Dismantling medical education’s incompatible ideology

Abstract

More than anything, I care about people. I am concerned about how the practices, structures, values, and ways of thinking embedded in medical education—i.e. our ideology—shape the experiences of people who work in our field. Despite being largely blind to its effects, ideology is powerfully at play in medical education—creating social identities, generating relationship patterns, justifying specific conduct, and maintaining and reproducing social order. Every educational system—including the entire medical education continuum—perpetuates ideology. We train future generations of physicians to uphold behavioral expectations and to maintain a specific social order. However, ideology is not always consistent. Individual aspects of our ideology can be incompatible, and, when they are, it is the people who carry the burden of the resulting tensions. Fortunately, ideology is maintained by our decisions and actions; therefore, we can change our decisions and thereby modify the ideology to work for us, not against us. Practice Points Medical education’s environment is constructed–formed by policies, practices, and structures we created. Embedded within this environment is ideology. Medical education’s ideology affects individuals by hailing us to be specific kinds of people. Aspects of medical education’s ideology can be incongruent. When hailed by ideology’s contradictory aspects, it is hard—sometimes impossible—to fulfill the call to be ‘good doctors’. That inability to answer the hailing can have detrimental impact on individuals.