When a patient's ethnicity is declared, medical students' decision-making processes are affected.
BACKGROUND
Disparity in health status and healthcare outcomes is widespread and well known. This holds true for Indigenous peoples in many settings including Australia and Hawaii. While multi-factorial, there is increasing evidence of health practitioner contribution to this disparity. This research explored senior medical students' clinical decision-making processes.


METHODS
A qualitative study was conducted in 2014 with 30 final year medical students from The University of Melbourne, Australia, and The John Burns Medical School, Hawaii, USA. Each student responded to questions about a paper-based case, first in writing and elaborated further in an interview. Half the students were given a case of a patient whose ethnicity was not declared; the other half considered the patient who was Native Hawaiian or Australian Aboriginal. A systematic thematic analysis of the interview transcripts was conducted.


RESULTS
The study detected subtle biases in students' ways of talking about the Indigenous person and their anticipation of interacting with her as a patient. Four main themes emerged from the interview transcripts: the patient as a person; constructions of the person as patient; patient-student/doctor interactions; and the value of various education settings. There was a strong commitment to the patient's agenda and to the element of trust in the doctor-patient interaction.


CONCLUSIONS
These findings will help to advance medical curricula so that institutions graduate physicians who are increasingly able to contribute to equitable outcomes for all patients in their care. The study also draws attention to subtle biases based on ethnicity that may be currently at play in physicians' practices.
Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
S C
SC
Ewen
Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
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J
Barrett
Aboriginal Health, School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.
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D
Paul
Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Brisbane, Queensland, Australia.|Discipline of General Practice, The University of Queensland, Brisbane, Queensland, Australia.
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D
Askew
School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
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G
Webb
Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
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A
Wilkin
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult; D000066491:Clinical Decision-Making; D004501:Education, Medical / Q000941:ethics / Q000379:methods; D005006:Ethnicity; D006303:Health Services, Indigenous / Q000941:ethics; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology; D044468:Native Hawaiian or Pacific Islander; D011287:Prejudice / Q000208:ethnology; D036301:Qualitative Research; D013337:Students, Medical / Q000523:psychology; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
Aboriginal health; Indigenous health; bias; clinical decision-making; health disparity; medical curriculum