배제의 과정에서 포용을 추구하는 법: 의과대학 학생선발(Med Educ, 2015)
Seeking inclusion in an exclusive process: discourses of medical school student selection
Saleem Razack,1,2 Brian Hodges,3,4 Yvonne Steinert1 & Mary Maguire5
지난 10년간, 국가적/세계적으로 의과대학 학생이 전체 인구에 대한 대표성을 높여서 사회의 다양성을 반영할 것에 대한 요구가 높아지고 있다. 그럼에도 불구하고, 의과대학 입학은 매우 경쟁이 높으며, 취약계층을 배제하고 있다.
In the last decade, growing concerns at both national and international levels have resulted in calls for an increase in the demographic representativeness of medical classes to better reflect the diversity of soci- ety.1–3 Despite this, entry into medical school remains highly competitive and exclusive of underprivileged groups.
의료전문직의 소중한 이상이란 학생들이 의과대학에 들어올 때 실질적으로, 그로기 법적으로 능력중심으로 입학하는 것이다.
The cherished ideal within the medical profession is that student selection for entry into medicine func- tions as a de facto and de jure systemof meritocracy.
인구학적 대표성을 반영할 것에 대한 요구와 학업성취에 바탕을 둔 경쟁적 선발방식은 본질적인 긴장관계에 있다.
There is an inherent tension between calls to address the demographic representativeness of the profession and the competitive process of selection driven by academic achievement.
"담화"란 여러 사회과학과 인문과학에서 사용되는 용어로서, 사회적, 조직적 실천을 조절하는데 중추적 역할을 한다. 이는 어떤 것이 다른 것에 비해서 갖는 가치가 어떠하고 그 정당성이 어떠한가에 대한 것을 포함하는 것이며, 담화라는 것은 특정 주제에 대해서 무엇을 말할 수 있고, 무엇을 말할 수 없는가에 대한 사회적 경계에 대한 신념, 사고, 행동를 규정짓는 조직적 방식이다.
‘Discourse’, a termused by many in the social sciences and humanities disciplines, can play a central role in regulating social institutional practices, including the valuing and justification of certain actions over others. Discourse canbe defined as an institutionalised way of believing, thinking and acting that includes allowing social boundaries to define what can and cannot be said about a particular topic.7
이론틀
Theoretical framework
푸코, 보르도, 바흐찐: 담화 분석의 이론적 기반
Foucault–Bourdieu–Bakhtin: the theoretical basis for the discourse analysis
담화 분석의 토대
Throughout the three phases of the study, our discourse analysis was grounded in the critical social and language theories of Michel Foucault, Pierre Bourdieu and Mikhail Bakhtin.9–11
푸코의 이론
Foucault’s theory of discourse was notably helpful in approaching the way in which discourses help construct versions of reality. Foucault12 was specifi- cally concerned with how, in a given set of social conditions and history, it becomes possible to say that certain things are ‘true’ and other things are not. What is considered to be true is linked to power dynamics that are embedded in discourses and practices that are not always immediately visi- ble to people involved in their (re)production. Accordingly, discourses form objects and exist through systems of distributions of power, which can lead either to the reproduction of existing structures or to the production of new ones.13 Foucault’s concept of discourse allowed us to appreciate what he called the ‘conditions of possi- bility’ for what agents of student selection and theapplicants who desire to be selected articulate in their representations of self. Conditions of possi- bility emerge as statements of truth ( enonc es) and make it possible to think, say and do certain things and not others. Statements of truth in turncan serve to generate ‘dividing practices’, or pro- cesses that categorise, classify and separate individ- uals. Discourses produced by organisations thus imply the creation, maintenance and transforma- tion of certain relations of power and control by contributing to the definition of ways of believing, thinking and acting, and of social boundaries that define ‘who’ can say ‘what’ in a given context.
보르도의 네 종류의 자본
Inspired by the economic notion of capital, Pierre Bourdieu discussed four kinds of capital:
- (i) eco- nomic capital: material and financial resources at the disposition of an individual;
- (ii) social capital: the potential and actual resources associated with the maintenance of a network of more or less insti- tutionalised relations;
- (iii) cultural capital: the cul- tural resources made available to a given individual, mainly through his or her family environment and schooling, and
- (iv) symbolic capital: any kind of resource (social, religious, ethnic, associative, gen- der-based, artistic, etc.) that is recognised in a given society or group that contributes to the definition of an individual’s social status.14
네 종류의 자본은 서로 다른 영역에서 작동한다.
Each of these different types of capital is operative within a distinctive ‘field’, which refers to a rela- tively autonomous game or competition for capital that takes place through a configuration of objec- tive relations that constitute an arena of the pro- duction, circulation and appropriation of goods, services, knowledge and status. Individuals may occupy different positions of power depending on their specific capital relative to each field. Accord- ing to Bourdieu, different forms of capital interact, and one’s standing in different fields as well as the opportunities that are put at one’s disposal derive from the outcomes of this interaction. Bour- dieu’s theory of capitals helped to frame how dif- ferent applicants’ experiences, backgrounds or modes of preparation for the selection process might be more or less valued by the admission committee. It also contributed to a better under- standing of the relationship between knowledge and power in the context of student selection. In fact, Brosnan15 discusses how medical education and admission into medical school can be concep- tualised as a field within which applicants’ portfo- lios, personal narratives, curriculum or interview answers can be understood as capital or market- able commodities.
We worked with Bakhtin’s dialogic view of language, in particular the concepts of ‘single-voiced’ (authori- tative) and ‘double-voiced’ (internally persuasive) discourses, in order to understand the mechanisms by which language may be used to assert power. Sin- gle-voiced or authoritative language (‘This is so...’) ‘is directed towards its referential object and consti- tutes the ultimate semantic authority within the lim- its of a given context’, whereas the double-voiced or internally persuasive discourse (‘This may be so in reference to that...’) inserts ‘a new semantic inten- tion into a discourse which already has, and which retains, an intention of its own’.16 The distinction between these two types of discourse helped us to understand how academic discourses come to pre- dominate over service-to-society discourses, and then to relate these to the social world through the knowledge–power relation theories of Foucault and Bourdieu’s concepts of the forms of capital. Exam- ining the discourses in this way can help us to understand how power might be asserted through language in order to claim ‘truth’.
Research questions
Phase 1. Stakeholders: institutions, credentialing and licensing bodies
Phase 2. Stakeholders: ACMs
Phase 3. Stakeholders: applicants to medical education programmes
Research phases
RESULTS AND DISCUSSION
조직의 '수월성'에 대한 표명방식: 학문 담화와 봉사 담화 사이의 긴장관계
Phase 1a. Institutional representations of excellence: tension between discourses of the academy and the service discourses of the profession
The lessons learned from this phase of the research can be summarised thus:
- 학문, 연귀, 지식은 의과대학이 '수월성'에 대하여 기술할 때 지배적인 방식이며, 이것이 의과대학간 위계를 형성한다.
scholarship, research and knowledge creation predominate when medical schools write about excellence, establishing a hierarchy among med- ical schools; - 수월성과 사회적 책무 사이에는 변증법적(dialectic) 긴장관계가 있다.
there is a dialectic tension between claims of excellence and those of social accountability; - 다양성이란 구체적인 목표이며, 수월성에 관한 담와에서는 인종, 종교, 성별과 같은 표면적인 특성으로 나타난다.
diversity appears as a reified object, tokenised into superficial features (race, religion, gender, etc.) within the discourses of excellence, and - '평등성'의 정의는 추상적이다.
equity remains vaguely defined.
정책서류: 긴장 해소를 위한 고장난 시도들
Phase 1b. Policy documents: dysfunctional attempts to resolve the tension
Our conclusions from this phase of the research can be summarised thus:
- 이 부분에서 분석한 서류는 '다양성'을 무언가 새로운 것처럼 제시한다.
the documents analysed in this section present diversity as something new; - '사회적 책무'에 대한 개념은 매우 모호하나, 변화의 이유로서의 가치를 지니고 있다.
the concept of ‘social accountability’ is defined vaguely, but valued as the reason for required change, and - 여러 서류에서 의학교육은 역사적인 것으로, 그리고 당연한 것으로 표명하고 있으며, 이는 다른 관점을 통합하는 것을 더 어렵게 만든다.
documents present medical education, as well as regulatory bodies, as ahistorical and as taken for granted, which makes it difficult to integrate alternative perspectives.
거시적 관점에서 미시적 관점으로: ACM(입학위원회)는 이러한 긴장 속에서 어떻게 운영되고 있는가?
Phase 2. From the macro to the micro: how do ACMs live the discursive tensions in their day-to-day practice of student selection?
The following two exemplar quotations from committee members encapsulate this tension:
- "학업성취도에 대한 중요도를 낮출 수는 없다. 이는 민주적인 사회에 반하는 것이고, 세살 때부터 부모가 숙제를 도와주는 부유한 가정에서 자란 학생의 성취도가 더 높다는 것을 이해하더라도 말이다"
I’m saying that we cannot discount academic performance. I mean, that frankly goes against everything in a democratic society – understanding that excellent performance is much easier if you come froma wealthy household, whose parents helped you with your homework since age three. - "기본적으로 지원자를 하나의 개인으로 평가해야 한다는 것이다. 어떤 해에도 입학정원을 온갖 종류로 분류해서 이 작은 구멍에 모든 사람들이 잘 맞게 하는 것은 불가능하다."
I think that the bottom line is that you have to evaluate the candidates that come to you as indi- viduals and in any given year you can’t start estab- lishing all sorts of quotas and trying to get people to fit into these little pigeon holes.
From the work in this phase of the research, we concluded that:
- 입학위원회는 다양한 우선순위 가운데서 복잡한 협상을 하고 있었으나, 수월성에 특히 관심을 두었고 있다.
members of selection committees negotiate a complex terrain with multiple priorities, but pay special attention to excellence, and - 다양성이 중요하고 오랜 역사의 불평등성을 해소해야 한다는 담화, 그리고 능력에 기반한 선발을 해야 한다는 담화 사이에는 긴장관계가 있다.
there is a tension in their discourse between the importance of diversity and the need to address historic inequities in the composition of the profession, and the notion of merit-based selection.
학생의 관점: 특권의 재생산을 통한 사회적 거리 횡단
Phase 3. The perspective of students: traversing social distances through the reproduction of privilege
The analysis of applicant interviews in this phase of the research afforded us the following insights:
- 지원자는 그들의 정체성과 '의료전문직'까지의 사회적 거리에 대한 인식 사이에서 협상을 하고 있다.
applicants negotiate their identities and their perceived social distance from the medical pro- fession; - 이러한 특징들 사이에서 어떻게 협상을 해 나가는지, 그리고 스스로의 진실성을 어떻게 수행하느냐 사이에는 긴장관계가 있다.
there are tensions between how they negotiate these features and how they perform their own sense of authenticity, and - 지원자들은 의료전문직의 특권을 알고 있으며, 선발 과정에서 적합한 것으로 보일만한 것으로 여겨지는 모범답안식 행동을 하며, 여기에는 계층, 성별, 언어에 대한 것을 포함된다.
participants understand the profession as privi- leged and perform by following scripted behav- iours that are seen as appropriate in the selection process and involve aspects of class, gender and language.
본질적으로 배제적인 과정 내에서 포용을 추구하는 방법
Seeking inclusion in an inherently exclusive process
학생 선발과정을 평가하고 인증함에 있어 다음의 원칙을 제안한다.
Specifically, we propose the following guiding prin- ciples through which to evaluate and accredit stu- dent selection processes for entry into medical school:
- 수월성을 추구함에 있어서, '수월성'의 정의는 학업적 그리고 사회에 대한 봉사 측면이 모두 들어가야 한다.
in the seeking of excellence, definitions of excellence that integrate both the academic and the service-to-society discourses should be included; - '포용' 측면에서 의과대학 지원 절차는 다양한 배경의 지원자에게 얼마나 열려있는가(ability to welcome)의 관점에서 평가되어야 한다.
to support inclusiveness, the process of applying to medical school is examined for its ability to welcome persons from diverse backgrounds; - 선발 도구는 교육과정의 성과와 그 배열이 일치해야 하며, 사회에 대한 봉사와 관련된 내용을 포함해야 한다.
the selection tools used should be aligned with desired curricular outcomes, including those related to service to society; - 잠재적 비뚤림을 찾아내고 해소함으로써 공정성을 강화할 수 있다.
fairness should be enhanced by ensuring that potential biases are examined and addressed, and - 선발 절차에 내재되어 있는 - 잘 드러나지 않는 - 사회적 문화적 자본으로부터 야기되는 권력 비대칭성을 해소하기 위해서는 투명성이 확보되어야 하며, 투명성은 모든 지원자에게 선발 절차에 대한 명확한 묘사와 지식을 제공함으로써 도달할 수있다.
transparency should be facilitated by clear descriptions and knowledge of the processes available to all candidates as an approach to addressing power imbalances that may result from the hidden forms of social and cultural capital inherent in the selection process.
Seeking inclusion in an exclusive process: discourses of medical school student selection.
Author information
- 1Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Abstract
CONTEXT:
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© 2014 John Wiley & Sons Ltd.
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