Embedding interpersonal stigma resistance into the medical curriculum: a focus group study of medical students
The University of Melbourne
How they used Delve
Researchers at the University of Melbourne used Delve to code six focus groups with 34 medical students on where mental-illness stigma shows up in training and how to build interpersonal stigma resistance into the curriculum, using Braun and Clarke's inductive thematic analysis with two primary coders and a clinician coding the first transcripts alongside.
“An inductive thematic analysis approach was used following Braun and Clarke's six steps for thematic analysis. Delve software was used to code transcripts. The first two transcripts were coded line by line and then discussed among the research team. Parent codes were developed, and the remaining transcripts were coded using an iterative process to review, define and refine codes.”
- Field
- medical education; mental-illness stigma
- Data
- Six focus groups (September to October 2021) with 34 second-, third- and fourth-year postgraduate medical students at the University of Melbourne Medical School
- Approach
- Inductive thematic analysis (Braun & Clarke's six steps); two primary coders plus a clinician co-coding the first two transcripts, parent codes agreed in team debriefings
- Data types
- Focus groups
Abstract
BACKGROUND: Mental-health-related stigma among physicians towards people with mental illnesses remains a barrier to quality care, yet few curricula provide training with a proactive focus to reduce the potential negative impacts of stigma. The aim of our study was to explore medical students’ perspectives on what areas of learning should be targeted (where stigma presents) and how they could be supported to prevent the formation of negative attitudes. METHODS: Six focus group discussions were conducted with second, third, and fourth-year postgraduate medical students (n = 34) enrolled at The University of Melbourne Medical School in September - October 2021. Transcripts were analysed using inductive thematic analysis. RESULTS: In terms of where stigma presents, three main themes emerged - (1) through unpreparedness in dealing with patients with mental health conditions, (2) noticing mentors expressing stigma and (3) through the culture of medicine. The primary theme related to ‘how best to support students to prevent negative attitudes from forming’ was building stigma resistance to reduce the likelihood of perpetuating stigma towards patients with mental health conditions and therefore enhance patient care. The participants suggest six primary techniques to build stigma resistance, including (1) reflection, (2) skills building, (3) patient experiences, (4) examples and exemplars, (5) clinical application and (6) transforming structural barriers. We suggest these techniques combine to form the ReSPECT model for stigma resistance in the curriculum. CONCLUSIONS: The ReSPECT model derived from our research could provide a blueprint for medical educators to integrate stigma resistance throughout the curriculum from year one to better equip medical students with the potential to reduce interpersonal stigma and perhaps self-stigma. Ultimately, building stigma resistance could enhance care towards patients with mental health conditions and hopefully improve patient outcomes.
Citation
Ashley McAllister, Kara Dickson, Mediya Rangi, Leonie Griffiths, Stefanie Dimov, Nicola Reavley, Stephanie Knaak (2023). Embedding interpersonal stigma resistance into the medical curriculum: a focus group study of medical students. BMC Medical Education. https://doi.org/10.1186/s12909-023-04512-w