How medical education institutions set up student advocates for failure

#MedTwitter fooled me into believing that medicine was transforming. That people were more comfortable engaging with politics and that we could be critical about our learning and teaching. I believed that the advocacy of people of colour was being heard and implemented meaningfully. Now within the throws of the cultural institution that is medicine, I realize that the online world is far from reality.

Medical education has major gaps.

Curricula lack any teeth when discussing the settler-colonial nature of our health system. Patient cases either ignore or pathologize racialized bodies. Knowledge about different cultural groups remains elective reading. Problematic histories and figures are glossed over, unmentioned, or valourized. Western saviourism is ever-present and representation is abysmal.

Why is there such a disconnect between the conversations happening online between racialized people and and the way real-life institutions teach and function? Perhaps because these two groups are mutually exclusive.

Racialized students are at the forefront of demanding change in medical education. But we are not allowed to ask to move from poor to ideal – rather we must move within the comfort levels of our white peers and institutional leaders. Sometimes that means not changing anything at all. We advocate for changes not to rectify our own education – but for the students that come after. It’s commendably selfless but unfairly draining and burdensome on the same select racialized faces.

Despite it all, we come together to write letters, develop new curricular content, sit on all the necessary advisory boards and closed-door conversations. We jump through every hoop to improve the function and culture of our institutions. But the institution has a rolodex of obstruction strategies:

1. Set up unpaid advisory committees where the end result is a report which can be celebrated as the desired outcome.

The important thing to temper any suggestions for rapid or radical change and to also fail to act on any of the other recommendations. The benefits of an unpaid committee is that they have no binding power to institute change and the largely racialized group will either be overburdened and drop off or lose support for their work.

2. Hide behind prominent Black and Brown faces in the institution to deflect legitimate criticism.

That is the purpose of a Diversity and Inclusion Officer anyways.

3. Ignore student campaigns.

Simply don’t respond to their open letters or requests for dialogue. If you are called out, simply defer to your busy schedule or set up a meeting for the students with someone lower in the chain of command and never follow up.

4. Talk about the past and how things have changed or been reconciled.

We used to be problematic in the past but we said sorry. Now there is absolutely nothing wrong with our culture.

5. Focus diversity training on individual white guilt rather than systemic change.

Our students need to know about their privilege and learn to bring it up unnecessarily to show themselves as allies. We need to make conversations about systemic change seem too complex and messy. Expressing guilt about your privilege is enough.

6. Create diversity quotas and scholarships but fail to examine why they are going unfilled/unclaimed.

We just don’t know why no Black, Indigenous or low income students are accepting their offers of admission to our school. We wish they would choose us – but we also don’t have any concrete way to ensure their safety once they get here.

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So where do we go from here?

When students make demands for change or call out decisions, they do not do so lightly. Our institutions need to stop creating roadblocks for student advocates. They need to reflect and be held accountable for their resistance. A culture is only partly inherited – it is also made.

Therefore the question to ask is not “why are students causing so much noise” but “why have we made our culture this way?”

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