Stigma: A curriculum to change attitudes, knowledge and skills
Journal
Medical Education
Journal Volume
42
Journal Issue
5
Pages
530-531
Date Issued
2008
Author(s)
Abstract
Context and setting Studies have shown that patients with stigmatised diseases, such as AIDS, suffer from misunderstanding and discrimination. Some patients report that the psychological pain caused by the experience of stigma is greater than the pain of the physical disorder. Stigma also exerts a negative impact on the process and outcome of health care because stigma often causes delay in the seeking of care or poor adherence to treatment. Provider prejudice (however unconscious) and ignorance about stigmatised diseases may compound these barriers to care. Why the idea was necessary Medical students must learn to recognise the social and psychological influences that impact on the health of their patients. We could find no account in the medical literature of a curriculum targeting the powerful impact of stigma upon patients and the doctor–patient relationship. This study reports an innovative curriculum designed to raise medical student awareness of stigmata and to empower students to develop advocacy skills to reduce the stigma affecting their patients. What was done In 2007, we implemented an elective course on stigmatised diseases. Ninety pre-clinical students enrolled and attended for 2 hours per week for 16 consecutive weeks. The course consisted of introduction and conclusion sessions plus 7, 2-week units on commonly stigmatised diseases in the study setting, including: AIDS; depression; epilepsy; facial deformity; infertility; obesity, and schizophrenia. The first week of each unit contained a didactic session with medical experts, patient representatives and patient advocates. Discussion sessions utilising methods such as debate, role play, film viewing and advocacy activities were offered in the second week of each unit. Students completed identical pre- and post-course surveys assessing their attitudes towards the 7 diseases or conditions featured in the course. Paired t-tests were conducted to examine the change in stigmatisation in 28 items. The data were analysed using sas Version 9.1. Evaluation of results and impact The results suggested that our course effectively reduced students’ attitudes about the stigmatisation associated with the diseases studied. Students indicated an increased willingness to work with a colleague who had facial deformity (t = − 2.95, P < 0.01), or suffered from epilepsy (t = − 3.13, P < 0.01), schizophrenia (t = − 4.50, P < 0.001) or depression (t = − 3.50, P < 0.001). Students also demonstrated increased receptiveness towards the idea of marrying someone with facial deformity (t = − 2.82, P < 0.01), epilepsy (t = − 3.86, P < 0.001), schizophrenia (t = − 2.68, P < 0.01) or depression (t = − 3.52, P < 0.001). Furthermore, the course was effective in decreasing students’ views of facial deformity as a superficial condition that does not require correction (t = 3.48, P < 0.001) and of schizophrenia patients as violent (t = 7.17, P < 0.001). An end-of-course evaluation using a 5-point Likert-type scale (1 = strongly disagree, 5 = strongly agree) demonstrated an average satisfaction score of 4.3. Self-assessment scores averaged 4.3 in increased knowledge, 4.4 in enhanced empathy and 4.5 in reflection on the stigma. Thematic analyses of the students’ final papers on a stigmatised disease of their choice suggested that the majority of students perceived an increase in their own advocacy skills by the end of the course.
Type
journal article