Discourses of disadvantage in an academic hospital: implications for education

  • Lindsay Baker University of Toronto St. Michael's Hospital
  • Emilia Kangasjarvi St. Michael's Hospital
  • Beck McNeil The 519 Church Street Community Centre
  • Patricia Houston University of Toronto
  • Stephanie Mooney St. Michael's Hospital
  • Stella Ng University of Toronto St. Michael's Hospital Women's College Hospital


Recent calls in medical education and health care emphasize equitable care for disadvantaged patient populations (DPP), with education  highlighted as a key mechanism to move toward this goal. However, in order to develop effective education strategies we must first better understand the DPP concept.

We conducted a theory-informed needs assessment to explore the concept of DPP as understood in our hospital.  Using an interpretive qualitative approach informed by principles of critical discourse analysis we conducted focus groups with trainees and staff across professions and groups, as identified in the hospital’s strategic plan, representing “patients experiencing disadvantage.”

We identified three main perceptions about DPP:  1) disadvantaged patients require care above and beyond what is normal; 2) the system is to blame for failures in serving disadvantaged patients; and 3) labelling patients is problematic and stigmatizing. In response, patients wanted to be first seen as valuable human beings rather than as a burden or category. Patients appreciated that the DPP concept opened up better access to care, but also felt ‘othered’ by the concept. As a result, patients felt they were not accessing the same level of care in terms of compassion and respect.

 Our findings suggest potential for three, theory-informed educational approaches to help improve care for patients experiencing disadvantage: 1) sharing authentic and varied stories; 2) fostering dialogue; and 3) aligning assessment approaches with educational approaches. Additionally, we suggest a need to define access beyond the ability to receive services; according to our participants, access must also engender a sense of common humanity and respect. 

Author Biographies

Lindsay Baker, University of Toronto St. Michael's Hospital
Assistant professor, Department of Psychiatry, Scientist, Li Ka Shing Knowledge Institute, and Lead Educator–Researcher, Centre for Faculty Development, St. Michael’s Hospital, University of Toronto
Emilia Kangasjarvi, St. Michael's Hospital
Research Coordinator
Beck McNeil, The 519 Church Street Community Centre
Director, Organizational Development
Patricia Houston, University of Toronto
Professor, Department of Anesthesia and Vice Dean MD Program University of Toronto
Stephanie Mooney, St. Michael's Hospital
Patient Experience Advisor
Stella Ng, University of Toronto St. Michael's Hospital Women's College Hospital
Director of Research, Centre for Faculty Development and Arrell Family Chair in Health Professions Teaching, St. Michael’s Hospital; Scientist, Centre for Ambulatory Care Education, University of Toronto
Major Contributions