“We're IMGs, and We're Often Seen as Human Garbage”: Rejection and Reproduction of Status Hierarchies in Medical Education

Abstract

The fact that status inequality exists between different types of medical trainees and physicians is widely accepted within medicine, and leads to differences in both treatment and quality of training, One important status difference exists between high-status USMDs, who are receiving an allopathic medical degree in the US, and low-status non-USMDs, who are either receiving an allopathic medical degree internationally, or an osteopathic medical degree. Little research has been conducted on how this status hierarchy is introduced and reproduced throughout medical education. In order to better understand this status (re)production, I qualitatively analyzed an electronic support forum on Reddit, called “Name and Shame 2019,” where 4th-year medical students discussed their experiences with status during residency interviews. Drawing from these students’ stories and discussions with their peers, I found that residency programs often reinforce this unequal status hierarchy to students during the interview process. Students then responded to this reinforcement in different ways: while lower-status non-USMD students were often able to reject these status hierarchies through discussion with their peers, higher-status USMD students tended to reproduce the reinforced status beliefs that benefited them. These findings shed light on how and why status hierarchies are constructed, reproduced, and rejected within medical education, while raising questions about how status inequality affects the equity of medical education, and the overall quality of medical care.