The Impact of Everyday Discrimination and Racial Identity Centrality on African American Medical Student Well-Being: a Report from the Medical Student CHANGE Study.
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.
Department of Psychological Science, University of Vermont, John Dewey Hall, Rm 338, 2 Colchester Ave., Burlington, VT, 05405-0134, USA. sylvia.perry@uvm.edu.
Sylvia P
SP
Perry
Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.|Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Rachel
R
Hardeman
Department of Psychology, Yale University, 2 Hillhouse Ave., New Haven, CT, 06520, USA.
Sara E
SE
Burke
Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, 717 Delaware St SE, Minneapolis, MN, 55414, USA.
Brooke
B
Cunningham
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.|Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Building 9, Mail code: 152 One Veterans Drive, Minneapolis, MN, 55417, USA.
Diana J
DJ
Burgess
Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.|Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Michelle
M
van Ryn
D001741:Black or African American; D015331:Cohort Studies; D006801:Humans; D063505:Racism; D012649:Self Concept; D012933:Social Identification; D013337:Students, Medical / Q000523:psychology*; D014481:United States
Discrimination; Medical student well-being; Racial identity