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Journal of Racial and Ethnic Health Disparities

, Volume 3, Issue 3, pp 519–526 | Cite as

The Impact of Everyday Discrimination and Racial Identity Centrality on African American Medical Student Well-Being: a Report from the Medical Student CHANGE Study

  • Sylvia P. Perry
  • Rachel Hardeman
  • Sara E. Burke
  • Brooke Cunningham
  • Diana J. Burgess
  • Michelle van Ryn
Article

Abstract

Positive psychological well-being is an important predictor of and contributor to medical student success. Previous work showed that first-year African American medical students whose self-concept was highly linked to their race (high racial identity centrality) were at greater risk for poor well-being. The current study extends this work by examining (a) whether the psychological impact of racial discrimination on well-being depends on African American medical students’ racial identity centrality and (b) whether this process is explained by how accepted students feel in medical school. This study used baseline data from the Medical Student Cognitive Habits and Growth Evaluation (CHANGE) Study, a large national longitudinal cohort study of 4732 medical students at 49 medical schools in the USA (n = 243). Regression analyses were conducted to test whether medical student acceptance mediated an interactive effect of discrimination and racial identity centrality on self-esteem and well-being. Both racial identity centrality and everyday discrimination were associated with negative outcomes for first-year African American medical students. Among participants who experienced higher, but not lower, levels of everyday discrimination, racial identity centrality was associated with negative outcomes. When everyday discrimination was high, but not low, racial identity was negatively related to perceived acceptance in medical school, and this in turn was related to increased negative outcomes. Our results suggest that discrimination may be particularly harmful for African American students who perceive their race to be central to their personal identity. Additionally, our findings speak to the need for institutional change that includes commitment and action towards inclusivity and the elimination of structural racism.

Keywords

Racial identity Discrimination Medical student well-being 

Notes

Acknowledgments

Dr. Hardeman acknowledges the support of the Veterans Affairs Associated Health Postdoctoral Fellowship Training Program.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Research Involving Human Participants

All procedures in studies involving human participants were in accordance with the ethical standards of the institutional and or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This research study was approved by the human subjects Institutional Review Boards of the University of Minnesota (IRB #0905S66901, approved 5 June 2009) and Mayo Clinic (IRB #13-004612, approved 13 July 2013).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Disclaimers

The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

Funding/Support

Support for this research was provided by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health under award number R01 HL085631. Dr. Perry was additionally supported by the NHLBI Supplement to Promote Diversity in Health Related Research of the NIH under award number R01 HL085631-S1. Dr. Hardeman was additionally supported by the NHLBI Supplement to Promote Diversity in Health Related Research of the NIH under award number 3 R01 HL085631-02S2.

Supplementary material

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Copyright information

© W. Montague Cobb-NMA Health Institute 2015

Authors and Affiliations

  • Sylvia P. Perry
    • 1
  • Rachel Hardeman
    • 2
    • 3
  • Sara E. Burke
    • 4
  • Brooke Cunningham
    • 5
  • Diana J. Burgess
    • 6
    • 7
  • Michelle van Ryn
    • 2
    • 3
  1. 1.Department of Psychological ScienceUniversity of VermontBurlingtonUSA
  2. 2.Division of Health Care Policy and ResearchMayo ClinicRochesterUSA
  3. 3.Department of Health Sciences ResearchMayo ClinicRochesterUSA
  4. 4.Department of PsychologyYale UniversityNew HavenUSA
  5. 5.Department of Family Medicine and Community Health, School of MedicineUniversity of MinnesotaMinneapolisUSA
  6. 6.Department of MedicineUniversity of MinnesotaMinneapolisUSA
  7. 7.Center for Chronic Disease Outcomes ResearchMinneapolis Veterans Affairs Medical CenterMinneapolisUSA

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