مطالعه‌ای کیفی بر موضوع «عدالت» در آموزش پزشکی در ایران

عدالت در جامعۀ ما مفهومی است که در عین بدیهی و مفروض دیده شدن، گنگ و پیچیده است. یکی از حوزه‌های مرتبط با عدالت در حوزۀ آموزش، آموزش پزشکی است. تجربۀ پزشک‌شدن در بستر آموزش پزشکی حاضر، درک و مفهوم‌پردازی نسبت‌به موضوع عدالت را شفاف می‌کند. هدف مطالعۀ حاضر، کشف و واکاوی درک و تجربۀ عدالت در میان دانشجویان پزشکی، استادان و مسئولان آموزش پزشکی است. مطالعۀ حاضر، یک مطالعۀ کیفی است که در سال 1400 انجام و در آن داده‌های 29 مصاحبۀ نیمه‌ساختاریافته (با استادان، دانشجویان و معاونان آموزشی در دانشگاه‌های علوم پزشکی) به روش تحلیل مضمون تجزیه و تحلیل شده است. نتایج نشان داد ازنظر مشارکت‌کنندگان، بی‌عدالتی قبل از ورود به رشتۀ پزشکی و ازطریق کنکور اتفاق می‌افتد. بسترهای غیرمنصفانۀ رقابت در جامعه، شکلی از ورود غیرمنصفانه به رشتۀ پزشکی را به وجود آورده است. از سوی دیگر، میدان آموزش پزشکی نیز خود در بر گیرندۀ بستری پیچیده از بی‌عدالتی است که با وجود ناپذیرفته‌بودن مرسوم است. مضامین احصاشده عبارت‌اند از ساختارهای نابرابرساز، جامعۀ کالایی و سیاست‌های غیرمنصفانه. مطابق نتایج تحقیق سیاست‌گذاری‌ها و راهبردهای عادلانه در بستری از جامعۀ کالایی و سرمایه‌دارانه، به ضد خود بدل می‌شوند و به بی‌نظمی ناعادلانه و نابرابری می‌انجامند. تناسب سیاست‌گذاری‌ها در آموزش پزشکی با تغییرات اجتماعی، چابکی و به‌روز‌بودن،‌ به عنوان ملزومات تغییر پیشنهاد می‌شود. اتخاذ سیاست‌های عادلانه در کنکور سراسری و میدان آموزش پزشکی، توزیع منصفانۀ جایگاه‌های شغلی، تناسب فعالیت بالین با حقوق و دریافت‌های دانشجویان پزشکی، از تغییرات فوری پیشنهادی در آموزش پزشکی روشن است که سیاست‌گذاری‌های کل‌نگرانه در آموزش پزشکی، مانع هدررفت حجم عظیمی از استعدادها در وزارت بهداشت می‌شود.

a qualitative study on the issue of justice in medical education in iran

introductionjustice, a multifaceted concept, encompasses a spectrum of theoretical and societal constructs. while often perceived as a self-evident and assumed notion, justice simultaneously presents a complex and challenging dimension in our society. medical education stands as a domain where the principles of justice find nuanced expression. the experiences of medical students during their university journey offer valuable insights into their comprehension and conceptualization of justice, particularly as members of the social elite. this study embarked on an exploration and analysis of perceptions and experiences of justice within the context of medical education, encompassing perspectives from students, professors, and medical education officials.  materials and methodsthis qualitative study was conducted in 2022 to investigate perceptions and experiences of justice in medical education in iran. the focus was on medical sciences at universities across the nation. participants were selected from universities affiliated with the ministry of health and medical education (mohme), institutions that play a pivotal role in medical education in iran. adhering to qualitative research principles, 29 semi-structured interviews were conducted with professors, students, and teaching assistants in the universities of medical sciences. the interviews aimed to delve into their perspectives on justice within the medical education landscape. after transcribing the interviews, the data were subjected to thematic analysis, a systematic method for identifying patterns and themes within the collected data. discussion of results and conclusionthe study findings revealed that injustice permeated the medical education landscape, manifesting even before individuals embarked on their medical careers. the current entrance exam system, despite its intention to ensure fairness, disproportionately would favor individuals from higher socioeconomic backgrounds, perpetuating inequalities among diverse social groups. this suggested that the pursuit of medical education remained largely confined to the privileged elite. within the medical education system itself, a complex web of injustices intertwined, often leaving students feeling a sense of unfairness. enrollment practices, including various quota systems, were identified as sources of discontent and dissatisfaction. furthermore, the students from privileged backgrounds enjoyed an advantage due to their superior personal and social circumstances. they were less concerned about their future job prospects, sometimes capitalizing on hidden or unreported income and securing more favorable post-graduation opportunities.the thematic analysis identified three overarching themes: unequal structures, commodity society, and unfair policies. the findings suggested that within the framework of a commodity-driven, capitalist society, even well-intentioned policies aimed at promoting educational justice could inadvertently contribute to perpetuating unfairness. this highlighted the insidious nature of inequality and commodification, transforming seemingly fair practices into unjust outcomes.despite policymakers’ efforts to foster justice in medical education, the prevailing context of inequality and commodification undermined these intentions. ultimately, the study underscored the need for a comprehensive approach that addressed both the structural inequities and pervasive commodification of education. only by addressing these root causes could we create a more just and equitable medical education system that truly reflected the ideals of meritocracy and fairness.despite the intentions of policymakers to promote educational equity in the medical field, the prevalent context of commodification and inequality rendered these policies ineffective and potentially unjust. the practical implementation of these policies often fell short and their outcomes could exacerbate the existing inequities.to address these challenges, there was a need for adaptable social policies that could evolve alongside social changes. this necessitated a dynamic and up-to-date approach to social policy formulation. a fair distribution of job opportunities and proportional rewards was crucial to ensure that talent was not solely driven by material aspirations but rather fostered and channeled towards self-improvement and societal advancement.moreover, there was a pressing need for theoretical clarification of the concept of justice. while the notion of justice was often taken for granted in iranian society and among policymakers, its complexities demanded a thorough examination. the foundational principles of justice and their underlying theories required further development, discussion, and clarification. the absence of a unified understanding of justice among policymakers highlighted the significance of this theoretical issue. the authors believed it had to be a priority for the academic community.