The impact of neighborhoods and friendships on interracial anxiety among medical students and residents: A report from the medical student CHANGES study

Marie V. Plaisime, Marie Jipguep-Akhtar, Joseph J. Locascio, Harolyn M.E. Belcher, Rachel R. Hardeman, Katherine Picho-Kiroga, Sylvia P. Perry, Sean M. Phelan, Michelle van Ryn, John F. Dovidio

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: To examine the experience of interracial anxiety among health professionals and how it may affect the quality of their interactions with patients from racially marginalized populations. We explored the influence of prior interracial exposure—specifically through childhood neighborhoods, college student bodies, and friend groups—on interracial anxiety among medical students and residents. We also examined whether levels of interracial anxiety change from medical school through residency. Data Source: Web-based longitudinal survey data from the Medical Student Cognitive Habits and Growth Evaluation Study. Study Design: We used a retrospective longitudinal design with four observations for each trainee. The study population consisted of non-Black US medical trainees surveyed in their 1st and 4th years of medical school and 2nd and 3rd years of residency. Mixed effects longitudinal models were used to assess predictors of interracial anxiety and assess changes in interracial anxiety scores over time. Principal Findings: In total, 3155 non-Black medical trainees were followed for 7 years. Seventy-eight percent grew up in predominantly White neighborhoods. Living in predominantly White neighborhoods and having less racially diverse friends were associated with higher levels of interracial anxiety among medical trainees. Trainees' interracial anxiety scores did not substantially change over time; interracial anxiety was highest in the 1st year of medical school, lowest in the 4th year, and increased slightly during residency. Conclusions: Neighborhood and friend group composition had independent effects on interracial anxiety, indicating that premedical racial socialization may affect medical trainees' preparedness to interact effectively with diverse patient populations. Additionally, the lack of substantial change in interracial anxiety throughout medical training suggests the importance of providing curricular tools and structure (e.g., instituting interracial cooperative learning activities) to foster the development of healthy interracial relationships.

Original languageEnglish (US)
Pages (from-to)229-237
Number of pages9
JournalHealth services research
Issue numberS2
StatePublished - Aug 2023

Bibliographical note

Funding Information:
Support for this research was provided by the Robert Wood Johnson Foundation – Health Policy Research Scholars Program (to M. V. Plaisime), the National Science Foundation Directorate for Social, Behavioral and Economic Sciences ‐ Postdoctoral Research Fellowship (to M. V. Plaisime), and the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (Award Nos. R01HL085631 to M. van Ryn, R01HL085631‐S1 to S. P. Perry, and R01HL085631‐S2 and R01HL085631‐S3 to R. R. Hardeman).

Publisher Copyright:
© 2023 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.


  • diversity equityand inclusion (DEI)
  • interracial anxiety
  • medical education
  • medical students
  • mixed effects longitudinal models
  • neighborhoods
  • residents


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