University of Wisconsin–Madison Medical College of Wisconsin

Critical Reflection to Investigate Medical Student Attitudes Toward Skin Tone in Their Preclinical Years

Molly Thapar, BS; Elizabeth Dominguez, BS; Katarina Stark, MD; Johnathon Neist, MLIS; Kerrie Quirk, MEd; Malika Siker, MD; Jeffery D. Fritz, PhD; Gretchen M. Roth, MD; Teresa Patitucci, PhD

WMJ. 2024;123(2):106-112

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Introduction: Implicit racial bias, defined as unreasoned judgement based solely on an individual’s skin color, is a persistent barrier to quality medical care for people of color in the United States. Early, learner-centered intervention is crucial to establish cultural competence within health professional training programs.

Methods: Over 3 academic years, preclinical, second-year medical students were asked to submit an anonymous critical reflection regarding skin tone in medicine (n=794). Critical reflection is an instructional approach that encourages students to investigate their own thoughts and actions. Course credit was given based on the honor system. Reflection submission content and student feedback were analyzed quantitatively and qualitatively using constructivist thematic analysis.

Results: Most students completed the assignment (93.0%) and reported feeling comfortable expressing themselves honestly in the anonymous format (84.6%). Students’ comfort level with honesty declined if they would have had to identify themselves (50.8%). Student comments indicated relief to have a place to process experiences and emphasized the importance of anonymity for value of this assignment. Thematic analysis identified 2 themes and 13 subthemes among student submissions. Submissions varied in format and typically contained multiple codes (4.08 ± 1.77 subthemes), indicating that students participated meaningfully in the assignment.

Conclusions: Although some educators may hesitate to address these topics, students at our institution appreciated having a space to process their thoughts. This assignment structure is an effective way for educators to address a difficult, sensitive, and important topic in a meaningful way with students.

Author Affiliations: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Charles, Nartey, Felton, Petty).
Corresponding Author: Eden F. Charles, email; ORCID ID 0009-0003-8254-2160
Funding/Support: This work was supported by a grant to the Medical College of Wisconsin from the Kern Family Foundation and the Kern Family Trust.
Financial Disclosures: Gretchen M. Roth, MD, reports receiving consulting fees from Abbvie and a grant from Novartis for non-branded continuing medical education. Molly Thapar was supported by the Elsa and Roger D. Cohen MD Children’s Wisconsin/Medical College of Wisconsin Summer Fellowship in Medical Education.
Acknowledgements: The authors wish to thank Adrienne German, Jean Mallett, and Toni Gray from the Medical College of Wisconsin for contributing to initial analysis of written reflections.
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