"We're IMGs, and we're often seen as human garbage outside of primary care": A qualitative investigation of dynamic status hierarchy construction online by medical trainees. (January 2023)

• Record Type: Journal Article
• Authors: Franklyn, Grace
• Is Part Of: Social science & medicine. Volume 317(2023)
• Publication Date: 2023-01
• Subjects: Professional status -- Status hierarchy -- International medical graduate (IMG) -- Doctors of osteopathic medicine (DOs) -- Medical education -- Medical students -- Social media; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2022.115611
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: In the United States health care system, "USMDs, " or allopathic US-trained medical graduates, are generally considered higher status than "non-USMDs, " or osteopathic and international medical graduates (also abbreviated as IMGs). Two key aspects of this professional hierarchy have yet to be understood: one, how it is socially and culturally reproduced during specific medical training timepoints, such as the US residency placement cycle; and two, how changes within this hierarchy may be occurring among the new generation of medical trainees and professionals. To answer these questions, I qualitatively analyzed comments from a selection of medical student Reddit posts, called "Name and Shame, " where users discussed their experiences with discrimination and mistreatment during residency interviews spanning 2018 to 2020. From this analysis, I found that after exposure to and discussion of stories of applicant mistreatment, while some students on the forum reproduced this professional hierarchy, others rejected this inequality, with non-USMD users advocating for themselves and USMD students supporting their lower status peers. These findings highlight that the construction and understanding of this USMD/non-USMD hierarchy may be more dynamic than previously thought, especially among contemporary trainees now entering the medical profession. Highlights: Non-USMD students face status discrimination during residency placement interviews. This reinforcement can lead to hierarchy acceptance and reproduction, or rejection. The USMD/non-USMD status hierarchy is more dynamic than previously thought. Social media is a rich location for future investigation on hierarchy reproduction.