The ideology of a medical school curriculum

There is perennial panic about overly ideological teaching in the arts and social sciences, often manifested in specific conservative backlash to otherwise quite innocuous academic theories.

Art by May Thet Naing

The decision about what is taught and what is not taught at university is deeply political. Knowledge does not exist in an objective sphere; the norms that govern who is able to produce, access and use knowledge are themselves political. Unfortunately, when the politics within our curricula are pointed out, it is often through critiques that are reactionary and right wing. There is perennial panic about overly ideological teaching in the arts and social sciences, often manifested in specific conservative backlash to otherwise quite innocuous academic theories. For instance, anxiety about the teaching of critical race theory (CRT) in schools and universities in the United States has recently been heavily weaponised against movements for racial justice. These critiques are analytically lacking: they misunderstand what CRT is, its role in modern social sciences academia, or indeed how students are taught to use it in the broader context of teaching.

Nevertheless, critiques of the implicit value judgments inherent in curriculum design can be important and valuable, particularly where it is otherwise uninterrogated. In the conservative narrative of universities, STEM occupies a unique pride of place. Practical scientific knowledge and degrees are held to be a non-ideological safe haven, where students learn to reproduce uncontentious empirical facts and produce more of their own through research. Obviously, however, conservatives do not hold all scientific knowledge in this high esteem. Modern human genomics and physiology confirms that biological sex is rather unstable. This reality is rejected as an ideological perversion of a supposedly uncontentious field because it confronts a transphobic vision of the world where gender is locked in by a prediscursive, unchanging sex binary.

Doctors are regularly ranked among the most trusted of all professions; however, reactionary forces are increasingly casting them as villains, insistent that young children are medically transitioning without appropriate oversight. Once again, these critiques are essentially entirely false and morally bankrupt. We know empirically that reduced medical gatekeeping saves lives and that the moral panic around transgender children does not describe a particularly real phenomenon. These criticisms are well-known, but perhaps what is less well-recognised is a critique of medicine’s sexual politics from the Left. 

Medical teaching about sexual health and reproduction is enormously inadequate. Teaching in medicine is conspicuously different to undergraduate studies and most other courses. For one, there is almost no choice in what you are taught. This clearly makes sense on a surface level –- a practicing doctor does not get to decide what diseases exist and ail people. Additionally, teaching is organised very differently to even an undergraduate health science degree. The human body’s various major organs and body systems provide a convenient heuristic to structure blocks of curricula around.

As a first year medical student at USyd you can expect to learn how the lungs, heart, kidney, gut, brain and musculoskeletal system, among other organs, work within siloed blocks of content that last roughly a month each. Some organs are conspicuously left out, like the mouth and teeth which are arbitrarily siphoned off to an entirely separate degree — dentistry. Others, like the eyes and skin, are not awarded their own dedicated blocks, much to the chagrin of ophthalmologists and dermatologists.

When I completed first year medicine in 2021, almost every block lasted for four weeks. Neuroscience was given an outsized six weeks, owing apparently to the unique complexity of the brain. The sexual health and reproduction (SHR) block was the seventh block of nine and was the shortest, lasting two weeks. I found the SHR block uniquely hard. In one week, we covered the enormous topic of pregnancy and contraception. In another we covered common sexually transmitted infections (STIs) and the litany of treatments for them. Meanwhile, we learned the whole anatomy of the male and female reproductive systems. It was also the first time that queer people, particularly men who have sex with other men (MSM), were explicitly mentioned and discussed — we are a “high risk” population. In the two week flurry, diseases like endometriosis were given a passing mention.

SHR block was genuinely conceptually challenging and perhaps the most content-dense block I have studied in two years of postgraduate medicine. I constantly wondered why content that profoundly affects vast swathes of the population, especially vulnerable people, had been so short-changed in the curriculum design. This feeling was especially heightened when I remembered the full week I had been given to digest pituitary gland hormones (a much more niche and simple topic) in the endocrinology block a couple of weeks earlier. 

Recently I was reminded of that experience when checking the Sydney Medical Program’s 2023 central academic calendar. Much to my surprise, the first year curriculum has received a minor update. Most blocks have remained the same — cardiology is still four weeks and neuroscience still is given a generous six. The endocrinology and SHR blocks though, once taught separately over a total six weeks, have been combined together and shrunk into one five week block. If it were possible, the SMP has managed to crunch the teaching of SHR even further.

There are many legitimate critiques to be made of doctors. Routinely doctors fail to recognise patients’ pain. They hold unchecked sexist, fatphobic and ableist biases that often dovetail and result in materially worse patient care. It is a terrible reality that chronic diseases like endometriosis take on average seven years to be diagnosed. In these critiques, the shortcomings of individual doctors are often blamed. While this is not entirely unfair, it is important to realise that medical school is currently setting students up to fail. 

The priorities that the curriculum sets up create a lasting schemata in students’ minds of which diseases and healthcare topics are important and which are unimportant. Medical school teaching is currently signalling to students that the study of sexual health and reproduction is unimportant, and increasingly so. This is at odds with reality. It ought to change.