Recognizing the Role of Language in the Hidden Curriculum of Undergraduate Medical Education: Implications for Equity in Medical Training

"I get to relate to my patients": Latinx medical students and residents' navigational capital in medical education

While the U.S. Latinx population has rapidly increased in the past 30 years, the number of Latinx physicians has not kept pace. Latinx students are often motivated to pursue medicine to serve those in their communities, which benefits Latinx community health outcomes through patient-clinician cultural and linguistic concordance. However, significant barriers often prevent Latinx people from successfully navigating the transition to and through medical school. This study utilized a qualitative, constructivist approach to investigate the transition to and through medical school and residency to further understand and prevent leakages for aspiring Latinx physicians. Using an assets-based framework of Community Cultural Wealth (CCW), we specifically explored navigational capital, to understand how Latinx learners navigate belonging in medicine. Through semi-structured interviews with 20 Latinx medical students and 14 residents, we found that learners understood and created belonging by navigating help-seeking and the imposter phenomenon through their respective pathways in medicine. Findings from this study may be used to develop support systems and resources to reduce the structural inequalities, barriers, and challenges Latinx students and future physicians encounter through medical education pathways.

Conceptual competence in medicine: promoting psychosomatic awareness in clinics, research and education

Introduction

In recent decades, psychosomatic medicine has developed into a distinct specialty, bringing specific clinical concepts to bear seeking to acknowledge the unity (not the identity) of the mind and body in clinical care. Such concepts form the identity of the psychosomatic field as a distinct discipline and its epistemological status between somatic medicine and psychiatry. Despite the importance of these concepts from an educational and a research perspective, too little attention has been paid to their clinical impact.

Methods

This paper investigated the general nature of concepts and their role and significance in structuring the clinical encounter and care, including consideration of their relevance for the hidden curriculum.

Results

Conceptual competence is defined as a transformative awareness of the multilayered, fallible, and plural nature of human concepts, which have both descriptive and evaluative and action-guiding properties having both an explicit and an implicit meaning. Conceptual competence in psychosomatic medicine entails dealing competently with the mind-body-distinction and the biopsychosocial model (and criticism of it) with respect to the clinical situation.

Discussion

Conceptual research is presented as an autonomous research area and the complement of empirical research, having a descriptive and a normative function: descriptively analyzing the concepts we have and normatively searching for the concepts that we need for the integrated care we strive for.

Advancing Equity: Understanding, Addressing, and Mitigating Bias in Assessment in Medical Education

Despite the growing presence of women and historically underrepresented groups in academic medicine, significant disparities remain. This article examines a key aspect of these disparities: biases in assessment and learning environments. Reviewing current literature, including in OBGYN, reveals persistent gender and racial biases in subjective clinical narrative assessments. The paper then outlines a 2-pronged approach for change: first, enhancing the learning environment, and subsequently, providing targeted recommendations for individuals, academic leaders, and healthcare institutions to effectively address these biases.

The Effects of Humor in Clinical Settings on Medical Trainees and the Implications for Medical Educators: A Scoping Review

Background

Clinical settings represent the site of patient care and clinical training for medical students and residents. Both processes involve social interaction, and humor is a fundamental component of social interaction that remains underexplored in medical education. This study investigated the impact of humor on medical trainees in the context of the clinical learning environment and examined the implications for medical educators.

Methods

Following scoping review methodology, the authors systematically searched six databases and Google Scholar in February 2021 and March 2022. Articles were screened and selected according to inclusion/exclusion criteria, and findings from included articles were synthesized using procedures of metasynthesis.

Results

Fifteen articles met inclusion criteria. Six themes emerged relating to the functions and effects of humor in clinical training settings: (1) managing emotions; (2) demarcating insider vs outsider status; (3) facilitating camaraderie; (4) ensuring conformity; (5) negotiating power differentials; and (6) fostering discrimination.

Conclusions

The use of humor by medical educators plays an integral role in trainees' everyday experiences. Positive humor helps with coping and communication, while negative humor serves as an indirect medium for communicating ridicule and prejudice. Further research drawing on social psychology theories may identify ways to reduce effects of negative humor and promote well-being and diversity in medical education.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01769-0.

Presenting complaint: use of language that disempowers patients

Caitríona Cox and Zoë Fritz argue that outdated medical language that casts doubt, belittles, or blames patients jeopardises the therapeutic relationship and is overdue for change

Contending with Our Racial Past in Medical Education: A Foucauldian Perspective

Practices of systemic and structural racism that advantage some groups over others are embedded in American society. Institutions of higher learning are increasingly being pressured to develop strategies that effectively address these inequities. This article examines medical education's diversity reforms and inclusion practices, arguing that many reify preexisting social hierarchies that privilege white individuals over those who are minoritized because of their race/ethnicity. Evidence: Drawing on the work of French theorist Michel Foucault, we argue that medical education's curricular and institutional practices reinforce asymmetrical power differences and authority in ways that disadvantage minoritized individuals. Practices, such as medical education's reliance on biomedical approaches, cultural competency, and standardized testing reinforce a racist system in ways congruent with the Foucauldian concept of "normalization." Through medical education's creation of subjects and its ability to normalize dominant forms of knowledge, trainees are shaped and socialized into ways of thinking, being, and acting that continue to support racial violence against minoritized groups. The systems, structures, and practices of medical education need to change to combat the pervasive forces that continue to shape racist institutional patterns. Individual medical educators will also need to employ critical approaches to their work and develop strategies that counteract institutional systems of racial violence. Implications: A Foucauldian approach that exposes the structural racism inherent in medical education enables both thoughtful criticism of status-quo diversity practices and practical, theory-driven solutions to address racial inequities. Using Foucault's work to interrogate questions of power, knowledge, and subjectivity can expand the horizon of racial justice reforms in medicine by attending to the specific, pervasive ways racial violence is performed, both intra- and extra-institutionally. Such an intervention promises to take seriously the importance of anti-racist methodology in medicine.