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Practice Paper 3 – Observation of Hospitals

One of the best ways of preparing for Paper 3 is to try lots of practice exams.

The following is a summary of a study that can be used for practice when preparing for the new Paper 3. You have one hour and need to answer all five questions.

The stimulus material below is based on a research article.

People living in poverty find it difficult to access health care resources (e.g. medical treatment, Doctor’s appointments, vaccinations, health insurance, etc.) Based on her experiences as a nurse, June Romeo became interested in studying the difficulties poor and marginalized people might have when it comes to accessing health care and she had “long been concerned about inequities in the allocation and distribution of health care resources. She “…began to wonder what it was like from the other vantage point: the recipient of care.” Thus, the aim of her study was to learn about what it was like for poor and marginalized people to try to access health care resources.

Romeo used a covert participant observation method by dressing as a homeless person and using a purposive sample she visited 9 hospitals in NYC that were designed to help underinsured and uninsured people. She visited these clinics every year, for five years, dressed as a homeless person. On each visit, she reported her symptoms to the Dr. by saying that “my head hurts real bad and I see sort of fuzzy…”

The way she was treated in these hospitals was consistent throughout the period of observation. In 7 of the 9 hospitals, she was disrespected and humiliated. She found that her questions about how long she had to wait weren’t answered, the check-ups weren’t very thorough, there were no diagnostic tests offered to try to find out what was wrong and there was no suggestion about when to return for a follow-up. Only 2 of these 7 clinics offered any treatment (which was Tylenol).

Romeo also gathered data by talking with homeless people on the streets and in the clinic waiting rooms during her observation periods. She talked with one man, Samuel (not is real name), who was suffering from gangrene in his feet and the previous night in his shelter he was held done by other men and his clothes literally taken off his back.  Romeo writes that all the way  on her way back to the hotel “thought about Samuel and she “still think(s) about him today and wonder(s) what finally became of him.”

One conclusion Romeo made from the study was that doctors and nurses working in healthcare for poor and marginalized people often have the assumption that poor people have health problems caused by their behaviour (e.g. being drunk or using drugs). She also felt that these people are treated like they don’t have feelings and sometimes like they don’t exist at all. She concedes that it is a difficult line of work to care for these people, but professionalism needs to be maintained and “…being aware of one’s biases, knowing one’s limitations, and recognizing burn-out is crucial for caregivers to the indigent and poor.”

Romeo, June Hart. Down and Out in New York City: A Participant-Observation of the Poor and Marginalized. Journal of Cultural Diversity. Winter2005, Vol. 12 Issue 4, p152-160. 9p.

Mark scheme coming soon…

Answer all of the following three questions, referring to the stimulus material in your answers. Marks will be awarded for demonstration of knowledge and understanding of research methodology.

1.(a) Identify the research method used and outline two characteristics of the method.

(b) Describe the sampling method used in the study.

(c) Suggest an alternative or additional research method giving one reason for your choice.

2.Describe the ethical considerations in reporting the results and explain additional ethical considerations that could be taken into account when applying the findings of the study.

3.Discuss the possibility of generalizing the findings of the study. [9]


Note: This was originally going into the revision textbook but I removed it because I didn’t think the subject of the study was psychological enough in focus. I’ve posted it here as it would be a waste not to use it for practice and it’s still useful for this purpose.

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