Legitimation Politics in Negotiating Sociological Input into Medical School Curricula

Social scientific research on medical education, particularly from a sociological perspective, has grown considerably in the last two decades, given the insights it is seen to offer on professional socialization generally. Despite posing important questions about the legitimacy and representation relating to decisions regarding the public’s health, medical education has attracted less research attention among political scientists and theorists. The idea of deliberative democracy allows us to contemplate the possibility that one’s interests can be represented even indirectly, such as through representation. Despite reforms, formal medical education remains a fundamental structure for reinforcing medicine’s claim to autonomy, exclusivity and discretion on account of the value to society of its specialized and uncodifiable knowledge. Little research on medical education has focused on situated negotiation over the interests, priorities, power and legitimacy of different voices in shaping the content of medical education. This paper considers mixed-method data on overlapping and conflicting student, teacher and institutional views on and responses to the introduction and journey of a mandatory ethnographic project in an undergraduate medical program in Canada. Responses reflect students’ desire to learn “real medicine”; institutional value placed on student perceptions; and teacher perspectives on the role of medicine in society. The seminar outlines the patterns and power differences in attempts by various actors to secure the capital to legitimate their voices. Appeals to the need of society were no match for the legitimacy afforded student and faculty perceptions of the primacy of “bio-medicine” in the medical curriculum. This research contributes to how the idea of deliberation can aid understanding social institutions in complex societies. It is questionable whether current individualistic reforms to medical education, such as teaching professionalism and promoting medical humanities, are sufficient to represent the health care interests of the populations that pay for medical education systems.