Saleem Razack1, Torsten Risør2, Brian Hodges3, Yvonne Steinert4. 1. Department of Pediatrics and Centre for Medical Education, McGill University, Montreal, Quebec, Canada. 2. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, and Norwegian Centre for E-health Research, Tromso, Norway. 3. Department of Psychiatry, Faculties of Medicine and the Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario,, Canada. 4. Family Medicine, Centre for Medical Education, McGill University, Montreal, Quebec, Canada.
Abstract
BACKGROUND: We examine the cultural myth of the medical meritocracy, whereby the "best and the brightest" are admitted and promoted within the profession. We explore how this narrative guides medical practice in ways that may no longer be adequate in the contexts of practice today. METHODS: Narrative analysis of medical students' and physicians' stories. RESULTS: Hierarchies of privilege within medicine are linked to meritocracy and the trope of the "hero's story" in literature. Gender and other forms of difference are generally excluded from narratives of excellence, which suggests operative mechanisms that may be contributory to observed differences in attainment. We discuss how the notion of diversity is formulated in medicine as a "problem" to be accommodated within merit, and posit that medical practice today requires a reformulation of the notion of merit in medicine, valorising a diversity of life experience and skills, rather than "retrofitting" diversity concerns as problems to be accommodated within current constructs of merit. CONCLUSIONS: Three main action-oriented outcomes for a better formulation of merit relevant to medical practice today are suggested: (a) development of assessors' critical consciousness regarding the structural issues in merit assignment; (b) alignment of merit criteria with relevant societal outcomes, and (c) developing inclusive leadership to accommodate the greater diversity of excellence needed in today's context of medical practice. A reformulation of the stories through which medical practitioners and educators communicate and validate aspects of medical practice will be required in order for the profession to continue to have relevance to the diverse societies it serves.
BACKGROUND: We examine the cultural myth of the medical meritocracy, whereby the "best and the brightest" are admitted and promoted within the profession. We explore how this narrative guides medical practice in ways that may no longer be adequate in the contexts of practice today. METHODS: Narrative analysis of medical students' and physicians' stories. RESULTS: Hierarchies of privilege within medicine are linked to meritocracy and the trope of the "hero's story" in literature. Gender and other forms of difference are generally excluded from narratives of excellence, which suggests operative mechanisms that may be contributory to observed differences in attainment. We discuss how the notion of diversity is formulated in medicine as a "problem" to be accommodated within merit, and posit that medical practice today requires a reformulation of the notion of merit in medicine, valorising a diversity of life experience and skills, rather than "retrofitting" diversity concerns as problems to be accommodated within current constructs of merit. CONCLUSIONS: Three main action-oriented outcomes for a better formulation of merit relevant to medical practice today are suggested: (a) development of assessors' critical consciousness regarding the structural issues in merit assignment; (b) alignment of merit criteria with relevant societal outcomes, and (c) developing inclusive leadership to accommodate the greater diversity of excellence needed in today's context of medical practice. A reformulation of the stories through which medical practitioners and educators communicate and validate aspects of medical practice will be required in order for the profession to continue to have relevance to the diverse societies it serves.
Authors: Arman A Shahriar; Kriti Prasad; Katherine Casty; Zarin I Rahman; Michael Westerhaus; David J Satin Journal: Adv Med Educ Pract Date: 2021-06-01
Authors: Anna MacLeod; Paula Cameron; Victoria Luong; George Kovacs; Lucy Patrick; Molly Fredeen; Olga Kits; Jonathan Tummons Journal: Adv Health Sci Educ Theory Pract Date: 2022-08-22 Impact factor: 3.629