Pride or prejudice? : in what ways does the ethnicity and culture of medical students, alongside the process of medical acculturation, impact on medical students' mental health, wellbeing and professional attainment

It has been shown in a number of studies that medical students are more vulnerable to mental illness and psychological distress than other students. Research by the General Medical Council (2017) found that differential attainment with regard to ethnicity exists in both postgraduate and undergraduate contexts, in recruitment, and across exam pass rates; this indicates that medical education and training may not be fair. The focus of this research project, arising from over 25 years of experience in this area, is to explore some of the factors related to students’ ethnicity and cultural environments that may have an impact on their mental health and well- being. It also considers the medical acculturation process that may make it more likely that some medical students will experience psychological and academic difficulties during their training. A qualitative thematic analysis (Braun & Clarke, 2005) of the assessment sessions of 24 medical students from different ethnicities and family backgrounds highlights the ways in which students’ lived experiences, both personal and in their medical training, affect their personal well-being and academic performance. The themes identified in this research are examined using a sociological and psychoanalytic lens, as well as that of critical race theory as in combination these offer the broad perspective and critique necessary to consider the sociocultural as well as the psychological aspects of this research enquiry. Sociology and anthropology consider the surrounding historical, social and cultural context of any action and interaction, whereas the focus of the psychoanalytic method is on what lies beneath the surface, in the unseen and the unspoken. As part of the methodology of this thesis, this research also considers the narrative arc and socio-cultural context of the research literature on this topic as a way of investigating patterns of thinking over time within Medicine and its social environment. The focus of this investigation is on the ways in which invisible, silent and unspoken currents within families, communities, institutions and wider society shape these students’ relationships with themselves and others. This research considers the possible reasons for the systemic silencing 3 of particular narratives, the effect this has, and how this can happen in subtle and complex ways. The themes illuminate factors within medical culture that create psychological pressure on all students. They also reveal dynamics of exclusion from pathways of influence, knowledge and support that can reinforce the effects of trauma, including intergenerational trauma. Individual and intergenerational trauma can be a result of experiences that include family difficulties, experiences of immigration and systems of inequality. This research adds to the debate about factors that impact on the mental health of all medical students and doctors as well as the ways that systemic discrimination and pathways of privilege may operate. It suggests different ways of thinking and acting that could be effective at an individual, clinical and whole- institution level, and reflects on what ‘culturally competent’ practice really means.