The Impact of Everyday Discrimination and Racial Identity Centrality on African American Medical Student Well-Being: a Report from the Medical Student CHANGE Study
- 616 Downloads
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.
KeywordsRacial identity Discrimination Medical student well-being
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 was obtained from all individual participants included in the study.
The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.
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.
- 9.Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: Institute of Medicine; 2002.Google Scholar
- 10.Smedley BD, Butler AS, Bristow LR. In the nation's compelling interest: ensuring diversity in the health care workforce. Washington, DC: Institute of Medicine; 2004.Google Scholar
- 16.Wang K. Racial identity of minority adolescents: a review of empirical research. American Counseling Association VISTAS Online 2011; Retrieved from http://counselingoutfitters.com/vistas/vistas11/Article_73.pdf. Available at. Accessed June 2, 2015, 2015.
- 19.Cross WE, Parham TA, Helms JE. Nigrescence revisited: theory and research. In: Jones R, editor. African American identity development: theory, research and intervention. 1 ed. Hampton, VA: Cobb & Henry; 1998. p. 3–72.Google Scholar
- 20.Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB, Yeazel MW, Hardeman R, Perry S, van Ryn M. Implicit and explicit weight bias in a national sample of 4,732 medical students: The medical student CHANGES study. Obesity. 2014;22:1201–8. doi: 10.1002/oby.20687
- 22.White JL, Parham TA. The psychology of blacks: an African American perspective. New Jersey: Prentice-Hall; 1990.Google Scholar
- 29.Kessler RC, Mickelson KD, Williams DR. The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior. 1999;208-230.Google Scholar
- 30.Thompson WE, Hickey J V. Social stratification in the U.S. class system. Soc. Focus. 5th ed., Boston: Pearson; 2005. pp. 183–187.Google Scholar