Culture, gender, sexual orientation and class representation within medical school has progressively diversified since the homogeny of the 1960’s, as described by Becker in Boys in White1. Increasing physician diversity is an important (and overdue) step for medical education programs.
In a study (nearly 15 years old, but I would argue, still relevant today) Brenda Beagan, a Canadian sociologist, conducted research to determine whether an increasing heterogeneity of learners is reflected in heterogeneous values, attitudes and practice styles within medical education.2 She conducted her research using surveys and semi-structured interviews at an anonymous Canadian medical school.
The punch line of this research is that despite the diversity of individuals, the culture of medical school enforces a group-think, which neutralizes cultural, gender, sexual and social differences.
Beagan outlines five factors that produce such an environment. They are:
- Time pressure. Students felt they were succeeding in their time-intensive scholastic activities. However, this was accomplished at the expense of failing to participate in social interests that pre-dated medical school.
- Isolation. Eighty-nine percent of students recognized the need for relationships outside of medical culture. Yet, numerous students acknowledged that relationships had been sacrificed for school. Segregation with like-minded others has long been recognized as an effective means of resocialization.
- Conformity of thought. With the exception of wanting to stand out as intellectually superior, no student desired to stand out in regards to social conduct. Conformity of thought was valued by the faculty to ensure consistent medical practice. Standardized critical thinking processes would guarantee “right” clinical answers.
- Resocialization. Forty-four percent of surveyed students expressed that they had lost touch with their self-identity pre-dating medical school. The establishment of new social structures of power (between patients, students and faculty) were cemented as normal, for there was no means of dissent. Previous values were suppressed in order to be a “good medical student.”
- Letting go of non-medical aspects of self. Physical manifestations of gender, culture and sexual orientation were supplanted to the generic model of medicine. This loss of community-based identity markers, and the adoption of social conduct typified within medicine, effectively erased diversity within the medical student population.
Drawing on previous works of sociology and philosophy, Beagan goes on to argue that the
view from nowhere – the supposed universal, impartial, egalitarian view – is impossible. Critical theory demands that CEs address the social and cultural influences that affect the situated nature of knowledge (and learning). Medical students, who are educated to view themselves as impartial, are fooled into presuming that equality marks their patient encounters.
Ultimately, Beagan concludes that medical education must begin to aid students in understanding their own “social locatedness.” A physician must comprehend the social constructs of medical knowledge and appreciate their personal reflexive biases. In doing so, genuine connections with patients will occur.
1. Becker, H., et al., Boys in white: Student culture in medical school. 1961, Chicago: University of Chicago Press.
2. Beagan, Brenda (2000) “Neutralizing differences: producing neutral doctors for (almost) neutral patients.” Social Science & Medicine 51: 1253-1265.
Image 2 courtesy of Christopher Schwarzkopf (WMDE), via Wikimedia Commons