Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual Medical Students ? A Report from Medical Student CHANGES

Purpose—A recent Institute of Medicine report concluded that lesbian and gay individuals face discrimination from health care providers and called for research on provider attitudes. Medical school is a critical juncture for improving future providers’ treatment of sexual minorities. This study examined both explicit and implicit biases against lesbian women and gay men among medical students, focusing on two predictors of such bias, contact and empathy. Method—This study included the 4,441 heterosexual first-year medical students who participated in the baseline survey of the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES), which employed a stratified random sample of 49 U.S. medical schools in fall 2010. The researchers measured explicit attitudes toward gay and lesbian people using feeling thermometer self-assessments, implicit attitudes using the Implicit Association Test (IAT), amount and favorability of contact using self-report items, and empathy using subscales of the Interpersonal Reactivity Index. Results—Nearly half (45.79%; 956/2,088) of respondents with complete data on both bias measures expressed at least some explicit bias and most (81.51%; 1,702/2,088) exhibited at least some implicit bias against gay and lesbian individuals. Both amount and favorability of contact predicted positive implicit and explicit attitudes. Both cognitive and emotional empathy predicted positive explicit attitudes, but not implicit attitudes. Conclusions—The prevalence of negative attitudes presents an important challenge for medical education, highlighting the need for more research on possible causes of bias. Findings on contact and empathy point to possible curriculum-based interventions aimed at ensuring high-quality care for sexual minorities. A recent Institute of Medicine (IOM) report noted that gay and lesbian individuals “face discrimination in the health care system that can lead to an outright denial of care or to the delivery of inadequate care. ”1(p62) Biases among health care providers may help explain a number of observed health disparities faced by these sexual minority groups, such as possible higher risks for cancer, HIV/AIDS, and eating disorders as well as less use of preventive health services.1,2 As a result, the IOM report called for more research on provider attitudes toward gay and lesbian individuals as a next step toward addressing unequal treatment. Given that medical schools represent a critical context in which lay people become providers, understanding the attitudes of heterosexual students entering the medical profession is an important aspect of building a medical school curriculum that can effectively address biases and help ensure future physicians will provide high quality care for sexual minorities. In this study, we aimed to assess the amount of bias against gay and lesbian people (i.e., less favorable attitudes toward gay and lesbian people relative to heterosexual people) among heterosexual first-year medical students and to investigate factors that may predict such bias. We examined both explicit and implicit attitudes. Explicit attitudes are consciously Burke et al. Page 2 Acad Med. Author manuscript; available in PMC 2016 May 01. A uhor M anscript