法。方法:在2023年2月至4月期间,我们采用半结构化访谈的方法对来自美国一家机构的3个内科住院医师项目的住院医师进行了定性研究。研究人员通过电子邮件招募了参与者,向他们展示了一份临床小品,并询问了临床管理和种族对他们决策的影响。我们进行了归纳主题分析,以确定新兴主题,并通过皮亚杰的认知冲突和学习框架来解释研究结果。结果24名居民完成了研究。出现了三个主要主题:(1)坚持以种族为基础的医学,其中信仰和临床推理围绕种族作为生物学的观点相一致;(2)信念与临床推理不一致的不平衡;(3)一种新的平衡,其标志是围绕种族作为一种社会结构和承认种族主义对个人健康的影响。住院医师描述了将种族理解为一种社会结构与将其视为生物学的临床规范之间的不协调,揭示了一个质疑和重构种族如何在临床护理中使用的过程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exploring Residents' Beliefs Regarding the Role of Race in Clinical Decision-Making: A Qualitative Study.

Background Race has long been treated as a biological determinant in medicine, and many US faculty still reference it in clinical contexts. As the field shifts away from this model, the medical community faces the challenge of addressing how race shapes patients' experiences and outcomes without reinforcing harmful practices. Internal medicine residents must navigate this transition amid conflicting guidance on incorporating race into clinical reasoning. Understanding how residents currently conceptualize and apply race in clinical contexts is essential to preparing them to deliver equitable, patient-centered care. Objective To understand residents' beliefs regarding race in clinical decision-making. Methods We conducted a qualitative study using semistructured interviews with residents from 3 US internal medicine residency programs within a single institution between February and April 2023. Participants were recruited via email, presented with a clinical vignette, and asked about clinical management and the impact of race on their decisions. We conducted an inductive thematic analysis to identify emergent themes and interpreted the findings through Jean Piaget's framework of cognitive conflict and learning. Results Twenty-four residents completed the study. Three main themes emerged: (1) a persistent belief in race-based medicine where beliefs and clinical reasoning aligned around the idea of race as biological; (2) a disequilibrium defined by discrepancy between beliefs and clinical reasoning; and (3) a new equilibrium marked by alignment around race as a social construct and recognition of racism's impact on individual health. Conclusions Residents described dissonance between understanding race as a social construct and encountering clinical norms treating it as biological, revealing a process of questioning and reframing how race is used in clinical care.

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来源期刊
Journal of graduate medical education
Journal of graduate medical education Medicine-Medicine (all)
CiteScore
3.20
自引率
0.00%
发文量
248
期刊介绍: - Be the leading peer-reviewed journal in graduate medical education; - Promote scholarship and enhance the quality of research in the field; - Disseminate evidence-based approaches for teaching, assessment, and improving the learning environment; and - Generate new knowledge that enhances graduates'' ability to provide high-quality, cost-effective care.
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