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Trainee CHANGE Studies

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Do interactions with LGBT individuals in medical school predict less sexual orientation bias?

In a study presented at the 2019 Society for Personality and Social Psychology convention, Natalie M. Wittlin and colleagues examined the relationship between early-career physicians’ interpersonal experiences during medical school and their biases against lesbian and gay individuals two years later, during residency.

Natalie Markowitz Wittlin, MS

Key findings:

  • The more they had interacted with LGBT individuals during medical school, the less bias against lesbian and gay individuals they reported during residency.
  • The more positive their interactions with LGBT individuals during medical school had been, the less bias against lesbian and gay individuals they reported during residency.
  • Those who had heard physicians make negative comments about sexual minority patients during medical school reported higher levels of bias against lesbian and gay individuals during residency.

Interacting with LGBT individuals during medical school may produce lasting reductions in bias against lesbian and gay individuals. Witnessing role models make disparaging remarks about LGBT individuals, however, may produce sustained increases in bias.

Read more here.

Do rates of burnout and career choice regret among resident physicians vary by clinical specialty?

In a paper in JAMA: The Journal of of the American Medical Association, Dr Lisolette Dyrbye and colleagues explored factors associated with symptoms of burnout and career choice regret during residency.

Key findings: Liselotte (Lotte) Dyrbye, MD

  • Burnout was prevalent in the sample (45.2%) but varied substantially by clinical specialty, with residents in urology, neurology, emergency medicine, ophthalmology and general surgery reporting more burnout. Female residents had a 7.6% higher risk of burnout than male residents.
  • Most resident physicians were satisfied with their career and specialty choice. However, career choice regret was reported by 14.1% of the sampled residents, and was highest among residents in pathology, radiology, and anesthesiology.
  • Residents with higher anxiety and lower empathy during medical school were at greater risk of subsequent burnout and specialty choice regret during residency.

The authors recommend further research to better understand differences in burnout and career choice regret among US resident physicians.

Read more here

Informal training experiences may contribute to changes in racial bias among medical students

In a study published in Social Psychology Quarterly, Dr. Sara Burke and colleagues examined the effects of both formal and informal experiences on non-African American medical students’ attitudes toward African Americans.

Key findings:Sara Burke, PhD

  • Interracial contact was an important predictor of positive attitudes toward African Americans.
  • Students who witnessed instructors make negative racial comments or jokes were significantly more willing to express racial bias themselves.
  • Formal training on issues related to racial bias was not significantly associated with attitudes toward African Americans

According to the authors “explicit antiblack attitudes remain an active and pressing concern in medical training and demonstrate the urgency of addressing racial bias in the informal culture of medicine.”

Read more here

Medical school factors associated with changes in implicit and explicit bias against gay and lesbian people

In a study published in the Journal of General Internal Medicine, Dr. Sean Phelan and colleagues examined how medical school curriculum, role modeling, diversity climate, and contact with sexual minorities predict bias against gay and lesbian people.

Sean Phelan, PhD, MPH

Key findings:

  • In medical schools where faculty discrimination against LGBT patients was more common, students experienced an increase in bias toward gay and lesbian people over the course of medical school.
  • Students who felt more prepared to care for LGBT patients had lower bias toward gay and lesbian people.
  • Both the amount of contact with sexual minorities and the perceived quality of that contact were associated with reduced bias during medical school.

Medical student biases toward sexual minorities may improve during medical school with training in providing care to sexual minorities, improved diversity climate, less negative role modeling, and more favorable interaction with sexual minorities.

Read more here

Does a negative medical school diversity climate impact the depression scores of medical students?

In a paper published in the Journal of the National Medical Association, Dr. Rachel Hardeman and colleagues examined whether students’ perceptions of their medical school diversity climate was associated with an increase depression symptoms over the course of medical school.

Key findings:

Rachel Hardeman, PhD

  • Nearly two-thirds of students reported exposure to a negative racial climate at their medical school, particularity witnessing racial insensitivity from other students or faculty. Most students also reported witnessing discrimination towards other students (81%) and negative role modeling (94%).
  • Negative racial climate, witnessed discrimination, and negative role modeling were independently and significantly associated with an increase in depression symptoms during medical school, even after controlling for students’ personal experiences of mistreatment.
  • A negative diversity climate is harmful to all students regardless of race, and is particularly detrimental to Asian students.

According to the authors, “creating an institutional environment that is fair, equitable and inclusive is vital to maintaining the health and well-being of all medical students. In order to do so, medical schools must seek to systematically document and understand the aspects of their institutional climate that contribute to both equity and inequity.”

Read more here and here

Study Quick Facts

Study background and purpose

Medical Student CHANGE & Medical Trainee CHANGE Studies were funded by two R01 grants from the National Heart, Lung and Blood Institute, National Institutes of Health*.  The study was originally conceived by Michelle van Ryn, PhD (Principal Investigator) and John (Jack) Dovidio, PhD (Yale Site Investigator) in order to determine whether medical training factors had an impact on physician biases and/or equity of care.

While there is clear evidence of disparities in health care and compelling evidence that provider bias contributes to a portion of these disparities, there is a dearth of research evidence regarding the individual and medical school/residency factors that increase or decrease the likelihood of new provider implicit and explicit bias. This study is designed to fill this gap in knowledge and to inform the development of effective interventions to reduce bias among emerging physicians.

The primary purpose of the studies is to examine the impact of medical school and residency organizational climate, role model behavior, and formal and informal training experiences on new physician biases and characteristics (well-being, attitudes, and practices) associated with disparities in care.

The secondary purpose of the studies is to examine the impact of medical school and residency characteristics on outcomes among new physicians who are members of marginalized social groups (under-represented minority, sexual minority, and have obesity).

*NHLBI, NIH, 1 RO1 HL085631 (2009-2015) and NHLBI, NIH, 2 RO1 HL085631 (2015-2019)

Study waves, sample sizes & response rates

Study conceptual model

What were the demographic characteristics of the CHANGE Study cohort in 2017?

  • Sample size: 3,058 third year residents participated in the CHANGE Study in 2017.
  • Gender: 49% of participants identified as men and 51% identified as women.
  • Age: the mean age of the participants was 29.8 years old (standard deviation 2.4 years). The youngest participant was 26 and the oldest was 55.
  • Race & Ethnicity:

  • Annual household income:

  • Sexual orientation:

How does the CHANGE study sample compare to medical trainees nationally?

The demographics of the first year students in the CHANGE baseline sample were similar to the demographics of all students who matriculated at US medical schools in 2010.

The Team

CHANGE Study Investigators (in alphabetical order)

Publications

2019

  • Factors influencing medical student self-competence to provide weight management services. (2019) Doshi RS, Gudzune KA, Dyrbye LN, Dovidio JF, Burke SE, White RO, Phelan SM. (2019). Clinical Obesity, 9(1), e12288. Full text.
  • Association of Racial Bias With Burnout Among Resident Physicians. Dyrbye LN, Herrin J, West CP, Wittlin NM, Dovidio JF, Hardeman RR, Burke SE, Phelan SM, Onyeador IN, Cunningham B, van Ryn M. JAMA Network Open, 2(7), e197457. Full text.
  • A Prognostic Index to Identify the Risk of Developing Depression Symptoms Among U.S. Medical Students Derived From A National, Four-Year Longitudinal Study. (2019) Dyrbye LN, Wittlin NM, Hardeman RR, Yeazel M, Herrin J, Dovidio JF, Burke SE, Cunningham B, Phelan SM, Shanafelt TD, van Ryn M. Academic Medicine 94(2): 217-226. Abstract.
  • The Value of Interracial Contact for Reducing Anti-Black Bias Among Non-Black Physicians: A Cognitive Habits and Growth Evaluation (CHANGE) Study Report. Onyeador IN, Wittlin NM, Burke SE, Dovidio JF, Perry SP, Hardeman RR, Dyrbye LN, Herrin J, Phelan SM, van Ryn M. (2019) Psychological Science. Abstract.
  • The Effects of Racism in Medical Education on Students’ Decisions to Practice in Underserved or Minority Communities. (2019) Phelan SM, Burke SE, Cunningham BA, Perry SP, Hardeman RR, Dovidio JF, Herrin J, Dyrbye LN, White RO, Yeazel MW, Onyeador IN, Wittlin NM, Harden K, van Ryn M. Academic Medicine, 94(8), 1178-1189. Abstract.
  • Contact and role modeling predict bias against lesbian and gay individuals among early-career physicians: A longitudinal study.(2019) Wittlin NM, Dovidio JF, Burke SE, Przedworski JM, Herrin J, Dyrbye L, Onyeador IN, Phelan SM, van Ryn M. Social Science and Medicine, 238: 112422. Abstract.

2018

  • Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians. (2018) Dyrbye LN, Burke SE, Hardeman RR, Herrin J, Wittlin NM, Yeazel M, Dovidio JF, Cunningham B, White RO, Phelan SM, Satele DV, Shanafelt TD, van Ryn M. JAMA, 320(11), 1114-1130. Full text.

2017

  • Beyond Generalized Sexual Prejudice: Need for Closure Predicts Negative Attitudes Toward Bisexual People Relative to Gay/Lesbian People. (2017). Burke SE, Dovidio JF, LaFrance M, Przedworski JM, Perry SP, Phelan SM, Burgess DJ, Hardeman RR, Yeazel MW, van Ryn M. Journal of Experimental Social Psychology, 71, 145-150. Full text
  • Social Dominance Orientation, Dispositional Empathy, and Need for Cognitive Closure Moderate the Impact of Empathy-Skills Training, but Not Patient Contact, on Medical Students’ Negative Attitudes toward Higher-Weight Patients. (2017). Meadows A, Higgs S, Burke SE, Dovidio JF, van Ryn M, Phelan SM. Frontiers in Psychology, 8, 504. Full text
  • Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students. (2017). Phelan SM, Burke SE, Hardeman RR, White RO, Przedworski J, Dovidio JF, Perry SP, Plankey M, A Cunningham B, Finstad D, Yeazel M, van Ryn M. Journal of General Internal Medicine, 32(11), 1193-1201. Full text
  • Informal Training Experiences and Explicit Bias against African Americans among Medical Students. Burke SE, Dovidio JF, Perry SP, Burgess DJ, Hardeman RR, Phelan SM, Cunningham BA, Yeazel MW, Przedworski JP, van Ryn, M. Social Psychology Quarterly, 80(1), 65–84. Full text

2016

  • Medical Students’ Learning Orientation Regarding Interracial Interactions Affects Preparedness to Care for Minority Patients: A Report from Medical Student CHANGES. (2016). Burgess DJ, Burke SE, Cunningham BA, Dovidio JF, Hardeman RR, Hou Y, Nelson DB, Perry SP, Phelan SM, Yeazel MW, Van Ryn M. BMC Medical Education, 16(1), 254. Full text
  • Association Between Perceived Medical School Diversity Climate and Change in Depressive Symptoms Among Medical Students: A Report from the Medical Student CHANGE Study. (2016). Hardeman RR, Przedworski JM, Burke SE, Burgess DJ, Perry S, Phelan S, Dovidio JF, van Ryn M. Journal of the National Medical Association, 108(4), 225-235. Full text
  • The Impact of Everyday Discrimination and Racial Identity Centrality on African American Medical Student Well-Being: a Report from the Medical Student CHANGE Study. (2016). Perry SP, Hardeman R, Burke SE, Cunningham B, Burgess DJ, van Ryn M. Journal of Racial & Ethnic Health Disparities, 3(3), 519-526. Full text
  • Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study. (2016). Hardeman RR, Perry SP, Phelan SM, Przedworski JM, Burgess DJ, van Ryn M. Journal of Racial & Ethnic Health Disparities, 3(2), 250-258. Full text

2015

  • Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study. (2015). Burke SE, Dovidio JF, Przedworski JM, Hardeman RR, Perry SP, Phelan SM, Nelson DB, Burgess DJ, Yeazel MW, van Ryn M. Academic Medicine, 90(5), 645-651. Full text
  • A Comparison of the Mental Health and Well-Being of Sexual Minority and Heterosexual First-Year Medical Students: A Report From the Medical Student CHANGE Study. (2015). Przedworski JM, Dovidio JF, Hardeman RR, Phelan SM, Burke SE, Ruben MA, Perry SP, Burgess DJ, Nelson DB, Yeazel MW, Knudsen JM, van Ryn M. Academic Medicine, 90(5), 652-659.  Full text
  • Medical Student Socio-demographic Characteristics and Attitudes toward Patient Centered Care: Do Race, Socioeconomic Status and Gender Matter? A report from the Medical Student CHANGES study. (2015). Hardeman RR, Burgess D, Phelan S, Yeazel M, Nelson D, van Ryn M. Patient Education & Counseling, 98(3), 350-355. Full text
  • Mental Well-Being in First Year Medical Students: A Comparison by Race and Gender: A Report from the Medical Student CHANGE Study. (2015).Hardeman RR, Przedworski JM, Burke SE, Burgess DJ, Phelan SM, Dovidio JF, Nelson D, Rockwood T, van Ryn M. Journal of Racial & Ethnic Health Disparities, 2(3), 403-413. Full text
  • The Joint Effect of Bias Awareness and Self-reported Prejudice on Intergroup Anxiety and Intentions for Intergroup Contact. (2015). Perry SP, Dovidio JF, Murphy MC, van Ryn M. Cultural Diversity & Ethnic Minority Psychology, 21(1), 89-96. Full text 
  • Beliefs About the Causes of Obesity in a National Sample of 4th Year Medical Students. (2015). Phelan SM, Burgess DJ, Burke SE, Przedworski JM, Dovidio JF, Hardeman R, Morris M, van Ryn M. Patient Education & Counseling, 98(11), 1446-1449. Full text
  • The Adverse Effect of Weight Stigma on the Well-Being of Medical Students with Overweight or Obesity: Findings from a National Survey. (2015). Phelan SM, Burgess DJ, Puhl R, Dyrbye LN, Dovidio JF, Yeazel M, Ridgeway JL, Nelson D, Perry S, Przedworski JM, Burke SE, Hardeman RR, van Ryn M. Journal of General Internal Medicine, 30(9), 1251-1258. Full text
  • Impact of Weight Bias and Stigma on Quality of Care and Outcomes for Patients with Obesity. (2015). Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Obesity Reviews, 16(4), 319-326. Full text
  • The Mixed Impact of Medical School on Medical Students’ Implicit and Explicit Weight Bias. (2015). Phelan SM, Puhl RM, Burke SE, Hardeman R, Dovidio JF, Nelson DB, Przedworski J, Burgess DJ, Perry S, Yeazel MW, van Ryn M. Medical Education, 49(10), 983-992. Full text
  • Medical School Experiences Associated with Change in Implicit Racial Bias Among 3547 Students: A Medical Student CHANGES Study Report. (2015). van Ryn M, Hardeman R, Phelan SM, Burgess DJ, Dovidio JF, Herrin J, Burke SE, Nelson DB, Perry S, Yeazel M, Przedworski JM. Journal of General Internal Medicine, 30(12), 1748-1756. Full text

2014

  • Implicit and Explicit Weight Bias in a National Sample of 4,732 Medical Students: The Medical Student CHANGES Study. (2014). Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB, Yeazel MW, Hardeman R, Perry S, van Ryn M. Obesity, 22(4), 1201-1208. Full text
  • Psychosocial Predictors of Attitudes toward Physician Empathy in Clinical Encounters among 4732 1st Year Medical Students: A Report from the CHANGES Study. (2014). van Ryn M, Hardeman RR, Phelan SM, Burke SE, Przedworski J, Allen ML, Burgess DJ, Ridgeway J, White RO, Dovidio JF. Patient Education & Counseling, 96(3), 367-375. Full text

2011

  • The Impact of Racism on Clinician Cognition, Behavior, and Clinical Decision Making. (2011). van Ryn M, Burgess DJ, Dovidio JF, Phelan SM, Saha S, Malat J, Griffin JM, Fu SS, Perry S. Du Bois Review: Social Science Research on Race, 8(1), 199-218. Full text

2010

  • Stereotype Threat and Health Disparities: What Medical Educators and Future Physicians Need to Know. (2010). Burgess, D. J., Warren, J., Phelan, S., Dovidio, J., & van Ryn, M. Journal of General Internal Medicine, 25 Suppl 2, S169-177. Full text

Working with CHANGES

Are data available for download?

Currently data are not available for download. However, we invite those interested in working with CHANGES data to contact us about becoming a guest investigator.

How can I become a guest investigator?

If you’re interested in becoming a guest investigator, we welcome you! We have established a set of guest investigator policies to ensure that all study products have the highest scientific integrity and to maintain inclusive and collegial collaborations.

Guest policies include:

  • Close collaboration with a core CHANGES investigator (i.e., “sponsorship”).
  • Submission of a signed data use agreement.
  • Submission of current human subjects research training documentation.
  • Submission of a Paper Proposal Form.
  • Participation in at least two CHANGES team video-conferences.
  • Commitment to following study rules and procedures for scientific integrity, data security, and collegiality.