Understanding how medical students select their specialty is a fundamental issue for public health and educational policy makers. One of the factors that students take into account is a specialty's prestige which hinges partly on its focus on technique rather than whole person. We examine the potential of a psychological framework, social dominance theory, to explain why some students, and not others, are drawn to more prestigious, technique-oriented specialties, based on their desire for hierarchy. We conducted a cross-sectional study among medical students at Institution X (N = 359). We examined the link between medical students' characteristics i.e. social dominance orientation (SDO), gender, age, and their career intention. We also examined level of medical students' SDO at different stages of the curriculum. SDO scores were significantly associated with technique-oriented career intentions (OR 1.56; 95 % CI [1.18, 2.06]; p = 0.001). The effect was independent of gender. Medical students' SDO scores were significantly higher in later stages of the medical curriculum (F = 6.79; p = 0. 001). SDO is a significant predictor of medical students' career intention. SDO scores are higher in students during the clinical phase of the curriculum. Medical socialization, involving the internalization of implicit and explicit norms, particularly in hospital settings, is likely to underpin our findings. This theory illuminates consistent findings in the literature on specialty prestige and the influence of medical school on career choice.

BackgroundThere is extensive evidence of health inequality across ethnic groups. Inequity is a complex social phenomenon involving several underlying factors, including ethnic discrimination. In the field of health care, it has been established that ethnic discrimination stems partially from bias or prejudice on the part of doctors. Indeed, it has been hypothesized that patient ethnicity may affect doctors’ social cognition, thus modifying their social interactions and decision-making processes. General practitioners (GPs) are the primary access point to health care for ethnic minority groups. In this study, we examine whether patient ethnicity affects the relational and decisional features of doctoring.MethodsThe sample was made up of 171 Belgian GPs, who were each randomly allocated to one of two experimental conditions. One group were given a hypertension vignette case with a Belgian patient (non-minority patient), while the other group were given a hypertension vignette case with a Moroccan patient (minority patient). We evaluated the time devoted by GPs to examining medical history; time devoted by GPs to examining socio-relational history; cardiovascular risk assessments by GPs; electrocardiogram (ECG) recommendations by GPs, and drug prescriptions by GPs.ResultsWe observed that for ethnic minority patients, GPs prescribed more drugs and devoted less time to examining socio-relational history. Neither cardiovascular risk assessments nor ECG recommendations were affected by patient ethnicity. GPs who were very busy devoted less time to examining medical history when dealing with minority patients.ConclusionsWe found no evidence that GPs discriminated against ethnic minority patients when it came to medical decisions. However, our study did identify a risk of drugs being used inappropriately in some ethnic-specific encounters. We also observed that, with ethnic minority patients, GPs engage less in the relational dimension of doctoring, particularly when working within a demanding environment. In general practice, the quality of the relationship between doctor and patient is an essential component of the effective management of chronic illness. Our research highlights the complexity of ethnic discrimination in general practice, and the need for further studies.

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Résumé En 2000, la psychose n’est plus la grande question de la pensée de l’homme sur lui-même, comme en 1800, à l’orée de la médecine scientifique. Tout le monde s’accorde à penser qu’il y a des folies transitoires, qu’il y a une folie dans la passion amoureuse, qu’il y a une folie dans l’histoire du monde. Mais alors, peut-on distinguer une folie universelle et a-temporelle, comme une structure psychotique, un tableau clinique contemporain ? Ces tableaux ne sont pas les mêmes à Bali, à Dakar et à Paris. Des psychotiques nouveaux vont arriver en 2003 : déréalisés, hallucinés, délirants avec un « appareil à penser », un vol de la pensée, une puce intracérébrale, ou alors hors-temps, hors-espace dans un réseau mondialisé, totalement virtuel, ... Ou encore avec un corps morcelé, à la machette, dans la région des Grands Lacs... Ou bien même habité par des esprits en ville ou guéris dans la brousse à distance par une incantation. Voilà pourquoi il nous faut penser, repenser, et n’en jamais finir de panser la folie humaine, dans sa singularité, entre nous et au cœur de nous-même.

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