There is an urgent need to move beyond lip service in equity commitments to robustly integrating equity concerns in medical education. Despite progress seen in areas including global public health, critical equity-oriented electives, and creating room for critical reflection in medical curricula, system-wide change is needed. Barriers to change, rooted in historical and political power dynamics persist, including the continued privileging of clinical evidence and practice over "soft" issues of equity and reflexivity; entrenched hierarchies within medical systems; and a lack of intersectional diversity among students and faculty. These barriers are shaped and contribute to the backlash against orienting medicine towards social justice.
Drawing upon recently completed PhD research involving interviews with 32 people working to integrate equity considerations in medical and health education in Canada and internationally (including clinicians, EDI faculty, curriculum developers, and other health education professionals), this paper looks at how politics and power have shaped equity work in medical education. A dominant theme emerging from this research concerns how the language and framing of equity has shifted in relation to social backlash against equity work, including anti-work, anti-EDI sentiment. This backlash has played an important role in the development (or lack thereof) of equity-oriented content, pedagogies, and practices within medical education contexts. The paper reviews examples of different tactics educators and advocates employ to navigate this backlash and create spaces for transformation, including: strategic reframing of equity's importance beyond identity categories, calls for overhauling the system with explicit attention to oppression and inequity; and individual and group acts of resistance within institutional constraints. The research demonstrates the centrality of community and relationship-building in moving meaningful equity work forward—an aspect that remains underemphasized in medical education discourse yet proves essential for creating change in hostile environments.
The analysis underscores the importance of institutional, pedagogical, and curricular change informed by anti-racist, intersectional, and decolonizing approaches. Such approaches can disrupt medicine's legacy of harm and centre experiences and positionalities that have been systematically overlooked, including those of racialized communities, students, and faculty.
