Social justice in medical education: inclusion is not enough-it's just the first step

Abstract

Introduction: Medical schools worldwide are creating inclusion policies to increase the admission of students from vulnerable social groups. This study explores how medical students from vulnerable social groups experience belongingness as they join the medical community.

Methods: This qualitative study applied thematic analysis to 10 interviews with medical students admitted to one medical school through an affirmative policy. The interviews followed the drawing of a rich picture, in which the students represented a challenging situation experienced in their training, considering their socio-economic and racial background. The analysis was guided by the modes of belonging (engagement, imagination, and alignment) described by the Communities of Practice framework.

Results: Participants struggled to imagine themselves as future doctors because they lack identification with the medical environment, suffer from low self-esteem, aside from experiencing racial and social discrimination. Participants also find it troublesome to engage in social and professional activities because of financial disadvantages and insufficient support from the university. However, participants strongly align with the values of the public health system and show deep empathy for the patients.

Discussion: Including students with different socio-economic and racial backgrounds offers an opportunity to reform the medical culture. Medical educators need to devise strategies to support students' socialization through activities that increase their self-esteem and make explicit the contributions they bring to the medical community.

Keywords: Affirmative policies; Medical education; Professional identity; Social justice.

Fig. 1

In this drawing, the ProFIS student (given the fictitious name of Daniel) depicted a race track as a metaphor to represent the undergraduate medical course. Daniel feels he is lagging behind and drew himself starting the race behind the “regular” students. Daniel also thinks that his running lane contains more hurdles than the lanes of regular students. Daniel also believes that the obstacles he faces are of a different nature—they are more challenging (in the picture, the barriers in Daniel’s lane are red, whereas the ones in the other lanes are green). The red barriers in Daniel’s lane represent his perceived knowledge deficit and the financial and social difficulties experienced by ProFIS students like him. He feels inferior and less capable than his classmates. That’s why Daniel wrote the words “EU” (I) and “INCAPACIDADE” (LACK OF CAPACITY) in the two text bubbles next to him. At the same time, Daniel feels supported by his family, which was represented on the bottom-right side of the picture with the words “TORCENDO” (CHEERING) and “AJUDANDO” (HELPING)