Symbolic access: medical students’ awareness of institutional culture and its influence on learning
Date
2024
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Abstract
Abstract Background: The discussion of access in medical education commonly has its focus on physical and epistemological access, leaving a qualitative gap regarding sociocultural factors which influence access in this context. This study introduces and defines symbolic access, a concept with a specific lens on sociocultural inclusion, and the impact it has on student learning within a South African medical school.
Methods: A phenomenographic design was used to explore conceptions of symbolic access and its impact on learning. Fifteen one-on-one exploratory interviews were conducted with final year medical students, a sample exposed to the entire 6-year medical programme. Interviews were analysed using Sjöström and Dahlgren‘s seven-step phenomenography model.
Results: Four categories of description were induced, describing students’ understanding of symbolic access, these were rejection, disregard, alienation and actualization. Five dimensions of variation were discovered, and they expressed the different ways the conceptions were experienced, these dimensions were: interactions with educators, peer relationships, educational environment, race and hierarchy. Categories of description and dimensions of variation formed the Outcome Space, a visual representation of the student experience of symbolic access. The outcome space had a double narrative related to symbolic access; exclusion (major) and actualization (minor). Medical student’s chief experience within the medical community was exclusion, however experiences of peer-relationships, clinical skills lessons and participation within the clinical setting facilitated feelings of community inclusion and impacted learning.
Conclusion: Despite exclusionary experiences, students articulated an awareness of attaining symbolic access during the clinical years, additionally meaningful and transformative learning experiences were described during these same years. The study found that attainment of symbolic access and students’ perceptions of valuable learning are linked. Health profession educationalists should design undergraduate curricula with early clinical immersion at the fore and explore symbolic concepts pertaining to access, as they are connected to meaningful learning experiences for the medical student.
Description
A research report submitted in partial fulfilment of the requirement for the degree of Master of Health Sciences Education to the Faculty of Health Sciences, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, 2023
Keywords
Sociocultural inclusion, Symbolic access, Medical education