Embedding interpersonal stigma resistance into the medical curriculum: a focus group study of medical students

Ashley McAllister; Kara Dickson; Mediya Rangi; Leonie Griffiths; Stefanie Dimov; Nicola Reavley; Stephanie Knaak

doi:10.1186/s12909-023-04512-w

Embedding interpersonal stigma resistance into the medical curriculum: a focus group study of medical students

BMC Med Educ. 2023 Sep 21;23(1):686. doi: 10.1186/s12909-023-04512-w.

Authors

Ashley McAllister¹, Kara Dickson², Mediya Rangi², Leonie Griffiths³, Stefanie Dimov², Nicola Reavley², Stephanie Knaak⁴

Affiliations

¹ School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia. ashley.mcallister@unimelb.edu.au.
² School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
³ Melbourne Medical School, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
⁴ Faculty of Nursing and Department of Psychiatry, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.

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.

Keywords: Curriculum design; Focus groups; Healthcare; Mental health; Qualitative research; Stigma; Stigma reduction; Student perceptions.

MeSH terms

Curriculum
Focus Groups
Humans
Learning
Medicine*
Students, Medical*