PDF(Pubmed)
Abstract：
BACKGROUND: An array of evidence shows how the presence of implicit bias in clinical encounters can negatively impact provider-patient communication, quality of care and ultimately contribute to health inequities. Reflexive practice has been explored as an approach to identify and address implicit bias in healthcare providers, including medical students. At the Lausanne School of Medicine, a clinically integrated module was introduced in 2019 to raise students\' awareness of gender bias in medical practice using a reflexivity and positionality approach. The purpose of this study is to describe the gender bias that were identified by medical students, analysing their types, places and modes of emergence during a clinical encounter. It further explores how positionality supported students\' reflection on the way in which social position modulates their relationship to patients.
METHODS: As part of the teaching activity, medical students individually reflected on gender bias in a specific clinical encounter by answering questions in their electronic portfolio. The questionnaire included a section on positionality. We qualitatively analysed the students\' assignments (n=76), applying a thematic analysis framework.
RESULTS: Medical students identified and described gender biases occurring at different moments of the clinical encounter (anamnesis (i.e. patient history), physical exam, differential diagnosis, final management). They causally associated these biases with wider social phenomena such as the gendered division of labour or stereotypes around sexuality and gender. Analysing students\' reflections on how their position influenced their relationship with patients, we found that the suggested exercise revealed a major contradiction in the process of medical enculturation: the injunction to be neutral and objective erases the social and cultural context of patients and impedes an understanding of gender bias.
CONCLUSIONS: Gender biases are present in the different steps of a clinical consultation and are rooted in broader gendered social representations. We further conclude that the tension between a quest for objectivity and the reality of social encounters should be made explicit to students, because it is constitutive of medical practice.
METHODS: As part of the teaching activity, medical students individually reflected on gender bias in a specific clinical encounter by answering questions in their electronic portfolio. The questionnaire included a section on positionality. We qualitatively analysed the students\' assignments (n=76), applying a thematic analysis framework.
RESULTS: Medical students identified and described gender biases occurring at different moments of the clinical encounter (anamnesis (i.e. patient history), physical exam, differential diagnosis, final management). They causally associated these biases with wider social phenomena such as the gendered division of labour or stereotypes around sexuality and gender. Analysing students\' reflections on how their position influenced their relationship with patients, we found that the suggested exercise revealed a major contradiction in the process of medical enculturation: the injunction to be neutral and objective erases the social and cultural context of patients and impedes an understanding of gender bias.
CONCLUSIONS: Gender biases are present in the different steps of a clinical consultation and are rooted in broader gendered social representations. We further conclude that the tension between a quest for objectivity and the reality of social encounters should be made explicit to students, because it is constitutive of medical practice.
摘要：
背景：一系列证据表明，临床接触中隐含偏见的存在如何对提供者与患者的沟通产生负面影响，护理质量，最终导致健康不平等。反身实践已被探索为一种识别和解决医疗保健提供者隐含偏见的方法。包括医学生。在洛桑医学院，2019年引入了一个临床综合模块,旨在使用反身性和定位性方法提高学生对医疗实践中性别偏见的认识.这项研究的目的是描述医学生发现的性别偏见，分析他们的类型，临床接触期间出现的地点和模式。它进一步探讨了立场如何支持学生反思社会地位如何调节他们与患者的关系。
方法：作为教学活动的一部分，医学生通过回答电子作品集中的问题，分别反映了特定临床中的性别偏见。问卷包括一个关于位置性的部分。我们定性分析了学生的作业(n=76)，应用主题分析框架。
结果：医学生识别并描述了在临床遭遇的不同时刻发生的性别偏见（回忆（即患者病史），体检,鉴别诊断,最终管理)。他们将这些偏见与更广泛的社会现象联系在一起，例如性别分工或围绕性和性别的陈规定型观念。分析学生对他们的位置如何影响他们与患者的关系的反思，我们发现，建议的练习揭示了医学文化发展过程中的一个主要矛盾:中立和客观的禁令消除了患者的社会和文化背景，阻碍了对性别偏见的理解。
结论：性别偏见存在于临床咨询的不同步骤中，并且植根于更广泛的性别社会表征。我们进一步得出结论，应该向学生明确追求客观性与社会现实之间的紧张关系，因为它是医疗实践的组成部分。
方法：作为教学活动的一部分，医学生通过回答电子作品集中的问题，分别反映了特定临床中的性别偏见。问卷包括一个关于位置性的部分。我们定性分析了学生的作业(n=76)，应用主题分析框架。
结果：医学生识别并描述了在临床遭遇的不同时刻发生的性别偏见（回忆（即患者病史），体检,鉴别诊断,最终管理)。他们将这些偏见与更广泛的社会现象联系在一起，例如性别分工或围绕性和性别的陈规定型观念。分析学生对他们的位置如何影响他们与患者的关系的反思，我们发现，建议的练习揭示了医学文化发展过程中的一个主要矛盾:中立和客观的禁令消除了患者的社会和文化背景，阻碍了对性别偏见的理解。
结论：性别偏见存在于临床咨询的不同步骤中，并且植根于更广泛的性别社会表征。我们进一步得出结论，应该向学生明确追求客观性与社会现实之间的紧张关系，因为它是医疗实践的组成部分。
