Students’ perceptions of race, ethnicity and culture at two UK medical schools: a qualitative study

Abstract

Globalisation has profoundly affected health care by increasing the diversity of clinicians and their patients. Worldwide, medical schools highlight the need for students to understand and show respect for patients and peers of different ethnicities. Yet a sound theoretical approach and robust methods for learning about cultural awareness are lacking. The reasons for this are unclear. To explore Year 2 medical students' understanding of the concepts of race, ethnicity and culture. This study was set in 2 universities in the north of England. The student population of each was of a similar ethnic mix but the universities differed in terms of local demography (a wide patient ethnic mix versus a predominantly White patient population with experience of social deprivation) and curricula (a curriculum involving problem-based learning and paper-based cases versus a curriculum involving early contact with patients). Participants comprised 49 Year 2 medical students (mean age 20.8 years), 40% of whom came from ethnic minority groups. Seven focus groups were held across the 2 universities to explore students' understanding of cultural awareness. Students were asked to discuss the terms 'race', 'ethnicity', 'culture' and 'cultural diversity'. Interviews were transcribed and analysed qualitatively using grounded theory. Themes were identified and validated by an independent researcher. Four overarching themes emerged: 'White fears' at discussing race-related issues; ethnic minority discomfort at being viewed as 'different'; difficulties in relating to professional boundaries, and barriers against talking about race beyond legitimate disease-related discourse. For students, discussion of race beyond the confines of medical discourse was problematic. If students are to develop professional holistic values towards patient care, they need more support in understanding their own personal values and uncertainties.