LAUSR

To the Editor: As early investigators and students, alongside learning how to conduct rigorous research, we aim to galvanize and engage in important discourses with individuals worldwide in an attempt to assist in systematically improving the field of healthcare. Thus, we wish to express our joy in reading and responding to the letter by Evans and McCaughan [1] commenting on our paper [2]. This well-written letter by UK medical students provides a valuable addition to the discussion on stigma within medical education. The authors provide insight gained through subjective personal experiences, which serve well to contrast the findings of our article. Moreover, the authors do well in identifying the need to shift the focus of research efforts from the existence of stigma in medical education to identifying ways to overcome it effectively. We would like to address several matters, however. First, the authors focus a large portion of their letter on the limitations of the methodology and lack of power within our study. We believe that this is redundant as we have clearly acknowledged these limitations within both the current study under focus [2] and the original study fromwhich this study’s dataset was retrieved [3]. As our conclusions were made in light of our sample size of 118, which we have acknowledged as falling short of the 236 respondents needed to achieve a representative sample [3], we did not include a section on generalizability in our original paper. We were also skeptical whether the trends we saw in our study would be the same elsewhere, especially given the heterogeneity in clerkship programs and student cohorts. Furthermore, our study was exploratory, conducted under a time-sensitive and resource-limited environment, with the aim of evoking discussion and identifying a potential need to conduct more rigorous studies in the future. Therefore, we believe that a sample size of 118 is substantial enough to feed this aim. Also, we were careful in ensuring that we did not overstep the bounds of our limitations when writing our results and the manuscript overall (e.g., we titled our paper the “potential” effect, not “the” effect). Additionally, many recommendations the authors make for future research (e.g., how to strengthen the rigor and generalizability of the study) were mentioned in our report (e.g., through the use of different research designs, larger cohorts, multi-comparison perspective). The authors do bring up an interesting recommendation, however, that future studies should include an assessment on the quality of physician engagement, to which we agree. The authors mentioned that they would be interested in a proposed mechanism for how increased years in medical school could lead to a significant reduction in stigmatizing attitudes but not a psychiatric clerkship. Due to our limitations and the parameters of the in brief report category, we decided not to discuss this in our study. We believe, however, that this venture could be interesting for researchers to take on, should future studies conducted with more rigor and generalizability find similar results. We found the subjective experiences of these medical students fascinating. They were fortunate to have a preceptor who challenged them to focus on stigma as a key component of their clinical rotation. It would be interesting to learn if every student in their class had a similar challenging and destigmatizing psychiatric clerkship. It sounds as though the authors are experiencing an effect of the hidden curriculum [4, 5]. Are the procedures and lessons associated with stigma reduction they experienced an explicit or implicit part of their * Anish Arora [email protected]