Teaching social and cultural awareness to medical students: "it's all very nice to talk about it in theory, but ultimately it makes no difference".

PURPOSE: To investigate the effect of exposure to a new course addressing social and cultural issues in medicine on third-year medical students' awareness and understanding of how these issues affect their lives as students, the lives of patients, the work of physicians, and patient-physician interaction. The course, Physicians, Patients & Society (PPS) was introduced at the time the school was moving to a PBL curriculum.
METHOD: In the late 1990s, a questionnaire was administered to third-year medical students at one Canadian medical school, prior to the curriculum change (Time 1). In-depth interviews were held with 25 of these students. A few years later, the same methods were repeated (Time 2) with a third-year class that had experienced the PPS course.
RESULTS: The response rate for Time 1 was 59% (n = 72), for Time 2, 51% (n = 61). Students in Time 2 did not demonstrate increased awareness of social and cultural issues. Most failed to recognize, or even denied, the effects of race, class, gender, culture, and sexual orientation. Those who acknowledged the effect of social differences tended to deny social inequality, or at best recognized disadvantages experienced by Others, but not the accompanying privileges enjoyed by their own social group.
CONCLUSIONS: In general, students concluded that learning about social and cultural issues made little or no difference when they did their clinical rotations. For a medical school to produce physicians who are sensitive to and competent working with diverse communities requires a balance between attention to "difference," attention to self, and attention to power relations.