ror.org/0161xgx34
Résumés
Abstract
Background: Black students and residents experience racism in medical school. This qualitative study documents Black students’ and residents’ experiences of racism using Critical Race Theory (CRT) and explores their coping mechanisms using the theatrical metaphor.
Methods: We conducted semi-structured interviews with four Black medical students and residents (two medical students and two residents) studying in Montréal and analyzed their experiences through counter-stories. We identified themes related to their experiences of racism during medical training and their coping mechanisms.
Results: Our analysis reveals these experiences of racism occur in academic and clinical settings (classes, internships, social interactions with peers, faculty, and patients, and through the curriculum), in the form of microaggressions. The analysis also indicates that Black students and residents try to cope with racism using a hyper-ritualization strategy to better fit in (e.g., clothing, behaviours).
Conclusion: Considering that Black students and residents experience various forms of racism (subtle or explicit) during their medical training, these findings urge us to increase awareness about racism of students, residents, teachers and health care workers in universities and teaching hospitals. Pathways to increase the representation of Black students and residents seem to be part of the solution, but improving the learning environment must be a priority to improve racial justice in medical training in Québec.
Résumé
Contexte : Les étudiants et les résidents noirs sont victimes de racisme dans les facultés de médecine. Cette étude qualitative documente les expériences de racisme des étudiants et des résidents noirs à l'aide de la théorie critique des races (TCR) et explore leurs mécanismes d'adaptation à l'aide de la métaphore théâtrale.
Méthodes : Nous avons mené des entrevues semi-structurées avec quatre étudiants en médecine et résidents noirs (deux étudiants en médecine et deux résidents) étudiant à Montréal et analysé leurs expériences par le biais de contre-histoires. Nous avons identifié des thèmes liés à leurs expériences du racisme pendant la formation médicale et à leurs mécanismes d'adaptation.
Résultats : Notre analyse révèle que ces expériences de racisme se produisent dans les milieux universitaires et cliniques (cours, stages, interactions sociales avec les pairs, le corps professoral et les patients, et dans le cadre du programme d'études), sous la forme de microagressions. L'analyse indique également que les étudiants et les résidents noirs tentent de faire face au racisme en utilisant une stratégie d'hyper-ritualisation pour mieux s'intégrer (par exemple, vêtements, comportements).
Conclusion : Étant donné que les étudiants et les résidents noirs sont confrontés à diverses formes de racisme (subtil ou explicite) au cours de leur formation médicale, ces résultats nous incitent à sensibiliser davantage les étudiants, les résidents, les enseignants et les travailleurs de la santé au racisme dans les universités et les hôpitaux universitaires. Les parcours visant à accroître la représentation des étudiants et des résidents noirs semblent faire partie de la solution, mais l'amélioration de l'environnement d'apprentissage doit être une priorité pour améliorer la justice raciale dans la formation médicale au Québec.
Parties annexes
Bibliography
- Hill KA, Samuels EA, Gross CP, et al. Assessment of the prevalence of medical student mistreatment by sex, race/ethnicity, and sexual orientation. JAMA Intern Med. 2020;180(5):653–65. https://doi.org/10.1001/jamainternmed.2020.0030
- Orom H, Semalulu T, Underwood W. The social and learning environments experienced by underrepresented minority medical students: a narrative review. Acad Med J Assoc Am Med Coll. 2013;88(11):1765–77. https://doi.org/10.1097/ACM.0b013e3182a7a3af
- Kristoffersson E, Rönnqvist H, Andersson J, Bengs C, Hamberg K. “It was as if I wasn’t there” – Experiences of everyday racism in a Swedish medical school. Soc Sci Med. 2021;270:113678. https://doi.org/10.1016/j.socscimed.2021.113678
- Espaillat A, Panna DK, Goede DL, Gurka MJ, Novak MA, Zaidi Z. An exploratory study on microaggressions in medical school: what are they and why should we care? Perspect Med Educ. 2019;8(3):143–51. https://doi.org/10.1007/s40037-019-0516-3
- Hariharan B, Quarshie LS, Amdahl C, Winterburn S, Offiah G. Experiencing racism within medical school curriculum: 2020 ICCH student symposium. Patient Educ Couns. 2022;105(7):2599–602. https://doi.org/10.1016/j.pec.2021.12.018
- Sue DW, Capodilupo CM, Torino GC, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62(4):271–86. https://doi.org/10.1037/0003-066X.62.4.271
- Johnson M, Seide W, Green-Dixon A, Randall V. Black students’ perception of belonging: a focus group approach with Black students at the uniformed services university of the health sciences. Int J Med Stud. 2021;9(2):124–8. https://doi.org/10.5195/ijms.2021.877
- Acheampong C, Davis C, Holder D, Averett P, Savitt T, Campbell K. An exploratory study of stress coping and resiliency of Black men at one medical school: A critical race theory perspective. J Racial Ethn Health Disparities. 2019;6(1):214–9. https://doi.org/10.1007/s40615-018-0516-8
- Diaz T, Navarro JR, Chen EH. An institutional approach to fostering inclusion and addressing racial bias: implications for diversity in academic medicine. Teach Learn Med. 2020;32(1):110–6. https://doi.org/10.1080/10401334.2019.1670665
- Dhalla IA, Kwong JC, Streiner DL, Baddour RE, Waddell AE, Johnson IL. Characteristics of first-year students in Canadian medical schools. CMAJ Can Med Assoc J J Assoc Médicale Can. 2002;166(8):1029–35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC100877/
- Khan R, Apramian T, Kang JH, Gustafson J, Sibbald S. Demographic and socioeconomic characteristics of Canadian medical students: a cross-sectional study. BMC Med Educ. 2020;20(1):151. https://doi.org/10.1186/s12909-020-02056-x
- Young ME, Razack S, Hanson MD, et al. Calling for a broader conceptualization of diversity: surface and deep diversity in four Canadian medical schools. Acad Med J Assoc Am Med Coll. 2012;87(11):1501–10. https://doi.org/10.1097/ACM.0b013e31826daf74
- Leduc JM, Kpadé V, Bizimungu S, et al. Black students applying and admitted to medicine in the province of Quebec, Canada: what do we know so far? Can Med Educ J. 2021. https://doi.org/10.36834/cmej.72017
- Lafortune G, Kanouté F. Récits d’expériences de jeunes issus de l’immigration en situation de décrochage : quand l’école « ne marche pas » ou est un bad trip. Éducation Francoph. 2019;47(1):131–48. https://doi.org/10.7202/1060851ar
- Magnan MO, Collins T, Darchinian F, Kamanzi PC, Valade V. Student Voices on Social Relations of Race in Québec Universities. Race Ethn Educ. 2021;1–17. https://doi.org/10.1080/13613324.2021.1890564
- Adler S, Boivin-Côté J, Ouizzane C, Gravel I, Leduc JM. Experienced or witnessed racism and microaggressions during medical education: an exploratory survey of medical students at a large Canadian medical school. Paper presented at the AMEE Conference, Lyon, France. 2022.
- Haney López IF. The social construction of race. In: Critical race theory: the cutting edge. 2nd ed. Philadelphia: Temple University Press; 2000. p. 163–75.
- Solórzano DG, Yosso TJ. A critical race counterstory of race, racism, and affirmative action. Equity Excell Educ. 2002;35(2):155–68. https://doi.org/10.1080/713845284
- Delgado R, Stefancic J, Harris A. Critical Race Theory: an introduction. 3rd ed. New York: NYU Press; 2017. https://doi.org/10.2307/j.ctt1ggjjn3
- Gillborn D. Rethinking White supremacy: who counts in ‘WhiteWorld.’ Ethnicities. 2006;6(3):318–40. https://doi.org/10.1177/1468796806068323
- Sue DW. Overcoming our racism: the journey to liberation. Jossey-Bass; 2003. https://doi.org/10.1002/9780787979690
- Cameron ES, Jefferies K. Anti-Black racism in Canadian education: A call to action to support the next generation. Healthy Popul J. 2021;1(1):11-15. https://doi.org/10.15273/hpj.v1i1.10587
- Der GS. Reframing critical anti-racist theory (CART) for contemporary times. Counterpoints. 2013;445:1-14.
- Sue DW, Capodilupo CM, Nadal KL, Torino GC. Racial microaggressions and the power to define reality. Am Psychol. 2008;63(4):277–9. https://doi.org/10.1037/0003-066X.63.4.277
- Pérez Huber L. Using Latina/o Critical Race Theory (LatCrit) and racist nativism to explore intersectionality in the educational experiences of undocumented Chicana college students. Educ Found. 2010;24(1–2):77–96. https://eric.ed.gov/?id=EJ885982
- Yosso TJ. Whose culture has capital? A critical race theory discussion of community cultural wealth. Race Ethn Educ. 2005;8(1):69–91. https://doi.org/10.1080/1361332052000341006
- Sleeter CE. Critical race theory and education. In: Banks JA, editor. Encyclopedia of diversity in education [Internet]. Thousand Oaks: SAGE Publications, Inc.; 2012. p. 491–4. Available from: http://sk.sagepub.com/reference/diversityineducation/n154.xml
- Goffman E. Gender advertisements. London: Palgrave; 1976. https://doi.org/10.1007/978-1-349-16079-2
- Goffman E. The presentation of self in everyday life. New York: Anchor books; 1959.
- Goffman E. Interaction ritual: essays in face-to-face behavior. New York: Pantheon Books; 1982.
- Goffman E. Stigma: notes on the management of spoiled identity. New York: Simon & Schuster; 1986.
- Solórzano DG, Yosso TJ. Critical race methodology: Counter-storytelling as an analytical framework for education research. Qual Inq. 2002;8(1):23–44. https://doi.org/10.1177/107780040200800103
- Savoie-Zajc L. L’entrevue semi-dirigée. In: Bourgeois I, editor. Recherche sociale : De la problématique à la collecte des données. 7th ed. Québec: Presses de l’Université du Québec; 2021. p. 273–96.
- Cohen L, Manion L, Morrison K. Research methods in education. 8th ed. London: Taylor & Francis Group; 2017. https://doi.org/10.4324/9781315456539
- Paillé P, Mucchielli A. L’analyse thématique. In: L’analyse qualitative en sciences humaines et sociales. 5th ed. Paris: Armand Colin; 2021. p. 269–357. Available from: https://www.cairn.info/l-analyse-qualitative-en-sciences-humaines--9782200624019-p-269.htm
- Hunting G. Intersectionality-informed qualitative research: a primer. Vancouver: The Institute for Intersectionality Research & Policy, SFU; 2014.
- Rodriguez JK. Intersectionality and qualitative research. In: Cassell C, editor. The SAGE handbook of qualitative business and management research methods: history and traditions. London: SAGE Publications; 2019. p. 429-461. https://doi.org/10.4135/9781526430212.n26
- Krumer-Nevo M, Sidi M. Writing against othering. Qual Inq. 2012;18(4):299-309. https://doi.org/10.1177/1077800411433546
- Girgulis K, Rideout A, Rashid M. Performance of Black and Indigenous applicants in a medical school admissions process. Can Med Educ J. 2021 Dec 31;12(6):35–42. https://doi.org/10.36834/cmej.72121
- Morrison N, Machado M, Blackburn C. Student perspectives on barriers to performance for black and minority ethnic graduate-entry medical students: a qualitative study in a West Midlands medical school. BMJ Open. 2019;9(11):e032493. https://doi.org/10.1136/bmjopen-2019-032493
- Woolf K. Differential attainment in medical education and training. BMJ. 2020; 368. https://doi.org/10.1136/bmj.m339
- Beagan BL. “Is this worth getting into a big fuss over?” Everyday racism in medical school. Med Educ. 2003;37(10):852–60. https://doi.org/10.1046/j.1365-2923.2003.01622.x
- Ahmed S. on being included: racism and diversity in institutional life. Duke University Press. 2012. https://doi.org/10.1515/9780822395324
- Gastaldo É. O Projeto Teórico de Erving Goffman: Erving Goffman e suas obras. 2022. Available from: https://www.youtube.com/watch?v=jPDl-L1sFtE
- Gastaldo É. Goffman e as relações de poder na vida cotidiana. Rev Bras Ciênc Sociais. 2008;23:149–53. https://doi.org/10.1590/S0102-69092008000300013
- Collins PH, Bilge S. Intersectionality. Malden, MA: Polity Press; 2016.
- Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Rev. 1991;43(6):1241–99. https://doi.org/10.2307/1229039
- Union Étudiante du Québec. La communauté étudiante noire et racisée: Expériences vécues et défis rencontrés. 2023. https://unionetudiante.ca/Media/publicDocuments/7763fe5f-7a64-46b9-93c4-dd326dbe1505.pdf
- Von Robertson R, Bravo A, Chaney C. Racism and the experiences of Latina/o college students at a PWI (Predominantly White Institution). Crit Sociol. 2016;42(4-5):715-35. https://doi.org/10.1177/0896920514532664
- Solórzano D, Allen WR, Carroll G. Keeping race in place: racial microaggressions and campus racial climate at the University of California, Berkeley. Chicano-Latino Law Rev. 2002;23(15):14-112. https://doi.org/10.5070/C7231021142
10.7202/1060851ar