UC Riverside

This dissertation is an examination of knowledge production and its legitimation in medical education. In this ethnography, I study an interdisciplinary faculty workgroup as they build a medical and health humanities program at the University of California, Riverside, from everyday academic practices of faculty and medical students, to programmatic and course development, and implementation. I explore the workgroup’s discursive practices of knowledge production, and its articulation with the relations of power inherent in biomedical power/knowledge.

Drawing from Foucault’s archaeologies/genealogies of power, and application of discourse analysis, I examine the effects of power embedded in social, cultural, and historical contexts to make visible what knowledges are authorized and what knowledges are marginalized in biomedicine’s discursive formations. I consider the social context of the workgroup’s discourse, its functions and meanings, and its positioning as it engages with biomedical discourse to decentralize, open space, and co-construct health and illness knowledges. I argue that the workgroup’s program development is an act of power that challenges empirical biomedical knowledge production in medical education.

Through observation of course implementation, I examine medical student practices that reify and resist both humanities, and biomedical discourse. And, the everyday ways medical students illustrate Foucault’s “docile” bodies as they enact biomedicine’s techniques of disciplinary power. I argue that the enactment of disciplinary techniques reifies biomedical knowledge authority over alternative knowledges. Conversely, considering medical students’ attitudes and behaviors toward biomedical measures of “competency”, I illustrate how biomedical discursive practices constrain their agency. I argue that through acts, attitudes, and beliefs that center their agency, students resist biomedicine’s techniques of power. While biomedical knowledges produce the doctors we need, it simultaneously limits potential for emancipatory discourses of care. I argue that medical training that forecloses alternative discourse of students, and knowledges is structurally violent.

This study contributes to current discourse in medical and health humanities that centers on integration of pluralistic knowledges and its operationalization. Giving attention to the ways in which discourse production in everyday practices can decentralized dominant narratives, this research contributes to understandings of how interdisciplinary knowledges of health expand perceptions of medical and health humanities knowledge praxis imaginaries.