when i say When I say… intersectionality in medical education research Lynn V Monrouxe
I am new. History made me. My first language was spanglish. I was born at the crossroads and I am whole.1 In these lines written by a feminist poet, we witness the interface of numerous personal identities – including ethnicity, culture, race, history, colour and possible migrant status – that combine to create a unique multidimensional woman. Over and above our categorisation by gender, race or ethnicity, the intersection of these identities uniquely shapes our health views, needs and experiences of events in which we participate. The aim of intersectionality research is to understand the hidden acts of multiple discriminations and to bring to the fore the impacts that cumulative aspects of ethnicity, gender and culture, for example, have on who we are and how we experience the world. The importance of understanding intersectionality does not vary across the different groups of patients, educators, medical students and doctors. Indeed, following a plethora of qualitative and quantitative research demonstrating the compound effects that multidimensional aspects of individuals have on patient illness and outcomes, medical education researchers have called for the inclusion of an intersectional framework within cultural competency education to facilitate doctors’ caring for a greater diversity of patients from marginalised populations.2 Furthermore, an understanding of how different
social categories intersect and impact on the identity formation of doctors themselves is of crucial importance within medical education.3 For example, such an understanding can help as we consider issues such as facilitators (and inhibitors) of success at medical school and the retention of physicians in practice.4 The concept of intersectionality has its roots in the feminist movement and the drive to shift the inequalities of power that result from the failure to consider women’s perspectives on the world. Likewise, researchers investigating class and race began to highlight these issues as analytical categories for investigation in an attempt to explain further inequalities. With the development of postmodern feminist theory, debates around the connections between these different oppressions began, highlighting, in particular, Black feminists’ concerns around the privileging of White middle-class women’s experiences within feminist research, and the use of the categories women and gender within research as relatively homogeneous entities. Consequently, intersectionality comprises a group of theories, which take us beyond the dichotomous categorical understanding of male versus female or Black versus White, and towards an understanding of how these interconnecting categories are experienced by individuals. This perspective recognises the impossibility of separating social categories such as race, class, gender and sexuality: the multiple identities we possess should be seen as transformational rather than additional. Thus each identity, as a result of its
Cardiff, UK
Medical Education 2014 doi: 10.1111/medu.12428
Correspondence: Dr Lynn V Monrouxe, Institute of Medical Education, Room 1.10, Upper Ground Floor, A Block, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK. Tel: +44 (0)2920 744435; E-mail: [email protected]
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 21–22
21
L V Monrouxe intersection with another, comprises a mutually adapted system of social relations.
how have they facilitated or constrained your personal journey?
Let us now continue by considering what exactly is intersecting. Rather than examining the strand or categories that intersect, it has been suggested that we should focus on the set of unequal social relations that lie behind these categories and hence examine the ontology of the categories – how particular identities have been constructed over time – and reveal the inherent power inequalities underpinning them. By replacing the categories themselves with terms such as ‘inequalities, sets of social relations, regimes and social practices’,5 we can consider the actions of both the powerful and the disadvantaged in order to comment on and affect social change. Consequently, when I say ‘intersectionality’, I mean that by examining mutually constituted identities through historical, political, social and cultural lenses – being mindful of their ever-changing nature – we might gain a deeper understanding of ‘the process by which they are produced, experienced, reproduced and resisted in everyday life’.6 So what is your narrative? What is the set of unequal social relations that lie behind your personal identities and
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REFERENCES 1 Morales AL. I am a child of the Americas. In: Morales AL, Morales R, eds. Getting Home Alive. Ithaca, NY: Firebrand Books, 1990;50. 2 Powell Sears K. Improving cultural competence education: the utility of an intersectional framework. Med Educ 2012;46:545–51. 3 Tsouroufli M, Rees CE, Monrouxe LV, Sundaram V. Gender, identities and intersectionality in medical education research. Med Educ 2011;45:213–6. 4 Costello CY. Professional Identity Crisis: Race, Class, Gender, and Success at Professional Schools. Nashville, TN: Vanderbilt University Press 2005. 5 Walby S, Armstrong J, Strid S. Intersectionality: multiple inequalities in social theory. Sociology 2012;46 (2):224–40. 6 McCall L. The complexity of intersectionality. Signs J Women Cult Soc 2005;30 (3):1771–800. Received 8 August 2013; editorial comments to author 17 October 2013, 2 January 2014, accepted for publication 13 January 2014
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 21–22
Copyright of Medical Education is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
I am new. History made me. My first language was spanglish. I was born at the crossroads and I am whole.1 In these lines written by a feminist poet, we witness the interface of numerous personal identities – including ethnicity, culture, race, history, colour and possible migrant status – that combine to create a unique multidimensional woman. Over and above our categorisation by gender, race or ethnicity, the intersection of these identities uniquely shapes our health views, needs and experiences of events in which we participate. The aim of intersectionality research is to understand the hidden acts of multiple discriminations and to bring to the fore the impacts that cumulative aspects of ethnicity, gender and culture, for example, have on who we are and how we experience the world. The importance of understanding intersectionality does not vary across the different groups of patients, educators, medical students and doctors. Indeed, following a plethora of qualitative and quantitative research demonstrating the compound effects that multidimensional aspects of individuals have on patient illness and outcomes, medical education researchers have called for the inclusion of an intersectional framework within cultural competency education to facilitate doctors’ caring for a greater diversity of patients from marginalised populations.2 Furthermore, an understanding of how different
social categories intersect and impact on the identity formation of doctors themselves is of crucial importance within medical education.3 For example, such an understanding can help as we consider issues such as facilitators (and inhibitors) of success at medical school and the retention of physicians in practice.4 The concept of intersectionality has its roots in the feminist movement and the drive to shift the inequalities of power that result from the failure to consider women’s perspectives on the world. Likewise, researchers investigating class and race began to highlight these issues as analytical categories for investigation in an attempt to explain further inequalities. With the development of postmodern feminist theory, debates around the connections between these different oppressions began, highlighting, in particular, Black feminists’ concerns around the privileging of White middle-class women’s experiences within feminist research, and the use of the categories women and gender within research as relatively homogeneous entities. Consequently, intersectionality comprises a group of theories, which take us beyond the dichotomous categorical understanding of male versus female or Black versus White, and towards an understanding of how these interconnecting categories are experienced by individuals. This perspective recognises the impossibility of separating social categories such as race, class, gender and sexuality: the multiple identities we possess should be seen as transformational rather than additional. Thus each identity, as a result of its
Cardiff, UK
Medical Education 2014 doi: 10.1111/medu.12428
Correspondence: Dr Lynn V Monrouxe, Institute of Medical Education, Room 1.10, Upper Ground Floor, A Block, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK. Tel: +44 (0)2920 744435; E-mail: [email protected]
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 21–22
21
L V Monrouxe intersection with another, comprises a mutually adapted system of social relations.
how have they facilitated or constrained your personal journey?
Let us now continue by considering what exactly is intersecting. Rather than examining the strand or categories that intersect, it has been suggested that we should focus on the set of unequal social relations that lie behind these categories and hence examine the ontology of the categories – how particular identities have been constructed over time – and reveal the inherent power inequalities underpinning them. By replacing the categories themselves with terms such as ‘inequalities, sets of social relations, regimes and social practices’,5 we can consider the actions of both the powerful and the disadvantaged in order to comment on and affect social change. Consequently, when I say ‘intersectionality’, I mean that by examining mutually constituted identities through historical, political, social and cultural lenses – being mindful of their ever-changing nature – we might gain a deeper understanding of ‘the process by which they are produced, experienced, reproduced and resisted in everyday life’.6 So what is your narrative? What is the set of unequal social relations that lie behind your personal identities and
22
REFERENCES 1 Morales AL. I am a child of the Americas. In: Morales AL, Morales R, eds. Getting Home Alive. Ithaca, NY: Firebrand Books, 1990;50. 2 Powell Sears K. Improving cultural competence education: the utility of an intersectional framework. Med Educ 2012;46:545–51. 3 Tsouroufli M, Rees CE, Monrouxe LV, Sundaram V. Gender, identities and intersectionality in medical education research. Med Educ 2011;45:213–6. 4 Costello CY. Professional Identity Crisis: Race, Class, Gender, and Success at Professional Schools. Nashville, TN: Vanderbilt University Press 2005. 5 Walby S, Armstrong J, Strid S. Intersectionality: multiple inequalities in social theory. Sociology 2012;46 (2):224–40. 6 McCall L. The complexity of intersectionality. Signs J Women Cult Soc 2005;30 (3):1771–800. Received 8 August 2013; editorial comments to author 17 October 2013, 2 January 2014, accepted for publication 13 January 2014
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 21–22
Copyright of Medical Education is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
