Sociodemographic disadvantage in the burden of stress and academic performance in medical school: implications for diversity in medicine

Abstract

Abstract Background Nontraditional students bring to medicine inherent characteristics and perspectives that enrich the learning environment and contribute to expanding diversity in medicine. However, research has shown that these students, by virtue of their sociodemographic backgrounds, face unique challenges in medical education, which ultimately place them at a disadvantage compared to traditional medical students. The purpose of this study is to explore relationships between sociodemographic factors, stress, and academic performance, in the context of student outcomes that may influence diversity in medicine. Methods Perceived Stress Scale-4 surveys collected at four educational milestones and exam performance data on 358 of 360 students were utilized for the purposes of this retrospective observational cohort study. Using independent samples t-test, mean stress and academic performance were compared between groups based on generational status, underrepresented in medicine (URM) status, socioeconomic status, and age at matriculation. Results were considered significant where (P < .05). Results First-generation college students had significantly higher stress at the end of third year clerkships (mean 7.8 vs. 6.8, P= .03). URM students had significantly lower pre-clinical exam scores (mean 81.37 vs. 83.07, P = .02). Students who were 30 years of age or older at matriculation had significantly lower exam scores on all academic performance measures. Conclusion Expanding the sociodemographic diversity among physicians, and by extension, medical students, has long been recognized as an important avenue to address healthcare inequities for marginalized populations in the US. Results from our study suggest that aspects of medical education undermine the success of URM and older medical students, and thwart well-being in first-generation medical students. Residency program directors continue to use USMLE test scores as a primary metric to screen applicants. Therefore, poor performance on these exams has profound consequences on career trajectory which, in turn, may be impeding progress towards increasing diversity in medicine. Stress, depression, burnout, the learning environment, and academic performance are intimately related. A deeper understanding of the interplay between sociodemographic characteristics and success in medical school, both psychosocially and academically, is prudent to achieve diversity in medicine and, ultimately, health equity.