The Value of Interracial Contact for Reducing Anti-Black Bias Among Non-Black Physicians: A Cognitive Habits and Growth Evaluation (CHANGE) Study Report.

Although scholars have long studied circumstances that shape prejudice, inquiry into factors associated with long-term prejudice reduction has been more limited. Using a 6-year longitudinal study of non-Black physicians in training (N = 3,134), we examined the effect of three medical-school factors-interracial contact, medical-school environment, and diversity training-on explicit and implicit racial bias measured during medical residency. When accounting for all three factors, previous contact, and baseline bias, we found that quality of contact continued to predict lower explicit and implicit bias, although the effects were very small. Racial climate, modeling of bias, and hours of diversity training in medical school were not consistently related to less explicit or implicit bias during residency. These results highlight the benefits of interracial contact during an impactful experience such as medical school. Ultimately, professional institutions can play a role in reducing anti-Black bias by encouraging more frequent, and especially more favorable, interracial contact.

Correction to: Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students.

Due to a tagging error, two authors were incorrectly listed in indexing systems. Brook W. Cunningham should be B.A. Cunningham and Mark W. Yeazel should be M.W. Yeazel for indexing purposes.

Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians.

Importance: Burnout among physicians is common and has been associated with medical errors and lapses in professionalism. It is unknown whether rates for symptoms of burnout among resident physicians vary by clinical specialty and if individual factors measured during medical school relate to the risk of burnout and career choice regret during residency. Objective: To explore factors associated with symptoms of burnout and career choice regret during residency. Design, Setting, and Participants: Prospective cohort study of 4732 US resident physicians. First-year medical students were enrolled between October 2010 and January 2011 and completed the baseline questionnaire. Participants were invited to respond to 2 questionnaires; one during year 4 of medical school (January-March 2014) and the other during the second year of residency (spring of 2016). The last follow-up was on July 31, 2016. Exposures: Clinical specialty, demographic characteristics, educational debt, US Medical Licensing Examination Step 1 score, and reported levels of anxiety, empathy, and social support during medical school. Main Outcomes and Measures: Prevalence during second year of residency of reported symptoms of burnout measured by 2 single-item measures (adapted from the Maslach Burnout Inventory) and an additional item that evaluated career choice regret (defined as whether, if able to revisit career choice, the resident would choose to become a physician again). Results: Among 4696 resident physicians, 3588 (76.4%) completed the questionnaire during the second year of residency (median age, 29 [interquartile range, 28.0-31.0] years in 2016; 1822 [50.9%] were women). Symptoms of burnout were reported by 1615 of 3574 resident physicians (45.2%; 95% CI, 43.6% to 46.8%). Career choice regret was reported by 502 of 3571 resident physicians (14.1%; 95% CI, 12.9% to 15.2%). In a multivariable analysis, training in urology, neurology, emergency medicine, and general surgery were associated with higher relative risks (RRs) of reported symptoms of burnout (range of RRs, 1.24 to 1.48) relative to training in internal medicine. Characteristics associated with higher risk of reported symptoms of burnout included female sex (RR, 1.17 [95% CI, 1.07 to 1.28]; risk difference [RD], 7.2% [95% CI, 3.1% to 11.3%]) and higher reported levels of anxiety during medical school (RR, 1.08 per 1-point increase [95% CI, 1.06 to 1.11]; RD, 1.8% per 1-point increase [95% CI, 1.6% to 2.0%]). A higher reported level of empathy during medical school was associated with a lower risk of reported symptoms of burnout during residency (RR, 0.99 per 1-point increase [95% CI, 0.99 to 0.99]; RD, -0.5% per 1-point increase [95% CI, -0.6% to -0.3%]). Reported symptoms of burnout (RR, 3.20 [95% CI, 2.58 to 3.82]; RD, 15.0% [95% CI, 12.8% to 17.3%]) and clinical specialty (range of RRs, 1.66 to 2.60) were both significantly associated with career choice regret. Conclusions and Relevance: Among US resident physicians, symptoms of burnout and career choice regret were prevalent, but varied substantially by clinical specialty. Further research is needed to better understand these differences and to address these issues.

Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students.

BACKGROUND: Implicit and explicit bias among providers can influence the quality of healthcare. Efforts to address sexual orientation bias in new physicians are hampered by a lack of knowledge of school factors that influence bias among students. OBJECTIVE: To determine whether medical school curriculum, role modeling, diversity climate, and contact with sexual minorities predict bias among graduating students against gay and lesbian people. DESIGN: Prospective cohort study. PARTICIPANTS: A sample of 4732 first-year medical students was recruited from a stratified random sample of 49 US medical schools in the fall of 2010 (81% response; 55% of eligible), of which 94.5% (4473) identified as heterosexual. Seventy-eight percent of baseline respondents (3492) completed a follow-up survey in their final semester (spring 2014). MAIN MEASURES: Medical school predictors included formal curriculum, role modeling, diversity climate, and contact with sexual minorities. Outcomes were year 4 implicit and explicit bias against gay men and lesbian women, adjusted for bias at year 1. KEY RESULTS: In multivariate models, lower explicit bias against gay men and lesbian women was associated with more favorable contact with LGBT faculty, residents, students, and patients, and perceived skill and preparedness for providing care to LGBT patients. Greater explicit bias against lesbian women was associated with discrimination reported by sexual minority students (b = 1.43 [0.16, 2.71]; p = 0.03). Lower implicit sexual orientation bias was associated with more frequent contact with LGBT faculty, residents, students, and patients (b = -0.04 [-0.07, -0.01); p = 0.008). Greater implicit bias was associated with more faculty role modeling of discriminatory behavior (b = 0.34 [0.11, 0.57); p = 0.004). CONCLUSIONS: Medical schools may reduce bias against sexual minority patients by reducing negative role modeling, improving the diversity climate, and improving student preparedness to care for this population.

Informal Training Experiences and Explicit Bias Against African Americans among Medical Students.

Despite the widespread inclusion of diversity-related curricula in US medical training, racial disparities in the quality of care and physician bias in medical treatment persist. The present study examined the effects of both formal and informal experiences on non-African American medical students' (N=2922) attitudes toward African Americans in a longitudinal study of 49 randomly selected US medical schools. We assessed the effects experiences related to medical training, accounting for prior experiences and attitudes. Contact with African Americans predicted positive attitudes toward African Americans relative to White people, even beyond the effects of prior attitudes. Furthermore, students who reported witnessing instructors making negative racial comments or jokes were significantly more willing to express racial bias themselves, even after accounting for the effects of contact. Examining the effects of informal experiences on racial attitudes may help develop a more effective medical training environment and reduce racial disparities in healthcare.

Internalized HIV and Drug Stigmas: Interacting Forces Threatening Health Status and Health Service Utilization Among People with HIV Who Inject Drugs in St. Petersburg, Russia.

Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services.

Lay Conceptions of Sexual Minority Groups.

Bisexual people are often implored to "pick a side," implying that bisexuality is both more controllable and less desirable than heterosexuality or homosexuality. Bisexual people's status as a social group perceived to fall between a traditionally advantaged group and a traditionally disadvantaged group may have the potential to clarify lay conceptions of sexual orientation. We examined participants' views of groups varying in sexual orientation by randomly assigning participants (including heterosexual men and women as well as gay men and lesbian women) from four samples to evaluate heterosexual, bisexual, or homosexual targets (N = 1379). Results provided strong evidence for the previously untested theoretical argument that bisexuality is perceived as less stable than heterosexuality or homosexuality. In addition, participants low in Personal Need for Structure rated female (but not male) bisexuality as relatively stable, suggesting that a preference for simple, binary thinking can partially explain a negative conception of an ostensibly "intermediate" identity. Bisexual targets were perceived as falling between heterosexual and homosexual targets in terms of gender nonconformity, and less decisive, less monogamous, and lacking in positive traits that were associated with homosexual targets. In sum, views of bisexual people were both more negative than and qualitatively different from views of gay men and lesbian women. We discuss the results as an illustration of the complex ways that perceivers' attitudes can differ depending on which target groups they are considering, suggesting that intergroup bias cannot be fully understood without attending to social categories viewed as intermediate.

Medical students' learning orientation regarding interracial interactions affects preparedness to care for minority patients: a report from Medical Student CHANGES.

BACKGROUND: There is a paucity of evidence on how to train medical students to provide equitable, high quality care to racial and ethnic minority patients. We test the hypothesis that medical schools' ability to foster a learning orientation toward interracial interactions (i.e., that students can improve their ability to successfully interact with people of another race and learn from their mistakes), will contribute to white medical students' readiness to care for racial minority patients. We then test the hypothesis that white medical students who perceive their medical school environment as supporting a learning orientation will benefit more from disparities training. METHODS: Prospective observational study involving web-based questionnaires administered during first (2010) and last (2014) semesters of medical school to 2394 white medical students from a stratified, random sample of 49 U.S. medical schools. Analysis used data from students' last semester to build mixed effects hierarchical models in order to assess the effects of medical school interracial learning orientation, calculated at both the school and individual (student) level, on key dependent measures. RESULTS: School differences in learning orientation explained part of the school difference in readiness to care for minority patients. However, individual differences in learning orientation accounted for individual differences in readiness, even after controlling for school-level learning orientation. Individual differences in learning orientation significantly moderated the effect of disparities training on white students' readiness to care for minority patients. Specifically, white medical students who perceived a high level of learning orientation in their medical schools regarding interracial interactions benefited more from training to address disparities. CONCLUSIONS: Coursework aimed at reducing healthcare disparities and improving the care of racial minority patients was only effective when white medical students perceived their school as having a learning orientation toward interracial interactions. Results suggest that medical school faculty should present interracial encounters as opportunities to practice skills shown to reduce bias, and faculty and students should be encouraged to learn from one another about mistakes in interracial encounters. Future research should explore aspects of the medical school environment that contribute to an interracial learning orientation.

Medical School Experiences Associated with Change in Implicit Racial Bias Among 3547 Students: A Medical Student CHANGES Study Report.

BACKGROUND: Physician implicit (unconscious, automatic) bias has been shown to contribute to racial disparities in medical care. The impact of medical education on implicit racial bias is unknown. OBJECTIVE: To examine the association between change in student implicit racial bias towards African Americans and student reports on their experiences with 1) formal curricula related to disparities in health and health care, cultural competence, and/or minority health; 2) informal curricula including racial climate and role model behavior; and 3) the amount and favorability of interracial contact during school. DESIGN: Prospective observational study involving Web-based questionnaires administered during first (2010) and last (2014) semesters of medical school. PARTICIPANTS: A total of 3547 students from a stratified random sample of 49 U.S. medical schools. MAIN OUTCOME(S) AND MEASURE(S): Change in implicit racial attitudes as assessed by the Black-White Implicit Association Test administered during the first semester and again during the last semester of medical school. KEY RESULTS: In multivariable modeling, having completed the Black-White Implicit Association Test during medical school remained a statistically significant predictor of decreased implicit racial bias (-5.34, p ≤ 0.001: mixed effects regression with random intercept across schools). Students' self-assessed skills regarding providing care to African American patients had a borderline association with decreased implicit racial bias (-2.18, p = 0.056). Having heard negative comments from attending physicians or residents about African American patients (3.17, p = 0.026) and having had unfavorable vs. very favorable contact with African American physicians (18.79, p = 0.003) were statistically significant predictors of increased implicit racial bias. CONCLUSIONS: Medical school experiences in all three domains were independently associated with change in student implicit racial attitudes. These findings are notable given that even small differences in implicit racial attitudes have been shown to affect behavior and that implicit attitudes are developed over a long period of repeated exposure and are difficult to change.

The Adverse Effect of Weight Stigma on the Well-Being of Medical Students with Overweight or Obesity: Findings from a National Survey.

BACKGROUND: The stigma of obesity is a common and overt social bias. Negative attitudes and derogatory humor about overweight/obese individuals are commonplace among health care providers and medical students. As such, medical school may be particularly threatening for students who are overweight or obese. OBJECTIVE: The purpose of our study was to assess the frequency that obese/overweight students report being stigmatized, the degree to which stigma is internalized, and the impact of these factors on their well-being. DESIGN: We performed cross-sectional analysis of data from the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES) survey. PARTICIPANTS: A total of 4,687 first-year medical students (1,146 overweight/obese) from a stratified random sample of 49 medical schools participated in the study. MAIN MEASURES: Implicit and explicit self-stigma were measured with the Implicit Association Test and Anti-Fat Attitudes Questionnaire. Overall health, anxiety, depression, fatigue, self-esteem, sense of mastery, social support, loneliness, and use of alcohol/drugs to cope with stress were measured using previously validated scales. KEY RESULTS: Among obese and overweight students, perceived stigma was associated with each measured component of well-being, including anxiety (beta coefficient [b] = 0.18; standard error [SE] = 0.03; p < 0.001) and depression (b = 0.20; SE = 0.03; p < 0.001). Among the subscales of the explicit self-stigma measure, dislike of obese people was associated with several factors, including depression (b = 0.07; SE = .01; p < 0.001), a lower sense of mastery (b = -0.10; SE = 0.02; p < 0.001), and greater likelihood of using drugs or alcohol to cope with stress (b = .05; SE = 0.01; p < 0.001). Fear of becoming fat was associated with each measured component of well-being, including lower body esteem (b = -0.25; SE = 0.01; p < 0.001) and less social support (b = -0.06; SE = 0.01; p < 0.001). Implicit self-stigma was not consistently associated with well-being factors. Compared to normal-weight/underweight peers, overweight/obese medical students had worse overall health (b = -0.33; SE = 0.03; p < 0.001) and body esteem (b = -0.70; SE = 0.02; p < 0.001), and overweight/obese female students reported less social support (b = -0.12; SE = 0.03; p < 0.001) and more loneliness (b = 0.22; SE = 0.04; p < 0.001). CONCLUSIONS: Perceived and internalized weight stigma may contribute to worse well-being among overweight/obese medical students.

The mixed impact of medical school on medical students' implicit and explicit weight bias.

CONTEXT: Health care trainees demonstrate implicit (automatic, unconscious) and explicit (conscious) bias against people from stigmatised and marginalised social groups, which can negatively influence communication and decision making. Medical schools are well positioned to intervene and reduce bias in new physicians. OBJECTIVES: This study was designed to assess medical school factors that influence change in implicit and explicit bias against individuals from one stigmatised group: people with obesity. METHODS: This was a prospective cohort study of medical students enrolled at 49 US medical schools randomly selected from all US medical schools within the strata of public and private schools and region. Participants were 1795 medical students surveyed at the beginning of their first year and end of their fourth year. Web-based surveys included measures of weight bias, and medical school experiences and climate. Bias change was compared with changes in bias in the general public over the same period. Linear mixed models were used to assess the impact of curriculum, contact with people with obesity, and faculty role modelling on weight bias change. RESULTS: Increased implicit and explicit biases were associated with less positive contact with patients with obesity and more exposure to faculty role modelling of discriminatory behaviour or negative comments about patients with obesity. Increased implicit bias was associated with training in how to deal with difficult patients. On average, implicit weight bias decreased and explicit bias increased during medical school, over a period of time in which implicit weight bias in the general public increased and explicit bias remained stable. CONCLUSIONS: Medical schools may reduce students' weight biases by increasing positive contact between students and patients with obesity, eliminating unprofessional role modelling by faculty members and residents, and altering curricula focused on treating difficult patients.

Comparison of daily step count between the Fitbit Inspire 3 and the activPAL 3 in adults with transtibial amputation.

Introduction: Physical activity has significant positive effects on health. Accelerometers can be used to track daily physical activity. The Fitbit Inspire 3 is a commercially available health and fitness tracker, but its validity for tracking steps among individuals with transtibial amputation has not been examined. Therefore, the purpose of this study was to evaluate the concurrent validity of the Fitbit Inspire 3 for assessing free-living daily steps in adults with transtibial amputation. Methods: Participants (n = 79) completed a general health survey and were provided with a Fitbit Inspire 3 and activPAL 3 accelerometer to wear concurrently for seven days in their home environment. Relationships between the activPAL and Fitbit Inspire 3 were examined using Pearson's Correlation. Paired samples t-tests, mean difference, mean absolute difference, and equivalence testing were used to compared daily step counts between Fitbit Inspire 3 and activPAL 3. Results: Average step counts were 5,768 ± 3,750 (mean ± SD) and 4,674 ± 3,081 by the Fitbit Inspire 3 and activPAL, respectively. A high correlation (r = 0.93) but significant mean difference was found between the activPAL 3 and Fitbit Inspire 3 (p < 0.001). The mean absolute difference between the devices was 1,347 ± 1,184 steps. On average, the Fitbit Inspire 3 counted 1,094 ± 1,423 more daily steps than the activPAL 3. Equivalency could not be claimed between the devices. Discussion: The Fitbit Inspire 3 counted more steps compared to the activPAL. Because of the significant mean differences and the large mean absolute difference between the devices, the activPAL 3 and Fitbit Inspire 3 are not interchangeable for estimating physical activity in individuals with transtibial amputation. However, due to the high correlation, the devices will produce similar classification rankings based on step counts.

Temporal Considerations in Brain Metastases Radiation Therapy: The Intersection of Chronobiology and Patient Profiles.

The circadian system, a vital temporal regulator influencing physiological processes, has implications for cancer development and treatment response. Our study assessed circadian timing's impact on whole-brain radiotherapy outcomes in brain metastases for personalized cancer therapy insights. The aim of the study was to evaluate circadian influence on radiation treatment timing and its correlation with clinical outcomes and to identify patient populations benefiting from interventions synchronizing circadian rhythms, considering subgroup differences and potential disparities. An IRB-approved retrospective analysis of 237 patients undergoing whole-brain radiotherapy for brain metastases (2017-2021), receiving over 80% of treatments in the morning or afternoon, was performed. Survival analyses utilized Kaplan-Meier curves. This was a single-institution study involving patients receiving whole-brain radiotherapy. Demographic, disease, and socioeconomic parameters from electronic medical records were collected. Morning treatment (n = 158) showed a trend toward improved overall survival vs. afternoon (n = 79); the median survival was 158 vs. 79 days (p = 0.20, HR = 0.84, CI95% 0.84-0.91). Subgroup benefits for morning treatment in females (p = 0.04) and trends in controlled primary disease (p = 0.11) and breast cancer metastases (p = 0.08) were observed. Black patients exhibited diminished circadian influence. The present study emphasized chronobiological factors' relevance in brain metastases radiation therapy. Morning treatment correlated with improved survival, particularly in specific subgroups. Potential circadian influence disparities were identified, laying a foundation for personalized cancer therapy and interventions synchronizing circadian rhythms for enhanced treatment efficacy.

Gendered Anti-Bisexual Bias: Heterosexual, Bisexual, and Gay/Lesbian People's Willingness to Date Sexual Orientation Ingroup and Outgroup Members.

Bisexual people may appear to have more potential romantic partners than people only attracted to one gender (e.g., heterosexual, gay, lesbian people). However, bisexual people's dating choices are limited by non-bisexual people's reluctance to date bisexual people. Studies have indicated that some heterosexual, gay, and lesbian people are reluctant to date bisexual people, particularly bisexual men. We extend current understandings of gendered anti-bisexual bias through investigating heterosexual, bisexual, gay, and lesbian people's reported willingness to date within and outside of their sexual orientation groups. Participants (n = 1823) varying in sexual orientation completed measures regarding their willingness to engage in a romantic relationship with heterosexual, bisexual, gay, and lesbian individuals. Heterosexual and gay/lesbian people were less willing to date bisexual people than bisexual people were to date them, consistent with anti-bisexual bias rather than mere in-group preference. Preferences against dating bisexual men appeared particularly strong, even among bisexual women.

Testing a Self-Affirmation Intervention for Improving the Psychosocial Health of Black and White Medical Students in the US.

Self-affirmation interventions have been shown to mitigate the negative psychological effects of stereotype threat on Black students in secondary and undergraduate education. However, there is currently limited research testing whether Black students in medical schools may also experience the negative influences of stereotype threat. Until now, it has been unclear whether Black (vs. White) students experience a lower sense of belonging in medical school and whether they can benefit from self-affirmation interventions during medical training. With a longitudinal field experiment, we tested (a) whether Black (vs. White) medical students in the US experience decrements in psychological well-being (i.e., fatigue, depression, anxiety), sense of belonging, perceived residency competitiveness, and residency goal stability; and (b) the extent to which a self-affirmation intervention would ameliorate any observed disparities in these outcomes for Black students. With a sample of 234 Black and 182 White medical students across 50 schools in the US, we found that Black students tended to report more fatigue and less belonging than White students; however, the self-affirmation intervention did not significantly influence students' fatigue, depression, anxiety, or belonging. Unexpectedly, Black students in the self-affirmation (vs. control) condition reported lower perceived competitiveness for residency. White students' perceived competitiveness for residency was unaffected by the intervention. Exploratory analyses revealed that Black (vs. White) students were less likely to indicate stable residency goals over time, which may be an indication of threat; however, this racial gap was eliminated with the intervention. We discuss the plausible reasons for these findings and provide recommendations for future work in this area.

A Longitudinal Study Exploring Learning Environment Culture and Subsequent Risk of Burnout Among Resident Physicians Overall and by Gender.

OBJECTIVE: To explore the relationship between learning environment culture and the subsequent risk of developing burnout in a national sample of residents overall and by gender. METHODS: From April 7 to August 2, 2016, and May 26 to August 5, 2017, we surveyed residents in their second (R2) and third (R3) postgraduate year. The survey included a negative interpersonal experiences scale (score range 1 to 7 points, higher being worse) assessing psychological safety and bias, inclusion, respect, and justice; an unfair treatment scale (score range 1 to 5 points, higher being worse), and two items from the Maslach Burnout Inventory. Individual responses to the R2 and R3 surveys were linked. RESULTS: The R2 survey was completed by 3588 of 4696 (76.4%) residents; 3058 of 3726 (82.1%) residents completed the R3 survey; and 2888 residents completed both surveys. Women reported more negative interpersonal experiences (mean [SD], 3.00 [0.83] vs 2.90 [0.85], P<.001) and unfair treatment (66.5% vs. 58.7%, P<.001) than men at R2. On multivariable analysis, women at R3 were more likely than their male counterparts to have burnout (odds ratio, 1.23; 95% CI, 1.02 to 1.48; P=.03). Both men and women who reported more negative interpersonal experiences at R2 were more likely to have burnout at R3 (odds ratio, 1.32; 95% CI, 1.14 to 1.52; P<.001). The factors contributing to burnout did not vary in effect magnitude by gender. CONCLUSION: These findings indicate women residents are more likely to have burnout relative to men in the third year of residency. Negative culture predicted subsequent burnout 1 year later among both men and women. Differences in burnout were at least partly due to differing levels of exposure to negative interactions for men versus women rather than a negative interaction having a differential impact on the well-being of men versus women.

A Comparison of Depression and Anxiety Symptoms Between Sexual Minority and Heterosexual Medical Residents: A Report from the Medical Trainee CHANGE Study.

Purpose: The pervasiveness of sexual minority stressors in the U.S. medical training environment is well documented, yet little is known about the mental health impact of such stressors on sexual minority medical residents. We compared depression and anxiety symptoms between sexual minority and heterosexual third-year medical residents, adjusting for depression and anxiety before residency, and examined the role of perceived residency belonging during the second year of residency as a predictor of subsequent sexual identity-based differences in depression and anxiety. Methods: In 2010-2011, first-year medical students enrolled in the Cognitive Habits and Growth Evaluation Study and completed surveys in the last year of medical school (MS4; 2014), as well as second (R2; 2016) and third (R3; 2017) year of residency. The surveys contained measures of sexual identity, residency belonging, depression, and anxiety. Results: Of the 2890 residents who provided information about their sexual identity, 291 (10.07%) identified as sexual minority individuals. Sexual minority residents reported significantly higher levels of depression (p = 0.009) and anxiety (p = 0.021) than their heterosexual peers at R3, even after adjusting for depression and anxiety at MS4. Sexual minority residents also reported a lower sense of belonging at R2 than did heterosexual residents (p = 0.006), which was in turn associated with higher levels of depression and anxiety at R3 (ps < 0.001). Conclusion: Sexual minority residents experienced higher levels of depression and anxiety than their heterosexual counterparts, and these mental health disparities were associated with lower perceived belonging in residency. Residency programs should prioritize evidence-based, targeted interventions for sexual minority mental health.

Contact and role modeling predict bias against lesbian and gay individuals among early-career physicians: A longitudinal study.

RATIONALE: Physician bias against sexual minorities can hinder the delivery of high-quality health care and thus contribute to the disproportionate prevalence of negative health outcomes within this population. Medical students' interpersonal experiences within the context of medical school may contribute to this bias. OBJECTIVE: The goal of the current research was to examine the relationship between these interpersonal experiences, reported by heterosexual, cisgender medical students, and explicit and implicit bias against lesbians and gay individuals, reported two years later during second year of medical residency. METHOD: Data were collected by surveying students (n = 2940) from a stratified sample of U.S. medical schools in fall 2010 (first semester of medical school), spring 2014 (final semester of medical school), and spring 2016 (second year of medical residency). RESULTS: Amount and favorability of contact with LGBT individuals, reported during the final semester of medical school, predicted lower levels of explicit bias against lesbian and gay individuals during second year of medical residency. Additionally, exposure to negative role modeling, also reported during the final semester of medical school, predicted higher levels of explicit bias against lesbian and gay individuals during second year of medical residency. Amount of contact with LGBT individuals - and in particular, with LGBT medical students - predicted lower levels of implicit bias against lesbian and gay individuals during second year of medical residency. Neither favorability of contact with LGBT individuals nor exposure to negative role modeling predicted implicit bias against lesbian and gay individuals during second year of medical residency. CONCLUSION: These results suggest that interpersonal experiences during medical school can systematically shape heterosexual, cisgender physicians' subsequent explicit and implicit bias against lesbian and gay individuals.

A Prognostic Index to Identify the Risk of Developing Depression Symptoms Among U.S. Medical Students Derived From a National, Four-Year Longitudinal Study.

PURPOSE: To determine baseline individual and school-related factors associated with increased risk of developing depression symptoms by year four (Y4) of medical school, and to develop a prognostic index that stratifies risk of developing depression symptoms (Depression-PI) among medical students. METHOD: The authors analyzed data from 3,743 students (79% of 4,732) attending 49 U.S. medical schools who completed baseline (2010) and Y4 (2014) surveys. Surveys included validated scales measuring depression, stress, coping, and social support. The authors collected demographics and school characteristics and conducted multivariate analysis to identify baseline factors independently associated with Y4 depression symptoms. They used these factors to create a prognostic index for developing depression. They randomly divided the data into discovery (n = 2,455) and replication (n = 1,288) datasets and calculated c statistics (c). RESULTS: The authors identified eight independent prognostic factors for experiencing depression symptoms during training within the discovery dataset: age; race; ethnicity; tuition; and baseline depression symptoms, stress, coping behaviors, and social support. The Depression-PI stratified four risk groups. Compared with the low risk group, those in the intermediate, high, and very high risk groups had an odds ratio of developing depression of, respectively, 1.75, 3.98, and 9.19 (c = 0.71). The replication dataset confirmed the risk groups. CONCLUSIONS: Demographics; tuition; and baseline depression symptoms, stress, coping behaviors, and social support are independently associated with risk of developing depression during training among U.S. medical students. By stratifying students into four risk groups, the Depression-PI may allow for a tiered primary prevention approach.