Biomedical subjects

Brenda L Beagan

Publications and source records attributed to Brenda L Beagan.

6 recordsLinked to original sources

PubMed2005

Everyday classism in medical school: experiencing marginality and resistance.

OBJECTIVE: To explore the medical school experiences of students who self-identify as coming from a working-class or impoverished family background. METHODS: A questionnaire was administered to Year 3 medical students at a Canadian medical school and in-depth interviews were held with 25 of these students (cohort 1). The same methods were repeated with another Year 3 class 3 years later (cohort 2). RESULTS: While having (or not having) money was the most obvious impact of social class differences, students also discussed more subtle signs of class that made it easier or more difficult to fit in at medical school. Students from working-class or impoverished backgrounds were significantly less likely to report that they fitted in well, and more likely to report that their class background had a negative impact in school. They were also more likely to indicate awareness that a patient's social class may affect their health care treatment. CONCLUSION: Students from working-class or impoverished backgrounds may experience alienation in medical school. Through the commonplace interactions of 'everyday classism' they may experience marginalisation, isolation, disrespect and unintentional slights. At the same time, they suggest that their experiences of exclusion may strengthen their clinical practice.

Adult↗

PubMed2004

The patient as text: a challenge for problem-based learning.

OBJECTIVES: To explore the values and assumptions underlying problem-based learning (PBL) cases through narrative analysis, in order to consider the ways by which paper cases may affect student attitudes and values. METHODS: Randomly chosen PBL cases from the first year curriculum at Dalhousie University medical school (n = 10) were coded by 3 independent reviewers attending to narrative components. RESULTS: The cases generally used spare, objective language, used the passive voice, eliminated agency, and employed linguistic markers to encode scepticism about patient reports. There was almost no sense of the presence of the patient as person in these cases in terms of their words, feelings, or their social and cultural context. The almost complete exclusion of the preferences and priorities of the patient was striking. CONCLUSION: The sample is small, the results only suggestive. Yet it appears that the cases used in PBL may unnecessarily, even unintentionally, encourage student detachment from the messiness of real patients' lives and emotions. Positioning a particular way of seeing - the doctor's gaze - as normative renders less visible the choices that are being made whenever an account is constructed. Including multiple voices in a case would complicate that tidy reduction of choices. Ongoing attempts to enrich the case format should be encouraged. At the same time, students may benefit from being taught the skills for critical analysis of the case itself.

Clinical Competence↗

PubMed2003

'Is this worth getting into a big fuss over?' Everyday racism in medical school.

INTRODUCTION: Faced with an increasingly diverse student body, educators in the health professions struggle for ways to foster equality and understand racism. The concept of 'everyday racism' provides an important tool for examining subtle processes that construct a racialised climate in medical schools and other institutions. OBJECTIVES: To examine the ways racism is understood and experienced within one medical school and investigate the micro level interactional processes that may perpetuate inequality. METHODS: A survey (n = 72) and interviews (n = 25) were conducted with third year students at one Canadian medical school. A second class was surveyed (n = 61) 3 years later and 25 more students were interviewed. RESULTS: Students identified the linguistic advantage enjoyed by some classmates from ethno-cultural minority groups, but were less likely to identify the advantages enjoyed by white students, who may be more readily granted student-doctor status. Students from racialised minority groups experienced marginalisation through segregation, and struggled to respond appropriately to racist jokes and comments from patients and staff. A third (29%) of those who identified as 'minority' group members did not feel they fitted in particularly well at medical school, compared with only 7% of 'non-minority' students (chi2 P = 0.006; t-test P = 0.004). CONCLUSION: Medical students from racialised minority groups may experience 'everyday racism', mundane daily practices which intentionally or unintentionally convey disregard, disrespect or marginality. Such experiences are particularly difficult to deal with. Educators have a responsibility to counter with sustained antiracism, learning to acknowledge salient differences without reinforcing hierarchies of superiority and inferiority.

Adult↗

PubMed2003

Teaching social and cultural awareness to medical students: "it's all very nice to talk about it in theory, but ultimately it makes no difference".

PURPOSE: To investigate the effect of exposure to a new course addressing social and cultural issues in medicine on third-year medical students' awareness and understanding of how these issues affect their lives as students, the lives of patients, the work of physicians, and patient-physician interaction. The course, Physicians, Patients & Society (PPS) was introduced at the time the school was moving to a PBL curriculum. METHOD: In the late 1990s, a questionnaire was administered to third-year medical students at one Canadian medical school, prior to the curriculum change (Time 1). In-depth interviews were held with 25 of these students. A few years later, the same methods were repeated (Time 2) with a third-year class that had experienced the PPS course. RESULTS: The response rate for Time 1 was 59% (n = 72), for Time 2, 51% (n = 61). Students in Time 2 did not demonstrate increased awareness of social and cultural issues. Most failed to recognize, or even denied, the effects of race, class, gender, culture, and sexual orientation. Those who acknowledged the effect of social differences tended to deny social inequality, or at best recognized disadvantages experienced by Others, but not the accompanying privileges enjoyed by their own social group. CONCLUSIONS: In general, students concluded that learning about social and cultural issues made little or no difference when they did their clinical rotations. For a medical school to produce physicians who are sensitive to and competent working with diverse communities requires a balance between attention to "difference," attention to self, and attention to power relations.

Adult↗

PubMedDate not supplied

Eating after breast cancer: influences on women's actions.

OBJECTIVE: To explore women's dietary actions after a breast cancer diagnosis and the factors influencing those actions. DESIGN: Individual interviews exploring women's perceptions. SETTING: Vancouver, British Columbia, Canada. PARTICIPANTS: A culturally diverse convenience sample of women (N = 30) aged 40 to 60 years diagnosed with breast cancer 6 months to 15 years previously. PHENOMENON OF INTEREST: Social and personal factors that influence dietary actions. ANALYSIS: Verbatim interview transcripts were coded and themes developed by sorting and summarizing coded transcript segments. RESULTS: Women held a wide range of beliefs concerning the relationship between diet and breast cancer, particularly their own cancer occurrence. Actions were not always consistent with professed beliefs. Some women believed that diet contributes to breast cancer, even their own cancer, yet made no diet changes; others did not believe in such a relationship but did change their diets postdiagnosis. Family support, employment, financial resources, cultural food patterns, and other health concerns were strong influences. CONCLUSIONS AND IMPLICATIONS: Although beliefs about diet-cancer connections affect actions concerning diet change, the relationship is not consistent. Diet change is also affected by social, cultural, and economic concerns that are at least as important as a woman's beliefs. Nutrient supplements appear to be a common, although perhaps temporary, response to diagnosis. Future research should explore the possibilities for nutrition professionals to help women think critically about the range of influences on their diets.

Adult↗

PubMedDate not supplied

Family influences on food choice: context of surviving breast cancer.

OBJECTIVE: To explore women's perceptions of family influences on food decision-making in the context of having had breast cancer or not having had breast cancer. DESIGN: Individual interviews exploring women's perceptions of their eating habits, health status, and diet, health, and breast cancer beliefs. SETTING: In Vancouver, a large, multicultural, Canadian city, interviews were held in women's homes or offices or at the university. PARTICIPANTS: A culturally diverse convenience sample of women aged 40 to 60 years, including breast cancer survivors (n=29) and women who had not had breast cancer (n=32). ANALYSIS: Verbatim interview transcripts were coded by one of the authors, and themes were developed by sorting and summarizing transcript segments. RESULTS: Women who had not had breast cancer believed that they were catering to family preferences, even at the expense of their own health. In particular, men's "meat and potatoes" diet proved to be a barrier to dietary change. Breast cancer survivors experienced family members more as supporting than resisting healthful eating. Believing that the diagnosis had shifted their priorities, some women made healthful dietary changes regardless of family response. CONCLUSIONS AND IMPLICATIONS: Women experience family influence as significant in food decision-making. An illness diagnosis may alter women's and their families' negotiations of competing values, such that healthful eating takes on greater priority than food preferences or maintaining social relations through catering to others' tastes. This may be an opportune time to help women introduce healthful eating.

Adult↗