A critical ethnographic study of discriminatory social practice during clinical practice in emergency medical care

Abstract

In the post-apartheid era, South Africa adopted an inclusive education system that was free of discrimination. This study uses an auto-ethnographic approach within the conceptual framework of Critical Race Theory using critical ethnographic methodology to explore how discriminatory social practice continues to manifest during clinical practice. As a qualitative study it examines the experiences and/or perceptions of racial discrimination between emergency medical care students and clinical mentors, emergency medical care students and patients, and clinical mentors and patients within the Emergency Medical Service during clinical practice. It is hoped that understanding the nature of discrimination may contribute towards recourse and its future management thereof. Semi-structured interviews were conducted, recorded and transcribed to enable the author to conduct thematic analysis. The study purposively sampled 13 Bachelor of Emergency Medical Care students and 5 Emergency Care (EC) providers for participation. Focus was placed on understanding racial discriminatory experiences of students and emergency care providers but due to the nature of the study, other forms of discrimination emerged during data analysis. While working with their mentors, student participants reported experiences of racial and gender discrimination during work-integrated learning as they were treated differently by their mentors and patients on the basis of skin colour and gender which denied them an equal opportunity to learn during clinical practice. Language was used as an intentional barrier to isolate students from the patients during work-integrated learning because EC providers would intentionally speak in a language not understood by the student and also fail to translate vital medical information about the case to the student. This practice, therefore, prevents the student from engaging in clinical decision-making or partaking in patient care. Consequently, clinical attachment is viewed as counter-productive and the workintegrated learning environment is not considered conducive for learning to take place. Not only does unfair discrimination within the pre-hospital setting have an impact on the learning opportunities of students but it also exists between EC providers. Such practice violates basic human rights and has the potential to negatively affect the clinical management of patients, thus it has the potential to violate the patient’s rights. This study confirms the existence of discriminatory practices during work-integrated learning which usually goes unnoticed and unreported, and as such, lacks a structured approach to redress the lack of inclusivity and equal access to clinical education.