Beyond the cultural myth of medical meritocracy

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.

‘Too male, too pale, too stale’: a qualitative exploration of student experiences of gender bias within medical education

“… 73 Yet, notions of meritocracy resemble a cultural myth. 74 It simply is not true that so long as one is intelligent, principled and ambitious, they can succeed in medicine. The concept of meritocracy remains intrinsically linked to ‘hierarchies of privilege’—hence, protected characteristics that fall outwith characteristics of the traditional medical patriarchy will be ‘excluded from narratives of excellence’ and act as barriers to success.…”

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Racial Privilege and Medical Student Awards: Addressing Racial Disparities in Alpha Omega Alpha Honor Society Membership

“…5 AOA membership aims to signal exceptional academic performance. However, it may be based on a meritocracy myth 6 in some circumstances, as getting into and succeeding in medical school can be more challenging for students of color, due to social barriers and biases. 7 Consequently, AOA, may be perpetuating-or worse, compounding-demographic privilege.…”