Thread by @javeedsukhera

Amidst increasing attention to the #mentalhealth of health workers, we explored how #stigma is understood/enacted in #MedEd. We learned that things are a lot more complicated than we thought. 🧵

@jelenapole @juveriazaheer @rachaelpack89 @MedEd_Journal

onlinelibrary.wiley.com/doi/abs/10.111…

We know #stigma can prevent help-seeking due to the risk/repercussions of disclosure. This topic has been well researched. See the article below and work of @drjessigold @KGoldMD for more details /1

healio.com/news/primary-c…

Yet, the pandemic has brought the hero narrative to the fore, a sentiment meant to praise workers, yet may stifle conversations about distress, burnout, and help-seeking. See the important work of @drbreenheroes for more on this and Dr. Breen's story/legacy. /2

So we set out to explore how learners encounter, understand, an enact #stigma in #MedEd through a critical discourse analysis including online discourse and supplemented by qualitative interviews. /3

After orienting to the topic, reviewing literature, and manually searching twitter, we found a tweet by @choo_ek that went viral. We chose this tweet as an index tweet and mapped out online discourse, followed by news articles, and interviews. /4

https://twitter.com/choo_ek/status/1282005053427990529?s=20&t=7WHu2zKiX7b4KQp8sSKBNg

Stigma was considered a🚩 rooted within the structural power of the medical education system and society at large, and thus particularly resistant to the efforts of individuals to spark change. There were many tensions depicted in the image below. /5

Disclosure was 'heroic' yet the system encouraged health workers to suppress emotions because they are often treated like cogs in a machine. Learners shared that the hero narrative can be harmful. /6

One stated that disclosure "feeds into hero culture and martyrship of physicians…willing to give up their lives rather than seeing them as human beings…people praise doctors for being so sacrificial…at the same time…need to be aware of the harm that they’re causing.” /7

Another said,

“we can teach people all about the stigma but if the structures aren’t in place to help them when they need it, no one’s going to disclose” /8

The implications of these findings are huge for work to address #wellbeing and #burnout. There is a central discrepancy between what is seen in public and private contexts. There is also a discrepancy between what actions and modes of resistance to stigma are possible. /9

Online disclosure during the unprecedented historical context of a global pandemic will likely disrupt existing norms. However, the idealized persona of a physician with the courage to be vulnerable conflicted with participants' daily reality. /10

There are therefore limits to how private thoughts may be disclosed within public spheres. Our findings also suggest that the emancipatory potential of help seeking, and disclosure is therefore constrained by power dynamics and structural norms. /11

Our findings also suggest that power from disclosure comes from working across existing hierarchies. Public discourse played a role in facilitating a shift because health worker disclosure seemed to bring health professionals/patients together around a shared human identity. /12

Ultimately,

Stigma appears to be deeply rooted within the medical education system and solutions likely require transformative, structural change.

Look forward to reading others' thoughts and feedback on this work. /END