(Dis)embodiment and medical education: How feminist organizational theories can help us think differently about gender

Abstract

Medical schools are places of science, scholarship and service; in other words, they are complex organizations. With their multiple mandates and inherent complexities, the struggle to balance sometimes contradictory priorities is apparent. Among a host of other concerns, issues of gender may appear less pressing. At first glance, the numbers look good. For example, women make up more than half of the medical students admitted to Canadian medical schools.¹ Yet, gender inequities persist,^{2, 3} with women leaders less represented the higher the role in the institutional hierarchy.⁴ And, of course, the very notion of gender as a simple binary is problematic, requiring medical schools to approach gender in a way that matches the complexities of its expression. Gender tends to be a ‘background identity’ that invisibly shapes more overt practices in medical education. It can manifest in implicit and seemingly self-evident ways through professional roles and identities; gender therefore colours the very image of what it is to be a doctor. Finding theoretical tools to help us think about the work of a medical school, and make visible the place of gender within it, is essential.

To support medical educators in building a theoretical toolkit for approaching gender critically, we turn to feminist organizational theory. This theoretical tradition has seldom been drawn upon in medical education scholarship (with some excellent exceptions^{3, 5, 6}). In particular, we highlight the insights of feminist organizational theorist, Joan Acker,⁷ that may help scholars think differently about how gender operates within medical schools.

Feminist critiques of organizational theories have helped make visible the gendered nature of contemporary organizations. And, while not widely engaged, there have been persistent calls in medical education for more use of feminist theories in our scholarship.⁸ These critical approaches can be especially helpful in understanding the potential for workplace technologies like artificial intelligence (AI) to entrench historical gender inequities, as argued by Bearman and Ajjawi.⁹

An important feminist voice is American sociologist Joan Acker. Acker made an indelible contribution to understanding gender at work and was an early proponent of intersectional approaches to feminism developed by Black feminist Kimberlé Crenshaw.¹⁰ In the context of organizational theories, Acker's work ‘Hierarchies, Jobs, Bodies: A Theory of Gendered Organizations’ was groundbreaking. Acker proposed a comprehensive theory on how gender shapes organizational structures and practices. She argued that gender is a fundamental yet often invisible organizing principle within institutions. Gendered norms and expectations shape how people behave, communicate and are evaluated in the workplace. Furthermore, she noted, gender hierarchies are perpetuated by excluding and denying the needs of workers' bodies—in other words, the ‘conceptual exclusion of the body as a concrete living whole’ in organizational life.⁷

Despite the impact of Acker's work in sociology and beyond, only a handful of medical education scholars^{3, 5, 6} have drawn on her work. These scholars have largely applied the gendered theory of organizations to better understand women's experiences (See Drumm and colleagues work on residents' pregnancy experiences⁶ and Blalock and colleagues' exploration of women students' perceptions of medical school⁵). Building on these key contributions, we highlight a key concept from Acker's work that has been under-developed, particularly in medical education: the disembodied worker.

The disembodied worker, a cornerstone of Acker's theory of gendered organizations, argues that male dominance is perpetuated through its invisibility. In turn, this invisibility rests on framing jobs as abstract and gender neutral and the ideal worker as disembodied. Clearly, disembodiment is not possible for any human worker; historically, however, the closest to this ideal was the young White, straight, cis, non-disabled, middle class man. The abstracted, ideal worker has no emotions, does not get sick and does not procreate. The disembodied worker is unencumbered by emotions, sexuality and domestic responsibilities—bodily demands historically considered the purview of women.

By extension, the ideal medical learner—a worker-in-training—is similarly disembodied. In other words, they lack any embodied characteristics that would impinge on performing the learner role. As a result, those who do not fit the norm face challenges such as discrimination when selecting male-dominated specialties; a sexist hidden curriculum; and career choice pressure aligned with ‘work-life-family balance’. However, like the actual worker, the learner can only exist in reality via a concrete, embodied person. Among other things, this ideal learner assumes the presence of abundant resources, like money, time and connections, and the absence of pressing concerns and challenges outside mastering the curriculum.

By conceptualizing the staff, students and faculty who make up an organization as universal, disembodied and genderless workers, gender-based inequities are hidden and appear like a natural and inevitable part of how institutions operate.⁷ Historically, medical schools have been able to overlook the ways in which gender influences their organizational division of labour, hierarchies and everyday work practices. However, as Acker points out, gender is not incidental, but fundamental to how organizations operate. Changing existing gender hierarchies requires acknowledging that medical schools are inherently gendered organizations and that gender plays a central role in shaping business as usual.

Medical education practice is deeply embodied, from the physical dexterity and strength required to perform clinical procedures, to professional norms relating to dress and personal grooming.¹¹ However, certain bodies are more welcome than others. How might medical education scholars explore medical schools as deeply gendered and embodied organizations? We believe Acker's disembodied worker concept holds potential for its role in theorizing AI, making work visible, enabling critical intersectional work and conceptualizing the body:

Anna MacLeod: Conceptualization; writing—original draft; writing—review and editing. Paula Cameron: Conceptualization; writing—review and editing.