The Hidden Burden: Qualitative Differences in How URiM Students Experience the Clinical Microenvironment

Area of Science:

• Medical Education
• Health Disparities
• Social Sciences in Medicine

Background:

• Medical students from underrepresented minority (URiM) backgrounds often face social challenges in clinical settings.
• Navigating these challenges requires social-emotional agility, which is not captured by traditional academic metrics.
• The impact of these unique experiences on URiM students' performance evaluations remains underexplored.

Purpose of the Study:

• To investigate the variations in clinical experiences between URiM students and white students.
• To determine if differences exist in quantitative performance evaluations between these groups.
• To understand how cultural and ethnic backgrounds influence medical students' clinical environment experiences.

Main Methods:

• A mixed-methods approach combining quantitative and qualitative data analysis.
• Retrospective analysis of standardized patient encounter scores for 534 medical students (2016-2018).
• Multivariable regression models used to assess score differences by race; semi-structured interviews conducted with 24 students.

Main Results:

• Overall average standardized patient encounter score was 88.7 (SD=5.6). White students averaged 89 (SD=5.3), and Black students averaged 87.9 (SD=7.4).
• Interview participants reported that race and gender influenced assessor interactions.
• Students described adapting to clinical environment expectations by altering speech, appearance, and self-perception.

Conclusions:

• URiM students experience distinct social dynamics in clinical settings that affect their interactions.
• Performance evaluations may not fully capture the complexities of URiM students' clinical experiences.
• Further research is needed to develop equitable assessment methods and support systems for URiM medical students.