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在医疗保健中再现“白人”:对加拿大劳动力中整合具有国际教育背景的医疗保健专业人员的批判性文献的空间分析。

(Re)producing "Whiteness" in Health Care: A Spatial Analysis of the Critical Literature on the Integration of Internationally Educated Health Care Professionals in the Canadian Workforce.

机构信息

T.O. Mickleborough is a postdoctoral fellow, The Wilson Centre, University of Toronto and University Health Network, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-4796-0282 .

M.A. Martimianakis is associate professor, Department of Pediatrics, University of Toronto and Hospital for Sick Children, and scientist, The Wilson Centre, University of Toronto and University Health Network, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-2531-3156 .

出版信息

Acad Med. 2021 Nov 1;96(11S):S31-S38. doi: 10.1097/ACM.0000000000004262.

Abstract

PURPOSE

There is a gap in the literature to understand how professionalizing systems intersect with socioeconomic and political realities such as globalization to (re)produce social inequities between those trained locally and those trained abroad. In this critical review, the question of how systemic racism is reproduced in health care is addressed.

METHOD

Electronic databases and nontraditional avenues for searching literature such as reference chaining and discussions with experts were employed to build an archive of texts related to integration of internationally educated health care professionals (IEHPs) into the workforce. Data related to workplace racialization were sought out, particularly those that used antiracist and postcolonial approaches. Rather than an exhaustive summary of the data, a critical review contributes to theory building and a spatial analysis was overlayed on the critical literature of IEHP integration to conceptualize the material effects of the convergence of globalization and professional systems.

RESULTS

The critical review suggests that professions maintain their value and social status through discourses of "Canadianness" that maintain the homogeneity of professional spaces through social closure mechanisms of credential nonrecognition and resocialization. Power relations are maintained through mechanisms of workplace racialization/spatialization and surveillance which operate through discourses of "foreign-trainedness."

CONCLUSIONS

Movement of professionals supports a professional system that on the surface values diversity while maintaining its social status and power through the (re)production of the discourse of "Whiteness." The analysis shows how in the process domestic graduates are emplaced as the "rightful" citizens of professional paces while IEHPs are marginalized in the workforce.

摘要

目的

文献中存在一个空白,即如何理解专业化系统如何与全球化等社会经济和政治现实交织在一起,从而(重新)产生在本地培训和在国外培训的人之间的社会不平等。在这篇批判性评论中,探讨了医疗保健中系统性种族主义是如何再现的问题。

方法

利用电子数据库和非传统的文献搜索途径,如参考文献链和与专家的讨论,建立了一个与整合具有国际教育背景的医疗保健专业人员(IEHP)纳入劳动力相关的文本档案。寻找与工作场所种族化相关的数据,特别是那些使用反种族主义和后殖民主义方法的文本。批判性评论不是对数据的详尽总结,而是有助于理论构建,并且对 IEHP 整合的批判性文献进行了空间分析,以概念化全球化和专业系统融合的物质影响。

结果

批判性评论表明,专业人员通过“加拿大”的论述来维护其价值和社会地位,这些论述通过资格不认可和再社会化等社会封闭机制来保持专业空间的同质性。权力关系通过工作场所种族化/空间化和监控机制得以维持,这些机制通过“外训”的论述运作。

结论

专业人员的流动支持一个专业系统,该系统表面上重视多样性,同时通过“白人”话语的(重新)产生来维护其社会地位和权力。分析表明,在这个过程中,国内毕业生被安置在专业场所的“合法”公民中,而国际教育背景的医疗保健专业人员则在劳动力中被边缘化。

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