Attending to Hauntings in Medical Education: How a Poverty Simulation Caused Injury to Learners During a Course About Professional Identity Formation

• In Event: The Haunted Curriculum: Engaging Present-Day Violence in the Education of Health Professional

Abstract

Leaders in medical education have recently demanded that educators explicitly acknowledge the hidden curriculum and the forms of power and hierarchy that structure medical education and practice. This emic terminology of the hidden curriculum tells us something more than just medicine’s recognition of its own problematic past: such a term like the hidden curriculum relies on an enlightenment logic that posits that making explicit or transparent can heal harms caused by injustices embedded in medical education and practice. This becomes obviously problematic when we critique curricula that attempt to teach about these injustices and hierarchies. The descriptive and explanatory case study I present draws on my own experience leading a new, longitudinal class for medical students about professional identity formation in which medical students were forced to engage in a poverty simulation as a way to understand inequities experienced by patients that learners will encounter. While well-intentioned, this educational intervention resulted in harming many students, particularly ones that had grown up in poverty. Analyzing the case, I will show how attempts to unmask the hidden curriculum can be fraught as it always implies an impossible promise of transparency. Applying Derrida’s deconstructivist linguistic analysis and the notion of the spectre to this case study, we can see why it is so challenging to attend to our racist and patriarchal past when we continue to inform medical education with values of objectivity and transparency. Instead, the concept of the haunted curriculum allows us to distance ourselves from the idea that we can remedy injustice through exposing the hidden, when it is impossible to do so. With the haunted curriculum, we recognize that it is impossible to rid ourselves of these ghosts and instead engage with them as they show up in our curricula. Our job as educators, then, comes to be one of a medium–mediating communication between the spirit world and the physical world-attending to these communications as part of our disposition towards knowledge.

Author

• Jennifer Karlin, University of California - San Francisco