Every year, over twenty thousand individuals enter US medical schools, beginning their transformation from laypeople to medical doctors. As part of this transformation, alongside acquiring the clinical knowledge and skills necessary to the practice of medicine, medical students are socialized into the culture of medicine, i.e., the values and norms of the profession. While this professional culture is often construed as neutral or even beneficent, in actuality it is permeated by normative cultural standards that reproduce broader social systems of oppression. A number of scholars have acknowledged and problematized these normative standards that pervade medical education in the US, however, much of the cultural reproduction implicit within medical socialization has yet to be uncovered and destabilized. In this dissertation, I set out to make visible and critically evaluate medical socialization’s reproduction of heteronormativity, a dominant cultural standard that privileges those who conform to the heterosexual norm, while marginalizing those who depart from it by virtue of their identities, behaviors, or characteristics. To accomplish this, I conducted three studies designed to assess the prevalence of heteronormativity in US medical schools, along with its concomitant impact on medical students and their well-being. In the first, previously published baseline study, I evaluated the psychological distress of first year medical students who enrolled in a national sample of US medical schools. I found that sexual minority students commenced their medical education while contending with a higher burden of depression and anxiety than their heterosexual peers. The second study reexamined these students four years later, as they were completing medical school. In it, I evaluated students’ exposure to heteronormative socialization, as well as the impact of such exposures on students’ psychological distress. I found that fully three-quarters of heterosexual students and nearly all sexual minority students were exposed to some level of heteronormative socialization while pursuing their medical education. Moreover, being exposed to heteronormative socialization predicted greater psychological distress among all students, regardless of their sexual minority status. In the third, mixed-method study, I triangulated quantitative and qualitative methods to conduct an in-depth investigation of the extent of heteronormativity within medical education. Centering the voices of sexual minority students enabled a deeper understanding of the marginalization they experienced as a result of their socialization to a heteronormative cultural standard. I found that sexual minority students were exposed to heteronormativity across the formal, informal, and hidden curricula of medical school, effectively precluding them from participating fully and authentically in their medical education. My findings paint a distressing picture of medical education that is pervaded by a heteronormative cultural standard that not only marginalizes sexual minority students, but is detrimental to the psychological well-being of all students, regardless of their sexual identity. If medical schools are sincere in their efforts to prepare diverse and culturally competent physicians who can meet the evolving health needs of all patients, they must do the hard work of confronting and destabilizing the heteronormative cultural standard that is currently characteristic of medical education.
University of Minnesota Ph.D. dissertation. May 2019. Major: Health Services Research, Policy and Administration. Advisor: Kathleen Call. 1 computer file (PDF); vi, 204 pages.
Medical Socialization & Its Discontents: Heteronormativity in US Medical Schools & Its Impact on Student Psychological Distress.
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