Spatial analysis is a research method that examines the social production of physical and symbolic spaces. It can be used to study how environments such as those found in higher education and healthcare become racialized. (Photo: iStock)

Recent findings published in Academic Medicine reveal how systemic racism is being fuelled in the healthcare system. As a result, foreign-trained health professionals face major challenges that their Canadian-trained peers do not.

The project was led by Dr. Tim Mickleborough, a postdoctoral fellow at UHN's Wilson Centre, and Dr. Maria Athina (Tina) Martimianakis, an affiliate scientist at The Institute for Education Research (TIER) at UHN.

"We wanted to re-explore the issue of bias and discrimination in healthcare using spatial analysis because there is a need to better understand how the production of insiders and outsiders manifests in healthcare spaces," says Dr. Martimianakis.

Canada has encouraged the immigration of internationally-trained professionals as part of a national strategy to address labour shortages in the healthcare system. However, systemic barriers faced by these individuals – including racism and inequality – prevent them from achieving their full potential in Canada.

To explore this issue, the researchers conducted a critical review of available literature relating to the integration of foreign-trained professionals into the workforce. They used spatial analysis to further examine the data.

Spatial analysis is an approach that is particularly well-suited to exploring how health education and professional spaces construct, and are constructed by, gender, race and class relations.

"The dominant discourse or talk contributing to workplace inequality and racism is the concept of 'whiteness,'" explains first author, Dr. Mickleborough. "'Whiteness' organizes social relations that emplace white professionals as the 'rightful' occupants of Canadian professional spaces while at the same time keeping 'others' in their place."

Dr. Tim Mickleborough and Dr. Maria Athina (Tina) Martimianakis
First author Dr. Tim Mickleborough is a postdoctoral fellow at The Wilson Centre at UHN and senior author Dr. Maria Athina (Tina) Martimianakis is an affiliate scientist at The Institute for Education Research (TIER) at UHN. (Photos: UHN Research, StRIDe Team)

Study findings suggest that, in healthcare spaces, this inequality is underpinned by attitudes and practices that support the notion that professional knowledge produced in Canadian universities – including local ways of speaking and interacting with patients – are more valid than foreign-trained knowledge and practices. Because foreign credentials and experience are not automatically recognized in Canada, international healthcare professionals must undergo relicensing.

"Relicensing, while an important process for ensuring quality and safety in the Canadian healthcare workforce, should only be a temporary measure and not a permanent mechanism of exclusion," says Dr. Mickleborough. "Instead, foreign-trained health professionals who have completed relicensing requirements seem to never be able to shed the stigma associated with being educated in a different country."

In addition to licensing requirements, foreign-trained health professionals are often encouraged to adopt local technical knowledge and an appreciation of Canadian social and cultural​ norms. Yet, despite accepting resocialization, health professionals who are visible minorities, particularly those with foreign accents, describe having to contend with impressions that they are less competent.

Indeed, having a foreign accent marks someone as requiring ongoing monitoring because there is the assumption that they have trained outside of Canada.

"These practices create workplace hierarchies that are highly racialized," comments Dr. Martimianakis.

"By examining how healthcare spaces are culturally and socially produced we can generate evidence-based changes to address systemic racism and discrimination," says Dr. Mickleborough. "Only then will we truly meet our goals of supporting diversity and inclusion in the workplace."

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