Micro Inequities and Everyday Inequalities: "Race," Gender, Sexuality and Class in Medical School

Abstract

Abstract: Medical students in the 1990s are heterogeneous in terms of gender, race, class and sexual orientation. Based on a survey of third-year students, student interviews, and faculty/administrator interviews at one Canadian medical school, this paper goes beyond the identification of blatant forms of discrimination to examine micro level interactional practices of inclusion and exclusion that cumulatively convey messages about who does and who does not belong in medical school. These micro inequities and everyday inequalities construct an institutional climate that may marginalize and alienate some students, reproducing hierarchies of inequality despite the institution's express commitment to formal equality. Resume: Les etudiants en medecine des annees 90 sont un groupe heterogene en ce qui concerne leur sexe, ethnicite, classe sociale et sexualite. Prenant comme point de depart un sondage d'etudiants en troisieme annee et des entrevues avec des etudiants, des membres du corps professoral et de l'administration a une ecole de medecine canadienne, cette etude va au-dela de l'identification des formes flagrantes de discrimination pour examiner a un niveau plus subtil les pratiques interactives d'inclusion et d'exclusion qui, prises dans leur ensemble, transmettent le message de qui devrait et qui ne devrait pas etre etudiant en medecine. Malgre l'engagement public de l'institution a une egalite formelle, ces micro-iniquites et injustices de tous les jours creent un climat institutionnel qui marginaliserait et alienerait certains etudiants en reproduisant des hierarchies d'inegalite. Elements in the students' background do not exert any decisive influence ... in medical school. Such background factors may have indirect influence in many ways, but the problems of the student role are so pressing ... that the perspectives developed are much more apt to reflect the pressures of the immediate school situation than of ideas associated with prior roles and experiences (Becker et al., 1961: 47). In this passage from Boys in White, a classic study of medical professional socialization, Howard Becker and his colleagues insist that social characteristics such as gender, race, (2) culture, social class, sexual orientation, and religion have little or no impact on medical student experiences. Social differences become background variables in the face of an overwhelming medical student culture. In their study, conducted in 1956-57, about 5% of the students in any class were women and 5% to 7% were non-white (1961: 60). (3) They really were boys in white -- in fact they were white boys in white. Over the next 40 years the profile of the typical North American medical school class changed considerably. By 1993, 42% of medical students in the United States were women (Bickel and Kopriva, 1993). In Canada, women's proportion of medical school classes increased from 9% in 1957-58 to 49% by 1997-98 (Association of Canadian Medical Colleges, 1998: 17). By 1991-92 African American, Native American, Mexican American, Puerto Rican, other Hispanic, and Asian or Pacific Islander students made up 27% of all medical students in the United States (Jonas et al., 1992: 1088; c.f. Foster, 1996). In Canada statistics on the race of medical students are not available. As well, medical students are somewhat older and better educated upon entry than they were in previous years (Gray and Reudy, 1998: 1047). Evidence also indicates there are more openly-identified gay/lesbian/bisexual medical students. There are currently gay and lesbian student caucuses in medical schools, a Canadian gay and lesbian medical student E-ma il list, a gay and lesbian committee of the American Medical Student Association (Oriel et al., 1996), and recent journal articles addressing the concerns of gays and lesbians in medicine (Cook et al., 1995; Druzin et al., 1998; Klamen et al., 1999; Oriel et al., 1996; Risdon et al., 2000; Rose, 1994; Wallick et al. …