Reflexivity and positionality applied to medical practice: a study on implicit gender bias with medical students in a Swiss university.

Details

Ressource 1Download: Arena_IJEH_2024.pdf (866.56 [Ko])
State: Public
Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_CF163CC1946F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Reflexivity and positionality applied to medical practice: a study on implicit gender bias with medical students in a Swiss university.
Journal
International journal for equity in health
Author(s)
Arena F., Geiser E., Auer S., Clair C., Schwarz J.
ISSN
1475-9276 (Electronic)
ISSN-L
1475-9276
Publication state
Published
Issued date
01/07/2024
Peer-reviewed
Oui
Volume
23
Number
1
Pages
132
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
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.
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.
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.
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.
Keywords
Humans, Sexism/psychology, Students, Medical/psychology, Students, Medical/statistics & numerical data, Male, Female, Switzerland, Surveys and Questionnaires, Physician-Patient Relations, Universities, Adult, Communication, Gender, Implicit bias, Masculinity, Medical education, Medical practice, Positionality, Reflexivity
Pubmed
Web of science
Open Access
Yes
Create date
01/03/2024 18:47
Last modification date
13/07/2024 7:20
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