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“We're IMGs, and we're often seen as human garbage outside of primary care“: A qualitative investigation of dynamic status hierarchy construction online by medical trainees

Journal: Social Science & Medicine Date: 2023/01, 317. doi: Subito , type of study: qualitative study

Full text    (https://www.sciencedirect.com/science/article/abs/pii/S0277953622009170)

Keywords:

foreign medical graduates [7]
graduate medical education [136]
internship and residency [150]
medical students [402]
primary health care [59]
professional status [3]
qualitative study [209]
social media [2]
status hierarchy [1]
United States [27]

Abstract:

In the United States health care system, “USMDs,“ or allopathic US-trained medical graduates, are generally considered higher status than “non-USMDs,“ or osteopathic and international medical graduates (also abbreviated as IMGs). Two key aspects of this professional hierarchy have yet to be understood: one, how it is socially and culturally reproduced during specific medical training timepoints, such as the US residency placement cycle; and two, how changes within this hierarchy may be occurring among the new generation of medical trainees and professionals. To answer these questions, I qualitatively analyzed comments from a selection of medical student Reddit posts, called “Name and Shame,“ where users discussed their experiences with discrimination and mistreatment during residency interviews spanning 2018 to 2020. From this analysis, I found that after exposure to and discussion of stories of applicant mistreatment, while some students on the forum reproduced this professional hierarchy, others rejected this inequality, with non-USMD users advocating for themselves and USMD students supporting their lower status peers. These findings highlight that the construction and understanding of this USMD/non-USMD hierarchy may be more dynamic than previously thought, especially among contemporary trainees now entering the medical profession.


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