The unequal making of clinicians: legitimation, participation, and cumulative disadvantage across the medical curriculum

Abstract

This study examines how ideas about ‘legitimate’ knowledge and participation are formed in Danish medical education, and how some students are disadvantaged in this process. Using Legitimation Code Theory and the concept of epistemic injustice, we analyse curriculum documents and interviews with 27 master's students from four medical schools. We find that the bachelor programme prioritises biomedical knowledge, while clinical training places greater emphasis on personal traits, social behaviour and conformity to professional hierarchies. Students describe experiences of being ignored, misunderstood or excluded, particularly in relation to gender, ethnicity and age. These experiences limit their opportunities to participate fully in learning and to be recognised as credible contributors. Such patterns create unequal learning conditions and hinder progression for some students. We argue that medical education would benefit from clearer accountability, broader educational priorities and more inclusive practices that support fair participation and learning for all students.