The widely acknowledged doctor shortage in Canada has recently motivated a more critical look at the licensure rates of International Medical Doctors (IMDs), also known as International Medical Graduates (IMGs). However, very little research has been conducted on the experiences of IMDs before they enter the Canadian medical system. This qualitative study collected interview data from 15 diverse IMDs seeking licensure in Ontario, Canada. The participants varied with respect to age, country of origin, English language proficiency on arrival, and time in Canada. In addition, two bridging support programs were observed, and interviews were conducted with three educators from the programs. The interviews were analysed using thematic content analysis (Boyatzis, 1998; Miles & Huberman, 1994). An analysis of metaphors used by the IMDs to describe their experiences during the licensing process supported the use of poetic representation for key findings, resulting in three poems that are interspersed in the body of the thesis (Ellingson, 2011; Glesne, 1997; Richardson, 2002; Richardson & Adams St. Pierre, 2005). The theoretical framework of the research was informed by Vygotskian Sociocultural Theory, which views learning as inseparable from social interaction and context (Vygotsky, 1987). Third-generation Activity Theory (AT), which has descended from Vygotsky’s work, was applied to highlight the higher-level systemic issues related to medical licensing. Results of this study indicate that IMDs with lower English proficiency face substantial difficulties on arrival, with limited access to the type of medically-relevant language instruction needed to support them. In fact, all pre-licensure IMDs struggle to access the interactional learning opportunities (i.e., Vygotskian “mediational means”) to support their entry into the system. Licensing challenges include limited exam preparation resources that support acquisition of Canadian cultural content; unequal access to clinical observerships; and a selection process which lacks transparency and emphasizes a screening tool unfamiliar to IMDs, the residency interview. Implications of this study include the revisiting of immigration policy; increasing the transparency and effectiveness of the selection process/residency interview; reviewing the role of clinical observerships in the selection process and exploring the potential of observerships to function as a licensure portfolio assessment.

Ce mémoire examine les pratiques des demandeurs d’asile dans les structures humanitaires médicales de l’île de Lesvos, en Grèce. Maintenus dans la zone-frontière que constitue l'île, les demandeurs d’asile vivent dans le camp de Moria, reconnu pour ses conditions de vie extrêmement mauvaises. Dans le cadre de leur processus d’asile, ils sont soumis à une procédure médicale, l’évaluation de vulnérabilité, dont le résultat influence leurs parcours. Dans le cadre d’un terrain ethnographique mené sur l’île à l’été 2018, j’ai effectué de la participation observante en tant qu’interprète au sein d’une clinique humanitaire, où des médecins bénévoles et des demandeurs d’asile négocient ensemble le pouvoir attribué à l’évaluation de vulnérabilité. Le mémoire analyse les pratiques des demandeurs d’asile à partir du concept d’agentivité circonscrite, une forme d'agentivité aux effets imprévisibles. Dans une première partie, je démontre que les demandeurs d’asile mettent en œuvre des stratégies pour négocier la situation inhumaine dans laquelle ils sont mis ainsi que pour obtenir une reconnaissance. Leurs stratégies se structurent autour d’une réappropriation des logiques du dispositif humanitaire, notamment des stéréotypes qui sont assignés aux réfugiés. Dans une seconde partie, j’examine en profondeur un élément de ces stratégies qui est central aux interactions de soin dans la clinique humanitaire : les documents médicaux. Je montre que ces documents sont une technologie flexible dont la fonction est détournée par les pratiques des demandeurs d’asile, qui les utilisent comme une ressource et comme une preuve. Finalement, j’analyse les différentes façons dont les médecins bénévoles réagissent à ces pratiques ainsi que leurs conséquences sur l’accès aux soins médicaux. Ces éléments établissent un portrait nuancé des effets du dispositif humanitaire établi aux frontières de l’Europe suite à la crise des réfugiés de 2015. / This study examines asylum seekers’ practices within medical humanitarian structures on Lesvos island, Greece. Maintained inside the border-zone constituted by the island, asylum seekers live in Moria camp, which is known for its extremely bad living conditions. In the context of their asylum process, they undergo a medical procedure, the vulnerability assessment, the result of which influences their trajectories. As part of an ethnographic fieldwork conducted on the island in the summer of 2018, I carried out observing participation as an interpreter in a humanitarian clinic, a space where volunteer doctors and asylum seekers negotiate the power attributed to the vulnerability assessment. This study analyses the practices of asylum seekers through the concept of circumscribed agency, which effects are unpredictable. I first show that asylum seekers set up strategies to negotiate the inhuman situation in which they find themselves, as well as to obtain recognition. Their strategies are structured around a reappropriation of the logics of the humanitarian device, notably the stereotypes assigned to refugees. The second part extensively examines an element of these strategies central to the care interactions taking place in the humanitarian clinic: the medical documents. I show that these documents act as a flexible technology and that their function is reconfigured by asylum seekers’ practices, who use them as resources and proofs. Finally, I highlight the different ways in which volunteer doctors react to these practices, along with their consequences on access to medical care. These elements provide a nuanced description of the effects of the humanitarian device established at Europe’s borders following the 2015 refugee crisis.

This thesis examines how cultural competency operates as a regime of governmentality. Inspired by Foucauldian genealogy, institutional ethnography, and Said’s concept of contrapuntality, this thesis problematizes the seamless production of racialized bodies in relation to mental disorder. I begin by elaborating a theoretical framework for interpreting race and madness as mutually constructed ordering practices. I then analyze what cultural competence produces and sustains in a position paper published by the Ontario Federation of Community Mental Health and Addiction Programs. I argue the Federation dismisses ongoing institutional violence—suggesting it is simply the perception, as opposed to the everyday reality, of discrimination that causes problems such as low educational attainment among youth of colour. To further support this claim, I deconstruct narratives of low self-esteem, maladaptive coping, depression, and denial of mental illness in the community needs assessments of two of the Federation’s member organizations: Hong Fook and Across Boundaries.

This thesis examines how cultural competency operates as a regime of governmentality. Inspired by Foucauldian genealogy, institutional ethnography, and Said’s concept of contrapuntality, this thesis problematizes the seamless production of racialized bodies in relation to mental disorder. I begin by elaborating a theoretical framework for interpreting race and madness as mutually constructed ordering practices. I then analyze what cultural competence produces and sustains in a position paper published by the Ontario Federation of Community Mental Health and Addiction Programs. I argue the Federation dismisses ongoing institutional violence—suggesting it is simply the perception, as opposed to the everyday reality, of discrimination that causes problems such as low educational attainment among youth of colour. To further support this claim, I deconstruct narratives of low self-esteem, maladaptive coping, depression, and denial of mental illness in the community needs assessments of two of the Federation’s member organizations: Hong Fook and Across Boundaries.