Medical Schools’ Responses to Race-Related News Events Affect Black Medical Students’ Mental Health

Experiencing racism can be hard on your health. In medical schools, the stress that comes from structural (i.e., societal-level) racism is an additional burden on Black students and faculty. A new study supported by the National Institute on Minority Health and Health Disparities (NIMHD) and based on a survey conducted in 2020 found that the stress caused by racial unrest and perceived racism can affect the mental health of Black students. The research suggests that medical schools can do more to address discrimination to support their students’ mental health.

The summer of 2020 saw a number of “seminal race events.” The video of Ahmaud Arbery’s murder became public in May. Only a few weeks later, George Floyd was murdered, leading to widespread protests. All of this was occurring against the backdrop of massive health disparities in COVID-19 deaths. Because these seminal events were either tied directly to Black male deaths or to the disproportionate number of deaths due to COVID-19 among Black or African American people in general, Black medical school students may have been particularly affected. Medical schools addressed these events to varying degrees. The researchers wanted to know how Black medical students were affected by their institutions’ responses to these specific events.

To find out, the researchers created an anonymous 37-item electronic questionnaire that was administered during 2 weeks in August 2020. They were trying to reach Black U.S. medical students, so they distributed the survey through the listserv of the Student National Medical Association, an organization that supports underrepresented minority groups in medicine. To supplement this effort, the researchers sent the survey to leaders of the Organization of Student Representatives (OSR) of the Association of American Medical Colleges (AAMC), and one of the researchers also posted a link to the survey on their social media accounts.

The survey used parts of two standardized questionnaires to measure depression symptoms and perceived discrimination. The researchers added questions to assess perspectives regarding whether and how institutions responded to seminal racial events, including the murders of Ahmaud Arbery and George Floyd and racial disparities in COVID-19 deaths.

Among the 750 students who completed the survey, 733 (97.7%) self-identified as Black and 586 (80.5%) as female; 450 (56.1%) were in their first or second year of medical school. Most of the students believed that they were watched more closely than other students (51.6%) and that they worked twice as hard to get the same evaluation as others did (66.9%). On the issue of seminal racial events, 20.8% reported that their institution never or rarely responded to them.

The researchers found that students who perceived frequent discriminatory experiences were more likely to have symptoms of depression, as were students who reported that their institutions did not respond to seminal racial events. Students who fell into both groups—experiencing discrimination frequently and working at institutions that did not respond—were even more likely to experience depressive symptoms than those who reported only one factor. If they perceived more frequent discriminatory experiences, students were more likely to report depressive symptoms following institutional lack of response to seminal racial events.

Although focused on medical students, these results are consistent with other studies of how discrimination affects mental health among Black people living in the United States. The researchers suggest that medical schools could do more to support Black students’ mental health. The team cited the work of Gray and colleagues, who outlined a four-part approach to promote anti racism in academic medical centers:

• Commit to recruiting, retaining, and promoting a diverse workforce.
• Empower everyone, including students, to speak up when they identify racism in the institution and work toward eliminating it.
• Form committees with members of the local community to review institutional health equity policies and advise on anti racism strategies.
• Critically review the institution’s current policies.

The authors noted that the participants all happened to see the link and decided to click it to complete the survey; the respondents may not be representative of Black medical students as a whole. In addition, the researchers asked about only three seminal race events at one moment in time, so the findings may differ when assessed over time.

Medical schools are a key part of the pathway of future physicians, so it is important that the mental health of all students is supported, the authors write. These students include medical students who identify as Black and are affected directly by racism. The researchers also suggested that future studies should examine how to reduce the impact of discrimination on medical students’ mental health. By reforming their culture, medical schools can reduce stress for students and give them a better chance at academic and career success.

Citation

Milam, A. J., Brown, I., Edwards-Johnson, J., McDougle, L., Sousa, A., & Furr-Holden, D. (2022). Experiences of discrimination, institutional responses to seminal race events, and depressive symptoms in Black U.S. medical students. Academic Medicine: Journal of the Association of American Medical Colleges, 97(6), 876–883. doi: 10.1097/ACM.0000000000004638

Page updated January 30, 2023