Advances in Health Sciences Education

, Volume 19, Issue 2, pp 161–181

The more it changes; the more it remains the same: a foucauldian analysis of Canadian policy documents relevant to student selection for medical school

  • Saleem Razack
  • David Lessard
  • Brian D. Hodges
  • Mary H. Maguire
  • Yvonne Steinert

DOI: 10.1007/s10459-013-9468-2

Cite this article as:
Razack, S., Lessard, D., Hodges, B.D. et al. Adv in Health Sci Educ (2014) 19: 161. doi:10.1007/s10459-013-9468-2


Calls to increase the demographic representativeness of medical classes to better reflect the diversity of society are part of a growing international trend. Despite this, entry into medical school remains highly competitive and exclusive of marginalized groups. To address these questions, we conducted a Foucauldian discourse analysis of 15 publically available policy documents from the websites of Canadian medical education regulatory bodies, using the concepts of “excellence” (institutional or in an applicant), “diversity,” and “equity” to frame the analysis. In most documents, there were appeals to broaden definitions of institutional excellence to include concerns for greater social accountability. Equity concerns tended to be represented as needing to be dealt with by people in positions of authority in order to counter a “hidden curriculum.” Diversity was represented as an object of value, situated within a discontinuous history. As a rhetorical strategy, documents invoked complex societal shifts to promote change toward a more humanistic medical education system and profession. “Social accountability” was reified as an all-encompassing solution to most issues of representation. Although the policy documents proclaimed rootedness in an ethos of improving the societal responsiveness of the medical profession, our analysis takes a more critical stance towards the discourses identified. On the basis of our research findings, we question whether these calls may contribute to the maintenance of the specific power relations they seek to address. These conclusions lead us to consider the possibility that the discourses represented in the documents might be reframed to take into account issues of power distribution and its productive and reproductive features. A reframing of discourses could potentially generate greater inclusiveness in policy development processes, and afford disadvantaged and marginalized groups more participatory roles in the discussion.


Discourse Social accountability Diversity Equity Medical student selection 

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Saleem Razack
    • 1
  • David Lessard
    • 2
  • Brian D. Hodges
    • 3
  • Mary H. Maguire
    • 4
  • Yvonne Steinert
    • 5
  1. 1.Department of Pediatrics and Centre for Medical EducationMcGill UniversityMontrealCanada
  2. 2.Department of AnthropologyMcGill UniversityMontrealCanada
  3. 3.Richard and Elizabeth Currie Chair in Health Professions Education, Wilson CentreUniversity Health NetworkTorontoCanada
  4. 4.Integrated Studies in EducationMcGill UniversityMontrealCanada
  5. 5.Center for Medical EducationMcGill UniversityMontrealCanada

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