Department of Psychiatry, Hartford Hospital, Hartford, Connecticut, USA.
Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Med Educ. 2022 Aug;56(8):823-833. doi: 10.1111/medu.14790. Epub 2022 Mar 13.
There has been a proliferation of initiatives targeted towards improving psychological wellbeing among medical learners. Yet many learners do not seek assistance due to stigma against help seeking. Understanding the prevailing discourses on the effects of mental health stigma in the context of medical education will improve insight on how to address stigma and improve wellbeing. In this study, the authors sought to explore discourses on stigma in medical education through a Foucauldian Critical Discourse Analysis.
The authors assembled several sets of texts related to stigma in medical education. The initial archive consisted of social media discourse and was expanded to include digital news media. Next, the authors conducted semi-structured qualitative interviews with medical students, residents and faculty. Using principles of Critical Discourse Analysis informed by the writings of Michel Foucault, the authors analysed the archive to identify truth statements, representative statements and discursive effects.
Analysis revealed an emancipatory discourse of disclosure that normalised help-seeking, which conflicted with a discourse of performance. Results suggested that public disclosure remains challenging in private contexts due to a medical culture that rewards perfectionism and lauds heroism. Discourses on performance positioned disclosure as disruptive to the system's need to maintain its own hegemony. Overall, stigma was perceived as rooted within the structural power of the medical education system and society at large.
Discourses on stigma in medical education hold implications for the teaching, learning and overall wellbeing of medical learners. The tensions between discourses on disclosure and performance have the potential to perpetuate further distress for learners and worsen asymmetries in power. Interventions to address stigma would benefit from understanding and addressing the role of power and hierarchy in maintaining and dismantling stigma.
针对提高医学生心理健康的举措层出不穷。然而，由于对寻求帮助的污名化，许多学生并未寻求帮助。了解医学教育中心理健康污名化的普遍影响，可以更好地了解如何解决污名化问题并改善学生的幸福感。在这项研究中，作者试图通过福柯的批判话语分析来探讨医学教育中的污名化话语。
作者收集了多组与医学教育中的污名化相关的文本。最初的档案包括社交媒体话语，并扩展到数字新闻媒体。然后，作者对医学生、住院医师和教师进行了半结构化的定性访谈。作者运用福柯著作中批判性话语分析的原则，对档案进行分析，以识别真实陈述、代表性陈述和话语效果。
分析揭示了一种将寻求帮助正常化的解放性披露话语，这与一种表现话语相冲突。结果表明，由于医学文化奖励完美主义和赞美英雄主义，公开披露在私人环境中仍然具有挑战性。表现话语将披露视为对系统维持自身霸权的干扰。总体而言，污名化被认为根植于医学教育系统和整个社会的结构性权力之中。
医学教育中的污名化话语对医学生的教学、学习和整体幸福感都有影响。披露话语和表现话语之间的紧张关系有可能使学生进一步感到困扰，并加剧权力的不对称。解决污名化问题的干预措施将受益于理解和处理权力和等级制度在维持和消除污名化方面的作用。
