A Narrative Review of Discrimination Experienced by Medical Students
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REVIEW
A Narrative Review of Discrimination Experienced by Medical Students Lillian Ng 1
&
Charlie Lin 1 & Marcus A. Henning 2
# International Association of Medical Science Educators 2019
Abstract Introduction The aim of this review was to clarify the nature of discrimination experienced by medical students and identify institutional responses and directions for future research. Method A narrative literature review of first-hand experiences of discrimination reported by medical students across a 10-year time period. Results Twenty-five reports with different methodologies were included. Discrimination was defined by a wide range of terms. Students had a range of responses to discriminatory treatment and many did not report their experiences. Conclusion Discrimination is a significant issue for medical students in clinical settings. Further research is needed to formulate institutional responses to understanding and addressing discrimination. Keywords Discrimination . Clinical . Education . Medical student . Hidden curriculum
Introduction The definition of discrimination is a bias or prejudice resulting in denial of opportunity or unfair treatment. Medical school is an institution rife with hierarchies of power, where discrimination can be inadvertently perpetuated [1]. Discrimination may be direct, overt or disguised [2] to the extent that students may doubt their experiences and judgement of it. The “hidden curriculum”, distinct from the formal curriculum, refers to the tacit communication of the culture of medicine rather than the transmission of knowledge and techniques [3, 4]. The hidden curriculum is a form of socialisation as students develop a professional identity as members of the medical profession. This may be part of students’ moral enculturation as they are role-modelled values and attitudes by senior clinicians and peers. The increasing awareness of
* Lillian Ng [email protected] 1
2
Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
unconscious bias [5] has led to formal tutelage in medical curriculums about deconstruction, the act of challenging assumptions about stereotypes and behaviours that affect a patient’s access to treatment [6]. Despite this, students find it difficult to identify discrimination as they may consider the experience to be a matter of perception. A narrative review of the literature was conducted with respect to perceived discrimination experienced by medical students in clinical settings. This form of review was chosen [7] to explore contextual influences underlying discrimination in preference to quantifying evidence or establishing the efficacy of a proposed intervention [8]. The aim was to clarify the nature of discriminatory experiences with a view to guiding research on institutional responses to address discriminat
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