Underprepared: influences of U.S. medical students’ self-assessed confidence in immigrant and refugee health care

ABSTRACT

Background

United States (U.S.) census data from 2017 indicates that the percentage of persons born outside of the U.S. is increasing. However, no studies describe the amount of class time focused on immigrant and refugee health during medical school in the U.S. nor on incoming residents’ confidence in providing culturally sensitive care. The objective of this study is to characterize final-year medical students’ exposure to immigrant and refugee health and their confidence in caring for these populations.

Methods

A voluntary, cross-sectional survey was sent electronically to fourth-year medical students at twelve U.S. medical schools in 2020, with 707 respondents (46% response rate). Questions addressed respondents’ curricular exposure to immigrant and refugee health care during medical school and their confidence in providing culturally sensitive care. Chi-square tests were used to assess relationships between categorical variables, and odds ratios were calculated for dichotomized variables.

Results

Most students (70.6%) described insufficient class time dedicated to culturally sensitive care, and many (64.5%) reported insufficient clinical exposure in caring for immigrants/refugees. The odds that incoming residents felt ‘usually’ or ‘always’ confident in their ability to provide culturally sensitive care to immigrants and refugees were higher in those with more class time on culturally sensitive care (OR 5.2 [3.6–7.4]), those with more clinical opportunities to care for immigrants and refugees (OR 7.2 [5.1–10.2]), and those who participated in a domestic low-resource or international elective (OR 1.4 [1.02–1.9]). More than half (55.3%) of respondents reported feeling ‘not at all’ or only ‘sometimes’ confident in their ability to provide culturally sensitive care to immigrants/refugees.

Conclusions

Most fourth-year U.S. medical students entering residency feel unprepared to deliver culturally sensitive care to immigrants and refugees. This may be mediated by increased exposure to didactic curricula class time and/or experiential clinical activities, as those factors are associated with improved student confidence

KEYWORDS:

• Refugee
• immigrant
• elective
• medical student
• undergraduate medical education
• cultural competence

Acknowledgements

We would like to thank the Medical Student Global Health study group, which helped to collect data from their institutions: Stacey Chamberlain from the University of Illinois at Chicago, Carmen Cobb from the University of California San Francisco, James H. Conway from the University of Wisconsin-Madison School of Medicine and Public Health, Elizabeth Groothuis form the Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, Ebba Hjertstedt from the University of Wisconsin-Madison School of Medicine and Public Health, Suet Kam Lam from the Cleveland Clinic Lerner College of Medicine and Case Western Reserve University School of Medicine, Megan McHenry from the Indiana University School of Medicine, and Theresa Nguyen from the Loyola University Medical Center/Stritch School of Medicine.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The publication of this work was supported by the Department of Family Medicine at the Wright State University Boonshoft School of Medicine. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by Wright State University.