This dissertation is based on the notion that understanding the early years of medical training is vital to gaining perspective on the socialization of future physicians. I find that the medical school socialization process is a complex and multidimensional one. Studies of this process over the years have failed to explore how the role of diverse social positions fits into the process. It is the premise of this dissertation that the medical school socialization process is likely one in which certain students (e.g. White, male, upper-middle class) will thrive while its effect on non-whites, women and lower income groups may be less beneficial. This, combined with the fact that members of marginalized social positions may begin their medical training with different resources and vulnerabilities than their counterparts who are part of the majority suggests that medical school socialization processes has the potential to be harmful to certain groups. In this dissertation, I use social position (race, gender, SES) to explore and understand three aspects of the medical school socialization process--psychological well-being, identity and attitudes towards patient care. I believe that these are three important elements that can have a profound impact on the experience of medical trainees and ultimately the type of physicians they will become. All analyses come from the Medical Student CHANGES Study. The first manuscript assesses whether there are race and gender disparities in mental and physical health in a national sample of first-year medical students; if there are race and gender differences in factors known to increase resiliency to stress (e.g. coping, mastery, social support, self esteem); and how race and gender intersect to impact depression and anxiety. The second manuscript examines if racial identity is a protective factor for depression and anxiety among African American first year medical students. It also explores the interaction between gender and racial identity and SES and racial identity and their impact on depressive and anxiety symptoms. The third manuscript explores the relationship between socio-demographic characteristics (gender, race and SES) and attitudes towards patient-centered care among African American and White first year medical students.In manuscript one, African American and female students were found to be at greater risk for depression and anxiety. African American students were also at greater risk of lacking psychosocial resources such as social support. In manuscript two, findings suggested that a high racial identity is not protective of depression and anxiety. Instead, I found that students with high racial identity were at greater risk for depression and anxiety. In manuscript three, I found that female gender and SES (low-middle income) were significant predictors of positive attitudes towards patient-centered care. Conclusions:This dissertation provides insight into the potential impact of the medical socialization process on students from marginalized social positions, more specifically; how the process impacts their psychological well-being, identity and attitudes towards patient care of students. The findings of this dissertation have practical implications for medical education, clinical care and health disparities.
University of Minnesota Ph.D. dissertation. January 2014. Major: Health Services Research, Policy and Administration. Advisors: Todd H. Rockwood, PhD
Michelle van Ryn, PhD, MPH. 1 computer file (PDF); xiv, 275 pages, appendix p. 168-275.
Hardeman, Rachel Renee.
Reconstructing research: exploring the intersections of race, gender and socioeconomic status in medical education.
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