Lauren D. Olsen's "Curricular Injustice"

Lauren D. Olsen is an assistant professor in the Department of Sociology within the College of Liberal Arts at Temple University.

She applied the "Page 99 Test" to her new book, Curricular Injustice: How U.S. Medical Schools Reproduce Inequalities, and reported the following:

From page 99:

made regarding curricular design. With independent courses, the average amount of time spent on social sciences within my sample of medical school curricula was just one week out of forty to forty-six weeks during which students take coursework, or just over 2 percent of curricular time in a given academic year. Thus, in many ways, the shoehorning of social sciences into one week appeared to render this material merely symbolic. But the curricular practices were quite productive and ideological. They did more than simply nothing because these decisions about curricular practices were not neutral. Johnson’s hypothetical case illustrates how these decisions contributed to the medical student’s epistemic socialization and reinforced white cisgender norms. Curricular designers thus contributed to the marginalization of social scientific content with their top-down decisions about where, when, and for how long the LCME standards were taught at their medical schools.

INCLUSION AS ADMISSIONS

Detailing the curricular designers’ decision making vis-à-vis the LCME standards and the social sciences was relatively straightforward in comparison to the other curricular decisions that clinical faculty members made. Another, more subtle way that the curricular designers included the social sciences was through admissions. They also did this with the humanities. Regarding the social sciences, inclusion-as-admissions came up through the clinical faculty members’ valuation of diversity for the POM small groups. Dr. Giannattasio, introduced earlier in this chapter, was going into more detail about how her school planned to engage in the instruction of social sciences in lieu of “formal instruction” that they would not have during those intersessions. She described the following exercise: “I mean we did one of these exercises where you like all stand up, and then you sit down after the certain qualifiers and you see who’s left standing.”

When a reader opens to page 99, they are brought to the close of the section detailing how medical educators make decisions about where, when, and for how long to include the social sciences into their curricular practices to meet the Liaison Committee on Medical Education’s standards, which are the definitive standards that U.S. medical schools must pass to maintain accreditation. As I describe, curricular designers decide to shoehorn in the social sciences, in ways that minimize their impact, marginalize their importance, and reify social inequalities. The readers then begin to see another way the curricular designers try to meet these standards — via inclusion-as-admissions. Here, readers are introduced to another way in which medical school leaders include the social sciences, by admitting students whose social identities will—in the eyes of the leaders—allow them to teach their peers and faculty members about the social sciences.

In terms of the Page 99 Test, I think it passes decently well—it illustrates some of core themes of the book, but not all of them. Most immediately, the examples on page 99 constitute curricular injustices, in that the pedagogical outcomes of devoting minimal time to racism or relying on students of color to teach about race reinforce to medical students that these topics do not matter as much material given more time and taught by clinical faculty. What is beyond the purview of page 99 is the reality that medical educators are by and large clinical (MD) faculty, why the structure of academic medical centers makes that the case, and how these clinical faculty make pivotal curricular decisions without the relevant expertise. Additionally, medical educators’ interpretations and incorporations of the humanities are missing from page 99. Ultimately, this book shows how medical educators make decisions that continue to uphold the white, elite status quo of their profession while dismissing, marginalizing, or problematizing the people and ideas that deviate from it.

Visit Lauren D. Olsen's website.

--Marshal Zeringue