The Impact of Trainee and Standardized Patient Race and Gender on Internal Medicine Resident Communication Assessment Scores

ABSTRACT Background Standardized patient (SP) encounters are commonly used to assess communication skills in medical training. The impact of SP and resident demographics on the standardized communication ratings in residents has not been evaluated. Objective To examine the impact of gender and race on SP assessments of internal medicine (IM) residents' communication skills during postgraduate year (PGY) 1. Methods We performed a retrospective cohort study of all SP assessments of IM PGY-1 residents for a standardized communication exercise from 2012 to 2018. We performed descriptive analyses of numeric communication SP ratings by gender, race, and age (for residents and SPs). A generalized estimating equation model, clustered on individual SP, was used to determine the association of gender (among SP and residents) with communication ratings. A secondary analysis was performed to determine the impact of residents and SP racial concordance in communication scores. Results There were 1356 SP assessments of 379 IM residents (199 male residents [53%] and 178 female residents [47%]). There were significant differences in average numeric communication rating (mean 3.40 vs 3.34, P = .009) by gender of resident, with higher scores in female residents. There were no significant interactions between SP and resident gender across the communication domains. There were no significant interactions noted with racial concordance between interns and SPs. Conclusions Our data demonstrate an association of resident gender on ratings in standardized communication exercises, across multiple communication skills. There was not an interaction impact for gender or racial concordance between SPs and interns.

Lack of Native Hawaiian Neurologists and Disparities in Care for Native Hawaiians in Hawaiʻi

Introduction: In Hawaiʻi, there are 367,000 Native Hawaiian and Pacific Islanders. Native Hawaiians experience health disparities in a variety of conditions, including stroke, diabetes, and cancer. Ethnic minorities are underrepresented among physicians; this lack of physician-patient racial concordance may contribute to the disparities, as recent studies suggest that racial discordance resulted in poorer healthcare quality. This study aims to assess the current status of neurological health disparities in the Native Hawaiian population in Hawaiʻi, with a focus on identifying neurologist ethnic representation, neurological diseases, and healthcare-related challenges disproportionately affecting Native Hawaiians. Methods: An anonymous survey on physician’s attitudes and practice was emailed to all neurologists in the Hawaiʻi Neurological Society from February 2019 to June 2019. Findings: Twenty-three full responses and one partial response was received. No participants self-identified as Native Hawaiian nor did they know of any Native Hawaiian neurologists in Hawaiʻi, yet all who completed the survey reported treating Native Hawaiians in their practice (n = 23), which identifies a gap in Native Hawaiian representation in the field of neurology in Hawaiʻi. In addition, majority of participants perceived that Native Hawaiians are disproportionately affected by neurological diseases and have difficulty accessing neurology services and obtaining quality care. Conclusions: Future focus on creating opportunities to improve racially discordant physician-patient relationships and to increase Native Hawaiian representation in neurology may help narrow the gap in health disparities experienced by Native Hawaiians.

“When Is Health Care Actually Going to Be Care?” The Lived Experience of Family Planning Care Among Young Black Women

While family planning care (FPC) visits may serve as opportunities to address gaps in knowledge and access to limited resources, young Black women may also face structural barriers (i.e., racism, discrimination, bias) to engaging in care due to the intersections of racial identity, age, and socioeconomic status. Findings from interviews with 22 Black women, ages 18 to 29 years, about the lived experience of FPC highlighted dynamic patient–provider encounters. Women’s narratives uncovered the following essences: silence around sex impedes engagement in care, patient–provider racial concordance as protection from harm, providers as a source of discouragement and misinformation, frustration as a normative experience, decision making excludes discussion and deliberation, medical mistrust is pervasive and a part of Black consciousness, and meaningful and empathic patient–provider encounters are elusive. Health systems should prioritize developing and enhancing young Black women’s relationship with FPC providers to help mitigate persistent inequities that perpetuate disadvantage among this population.

Physician–patient racial concordance and disparities in birthing mortality for newborns

Recent work has emphasized the benefits of patient–physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn–physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.

The Effect of Patient-Centered Communication and Racial Concordant Care on Care Satisfaction Among U.S. Immigrants

Immigrants living in the United States experience disparities in satisfaction with medical care. Practicing patient-centered communication and providing racially (or race-concordant) concordant care are suggested as effective approaches to improve care satisfaction. Using the Medical Expenditure Panel Survey, we found that immigrant patients with medical providers who practiced patient-centered communication were more likely to be satisfied with the care they received regardless of patient–provider racial concordance, and that simply having racially concordant medical providers did not significantly affect the satisfaction level for immigrant patients. The findings suggest that providing patient-centered communication may mitigate racial and cultural differences between providers and patients, and is key to reducing disparities and improving immigrant patients’ satisfaction level with medical care.

Is Patient-Provider Racial Concordance Associated with Hispanics’ Satisfaction with Health Care?

This study adds a gender approach to determine how patient provider racial concordance and acculturation affect Hispanics’ satisfaction with care and inform more nuanced approaches to improving the quality of care for this population. Using the Medical Expenditure Panel Surveys (MEPS) from 2009–2011, four binary satisfaction outcome measures were created from the MEPS: “doctor showed respect”, “spent enough time”, “explained things in a way you could understand”, and “listened carefully”. Next, a Probit model was employed to estimate the impact of racial concordance and acculturation on the probability of being satisfied with provider care for both male and female Hispanics. For Hispanic women, no significant association was found for the relationship between patient-provider concordance and the overall satisfaction with their care. Hispanic men were found to be less likely to be satisfied with some aspects of their medical care when they were racially concordant with their provider. Overcoming assumptions about shared identity is a crucial step in providing culturally competent care for all patients. There is a need for additional considerations in medical training to help physicians connect with patients, regardless of any type of observable concordance.