'Being on Both Sides': Canadian medical students' experiences with disability, the hidden curriculum, and professional identity construction

Abstract

Purpose Medical students with disabilities hold firsthand knowledge as health care recipients, yet face barriers to disclosure and support. Their experiences provide a unique lens for understanding professional identity construction; this study explored how disabled medical students experience training as both patients and trainees. Method The authors conducted qualitative interviews with 10 medical students at the University of Toronto Faculty of Medicine with self-identified disabilities. They performed textual analysis of documents concerning medical student wellness from 13 Canadian universities, including policies, student services, and student blogs (July 2016 to March 2017). Using principles of critical discourse analysis, the authors coded the interviews and texts to identify operating discourses and core themes, drawing from sociocultural theories of professional identity construction and the hidden curriculum. Results Two dominant discourses emerged from the interviews and texts, revealing institutionalized notions of the perceived "good student" and "good patient." These roles held contradictory demands, demonstrating how institutions often implicitly and explicitly framed wellness as a means to optimal academic performance. Two additional themes, "identity compartmentalization" and "identity intersection," captured students' experiences navigating identities as patients and trainees. Although students lacked explicit opportunities to express their expertise as patients in the formal curriculum, their experiences in both roles led to improved communication, advocacy, and compassion. Conclusions Institutional discourses around disability and academic performance hold material implications for curricular content, clinical teaching, and availability of supports in medical school. By repositioning students' experiences with disability as sources of expertise, this study highlights opportunities for teaching compassionate care.