Study addresses “leaky pipeline” that prevents Black medical students in reaching their residency goals

Self-affirmation, the practice of reflecting upon one's most important values, can aid Black medical students in reaching their residency goals. But conversely, it can lead to the perception that they are less qualified for a prestigious residency than their peers.

The pandemic has underscored the racial disparities in the quality of healthcare, a field in which Black Americans are vastly underrepresented as medical physicians.

New Northwestern University research aims to address the "leaky pipeline" preventing Black medical students from completing medical school to pursuing residencies in high-need and underrepresented areas.

Sylvia Perry, assistant professor of psychology in the Weinberg College of Arts and Sciences at Northwestern, is the lead author of the study, which found that Black medical students reported higher levels of fatigue, a lower sense of belonging, and a greater likelihood of changing their medical residency plans than their white counterparts.

It is the first study to attempt experimentally to mitigate such discrepancies with a self-affirmation intervention and the first study to show that self-affirming can promote goal pursuit in a medical education context.

An unexpected finding of the study was that self-affirmation decreased a sense of competitiveness for prestigious residencies.

This would suggest that if Black medical students are not properly supported during their training, then self-affirming may lead them to accept that extremely competitive residency is unobtainable."

Sylvia Perry, Study Lead Author and Assistant Professor of Psychology in Weinberg College of Arts and Sciences, Northwestern University

About the self-affirmation experiment:

For the longitudinal field experiment, the researchers sampled 234 Black and 182 white medical students across 50 schools in the U.S.

Students completed computerized tasks at three points during their second year of medical school. The self-affirmation intervention group ranked a list of values from most important to least important and wrote about why the most important value mattered to them. Control environment students were asked to write about why their least important value would be important to someone else.

Students were asked to report their well-being, sense of belonging, perceived residency competitiveness, and residency goals. Responses were coded during each wave of testing to see if responses changed or stayed the same.

The researchers found that Black students tended to report more fatigue and less belonging than white students.

They also found that the self-affirmation intervention did not significantly influence students' fatigue, depression, anxiety for belonging. Unexpectedly, Black students in the self-affirmation (vs. control) condition reported lower competitiveness of residency.

Analyses revealed that Black students, compared with white students, were less likely to indicate stable residency goals over time, which may be an indication of stereotype threat. However, this racial gap was eliminated with the intervention.

White students' perceived competitiveness for residency was unaffected by the intervention.

Next steps:

Perry says the researchers will look further into other predictors of well-being, belonging and residency goal stability, including whether going to medical school at a Historically Black College and University (HBCU), compared to a predominately white institution, provides supportive and protective effects that help Black medical students thrive.