Despite a growing diversity within society and health care, there seems to be a discrepancy between the number of cultural minority physicians graduating and those in training for specialization (residents) or working as a specialist in Dutch academic hospitals. The purpose of this article is to explore how performance appraisal in daily medical practice is experienced and might affect the influx of cultural minority physicians into specialty training. A critical diversity study was completed in one academic hospital using interviews (N = 27) and focus groups (15 participants) with cultural minority physicians and residents, instructing specialists and executives of medical wards. Data were digitally recorded and transcribed verbatim. A thematic and integral content analysis was performed. In addition to explicit norms on high motivation and excellent performance, implicit norms on professionalism are considered crucial in qualifying for specialty training. Stereotyped imaging on the culture and identity of cultural minority physicians and categorical thinking on diversity seem to underlie daily processes of evaluation and performance appraisal. These are experienced as inhibiting the possibilities to successfully profile for selection into residency and specialist positions. Implicit criteria appear to affect selection processes on medical wards and possibly hinder the influx of cultural minority physicians into residency and making academic hospitals more diverse. Minority and majority physicians, together with the hospital management and medical education should target inclusive norms and practices within clinical practice.

Responsive evaluation honors democratic and participatory values and intends to foster dialogues among stakeholders to include their voices and enhance mutual understandings. The question explored in this article is whether and how responsive evaluation can offer a platform for moral learning ( Bildung) in the interference zone between system and lifeworld. A case example from Dutch psychiatry is presented. Policy makers aimed to develop a “monitoring instrument” for closed psychiatric wards to protect patient rights and prevent incidents. Tensions arose between strategic action and system values (accountability, efficiency, control, safety) and the search for meaning and morality. Several dynamics were set in motion. Through the creation of communicative spaces in which there was room for expression of emotions and stories, the “colonization” by system values was countered. Another dynamic called “culturalization” started simultaneously, that is, adoption of lifeworld values in the system world, which resulted in constructive dialogues on the meaning of good care and moral learning.

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As cultural minority students were confronted with microaggressions, the medical school did not succeed in creating a safe education environment for all students. Contrary to their aims and intentions, intercultural competence activities had limited effect and seemed to support the polarisation of cultural minority and majority students and teachers. This can be seen as pointing towards a hidden curriculum privileging majority over minority students. For structural integration of intercultural competency in medical education, the focus must penetrate beyond curricular activities towards the critical addressing of the culture and structure of medical school. Collective commitment to creating a safe and inclusive education climate is vital. This requires fostering social cohesion between minority and majority students and teachers, raising awareness and the practice by all involved of critical (self-)reflexivity on cultural prejudice and dominant, exclusionary norms in academic medicine.