Negotiation of sociopolitical issues in medical education program planning that addresses racial and ethnic disparities
Mosley, Letha J.
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A biased health care system exists in the United States in which racially and ethnically marginalized patients receive a lower quality of care than their White counterparts. Two recommended avenues for addressing this health care disparity within medicine are programs that 1) increase workforce diversity and 2) enhance cultural competency training within medical education. Adult education has a strong scholarly presence in evaluating and promoting program planning in various settings, but has offered limited investigation within medical education. The purpose of this qualitative study was to understand the sociopolitical issues individuals face in medical education when engaged in program planning designed to address racial and ethnic disparities. The research questions that guided this study were: 1. What are the sociopolitical issues medical education planners encounter when designing programs to address racial and ethnic disparities? 2. How do planners work within the context of medical education to plan programs relative to racial and ethnic disparities? 3. How does the planning context influence the sociopolitical issues associated with program planning that addresses racial and ethnic disparities? This collective case study and cross-case analysis included a cross section of fourteen participants purposefully selected from two predominantly black and two predominantly white medical schools. The primary focus was on experiences in program planning. Data sources included interviews, documents, observations, and field notes with analysis using the constant comparative method. Findings indicated social, political, economic, and personal issues affected the planning process. Consistent patterns were noted on issues related to organizational culture, funding, intersections of racism and sexism, and line authority. Although participants identified several substantive, meta-, and intra-personal negotiations, relationship development was consistently identified as the most important strategy to employ to sustain the planner and change the planner’s power base. Three conclusions were drawn relative to medical education program planning that addresses racial and ethnic disparities: 1) Program planning is affected by the planner’s positionality and by their appointment level; 2) Program planning is most effective when it is evidence-based, outcome oriented, and embedded as part of the institutional mission; and 3) Most program planning negotiations center around power relationships.