Medical school wokeness imperils precarious Jenga tower of health care

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Canadians horrified by Aaron Sibarium’s account last month in The Washington Free Beacon disclosing shocking revelations about trainee doctors’ incompetence at the University of California at Los Angeles (UCLA) should not lean away in ambivalence, nor imagine that Canada is by any stretch of the imagination immunized from the self-same malaise, one that casts a grim shadow across our nation’s health-care horizon.

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In that explosive report, whistleblowers spotlighted racially biased admissions at UCLA’s medical school, coupled with ballooning lacunae in junior doctors’ general knowledge of medicine. “I have students on their rotation who don’t know anything,” was one of the standout comments from one professor on the UCLA admissions committee. When I read that a student incapable of locating a major artery berated their mentor, it came as no surprise whatsoever. But surprise or not, the realization that failure rates in routine medical competency examinations have skyrocketed — up tenfold in some benchmark areas such as Family Medicine — is far more emblematic of an impending crisis. Buckle up, patients, it’s going to be a bumpy ride.

In Canada, our elected politicians are quick to point out that Canadian health care is the exclusive domain of the public sector — the enduring legacy of legendary national hero Tommy Douglas — and that government keeps a firm hand on the tiller. But trusting the political class in these dangerous days is tantamount to masochistic derangement, so I wanted to uncover more.

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Recently, I spoke in depth with three well-placed professors teaching or administrating at leading Canadian medical schools. All three asked to remain anonymous for fear of the retributive repercussions routinely inflicted by their universities’ personnel departments and, in this article, go by they/them pronouns. Taken individually, their stories might be interpreted as anecdotal curiosities: unconnected tales of woe from disgruntled teachers on the margins; but taken together — scrutinizing the intersection that the left-leaning progressives always insist we must — a picture is revealed of a precarious Jenga tower of medicine, one where many of the constituent blocks are being systematically eroded and removed, threatening an ineluctable collapse in the provision of Canadian health care.

The first of the trio, a self-declared — but now sheepishly repentant — advocate for social medicine initiatives aimed at improving health outcomes among poor Canadians, told me that they first noticed something was up with the day-to-day praxis of training physicians when curriculum changes forced freshman medical students to endure lectures by shockingly left-leaning speakers. My informant, a physician, admits that for four years at McMaster University they helped transform the medical curriculum towards a more social justice lensing, but remains vehement about their motives: “The majority of disadvantaged people (in Hamilton, Ont.) are white.” Then, around 2016 — early in Justin Trudeau’s administration — doubts began to loom. In a session on reproductive rights and abortion, a module aimed at coaching new doctors on their own and others’ sensitivities around these divisive issues, centre stage was taken by a self-proclaimed “feminist ethicist” who went on to declare what was, to their mind, the irrefutable truth that men and women can never be equal. This was demonstrably a political opinion.

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Very quickly it became clear to this doctor that the bizarre, neo-Marxist politicking that pervades social work was being ported over to medicine. Elsewhere, even university deans began openly ridiculing Donald Trump supporters and making tactless remarks in curriculum meetings. Such tolerance for fostering Trump Derangement Syndrome among young doctors, set against those regulators fastidiously jeopardizing other professionals’ credentials — think Jordan Peterson — revealed scandalously asymmetric political bias within the establishment. Crucially, for this doctor, such ongoing politicization of physicians and their mentors began to raise red flags because it so transparently threatens to alienate patients with certain unacceptable views.

Everywhere, it seemed, the medical curriculum was sprouting wild claims and assertions whilst, simultaneously, administrators were busily deprioritizing a clear focus on objective truth. Just prior to the pandemic, McMaster launched so-called “anti-oppression” sessions for its trainee physicians, hosted by an expert with a doctorate in microaggressions: “Who’s giving people PhDs in these frivolous subjects?” my source asks with unconcealed exasperation.

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Then, a fellow doctor and outspoken vaccine sceptic had his licence suspended and lost his job at a nearby university hospital. “I always used to think that physicians are critical thinkers,” my source laments. “I now recognize we are not critical thinkers; we don’t train critical thinking. We like head-nodders and rule-followers.” It transpires that admissions interviews are now so peppered with the word “intersection” that it’s hard not to feel nauseous, but in fairness, eager students are simply box-checking and are not themselves to blame.

At McMaster, as elsewhere, competition for every hour of curriculum time is intense, so much so, that programs barely meet the bar for accreditation. Yet, inexplicably, I’m also told that in recent years Indigenous knowledge has been assiduously onboarded. “Do we need three hours on decolonization?” But the professors were told this was a sacred subject, and the university forbade any discussion because, my source says, “It was outside our teaching expertise. … Nobody was allowed to question the invited speaker. Everything was racist.”

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Another emerging spectre that came to the fore was so-called “critical reflexivity,” which goads doctors to navel-gaze and then swear fealty to a doctrine that perceives everything as a hierarchy of power and oppression. In essence, then, the university’s philosophy department has hijacked its own medical school. Ask community doctors 50 kilometres away from Hamilton and no one knows what any of this means. Yet, at McMaster, seminar attendees are routinely browbeaten: “Have you re-examined this pharmaceutical product through a diversity lens?” Of course, the correct answer to this is no, because it is irrelevant. My interviewee sighs, collecting their thoughts. “It’s too big for one person. It affects my health. I thought I could do something, but the highest levels of the administration support this; the accreditors support this.”

My second foray was with a well-placed administrator at the University of Toronto’s Temerty School of Medicine, on a warm evening over a cold beer in a pub somewhere in Yorkville. A similar picture soon emerged. I began by refuting the idea that Canadian medicine is in crisis, on the well-founded grounds that having taught hard-core organic chemistry for a decade, I know that most students enrol expressly to fulfil tough medical school requirements. But I was soon put right. As this fellow scientist was at pains to point out, in this modern era of diversity, equity and inclusion (DEI) — and anti-meritocracy — such “colonial” prerequisites have long since been consigned to the academic dustbin.

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Recounting an especially combative curriculum meeting, they described how deans from across the university had expressed anxiety over the emerging “uncompetitiveness” of U of T graduates, striving to enrol at medical schools, due to their lower grades — largely because STEM subjects at the university are so notoriously demanding. These deans have now successfully pressed for an easing in grading practices.

Until recently, medical schools favoured science training among successful candidates. Yet my source avowed that today, students need only a couple of courses in nutrition to satisfy the prerequisite for scientific knowledge among the next cohort of Toronto doctors. “Why do you think I go to the gym every single day? I can’t afford to fall sick, not with these people practising medicine.” Or words to that effect. I was dumbstruck.

But the problem is more of a general, rather than a local anesthetic. “There’s a crisis of competence coming down the pipe,” I was told, and then updated on the bleak reality, namely that the cream of Toronto’s medical establishment, many of them septuagenarians, will inevitably retire over the next three years, vacating hard-won roles built on international reputations for bona fide medical excellence. I thought back to the text message from my own doctor after my first-ever colonoscopy, during the 2020 pandemic. “You’re lucky: you got Dr. Ted Ross,” it said. It happens that Ross graduated from U of T in 1975, which makes him close to 70. I’m persuaded. So, the Vieille Garde is departing and their replacements — the New Equitarians — I am told will be mere shadows of their predecessors.

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My third source, like the first, is a Hamilton-Niagara region community doctor, and a seasoned teacher who also expressed profound disillusionment with the activism now entrenched in the physician recruitment and apprenticeship process, drawing on first-hand experience training young would-be doctors at one of the region’s top medical schools. This individual has a profound depth of lived experience — the only kind worth having — and has worked extensively with marginalized groups, including the impoverished in our inner cities and First Nations people — citizens endlessly harassed by the virtues and values projected on them by white, middle-class ideologues. On our video call, I was soon to be disabused yet further of the notion that Canadian medicine was in rude health.

Enumerating their concerns with the calm precision of the medical professional, this doctor confirmed that medical school admissions committees are indeed prioritizing candidates who espouse social justice mantras in their applications. Bearing in mind Sibarium’s story, and that I, too, have reported on the trajectory of U of T faculty in particular, to be wreathed in glory for pledging allegiance to DEI, this is, in hindsight, an inevitable development. Moreover, traditional Family Practice is suffering, largely because today’s newcomers are not wowed, in the slightest, by the prospect of handling countless white, lower- or middle-class patients presenting with tedious medical complaints. Why? Because there is little-to-no prospect for broadcasting their moral superiority, deepening their social justice values or thereby supercharging their careers. After all, working with the “unhoused” as overpaid social workers, and climbing in and out of tents with granola bars and juice boxes for groups such as the mentally ill, racialized minorities and untreated drug addicts, is where the virtue signalling is at its most attractive.

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Today, apparently, the academic cut-off for entry to the less urban Northern Ontario Medical School in Thunder Bay, Ont., is set at a 3.0 Grade Point Average. Yet no one talks openly about the “social” cut-offs. Anyone applying who isn’t white or heterosexual scores bonus points by dint of their ethnicity (for some), their sexuality (for a few more), and their gender identity (for many). Whereas a decade ago, these medical schools sought out prospective students born and raised in rural Canada in long-range hopes of their eventual return, today’s expectations now demand that incoming students “check their privilege” and are able to “reflect on the many ways they have experienced being an oppressor, or an oppressed member of society.” One nursing student reportedly quipped, “They kept wanting me to talk about my experiences of oppression as a Black person. But I was privileged: I had tennis lessons from age seven.”

Our conversation broadened to underscore the progressive evisceration of Canadian medicine, this last doctor warming to my Jenga tower analogy. It is true, they declared: there are pockets within medicine where the “first-do-no-harm” doctrine has been utterly obliterated. Consider, for instance, the field of addiction medicine, where the new orthodoxy has been to expunge the very words “addiction,” “treatment” and “recovery” from the medical lexicon when working with people who use drugs. Why? Because such words epitomize a language of white, Eurocentric dominance. But it is this self-same permissive Eurocentricity that insists drug users have rights to a clean drug supply and safe-injection spaces, unfettered from social norms — rather than charting a path to better health, independence and higher social functioning. “People are entitled to their euphoria,” I’m told, with an admirably expressionless conviction that makes me question whether they’re pulling my leg. The silence sprung from this ludicrous revelation hangs between us. The doctor sums up eloquently. What we are dealing with here is merely palliative care. In a nutshell it amounts to an ethnic cleansing of the lower socioeconomic classes, especially Indigenous Canadians, who are more at risk of succumbing to the perils of drug and alcohol abuse.

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What else did I learn from my academic triumvirate? Unsurprisingly, that pediatric gender medicine is another glaring gap. This second potentially fatal chink in the tower has been swiftly and robustly plugged in recent days by the American College of Pediatricians. But for Canadians, the collective amnesia over alarming leaked documents from the World Professional Association for Transgender Health (WPATH) and the widespread dismissal of the findings of England’s Cass Review are now amplified to comic proportions, making a mockery of attempts this side of the border to protect Canadian children from harmful gender ideology and medicalization. “Make no mistake,” I was warned. “Families are being destroyed here in Canada; children’s lives are being destroyed.”

I reflect on my three interviews. It turns out there are many other Jenga blocks being dislodged as accreditors and regulators take turns removing them. I hark back to Sibarium’s article and my first interview. Accreditors are looking to address perceived student mistreatment, claiming medicine embraces a culture of bullying and shaming, and mandating anonymous reporting systems to the point where medical faculty are now disinclined to give critical feedback. Apprentice doctors are being persuaded that obesity shouldn’t be considered a disease and that exhorting overweight patients to comply with dietary restrictions is no longer permissible. A cursory glance into continuing education among family doctors uncovers learning modules where it is impossible to avoid the intersectional clap-trap, as empitomized in a recent podcast by the Canadian College of Family Physicians. Even more gaps are poised to appear, the soon-to-vanish blocks etched with terms such as “geriatric medicine” and “end-of-life care.” The tower looks ever more precarious.

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“They will have big shoes to fill,” I say out loud, thinking of the current crop of physicians, and the superannuated crowd of world-class doctors they will soon displace.

“They will make their own shoes,” says my last guest.

Come election time, the next Canadian government will have to pivot quickly to save the Jenga tower from falling. It is essential we shore up our medical education system with a hard return to medical science before everyone is crushed by the impending collapse of competence. I can think of one practical solution: a Trudeau government might choose to slacken the criteria for medical assistance in dying. That would certainly do the trick, but no one in their right mind should vote for it.

Special to National Post

Leigh Revers is Associate Professor in the Institute for Management & Innovation at the University of Toronto.

leighrevers.com

leighrevers.substack.com/

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