Symptoms of Depression and Anxiety Among Black Medical Students: the Role of Peer Connectedness and Perceived Discrimination

This study examined the association between discrimination, peer connectedness, and mental health symptoms among Black medical students. Data were collected from a convenience sample of Black medical students via an anonymous electronic questionnaire (n = 733) in year 2020. The Patient-Reported Outcomes Measurement Information System Depression and Anxiety forms were used to measure depression and anxiety symptoms. Structural equation modeling was used to examine the association between discrimination, peer connectedness, and mental health symptoms (Mplus 7.3). The majority of the participants were female (80%), approximately 40% were third or fourth year medical school students, and 13% had a clinical diagnosis of depression/anxiety before medical school. About half of the students reported being watched more closely than their classmates, and 66% reported feeling the need to work twice as hard as others to get the same treatment or evaluation. The majority of students reported that their peers were supportive of their academic success (60.7%), and 53% reported that students often or always invited them to social outings. The mean T-score for depressive symptoms was 53.6 (SD = 7.8), and the mean T-score for anxiety symptoms was 58.6 (SD = 8.4). Overall, findings indicated a high prevalence of anxiety and depression symptoms among Black medical students, and increased discrimination was associated with more mental health symptoms among males. Additionally, increased peer connectedness was associated with fewer symptoms of anxiety among males and females and fewer depressive symptoms among females. Addressing discrimination among medical students may improve mental health among Black medical students.

Experiences of Discrimination, Institutional Responses to Seminal Race Events, and Depressive Symptoms in Black U.S. Medical Students

PURPOSE

To examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students.

METHOD

This study collected data from a convenience sample of Black U.S. medical students via an anonymous electronic questionnaire in August 2020 that was distributed through the Student National Medical Association and Organization of Student Representatives listservs and an author's social media accounts. It included questions on demographics, institutional responses to seminal race events, experiences of discrimination, and symptoms of depression. Path models were used to examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students.

RESULTS

Of the 750 students completing the survey, 733 (97.7%) were Black. Experiences of discrimination and a lack of institutional responses to seminal race events were associated with more depressive symptoms (b = 0.19, 95% CI: 0.11, 0.26; P < .001 and b = 0.12, 95% CI: 0.04, 0.20; P = .01). After controlling for gender and clinical diagnosis of depression or anxiety before medical school, there was a relationship between experiences of discrimination and institutional responses to seminal race events such that students who reported more experiences of discrimination were more likely to report that their institution did not respond to seminal race events (b = 0.41, 95% CI: 0.34, 0.48; P < .001). Experiences of discrimination moderated the relationship between institutional responses to seminal race events and depressive symptoms (i.e., the relationship between a lack of institutional responses to seminal race events and depressive symptoms was stronger among students who reported more frequent experiences of discrimination).

CONCLUSIONS

Institutions dedicated to supporting Black medical student wellness must be diligent in cultivating a culture intolerant of discrimination and deft in their responses to seminal race events in the larger culture.

FMAQ-S: Development of a Short Form of the Family Medicine Attitudes Questionnaire

Introduction

Identifying and training students who choose family medicine careers is essential to meeting primary care workforce needs in the United States. Medical students' positive attitudes toward family medicine are associated with students' choice of family medicine as a specialty. This study sought to refine a previously tested questionnaire assessing US medical students' attitudes toward family medicine by shortening the questionnaire to make it more useful in educational practice and research settings.

Methods

We refined our existing 14-item questionnaire by item analysis and validation. We conducted item analysis using a graded response model approach after identifying the unidimensionality of the original scale. We selected items based on their item discrimination parameters and item information levels, and calculated the correlation between specialty choice and family medicine attitudes score to evaluate criterion validity.

Results

Exploratory factor analyses indicated the questionnaire is unidimensional. Among the original 14 items, 10 items had high item discrimination parameters and low standard error of measurement. These 10 items contribute the most to distinguishing individuals' differences in family medicine attitudes and were selected for inclusion in the short-form questionnaire (FMAQ-S). The point-biserial correlation between the short-form scale and students' choice of family medicine was 0.378, which provides supporting evidence for criterion validity.

Conclusion

The FMAQ-S is a concise and validated measure for assessing medical student attitudes toward family medicine. This abbreviated questionnaire can be used by medical educators to identify students for specific programming or interventions intended to support family medicine specialty choice.

Attitudes Toward Family Medicine Among Students Choosing Other Primary Care Specialties

BACKGROUND AND OBJECTIVES

Little is known about how medical students choose between primary care specialties. We compared the attitudes toward family medicine of medical students intending to practice primary care but not family medicine (PCNFM), with students intending to practice family medicine (FM) and those intending nonprimary care (NPC) careers.

METHODS

The Family Medicine Attitudes Questionnaire (FMAQ) was distributed to 2,644 fourth-year medical students at 16 medical schools in spring 2017. Respondents were stratified by career intention. In this secondary data analysis, we used descriptive statistics to characterize responses to each questionnaire item and FMAQ total score, and analysis of variance with Bonferroni post hoc analyses to compare category and item mean responses.

RESULTS

Of 2,644 fourth-year medical students who received the FMAQ, 1,188 (41.8%) submitted usable responses. The 14-item FMAQ has a maximum score of 70. Mean total scores differed by category: 59.05 for FM, 52.88 for NPC, and 54.83 for PCNFM (F=108.96, P&lt;.01); the differences between each possible pairing were significant (P&lt;.05). Comparing the responses of students intending PCNFM careers with those of students intending NPC careers, there were no differences in mean responses for 8 of 14 FMAQ items. Responses of students intending PCNFM careers were similar to students intending FM for only 4 of 14 items (P&lt;.05).

CONCLUSIONS

Fourth-year students intending to match into PCNFM have attitudes toward FM that more closely approximate the attitudes of NPC students than the attitudes of FM students. Future research should explore implications for curricular development, student mentorship, and career advising.

Are Clinicians Contributing to Excess African American COVID-19 Deaths? Unbeknownst to Them, They May Be

African Americans are overrepresented among reported coronavirus disease 2019 (COVID-19) cases and deaths. There are a multitude of factors that may explain the African American disparity in COVID-19 outcomes, including higher rates of comorbidities. While individual-level factors predictably contribute to disparate COVID-19 outcomes, systematic and structural factors have not yet been reported. It stands to reason that implicit biases may fuel the racial disparity in COVID-19 outcomes. To address this racial disparity, we must apply a health equity lens and disaggregate data explicitly for African Americans, as well as other populations at risk for biased treatment in the health-care system.

Student Interest in a Primary Care of Underserved Populations Course

BACKGROUND AND OBJECTIVES

Medical students often lack curricular offerings specific to the care of underserved populations. We surveyed first- and second-year students to inform the development of a 4-week course on the skills necessary to care and advocate for underserved populations within a primary care context. This study assessed students' interest in the potential course, interest in primary care (PC) and underserved care (UC), and factors that would make the course more or less interesting to students.

METHODS

The authors designed and offered a survey examining UC, PC, and course interest to all first- and second-year students at one institution. Open-ended free-text survey responses were qualitatively analyzed using content analysis.

RESULTS

Response rate was 72% (271/374). Most responding students (90%; 198/220) were very to somewhat interested in UC; 60% (132/220) were very to somewhat interested in PC; and 79% (173/220) were very to somewhat interested in the described course. Very interested students were more likely to endorse interest in learning about community advocacy, having a faculty mentor, clinical care experience, and loan repayment than those with low course interest (P&lt;.001). Analysis of open-ended responses revealed an emphasis on advocacy and career feasibility, resulting in the inclusion of these topics in the final course curriculum.

CONCLUSIONS

This manuscript outlines potential areas of engagement for students demonstrating low or high interest in a Caring for Underserved Patients course. Our study may inform educators seeking to develop similar curricular interventions, particularly those who aim to recruit students to PC or UC careers.