Navigating social distance in foundational clinical encounters: Understanding medical students’ early experiences with diverse patients

Abstract

Background: Social distance between patients and physicians has been shown to affect the quality of care that patients receive. Little is known about how social distance between students and patients is experienced by learners during early clinical exposures in medical school.

Objective: This study aims to explore students’ stories of experiencing social distance with patients with concordant and discordant social characteristics as themselves, respectively, as well as students’ needs from medical curricula regarding developing social competence.

Methods: Semi-structured interviews of medical students [n = 16] were performed, and a post-interview survey and a visual analog scale were completed. The interviews were audio-recorded and transcribed. The written transcripts were coded using the constant comparison method and analyzed for emerging themes.

Results: Students experience social distance with patients; yet, they are not taught explicitly by their preceptors how to manage these experiences. Students identified their needs for the curriculum in regard to developing social competence and proposed various strategies and curriculum recommendations.

Conclusions: Our results support that students believe that social competence training is important for their professional development to improve relationship-building with diverse patients. As such, it would be valuable to incorporate student recommendations in the formation of a social competence curriculum.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Intersectionality: Is a theoretical framework that postulates that multiple social identities intersect at the level of individual experience to reflect multiple interlocking systems of privilege and oppression at the social–structural level.

Social distance: The difference in social positioning between two individuals, including socially meaningful forms of group belonging such as, but not limited to, gender, class, culture, language, ability and sexual orientation, experienced through the course of a relationship.

Social competence: Is a process based on knowledge, skills, and attitudes that support effective interaction between the physician and the patient despite the intervening social distance.

Notes on contributors

Miesha Roberts-MacDonald, BHSc, is a third-year medical student at McGill University with an Honors bachelor of Health Science from the University of Ottawa.

Dr. Saleem Razack, MD, FRCPC, is practicing pediatric critical care medicine physician, professor of pediatrics, member of the Centre for Medical Education, and director of the Office of Social Accountability and Community Engagement in the Faculty of Medicine at McGill University.