by Gary L. Beck Dallaghan, Ph.D. | November 2, 2022 Article Citation: Wilkinson R, Huxley-Reicher Z, Conner Fox GW, Feuerbach A, Tong M, Blum J, Pai A, Karani R, Muller D. Leveraging Clerkship Experiences to Address Segregated Care: A Survey-Based Approach to Student-Led Advocacy. Teach Learn Med 2023; 35(4):381-388. DOI: 10.1080/10401334.2022.2088538 What is this article about? Segregated care, defined as segregating patients receiving Medicaid from patients with private insurance, leads to de facto segregation based on race and socioeconomic status. Medical students at a New York academic health center recognized the inequitable treatment and sought to address it by collecting survey data from medical students. Why should you read the article? The study was done at a large academic medical center in New York City with 3rd year medical students. A survey instrument was designed to gauge the prevalence of segregated care, understand its impact on medical education, and identify opportunities for structural change. The survey included 16 questions; 8 were multiple choice and 8 open-ended questions. Analysis included descriptive statistics and thematic analysis. The survey was administered in March, 2019 to 140 students. Of the 65 respondents, 36 (56.3%) reported witnessing separation of patients by insurance status. Thirty-three (51.6%) reported witnessing differences in care based on insurance status. The frequency of these reports varied by rotation. How can you use this article? Thematic analysis resulted in four themes: disparate patient care (involved two subthemes of structural separation and differences in care), differences in educational opportunities, and negative emotional consequences. Disparate patient care was noted in different physical locations (ie type of clinic) as well as preceptor behaviors. Educational opportunities were better with Medicaid patients because they were allowed to do complete work-ups on them, but those with insurance were given special treatment and were allowed to opt out of being seen by students. Recognition of these disparities resulted in students feeling hopeless and cynical about healthcare. The survey demonstrated widespread segregation of care that was having a negative impact on training experiences. Although the response rate was low, survey data was used to advocate for structural changes. Review Author: Gary L. Beck Dallaghan, PhD; Professor, Department of Medical Education, University of Texas at Tyler School of Medicine, Tyler TX. Member organization: Council on Medical Student Education in PediatricsAddressing Segregated Care Using Clerkship Experiences