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Everyday classism in medical school: experiencing
marginality and resistance
Brenda L Beagan
OBJECTIVE To explore the medical school experi-
ences of students who self-identify as coming from a
working-class or impoverished family background.
METHODS A questionnaire was administered to Year
3 medical students at a Canadian medical school and
in-depth interviews were held with 25 of these stu-
dents (cohort 1). The same methods were repeated
with another Year 3 class 3 years later (cohort 2).
RESULTS While having (or not having) money was
the most obvious impact of social class differences,
students also discussed more subtle signs of class that
made it easier or more difficult to fit in at medical
school. Students from working-class or impoverished
backgrounds were significantly less likely to report
that they fitted in well, and more likely to report that
their class background had a negative impact in
school. They were also more likely to indicate
awareness that a patient’s social class may affect their
health care treatment.
CONCLUSION Students from working-class or
impoverished backgrounds may experience alienation
in medical school. Through the commonplace inter-
actions of Ôeveryday classismÕthey may experience
marginalisation, isolation, disrespect and uninten-
tional slights. At the same time, they suggest that their
experiences of exclusion may strengthen their clinical
practice.
KEYWORDS education, medical, undergraduate ⁄
*methods; *socio-economic factors; students, med-
ical ⁄*psychology; questionnaires; qualitative
research; Canada.
Medical Education 2005; 39: 777–784
doi:10.1111/j.1365-2929.2005.02225.x
INTRODUCTION
In a recent survey, Dhalla and colleagues found that
Canadian medical students had significantly higher
socio-economic status than the general population as
measured by parental education, occupation and
household income.
1
The parents of medical students
were 4)6 times more likely to have a graduate degree
than the average Canadian and 6 times as likely to
have an annual household income greater than
$150 000. The authors argue that the magnitude of
socio-economic differences between medical students
and the rest of the population is disturbing not only
because members of all social classes should have
equal access to medical education, but also because
patients from all social classes should have equal
access to doctors who understand the realities of their
lives.
Socio-economic status is a key social determinant of
health
2–4
and there is reason to question whether the
high social class standing of doctors is a barrier to
effective practice with patients experiencing poverty.
5
Health professionals often have considerable diffi-
culty in understanding the assumptions, norms and
values, and realities of low-income patients, resulting
in significant miscommunication, which exacerbates
health disparities between social groups.
6
While we know that few people from low-income
backgrounds enter medicine, we know little about
the experiences of those who do. The occasional
discussions of social class and medical education in
North America have suggested that even those
medical students who do come from low-income
origins have adopted middle-class norms and values
by the time they gain admittance to medical school.
7,8
professional attitudes and behaviour
School of Occupational Therapy, Dalhousie University, Halifax, Nova
Scotia, Canada
Correspondence: Brenda L Beagan PhD, School of Occupational Therapy,
Dalhousie University, Halifax, Nova Scotia B3H 3J5, Canada.
Tel: 00 1 902 494 6555; Fax: 00 1 902 494 1229;
E-mail: brenda.beagan@dal.ca
Blackwell Publishing Ltd 2005. MEDICAL EDUCATION 2005; 39: 777–784 777
In contrast, in a study of 80 medical students, 1 of the
2 students who self-identified as being working-class
joked that the hardest thing for him to learn at
medical school was Ôthe wine and cheeses.Õ
9
This
suggests that at least some students are very aware of
class differences in medical school, and these differ-
ences may affect where and when they feel comfort-
able. If this is the case, it may also indicate the
presence of Ôeveryday classismÕ,
10
the perpetuation of
structural social class hierarchies through everyday,
commonplace practices. The current study used
qualitative interviews and survey data to explore the
experiences of students who came from a working-
class or impoverished family background at 1 Cana-
dian medical school.
METHODS
In the late 1990s I administered a questionnaire to
Year 3 students (response rate 59%, n¼72) and
interviewed 25 members of the same class; 3 years
later I gave a similar questionnaire to another Year
3 class (response rate 51%, n¼61) and conducted
another 25 student interviews. I report here on the
combined research findings from the 2 student
cohorts in terms of their perceptions of how their
social class affected their experiences in medical
school. The questionnaire included both open-
ended and closed questions assessing the extent to
which students felt they fitted in at medical school,
the extent to which they identified themselves as
future doctors, what they had Ôput on holdÕduring
medical school, and the extent to which they felt
social group membership affected medical students
and doctors. The questionnaire was administered
through student mailboxes with a follow-up notice,
a second questionnaire package and a final
reminder.
Interview participants volunteered through the
questionnaire. The 60–90-minute interviews took
place primarily in students’ homes, following a
semistructured interview guide focused on students’
experiences of medical school, how they came to feel
they belonged in medical school, and how they
thought their experiences were shaped by the social
relations of race, class, gender and so on. Tape-
recorded and transcribed verbatim, the interviews
were coded inductively; for example, an initial broad
theme of Class was later broken down into subthemes
such as Perceptions of Class, Marginalisation, Anti-
elitism and Isolation. Words or phrases in quotation
marks in the text are direct quotes from participants.
The characteristics of research participants are
depicted in Table 1.
Here I report primarily the qualitative interview data,
along with the most relevant questionnaire data,
using only descriptive statistics. Chi-square results
indicate whether distribution on a particular variable
is affected by student self-identification of social class;
t-test results indicate whether differences in means
between groups are significant. As a condition of
access, the medical school involved in this research is
not identified. The school was located in a large
Canadian city with a diverse population.
RESULTS
Despite the fact that almost all interviewees insisted
that there were no working-class students in the
school, about 15% of each group self-identified as
coming from a working-class or impoverished family
background; another quarter to a third came from
lower middle-class backgrounds:
professional attitudes and behaviour
Overview
What is already known on this subject
Canadian medical students are disproportion-
ately likely to come from upper-class and
middle-class family backgrounds. Health pro-
fessionals’ difficulties in identifying with the
realities of low-income patients may exacer-
bate health disparities.
What this study adds
We know very little about the experiences of
students from working-class or impoverished
family backgrounds while they are in medical
school. This study suggests ongoing marginal-
ity and alienation, which may make their
experiences more difficult, but may also have
valuable effects on future clinical practice.
Suggestions for further research
Longitudinal studies might document the
extent to which social class continues to affect
students through residency and into clinical
practice.
778
Blackwell Publishing Ltd 2005. MEDICAL EDUCATION 2005; 39: 777–784
ÔI came from a very blue-collar family... Between the
lot of them they can build a house. There are all
the different trades: carpenters, sheet metal work-
ers, drywallers, pretty much everything... My father
works in one of the hospitals as one of the
maintenance guys. My mother works in the hospital
cafeteria.Õ(Cohort 2)
The perception that class = money
In the interviews, most students tended to equate
social class with money. They frequently mentioned
that some classmates had fancy cars, condominiums
near the hospitals, expensive vacations in exotic
places, and spent their free time sailing or skiing
rather than working to earn tuition fees. Some
remarked on the number of classmates who had had
private school educations. One of the major distinc-
tions seen as a mark of class was the level of student
loan debt:
ÔMy friends have $80 000 student loans and I donÕt
so, yeah, it makes a big difference.’ (Cohort 2)
Even with loans, some students did not always have
enough money for food and books, despite having
part-time jobs. This can foster resentment; 1 partici-
pant suggested that some of his classmates had never
had to worry about tuition or paying rent:
ÔBasic things that a lot of people have to worry
about, they never had to worry about.Õ(Cohort 2)
Class as social and cultural capital
Yet social class is not just about money. Class also
operates on the more subtle level of cultural capital
and social capital, involving expectations, future
aspirations, support for particular choices, role
models, values, social networks, knowing the right
people, having the right kinds of hobbies, playing the
Table 1 Characteristics of the samples
Characteristic
Cohort 1 survey
sample (n¼72)
Cohort 2 survey
sample (n¼61)
Cohort 1 interview
sample (n¼25)
Cohort 2 interview
sample(n¼25)
Gender
Female 36 (50%) 32 (53%) 14 (56%) 14 (56%)
Male 36 (50%) 29 (47%) 11 (44%) 11 (44%)
Age
Mean age 27 years 28 years 28 years 27 years
Range 24–40 years 25–39 years 23–40 years 23–38 years
Social class background*
Upper ⁄upper middle 36 (50%) 33 (54%) 14 (56%) 14 (56%)
Lower middle 23 (32%) 17 (28%) 6 (24%) 8 (32%)
Working ⁄poor 11 (15%) 10 (16%) 5 (20%) 3 (12%)
Other 2 (3%) 1 (2%) 0 0
Race ⁄ethnicity
Euro-Canadian 38 (53%) 37 (61%) 18 (72%) 17 (68%)
Asian 15 (21%) 14 (23%) 6 (24%) 6 (24%)
South Asian 6 (8%) 4 (6%) 0 1 (4%)
Jewish 2 (3%) 1 (2%) 1 (4%) 0
Aboriginal 1 (1%) 0 0 0
African ⁄Caribbean 0 1 (2%) 0 1 (4%)
Not given 10 (14%) 4 (6%) 0 0
First language
English 52 (72%) 51 (84%) 23 (92%) 16 (64%)
Not English 20 (28%) 10 (16%) 2 (8%) 6 (24%)
English and another àà0 3 (12%)
* As self-identified by students.
Euro-Canadian includes ÔCanadianÕ, British, Scottish, Irish, American, German, Scandinavian, Polish, Italian,
Portuguese, Oceanic. Asian includes Chinese, Japanese, Korean, Taiwanese, Indonesian, Malaysian. South Asian
includes Indian, Punjabi, Pakistani.
àWas not offered as an answer category on the survey.
779
Blackwell Publishing Ltd 2005. MEDICAL EDUCATION 2005; 39: 777–784
right kinds of sports, knowing which is the right fork
to use at a formal dinner, being able to make the
right sort of small talk, having the right clothes,
accent and demeanour.
11
One of the most obvious
aspects of social capital is the network of connections
available to students whose parents are doctors.
Several upper-class and upper middle-class students
spoke of the advantage they had even in negotiating
the application process:
ÔYou know, who is at the dinner table, the kind of
advice you are getting, the support you are getting
and what kind of letters of reference you are
getting. Because if your parents are buddies with
[the] programme cardiologist and he is over for
dinner then it is much more easy to make those
kind of connections that result in better letters.Õ
(Cohort 2)
Students also raised the importance of being able to
chat about golf in the operating room in order to
connect with staff doctors, and described school
activities such as ski trips as key to connecting with
classmates. These are expensive, usually upper mid-
dle-class, activities. A few students spoke of feeling at
home at receptions and formal social gatherings –
and even simply feeling comfortable around doctors
– due to their upper-class or middle-class back-
grounds. One young woman, the daughter of 2
doctors, commented:
ÔA lot of the people in my class come from wealthy
homes, upper middle-class. and just in so doing you
get used to a lot of social things, like what is socially
acceptable. So you can go out to a fancy restaurant
with your attending and know what fork to use...
[Otherwise] you donÕt know how to interact with
people, you’re like, ‘‘Gosh, you’re a doctor!’’ instead
of, like, all your friends’ parents have been
doctors.’ (Cohort 2)
In contrast, a student who self-identified as coming
from a working-class family described a social gath-
ering at the home of the associate dean, where she
felt completely out of place, not knowing where to sit,
how to interact, what fork to use or how to make
appropriate small talk:
ÔLetÕs just say I don’t share Dr Smith’s interest in
yachting in the Caribbean, you know what I mean?
[laughing]’ (Cohort 1)
Some students from low-income backgrounds even
described a struggle to construct the professional
appearance expected in medicine. The Ôright lookÕ
felt wrong for them. One woman noted that the first
time she felt she actually belonged in medical school
was during a Year 3 elective in a clinic for low-income
patients:
ÔI had the thrill of my lifetime at the clinic. I could
just dress in whatÕs in my closet and not feel bad
about it. and I could talk my natural way. and I
totally fit in over there!’ (Cohort 1)
Marginalisation
There was considerable agreement in the combined
cohort questionnaire results that students from
upper-class or upper middle-class backgrounds,
especially the children of doctors, found it easiest
to fit in at medical school and could adopt a
student-doctor identity more readily. While only a
third (34%) of respondents agreed or strongly
agreed with the statement that ÔStudents who come
from upper-class backgrounds find it easier to fit in
during medical trainingÕ, when reporting on their
own experience, 43% of upper-class or upper
middle-class students said they fitted in very well in
medical school, while only 29% of students from
working-class or impoverished backgrounds rated
themselves as fitting in very well (v
2
P¼0.05).
Students from upper-class and upper middle-class
backgrounds also more strongly agreed with the
statement ÔMost of my social time is spent with
other medical studentsÕ(mean 3.0, where
1¼strongly disagree, 5 ¼strongly agree), com-
pared with working-class ⁄poor students (mean 1.95;
t-test P¼0.000). One interviewee argued that she
could never fit in at medical school, could never be
Ôa proper med studentÕ, and had needed to
subdue significant parts of her personality to try to
fit in.
Students from impoverished or working-class back-
grounds were disproportionately likely to report
that their class background had a negative impact
during training (Table 2). As 1 questionnaire
respondent wrote in response to an open-ended
question:
ÔI cannot relate to many of my classmates who come
from very wealthy, Anglo-Saxon backgrounds.Õ
(Cohort 1)
Working-class students whose family members
worked around the hospitals (as custodial staff,
cafeteria staff, clerical staff) were routinely reminded
of their class backgrounds as classmates engaged in
Ôboundary markingÕ, clarifying their emerging
professional attitudes and behaviour
780
Blackwell Publishing Ltd 2005. MEDICAL EDUCATION 2005; 39: 777–784
student-doctor identities by noting their relative
position in the health care hierarchy:
ÔI hear jokes amongst my class too, like people
saying about the hospital greens we wear, ‘‘Oh
donÕt get us confused with the janitors,’’ and things
like that... I feel like I should get up and stand up
for him and say, ‘‘Hey my dad does this,’’ but most
times I just don’t bother. I don’t want to get into a
fight or anything like that.’ (Cohort 2)
Students also suggested that the cases used for
tutorial learning – while intended to be inclusive and
to reflect a diverse patient population – entrenched
stereotypes about people living in poverty, always
depicting them as drug-addicted, alcoholic or smok-
ers. Students felt angry and defensive when patients
depicted negatively could easily have been their
family members. Participants also mentioned the
derogatory terms routinely used by students and staff
to refer to indigent patients. Lecturers, clinical
faculty and fellow students frequently called home-
less, destitute and ⁄or drug-addicted patients ÔEast
Side specialsÕ, referring to the impoverished inner
city.
Working-class anti-elitism
Students from working-class or impoverished back-
grounds expressed an anti-elitism that prevented
them from fully identifying with other medical
professionals. One student in cohort 1 noted that she
came from the Ôother side of the tracksÕand still
belonged there; she repeatedly stated that she would
never become Ôone of ThemÕ, referring to other
doctors. Others insisted that the mandatory dress
code was elitist:
ÔIÕve never worn a tie. and I never will... To me, it
symbolises everything that sets the doctor and the
patient apart. It’s like... ‘‘I’m somewhat better than
everyone else.’’ ... It gets in the way of good
communication.’ (Cohort 1)
Some of the students who self-identified as working-
class also described themselves as being less intimid-
ated by instructors and attending doctors, less likely to
express deference to authority, and more likely to
speak up when they saw things they questioned or
disagreed with. One student, who spent his summers
fishing to pay for tuition, commented that having
watched Ôbig tough guys puking over the side of a boatÕ
helped him feel less intimidated by attending clini-
cians.
Some of the students from low-income backgrounds
thought their classmates tended to show little respect
for others:
ÔMost of my class is the pampered elite ... A lot of
[them] have no basic human respect for the dignity
of other people.Õ(Cohort 1)
On the questionnaire, 43% of upper-class or upper
middle-class students, compared with 19% of work-
ing-class or poor students, indicated that a patient’s
social class makes little or no difference to the way
they are treated in the health care system (v
2
P¼0.049). Several interviewees wondered how well
the majority of their classmates would be able to
relate to patients from low-income backgrounds.
One described other students and doctors as
Ôstepping on peopleÕ, misusing power and privilege.
Another suggested that doctors from impover-
ished backgrounds would be superior care
providers:
ÔIf I was to pick the ultimate clinician or whatever,
IÕd pick somebody from a background that strug-
gled, right? Because you just know the value of hard
Table 2 Impact of students’ social class background on medical school experiences
To what extent do you think each of the following
factors has affected your experience of medical
training, negatively (1) or positively (7)? 1–2 3 4 5 6–7
Your social class background
Working-class ⁄poor % 5 24 48 14 9
Lower middle-class % 2 19 48 24 7
Upper ⁄upper middle-class % 2 3 50 29 16
v
2
P¼0.05
Working-class ⁄poor mean ¼4.05, upper ⁄upper middle-class mean ¼4.59; t-test P¼0.038
781
Blackwell Publishing Ltd 2005. MEDICAL EDUCATION 2005; 39: 777–784
work; nothing’s come easy. So you’d have respect
for your patients.’ (Cohort 1)
Growing social distance from friends and family
The anti-elitism typical of many working-class com-
munities
12
also means that for some students the
isolation and marginalisation they feel in medical
school may be echoed by a growing social distance
from family and old friends who cannot relate to
their emerging new socio-economic status. Several
students described their families as less than
impressed, even less than supportive, when they were
accepted into medical school:
ÔMy dad hated doctors, because he overheard a lot
of really unfortunate locker room talk, as a janitor
in the operating room. You know, about money...
So he has a really bad attitude. He was not proud of
me at all.Õ(Cohort 1)
In the questionnaire data, upper-class and upper
middle-class students were more likely to strongly
agree with the statement ÔMy family has been
extremely supportive during medical schoolÕthan
were working-class and poor students (means 4.42
and 3.76, respectively, where 1 ¼strongly disagree,
5¼strongly agree; t-test P¼0.03).
Several students described a growing gap between
themselves and their families as their class status
began to shift, a gap they described as getting wider
over time, not narrower:
ÔIn a way itÕs kind of separated me from my family.
and I feel kind of, like, I don’t really want to
embrace the social life with doctors and medical
students, because I don’t want to become more
isolated from my family.’ (Cohort 1)
Some working-class students described their families
and old friends as putting them on a pedestal, and
presenting them with heightened expectations; oth-
ers were accused of thinking they were better than
everyone else, becoming snobs, moving beyond their
roots. Some students were also the butt of family
jokes about staying in school forever to avoid getting
aÔreal jobÕ.
DISCUSSION
This study is limited by its reliance on data
from a single medical school; the experiences of
working-class students may well differ in other Cana-
dian schools and schools outside Canada. Moreover,
it is limited by the research methods used. The
questionnaire data are largely descriptive, and the
qualitative data – while rich in describing the realities
of a small number of students – inherently lack
generalisability. The questionnaire data are further
limited by a low response rate that inevitably raises
questions about whether responders and non-
responders had very different experiences and views.
Nonetheless, it provides an initial exploratory look
into the experience of social class differences in
medical school, as opposed to the prevalence of class
differences.
Both the qualitative interview data and the question-
naire data suggest that while students from low-
income backgrounds can certainly gain entry to
medical school, once there they may be less likely to
feel they belong. In each cohort, students who self-
identified as coming from working-class or impover-
ished backgrounds felt disadvantaged by not having
the social networks that could have helped them
excel in medical school; felt alienated by upper-class
and upper middle-class cultural ways of being that are
normative in medical school; felt they fitted in less
well at school and that they also faced growing
isolation from family and community, and felt
marginalised by jokes and derogatory comments that
suggested they did not quite belong.
The notion of Ôeveryday classismÕ
10
is useful for
understanding the micro level processes through
which social class differences may be experienced
and perpetuated in Canadian society, where most
citizens express commitment to social equality.
Drawing on Essed’s notion of everyday racism, we can
think of this as involving inequitable Ôpractices that
infiltrate everyday life and become part of what is
seen as ‘‘normal’’ by the dominant group.Õ
13
Everyday
racism refers to commonplace interactions whose
effects taken individually may seem trivial. Yet each
racist joke, assumption or interaction is contextual-
ised by a cumulative history of such trivial incidents in
one’s own past experiences as well as in the experi-
ences of loved ones. Each incident – often too minor
in isolation to warrant response – helps to uphold
social relations of power and exclusion.
Representing more than simply material resources,
social class inequities are upheld through Ôongoing,
everyday, taken-for-granted practicesÕwhich perpetu-
ate hierarchies of difference.
14
The signs and symbols
of class are present in minute, mundane, daily
practices, which allow some people to fit in easily in
professional attitudes and behaviour
782
Blackwell Publishing Ltd 2005. MEDICAL EDUCATION 2005; 39: 777–784
particular social settings while others do not. Derog-
atory language used to refer to people living in
poverty, jokes about people in blue-collar positions
and stereotyping of impoverished patients can be
seen as ÔmicroaggressionsÕ,
15
slights which – usually
unintentionally – convey disregard, disrespect, mar-
ginality or contempt. Such slights may act as Ôstatus
remindersÕ, having a Ôlevelling effectÕon recipients
who are implicitly being told to Ôstay in your place.Õ
16
These are powerful, if indirect, ways of reproducing
class relations.
10,17
The experiences of everyday classism, alone, are not
likely to prevent a working-class student from suc-
ceeding in medicine. They may, however, require
that student to engage in a set of imperceptible
practices to counter the constant – even if unin-
tended – messages of marginality, such as self-talk
about being good enough to be in medicine,
conscious or unconscious efforts to pass as middle-
class, seeking out allies, and avoiding uncomfortable
social settings with others in medicine. There may
simply be extra work and extra struggle involved in
being in medicine for someone who comes from a
working-class or impoverished background.
At the same time, the anti-elitism conveyed by some
students may be a potent weapon against classism. At
least some working-class students seem to engage in a
reversal of values, constructing Ôthe pampered eliteÕ
as lacking in real world knowledge and being overly
deferential to authority. They suggest that doctors
from disadvantaged backgrounds will be better able
to relate to patients, will be more respectful of others,
and will resist misusing unearned power and privi-
lege. This working-class resistance
18,19
challenges
social class relations, staking a claim for those Ôfrom a
background that struggledÕas superior, as Ôthe ulti-
mate clinicians.ÕFuture work should examine the
extent to which doctors from such backgrounds do,
in fact, practise differently.
Working-class students do not lack social and cultural
capital. Rather, the social networks, habits, values,
expertise and ways of being that are valued in working-
class settings are actively devalued within the middle-
class norms of medical school. These students do not
necessarily wish to become middle-class; some actively
resist this, viewing their own cultural ways of being as
valuable resources. Rather than asking these students
to change in order to fit in, it is up to the institution to
accommodate their diversity. Medical educators have a
responsibility to foster a learning environment that
equally enables all students to succeed. It is the job of
educators to examine our own practices, the ways of
being that shape what is considered the norm in our
schools, to see where we are perpetuating unintended
messages about who belongs and who does not belong
in our programmes.
Acknowledgements: none.
Funding: this study was funded by the Social Sciences and
Humanities Research Council of Canada.
Conflicts of interest: none.
Ethical approval: as a condition of access, the medical
school involved in this research is not identified. The study
was given ethical approval by the university research ethics
board.
REFERENCES
1 Dhalla IA, Kwong JC, Streiner DL, Baddour RE, Wad-
dell AE, Johnson IL. Characteristics of first-year stu-
dents in Canadian medical schools. CMAJ
2002;166:1029–35.
2 Health Canada. Strategies for Population Health: Investing
in the Health of Canadians. Catalogue no. H39–3
16 ⁄1994E. Ottawa: Ministry of Supply and Services,
Canada 1994.
3 Raphael D. Poverty, Income Inequality and Health in
Canada. Toronto: CSJ Foundation for Research and
Education 2002.
4 Wilkinson R, Marmot M. Social Determinants of Health:
the Solid Facts. Copenhagen: World Health Organisa-
tion European Office 1999. http://www.who.dk/
document/E59555.pdf. [Accessed 21 October 2003].
5 Duffin J. What goes around comes around: a history of
medical tuition. CMAJ 2001;164:50–6.
6 Kiefer CW. Health Work with the Poor: a Practical Guide.
New Brunswick, New Jersey: Rutgers 2000.
7 Cockerham WC. Medical Sociology. 6th edn. Englewood
Cliffs, New Jersey: Prentice Hall 1995.
8 Roter D, Hall JA. Doctors Talking with Patients ⁄Patients
Talking with Doctors. Westport, Connecticut: Auburn
House 1992.
9 Haas J, Shaffir W. Becoming Doctors: the Adoption of a Cloak
of Competence. Greenwich, Connecticut: JAI Press 1987.
10 Bellamy LA. Capital, habitus, field and practice: an
introduction to the work of Pierre Bordieu. In: Erwin L,
MacLennan D, eds. Sociology of Education in Canada:
Critical Perspectives on Theory, Research and Practice. Tor-
onto: Copp Clark Longman Ltd. 1994;120–36.
11 Dunk T. It’s a Working Man’s Town: Male Working-class
Culture. Kingston: McGill-Queens University Press 1991.
12 Beagan B. Micro inequities and everyday inequalities:
ÔraceÕ, gender, sexuality and class in medical school.
Can J Sociol 2001;26:583–610.
13 Essed P. Understanding Everyday Racism: an Interdisci-
plinary Theory. New York: Sage 1991.
14 O’Brien J. Introduction: differences and inequalities.
In: O’Brien J, Howard JA, eds. Everyday Inequalities:
783
Blackwell Publishing Ltd 2005. MEDICAL EDUCATION 2005; 39: 777–784
Critical Inquiries. Malden, Massachusetts: Blackwell
1998;1–39.
15 Pierce CM. Stress analogues of racism and sexism: ter-
rorism, torture and disaster. In: Willie CV, Reiker PP,
Kramer BM, Brown BS, eds. Mental Health, Racism and
Sexism. Pittsburgh: University of Pittsburgh Press 1995.
16 Harrell SP. A multidimensional conceptualisation of
racism-related stress: implications for the well-being of
people of colour. Am J Orthopsychiatry 2000;70:42–57.
17 MacLeod J. Ain’t No Makin’ It: Aspirations and Attainment
in a Low-income Neighbourhood. San Francisco: Westview
Press 1995.
18 Willis P. Learning to Labour: How Working Class Kids Get
Working Class Jobs. New York: Columbia University Press
1977.
19 Davies S. Cultural theories of class inequality in Cana-
dian education. In: Erwin L, MacLennan D, eds. Soci-
ology of Education in Canada: Critical Perspectives on
Theory, Research and Practice. Toronto: Copp Clark
Longman Ltd. 1994;83–101.
Received 14 May 2004; editorial comments to author 14
July 2004; accepted for publication 19 August 2004
professional attitudes and behaviour
Blackwell Publishing Ltd 2005. MEDICAL EDUCATION 2005; 39: 777–784
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