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Influence of patient immigrant status on physician trainee diabetes treatment decisions: a virtual patient experimental study


To determine the effect of patient immigrant status on physician trainees’ diabetes treatment decisions. Participants were 140 physician trainees (‘providers’). Providers viewed videos and vignettes of virtual patients differing in immigrant status (born in Mexico or U.S.; other characteristics held constant). Analyses were completed at the group and individual levels. Providers were less likely to refer foreign-born (vs. U.S.-born) patients to endocrinology. Individual-level results showed an almost even split between treatment ratings for foreign-born vs. U.S.-born patients for three decisions (take no action, add oral hypoglycemic agent, add/switch to insulin), explaining why group-level differences for these ratings did not emerge (i.e., they were cancelled out). Physician trainees are less likely to refer foreign-born patients to endocrinology. Half of individual-level decisions were influenced by patient immigrant status, but group-level analyses mask these differences. Systematic treatment differences based on non-relevant factors could lead to adverse outcomes for immigrants.

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Loretta Hsueh, PhD, received funding from The Permanente Medical Group (TPMG) Delivery Science Fellowship Program.


This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by Award Number TL1TR002531 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Jesse C. Stewart.

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All procedures performed 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. Our Institutional Review Board approved this study.

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Hsueh, L., Hirsh, A.T., Zapolski, T. et al. Influence of patient immigrant status on physician trainee diabetes treatment decisions: a virtual patient experimental study. J Behav Med 44, 662–672 (2021).

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