By Irina Haivas Iasi

Learning about social and cultural issues makes little or no difference to medical students, according to a recent study published in Academic Medicine (2003;78:605-14).

The study found that a new course addressing social and cultural issues in medicine had an insignificant effect on medical students from Dalhousie University, Canada. The researcher, Brenda Beagan, used questionnaires and interviews to compare a group of students that took this course with a control group that did not. She found that students in both groups failed to recognise, or even denied, the effects of race, class, sex, culture, and sexual orientation on their experiences.

Those students who acknowledged the effect of social differences denied the effect of social inequality and power relations. In some instances, students recognised disadvantages experienced by others but not the accompanying privileges enjoyed by their own social group.

In both groups, students from a racial or cultural minority or from a lower social class were more likely to consider that race, culture, and class, respectively, had an effect on their experience in medical school.

Also, the course did not affect students' perceptions of the effect on practice of doctors' own social and cultural factors. Moreover, students that underwent the course were less likely to think patients' social characteristics affect their treatment than the students in the control group.

In general, students declared that there was no time or space for practicing socially and culturally sensitive medicine on the wards. They found such a subject irrelevant when faced with the pragmatic considerations of the "real world."

Beagan concludes that medical universities need to produce doctors who are sensitive to and competent at working with the diversity of their communities. She says that this requires a balance between attention to differences, to self, and to power relations.