The medical profession needs to adapt to the socio-political challenges of the 21st century. These have been described as the ‘Health Society’. Medical professionalism, however, is characterised by conservative values that are perpetuated by the professional attributes of autonomy, authority, and state-sanctioned altruism. The medical education enterprise is a replication and continuation of these values, sanctioned by its accreditation agencies. The Australian Medical Council through its accreditation standards only sanctions the formal curriculum. The status quo, however, is maintained by social, cultural and political parameters enmeshed in the informal and hidden curricula. By not addressing informal and hidden value constructs that maintain elitist medical arrogance the accreditation agency fails to uphold its remit. This paper explores the philosophical and empirical bases of these phenomena and illustrates them by means of a case study. Medical education and its sanctioning structure and agency are confirmed as forceful political enterprises. We conclude that explicit review of the informal and hidden curriculum is a feasible and necessary prerequisite for medical education reform and change.
Is accreditation of medical education a commendable technical quality assurance effort, or a superficial political exercise to maintain the power base of the medical profession? The stated purpose of accreditation efforts in medical education is quality assurance for the public good (Karle, 2008). In fact, on reading World Federation for Medical Education documents and quite possibly the constitutional papers of all accrediting agencies around the world, accreditation is a lofty affair wholly grounded in sound social and philosophical commitments to human well-being and advancement. This is, of course, exactly how the medical profession (and for that matter, every profession apart from, possibly, theoretical astrophysics) wants to be seen, and how most health bureaucracies, industries, and consumer groups prefer to see the induction of new members into the sanctum of medical professionalism.
There is, however, a darker side to medical curriculum accreditation. This perspective relates to the creation, maintenance and protection of power and dominance of a privileged elite. This medical dominance, in terms of educational development, may well start formally with the blessing Medical Schools receive from their accrediting agencies.
In this article we will review the nature and attributes of the medical profession, the functions and agencies it deploys to maintain its socio-economic privileges (autonomy, authority, and state-sanctioned ‘altruism’ – Freidson, 1970), the construction and role of medical knowledge in formal, informal, and hidden curricula, and the rhetorical efforts that accreditation agencies unleash to maintain the status quo. Having thus constructed a political discourse of medical education accreditation we will conclude this piece with a narrative case study, illustrating these issues in one particular Australian accreditation exercise.