Background: To fight racism and its potential influence on health, health care professionals must recognize, name, understand and talk about racism. These conversations are difficult, particularly when stakes feel high-in the workplace and in interracial groups. We convened a multidisciplinary, multi-racial group of professionals in two phases of this exploratory project to develop and pilot an intervention to promote effective dialogues on racism for first year medical students at the University of Minnesota Medical School. Methods: Informed by a Public Health Critical Race Praxis (PHCRP) methodology in Phase I, initial content was developed by a group of seven women primarily from racial and ethnic minority groups. In a later phase, they joined with five White (primarily male) colleagues to discuss racism and race. Participants met monthly for 12 months from Jan 2016-Dec 2016. All participants were recruited by study PI. An inductive approach was used to analyze meeting notes and post intervention reflections to describe lessons learned from the process of employing a PHCRP methodology to develop the aforementioned curriculum with a multidisciplinary and multi-racial group of professionals dedicated to advancing conversations on racial equity. Results: Participants from Phase I described the early meetings as “powerful,” allowing them to “bring their full selves” to a project that convened individuals who are often marginalized in their professional environments. In Phase II, which included White colleagues, the dynamics shifted: “…the voices from Phase I became quieter…”; “I had to put on my armor and fight in those later meetings…” Conclusions: The process of employing PHCRP in the development of an intervention about racism led to new insights on what it means to discuss racism among those marginalized and those with privilege. Conversations in each phase yielded new insights and strategies to advance a conversation about racism in health care.

Objectives: Although a range of factors shapes health and well-being, institutionalized racism (societal allocation of privilege based on race) plays an important role in generating inequities by race. The goal of this analysis was to review the contemporary peer-reviewed public health literature from 2002-2015 to determine whether the concept of institutionalized racism was named (ie, explicitly mentioned) and whether it was a core concept in the article. Methods: We used a systematic literature review methodology to find articles from the top 50 highest-impact journals in each of 6 categories (249 journals in total) that most closely represented the public health field, were published during 2002-2015, were US focused, were indexed in PubMed/MEDLINE and/or Ovid/MEDLINE, and mentioned terms relating to institutionalized racism in their titles or abstracts. We analyzed the content of these articles for the use of related terms and concepts. Results: We found only 25 articles that named institutionalized racism in the title or abstract among all articles published in the public health literature during 2002-2015 in the 50 highest-impact journals and 6 categories representing the public health field in the United States. Institutionalized racism was a core concept in 16 of the 25 articles. Conclusions: Although institutionalized racism is recognized as a fundamental cause of health inequities, it was not often explicitly named in the titles or abstracts of articles published in the public health literature during 2002-2015. Our results highlight the need to explicitly name institutionalized racism in articles in the public health literature and to make it a central concept in inequities research. More public health research on institutionalized racism could help efforts to overcome its substantial, longstanding effects on health and well-being.

OBJECTIVES/SPECIFIC AIMS: Calls to break the silence around the effects of racism on health are growing. Few researchers have examined the relationship between medical student characteristics and students’ comfort, motivation, and skill to discuss racism. This paper examines medical student characteristics associated with readiness to talk about racism among first-year medical students at the University of Minnesota. METHODS/STUDY POPULATION: In February 2017 prior to a lecture on racism and health, we invited first year medical students to participate in a web-based survey about their experiences and comfort discussing racism. We calculated descriptive statistics and measured differences by student race (White vs. Asian vs. Black/multiracial/other) and undergraduate major type (STEM vs. non-STEM) using χ 2 tests for variables with categorical responses and generalized linear regression models with pairwise comparisons (i.e., 2-sample t -tests) for variables with continuous responses. RESULTS/ANTICIPATED RESULTS: (n=107/163). The majority of students were male (53%); White (75%); and majored in STEM majors in college (85%). College major was not associated with race. Students’ responses to multiple items suggest that the vast majority perceived racial inequality as a major problem in the United States. Race was significantly associated with only 1 of these items. Specifically, 100% (16/16) of Black/multiracial/other students [under-represented minority (URM) students] reported “too little attention” is paid to race and racial issues, while only 53% of White students (42/79) and 55% of Asian students (6/11) chose this response. Students with non-STEM majors and students who identified as URM students reported talking about racism with friends more often than STEM majors and white students, respectively. In conversations about race at school, two-thirds of students were concerned that they might unintentionally offend others or be misunderstood. However, non-STEM majors and URM students were significantly less worried that they would unintentionally offend others in conversations about race at school than STEM majors and white students. Larger percentages of URM students (50%) than White students (25%) were afraid that others would not respect their views because of their race. White students were more afraid that they might that they would be called racist than URM students. DISCUSSION/SIGNIFICANCE OF IMPACT: Many students find it challenging to discuss race and racism in medical education settings. URM students and non-STEM majors reported greater frequency talking about racism with friends and appear to be less anxious in conversations about racism than White students and STEM majors respectively. Given non-STEM majors' greater psychological safety discussing racism, future research should explore whether non-STEM majors are better prepared and more motivated to address racial disparities in health and health care than STEM majors. Such research could have important implications for medical school admissions.

Objective: Patient–provider communication has been found to be less patient centred, on average, with patients who are members of stigmatized or minority groups. Obesity is a stigmatized condition, and thus, people with obesity may experience less patient-centred communication (PCC). The objective of this study was to assess the association between patient body mass index (BMI) and self-reported quality of PCC experienced over a 12-month period and whether that relationship differed for men and women. Methods: Data collected for the National Cancer Institute's Health Information National Trends Survey were analysed. Respondents who reported a BMI ≥ 18.5 kg/m2 and indicated having seen a healthcare provider outside of an emergency room in the last 12 months were included. PCC was measured using a validated six-item scale. Multivariate logistic regression was used to model the odds of reporting PCC greater than the sample median. Results: Compared with people with normal weight BMIs, no associations were found between overweight (odds ratio [OR] = 0.84, p = 0.17), class I & II obesity (OR = 0.94, p = 0.68) or class III obesity (OR = 0.86, p = 0.47) and PCC. There was a significant interaction (p = 0.015) such that for men, but not women, higher BMI was associated with less PCC. Conclusion: Unlike evidence that women experience more weight stigma, in the healthcare domain, men may be at elevated risk of experiencing communication influenced by weight stigma.

Due to a tagging error, two authors were incorrectly listed in indexing systems. Brook W. Cunningham should be B.A. Cunningham and Mark W. Yeazel should be M.W. Yeazel for indexing purposes.

<h3>Importance</h3><p>Burnout among physicians is common and has been associated with medical errors and lapses in professionalism. It is unknown whether rates for symptoms of burnout among resident physicians vary by clinical specialty and if individual factors measured during medical school relate to the risk of burnout and career choice regret during residency.</p><h3>Objective</h3><p>To explore factors associated with symptoms of burnout and career choice regret during residency.</p><h3>Design, Setting, and Participants</h3><p>Prospective cohort study of 4732 US resident physicians. First-year medical students were enrolled between October 2010 and January 2011 and completed the baseline questionnaire. Participants were invited to respond to 2 questionnaires; one during year 4 of medical school (January-March 2014) and the other during the second year of residency (spring of 2016). The last follow-up was on July 31, 2016.</p><h3>Exposures</h3><p>Clinical specialty, demographic characteristics, educational debt, US Medical Licensing Examination Step 1 score, and reported levels of anxiety, empathy, and social support during medical school.</p><h3>Main Outcomes and Measures</h3><p>Prevalence during second year of residency of reported symptoms of burnout measured by 2 single-item measures (adapted from the Maslach Burnout Inventory) and an additional item that evaluated career choice regret (defined as whether, if able to revisit career choice, the resident would choose to become a physician again).</p><h3>Results</h3><p>Among 4696 resident physicians, 3588 (76.4%) completed the questionnaire during the second year of residency (median age, 29 [interquartile range, 28.0-31.0] years in 2016; 1822 [50.9%] were women). Symptoms of burnout were reported by 1615 of 3574 resident physicians (45.2%; 95% CI, 43.6% to 46.8%). Career choice regret was reported by 502 of 3571 resident physicians (14.1%; 95% CI, 12.9% to 15.2%). In a multivariable analysis, training in urology, neurology, emergency medicine, and general surgery were associated with higher relative risks (RRs) of reported symptoms of burnout (range of RRs, 1.24 to 1.48) relative to training in internal medicine. Characteristics associated with higher risk of reported symptoms of burnout included female sex (RR, 1.17 [95% CI, 1.07 to 1.28]; risk difference [RD], 7.2% [95% CI, 3.1% to 11.3%]) and higher reported levels of anxiety during medical school (RR, 1.08 per 1-point increase [95% CI, 1.06 to 1.11]; RD, 1.8% per 1-point increase [95% CI, 1.6% to 2.0%]). A higher reported level of empathy during medical school was associated with a lower risk of reported symptoms of burnout during residency (RR, 0.99 per 1-point increase [95% CI, 0.99 to 0.99]; RD, −0.5% per 1-point increase [95% CI, −0.6% to −0.3%]). Reported symptoms of burnout (RR, 3.20 [95% CI, 2.58 to 3.82]; RD, 15.0% [95% CI, 12.8% to 17.3%]) and clinical specialty (range of RRs, 1.66 to 2.60) were both significantly associated with career choice regret.</p><h3>Conclusions and Relevance</h3><p>Among US resident physicians, symptoms of burnout and career choice regret were prevalent, but varied substantially by clinical specialty. Further research is needed to better understand these differences and to address these issues.</p>

Increasing evidence suggests that bisexual people are sometimes evaluated more negatively than heterosexual and gay/lesbian people. A common theoretical account for this discrepancy argues that bisexuality is perceived by some as introducing ambiguity into a binary model of sexuality. The present brief report tests a single key prediction of this theory, that evaluations of bisexual people have a unique relationship with Need for Closure (NFC), a dispositional preference for simple ways of structuring information. Participants (n=3406) were heterosexual medical students from a stratified random sample of 49 U.S. medical schools. As in prior research, bisexual targets were evaluated slightly more negatively than gay/lesbian targets overall. More importantly for the present investigation, higher levels of NFC predicted negative evaluations of bisexual people after accounting for negative evaluations of gay/lesbian people, and higher levels of NFC also predicted an explicit evaluative preference for gay/lesbian people over bisexual people. These results suggest that differences in evaluations of sexual minority groups partially reflect different psychological processes, and that NFC may have a special relevance for bisexual targets even beyond its general association with prejudice. The practical value of testing this theory on new physicians is also discussed.