Medical fetishism in education: gendering the ‘clinical’ metaphor

ABSTRACT

Teaching is increasingly called upon to become a clinical practice profession, like medicine. The term ‘clinical’ is used in a common-sense way to describe idealized teaching practice, as if universally understood to be a superior and desirable way to enact professionalism. Yet there is little in the literature that mounts a feminist critique of the cultural politics put to work through the word ‘clinical’ in education. We ask what it reifies and how it operates to firm up inequalities and binaries, especially in relation to the gendered concept of ‘mastery’, the unquestioning adoption of epidemiological-style evidence-based practice and the worship of masculinist data cults. We call for further work to explore how teachers both take up and resist the clinical label.

KEYWORDS:

• Clinical teaching
• evidence-based education
• discourse analysis
• feminism
• visible learning

Introduction: ‘Clinical’ as redundant … and yet not

The word ‘clinical’ has been increasingly used to describe degrees offered to prospective teachers by tertiary education providers, including the University of Glasgow and the University of Melbourne, for example. The latter’s Master of Clinical Teaching, for example, uses the word ‘clinical’ to refer to ‘well-defined’ evidence-based teaching practice (2011). Etymologically, ‘clinical’ comes from the Greek ‘klinikos’, related to a patient in bed, on an ‘incline’. In medicine, the word continues to refer to practice at the bedside, suggesting a power relationship between implied doctor and patient actors (Posen 2005; Janick and Fletcher 2009; McKnight and Morgan 2020). It also relates to the ‘clinic’ as a place, where ‘objective or standardized methods [are used] … to describe, evaluate and modify human behaviour’ (Merriam Webster 2017a). Commonly, ‘clinical’ is used to refer to an emotional state of being ‘coolly dispassionate’ (Merriam Webster 2017a). It is perhaps no surprise then, that a ‘clinical’ orientation is increasingly adopted across contemporary Western helping professions, in a larger paradigm of competition, measurements, numbers, benchmarks, datafication (Kitchin 2014) and dominant scientific rationality (Harding 1986); this is a climate less disposed to more ‘emotional’ versions of professionalism, such as those based on engendering hope (Groopman 2007) or compassion (Boyatzis, Smith, and Van Oosten 2019). In this article, we propose, though discursive analysis, that this preference, specifically enacted in the concept of ‘clinical teaching’, is gendered.

In relation to ‘clinical’ meaning working closely with patients or students, teacher education, at least in recent years, and across many universities, has always already been ‘clinical’, in the sense that large parts of it happen through practicums and internships in schools. Teachers learn to be teachers by working in classrooms, with students and practitioner supervisors. The concept of praxis, or theory enacted in practice, has a rich history in education since Paulo Freire’s (1972) work, informing teacher preparation courses and opportunities for critical reflection. What ‘clinical’ adds, when it might be argued to be redundant, is unclear.

This article is not a critique of valuable initiatives within clinical teaching courses, such as seeking closer relationship between universities and schools. Nor is it a personal attack on academics such as John Hattie, whose thinking around the nature of teaching is inevitably ever evolving (Knudsen 2017); Hattie has already distanced himself from some ways in which data-dominated systems have taken up his Visible Learning (2008) work, especially via explicit, ‘evidence-based’ learning intentions delivered to students in scripted and non-negotiable formats.

The article instead thinks with cultural theory, in particular Stuart Hall’s concept of the fetish, Sandra Harding’s feminist arguments against scientism, and Lakoff and Johnson’s insistence on the power of metaphor, to determine a gender politics of choosing to use this word. In relation to ‘scientism’ we mean, as per a dictionary definition (Merriam Webster 2017b), ‘an exaggerated trust in the efficacy of the methods of natural science applied to all areas of investigation (as in philosophy, the social sciences, and the humanities)’. We inflect this with Harding’s critique of claims that a dominant Western ‘science’ is superior to all other ways of knowing because it is purportedly objective, pure, neutral, unbiased and free of ideology. We resist taking any simplified position of claiming all quantitative research is ‘bad’, for example. All methodologies and methods have their uses, depending on the research questions being asked. Rather, we are interested in the dominance of the ‘clinical’ in education and have sought to unravel ideological resonances in educational use of this word, and posturings around what it is for. Proponents of clinical education sometimes deny medical links (Munro et al. 2016) so it would appear that there is no overt way that clinical teachers are like clinical doctors, despite the etymologically established medical origins of the word. There is more at work here.

We argue that the word ‘clinical’ does political work related to those medical origins of the metaphor (McKnight and Morgan 2020); it seems likely that this metaphor does have powerful effects of ‘affinity’ (Burn and Mutton 2015, 218) that link teachers and doctors intimately. We seek to demonstrate in this particular interdisciplinary article, following our close work with the literature, that the allure of the master in his white coat, looking through his lens, collecting his data … and profiting as an entrepreneur promises a particular kind of professionalism to teachers, and serves to fetishize the power of the clinical in contemporary educational contexts.

Our critical scholarship contributes an explicitly feminist analysis to the field of critique of scientism (the unquestioned adoption of scientific thinking and practice in all areas of life) in education and education research, and also beyond (Conrad 2007). While the limitations and threats of scientism in education have been passionately described in previous decades (see for example Hammersley 1997; 2001; St. Pierre 2006), scientism is today newly alive and well via the Visible Learning programme (Hattie 2008). This is an ‘evidence-based’ and male guru-led (Eacott 2017) approach which now dominates the educational discourse of at least 23 nations (Knudsen 2017).

Visible Learning, and its distillation into government-driven teaching standards in Australia (see Department of Education and Training 2017), requires teachers to comply with John Hattie’s compiled evidence for teaching effectiveness based solely on his meta-analysis of quantitative research in education, and to eschew their own beliefs or narratives (Hattie in Knudsen 2017). Hattie’s Visible Learning: A synthesis of over 800 meta-analyses (2008) is redolent with medical anecdote and metaphor, opening with the story of a medical team saving a young boy through precise testing, diagnosis and intervention (viii) as inspiration for teachers. We note that we are not the first to focus on the ‘clinical’ in education, which has also been critiqued as a colonizing and pathologizing project (Gale and Parker 2018), or on the medical/scientific in education (see for example Hammersley 1997; Eisner 1967/2017; 2001/2017; Biesta 2007). We work in an interdisciplinary partnership, with different motivating theory, however, which describes new gendered dimensions to this project.

Methods: thinking with theory

This is a conceptual article, that takes the metaphor of clinical education in education literature, and reads it through (Jackson and Mazzei 2012) the theories of scholars interested in the politics of language. We define this work as a political reading, in which, rather than coding texts, we have been alert to the ‘connectivities’ (Jackson and Mazzei 2012, 2) emerging between theoretical concepts and descriptions of clinical teaching. It is a feminist reading in that, as Sandra Harding says, we view gender as.

a fundamental category within which meaning and value are assigned to everything in the world, a way of organizing human social relations (1986, 57)

We are therefore interested in how meaning is assigned to teaching through the gendered metaphor of the ‘clinical’, and what is organized, socially and hierarchically, in the relations imagined and realized therein. We are alert to the productive power of discourse and the ways it is used in teacher education to reinforce hierarchies and imagine subjectivities (Chang-Bacon 2020), and also to position ‘the feminine’ professional as ‘other’ (Moratti 2020). Teachers are addressed by discourse in various pedagogical ways (Ellsworth 1997) that attempt to teach them how to be. Judyth Sachs (2003) has demonstrated how this understanding of the capacity of discourse to shape particular kinds of aspirational teacher identities can inform research. She sketches, in the early twenty-first century, contrasting activist and entrepreneurial figurative teachers, with the latter being individualistic, competitive, externally defined and standards-led.

We perceive strong echoes of this latter figure in the discourse of clinical teaching and seek to unpack the workings of the metaphor and identify more specific figurations. Margaret Thornton argues that such figures, within meritocratic professionalism in academia, are inevitably ‘constituted as gendered creations’ (2003, 127) who must ceaselessly strive to recreate themselves in the image of an idealized ‘benchmark man’. This is suggested by the endless teacher improvement of a University of Melbourne clinical teaching marketing video that exhorts ‘you can be a good teacher, but you can always be a better teacher’ if you adopt Hattie’s clinical model. We are interested in, metaphorically, who practices clinical teaching and the kinds of figures that materialize through the entailments (Lakoff and Johnson 1980) of the metaphor. We ask what these figures themselves represent and what kinds of gendered performativities (McKnight 2016) they invite for teachers.

Through asking these questions, and studying the literature of both our disciplines for affordances of the concept of clinical education (McKnight and Morgan 2019; 2020) we have also identified the way the ‘clinical teacher’ suggests five overlapping figures that are fetishized by education, but originate in, or are closely linked to medicine: the master; the doctor enacting evidence-based practice; the data-driven scientist; the omnipotent viewer and the competitive capitalist. These masculine figures, contemporary versions of the ‘quality cops and the science stormtroopers’ of earlier critique (St. Pierre 2006, 241). They are proliferations of ‘benchmark man’ (Thornton 2003, 127), the idealized, normative, competitive instrumentalist focused on audit, visibility and accountability. They enforce ‘your father’s paradigm’ (Lather 2004, 15) through their strict refusal to countenance other forms of evidence. They inhabit a neoliberal imaginary in which the preoccupations of each, whether control, precision, numbers, evidence or profits, are substitutes (Hall 1997) for admiring what is culturally inscribed as masculine (Grumet 1988).

This is Hall’s concept of the fetish – that something that seems harmless or neutral to look at (such as numbers) is a substitute for celebrating and enforcing something less politically correct (masculinist power). In this article, we seek to explain the process of identifying these figures to the reader, in the hope that our own approaches might inspire and inform more critical engagement with medical metaphor in education.

In the following section we describe in detail the theoretical resources that we are thinking with, in reading the literature around clinical education, and the specific affordances that each theorist offers this project. We then discuss the questions that each theorist’s work invites us to pose. We hope to provide other researchers with a broader understanding of the always-forming and contested nature of metaphor itself, of the intentions of the word ‘clinical’ and of the need to critically and creatively explore multiple ways we conceptualize and enact teachers’ work.

Concepts and resources

The fetish as useful concept

Fetishizing is a process of disavowal. Hall writes that ‘disavowal is the strategy by means of which a powerful fascination or desire is both indulged and at the same time denied’ (1997, 267). Drawing on Homi Bhaba, he describes the way disavowal allows for the embracing of an official, ostensibly progressive belief, while simultaneously upholding an archaic and secret one. It is a process of ‘looking and not looking’ (1997, 268), seeking a pleasure that can never be fulfilled. We borrow this concept to ask, when education focuses on and admires the ‘clinical’ with such fervour (McKnight and Morgan 2019), what is really being examined. Something is rejected, in the ‘domain of the careful gaze’ described so aptly by Foucault in The birth of the Clinic: An archaeology of medical perception (1989/2003, xiv). This medical gaze objectifies the patient and separates body and identity, just as quantitative educational research via RCTs and their attendant teacher guidelines separates students from their representations as data. Clinical teachers, rather than knowing their students, know what to do (University of Melbourne 2016). There are contradictory agendas operating here, one scientifically ‘modern’ and one that ‘articulates difference and division’ (Bhaba, cited in Hall 1997, 267) particularly in relation to gender.

We bring these questions to our reading of the literature around clinical teaching and ask who or what constitutes the origins of the gaze in education; we note our ocular-centric language here, but this usage is deliberate and relevant to the dominant visuality of the scientific practitioner in education (McKnight and Whitburn 2017). Above all, in this article, we have sought to explore who is, figuratively, doing the looking, and thereby the fetishizing of data above all else. We have tried to define the notionally progressive discursive figures who secure teachers’ hegemonic consent to what seems ‘commonsensical’ (Lazar 2007, 147): that better teaching is more ‘clinical’. The clinical metaphor simultaneously enacts differences and divisions, especially those organized by gender, that may benefit some more than others.

The science question in clinical teaching

Harding’s The Science Question in Feminism (1986) describes ‘the ways science is used in the service of sexist, racist, homophobic and classist social projects’ (21), for example through technologies that move control from women’s lives to men in dominant groups. The adoption of clinical metaphor in education might be understood to be one of these technologies, shifting power from teachers in a feminized profession (Apple 1986) to bureaucrats and data scientists who are predominantly male. Yet Harding also warns of believing in a pure science that may be used one way or another, independent of social constructs. Science, she argues, is always a social construct. She discusses reading a text ‘to reveal the social meanings – the hidden symbolic and structural agendas – of purportedly value neutral claims and practices’ (23) and then specifically draws attention to the ways metaphors related to gender politics ‘continue to shape the cognitive form and content of scientific theories and practices, even when they are no longer overtly expressed’ (27). We propose the clinical metaphor in education to be one of these purportedly neutral agents and seek to identify what it allows to form in a contemporary educational imaginary.

The politics of metaphor

Lakoff and Johnson (1980) provide useful resources for the study of metaphor, despite critique of their own shortcomings in relation to sexual politics (Altman 1990; McKnight and Whitburn 2018). They emphasize, in a manner synergistic with Hall’s fetish theory, how metaphors both highlight and hide (10) and how they expose values embedded in cultures (22) and beyond this, also work to shape social and political realities (159), as Harding describes. They attest to the power of metaphor as ‘a guide for future action’ (156), such that a ‘clinical teacher’ driven by the desire to be a clinician may behave differently from a ‘teacher’ imagining the role differently. They provide insights into the function of entailments (156), or ideas attached to a metaphor, that are intrinsic to how a metaphor operates. We investigate, therefore, the entailments of the clinical metaphor in education and what they make coherent about the subject addressed as the clinical teacher.

Locating ourselves in this work

As a medical doctor and a doctor of educational philosophy writing together, we share knowledge of our separate disciplines and literatures. Writing in an interdisciplinary partnership enables deep expertise in more than one area and, particularly for Lucinda as an education scholar, inoculation against the intimidatory and bullying powers of medical discourse (McKnight and Morgan 2019) which may lead to the failure to engage critically with its effects.

Together we draw on theoretically informed language analysis to assess how discourse can be used in an attempt to structure ‘socially embedded, unconscious expectations of how the world will work, to reaffirm social locations, perceptions and benefits of privilege’ (Mackey 2014, 242). We are both interested in how calls to professionalism in both our disciplines often seem to rely on recourse to a limited masculinist and positivist version of what science even is (Harding 1986; Shiva). As educators of medical registrars and pre-service teachers we are concerned not only about what kinds of professionals this produces, but also about what is shut down in the process.

Findings and discussion: figures taking shape

We have searched for and read literature describing clinical teaching programmes in education, and also materials promoting them. We have kept in mind an understanding of addressivity, that any ‘word in living conversation’ (Bakhtin 1981, 280) orients itself towards an answer, both articulating and seeking a response. Through this process ideology becomes embedded in metaphor, and metaphor seeks to shape the world. For example, the word ‘clinical’ addresses potential teachers and hopes that the student undertaking a masters in ‘clinical education’ accedes to becoming a clinical teacher, or even enthusiastically embraces the label.

This is not, however, such a simple process as Louis Althusser’s (1971) theory of interpellation might suggest. He describes the way subjects are created through bring ‘hailed’ or ‘interpellated’, meaning that they are addressed, and in recognizing themselves, or a desirable version of themselves, in the address, they become identified as a target, or subject of discourse. As both Ellsworth and Sachs have argued, identity is formed through discursive address which invites the taking up of exhortations to particular kinds of performance. Judith Butler (1997) has complicated this, however, by emphasizing the iterative nature of interpellation. By being addressed over and over again as a clinical teacher, the contours of this teacher are created in space and time. Yet at the same time, this opens up possibilities to speak back.

As Butler says, ‘one is not simply fixed by the name one is called’ (1997, 2). While we set out originally merely asking what is achieved though invoking the metaphor of clinical teaching, in line with our guiding theory, we found our notes taking shape as five figures notionally addressed by the clinical metaphor: the master, the medical doctor implementing evidence-based practice; the data-driven scientist: the omnipotent viewer and the competitive capitalist. We suggest these figures as propositions put to teachers, not as definitions of them, as we recognize discourse’s capacity to both constrain and enable.

The following figures assemble from our reading as overlapping or merging to define the idealized clinical teacher; they are loosely structured and yet interdependent. We problematize them in this discussion by suggesting their limitations, based on the theories of Hall, Harding, Lakoff and Johnson, and others, and also by drawing on medical literature that explores what the concepts of clinical teaching and evidence-based practice afford medicine. We do not present these figures as fixed versions of teachers or suggest that the calls to subjectification made by these figures are necessarily complied with.

We do, however, believe that teachers need to negotiate these calls in establishing their own professional identities and that there is value in determining who stands to benefit through acquiescence. At ‘the intersection of activities, judgements, emotions and desires … teachers are produced as particular kinds of professionals [emphasis in original]’ (Zembylas 2005, 37): the following figures form at this junction to promise a particular kind of professionalism and attempt to articulate and secure particular forms of response. The appeal of these figures attempts to ensure that heterogeneity is ‘masked by attributions of a unified, or standard ‘teacher identity, as in certain disciplining conceptions of ‘professionalism’ (37).

1. The clinical teacher as master

The literature around clinical teaching invokes the gendered concept of ‘masterliness’ (McLean Davies et al. 2013, 93), a term that ignores feminist calls for inclusive language in education, for language that does not position female subjects as inferior (Gilbert 1994). Clinical teachers become masters of their trade, executing their labour in a way superior to mere ‘teachers’. Yet the assumed neutrality of a word like ‘master’ is surprising. ‘Master’ has long been an issue for feminists, an example of the ‘semantic derogation of women’ (Spender 1980/1985, 16) in that it is a word that has a negative female version, the sexualized ‘mistress’. It has been several decades now since Spender’s work on Man Madeade Language (1980/1985) with its argument that the use of a symbol culturally encoded as male promotes the visibility and primacy of males at the expense of women (153). It seems an extraordinary postfeminist move to resurrect this term uncritically; for all the discussion of the tensions around the clinical metaphor (McLean Davies et al. 2015, 515), the gendered binary of superior/inferior inherent in ‘masterliness’ is not acknowledged. Can this term be taken over by women, or those of non-binary genders, and re-purposed for diverse teachers? We argue, along with Spender, that the use of such terms perpetuates the ‘male as norm syndrome’ (2), and that by using the term, those of non-male genders perform acquiescence to disadvantageous gendered binaries, rather than investing language with new meaning, or finding new forms (5).

In this case, the figure of master clinical teacher potentially restricts entry to a symbolic order of professional competence defined as a masculine domain. Whether or not this is the case, the language used calls on teachers to be masters, and fetishizes masculine power. This is what is actually being relished, and dwelt upon, in the guise of the expert. Such teacher-masters may ostensibly be especially efficient, or more proximal to the classroom, but in fact represent fetishized masculine power, and simultaneously, feminine submission, through the iterative performance of a gendered binary every time the word is used. Flipping the binary is always handy to demonstrate this: the masterly teacher is an entirely different figure from the mistress-ish one.

• 2. The clinical teacher as doctor

The literature around clinical teaching often mentions its antecedents in medicine, as well as sometimes denying them. The invocation of the medical here is no coincidence; as an enclave of male power, the medical profession has ‘a unique and frequently unquestioned position as “authority”’ (Spender 1980/1985, 172). Teacher education, on the other hand, is culturally classed as women’s work (Grumet 1988). Perhaps the clinical is therefore invoked as resistance to a threatened, and indeed actual in England, ‘symbolic annihilation of university-based teacher education labour’ (Spencer 2013, 309), with ‘clinical’ teachers, as opposed to regular workers in the feminized profession of teaching, empowered by masculinist authority.

Clinical teaching requires the unquestioning adoption of evidence-based practice and assumes that ‘teachers who use a specific form of evidence-based, diagnostic, interventionist teaching have a positive effect on learning outcomes’ (McLean Davies et al. 2013, 93). Ironically, this effect has not yet been demonstrated by evidence (Burn and Mutton 2015). This leads us to ask what is going on via the adoption of the clinical metaphor, and its entailments of evidence-based practice and statistical expertise, especially when evidence-based medicine is said to be in crisis (Greenhalgh, Howick, and Maskrey 2014). In medicine, assumptions about incentivising compliance with evidence-based practice also informed the UK’s £1bn Quality and Outcomes Framework (QOF) for doctors. This intervention has now been shown to have had minimal impact on mortality (Ryan et al. 2016), but to have undermined professional autonomy, compromised patient care and increased administrative burdens and work stress (Russell 2015; Roland and Guthrie 2016).

Importing evidence-based practice from medicine wilfully ignores this ‘crisis’ (Greenhalgh, Howick, and Maskrey 2014) in the evidence-based movement in medicine, and thereby enacts the way a fetish is indulged (a preoccupation with doctors) and denied (failing to engage with actual issues in the field). Evidence-based practice has not been welcomed with open arms by the medical profession (Weatherall 2014) and is also much critiqued for:

• being audit driven and technocratic.

• devaluing tacit knowledge.

• the crushing volume of evidence that must be considered.

• being evidence rather than patient-driven.

• using too many algorithms, rules and templates

• its inability to cope with complexity (in medical terms, multimorbidity, and in education terms, intersectionality would be an appropriate substitute)

• the distortion of evidence by vested interests (Greenhalgh, Howick, and Maskrey 2014).

Yet teachers are still called upon to be clinical practitioners enacting evidence-based medical-style practice. Medicine itself here is being looked at, and yet not looked at. It functions as a symbolic imaginary of power, represented by the white-coated expert, but divorced from the messy debates happening in the discipline. The longing for masculine power, for phallic authority and status, supersede a critical engagement with clinical practice in medicine. Scientism reigns supreme.

This subterfuge needs to be acknowledged and addressed in education, with the ways medical authority aligns with corporate interests being particularly prescient in relation to publishers and data companies’ increasing inroads into multiple aspects of school education, and potentially, into teacher education.

• 3. The clinical teacher as statistician

Clinical teachers are addressed as experts in the use of data and evidence to drive interventions into learning (McLean Davies et al. 2013, 93). Yet data are treated as neutral in the clinical education literature, as benign entities from pure science. Again, this can be understood as a form of fetish, of looking hungrily at the data for imperatives for practice, yet failing to acknowledge the power at work through them. Data, as a gendered and masculinist construct (Spender 1982), need to be treated critically; clinical teaching discourse, however, also enacts the fetishization of data through the masculinized terms that shape its deployment (‘tools’, ‘toolkits’, ‘impacts’, ‘rankings’, ‘effects’, ‘HITs’ [high impact teaching strategies], ‘measures’, ‘mastery’ and so on). For the clinical teacher, data must be dealt with ‘rigorously’ (Kriewaldt and Turnidge 2013, 110) and obeyed to achieve the holy grail of ‘what works’ (Biesta 2007, 1). This word, ‘rigorously’ used throughout the literature, exhorts an eager and vigorous (but not critical) frottage of data, a delight in severity, strictness and harshness, and in the linearity of cause and effect.

Meanwhile, the public is warned that ‘education at universities has been in the world of sociology rather than in the harder sciences’ (Singhai 2017) and that this must be corrected, reinforcing the gendered hard/soft binary. In universities, feminist researchers have humorously but pointedly claimed that ‘real’ researchers are meant to collect only ‘hard’ data (Gherardi and Turner 1987). ‘Rigor’ means to ‘be stiff’ (Merriam Webster 2019). We wonder if ‘clinical’ teachers, required to examine spreadsheets and base all pedagogical decisions on numerical data, are actually performing compliance with regimes of authoritarian power (McKnight 2016), as statisticians proficient in the hard, masculine world of numbers.

A preoccupation with the word ‘data’ in educational discourse (Kitchin 2014), when teachers have always collected information about students through various forms of assessment, also ignores the scandals around dirty data in medicine, and data’s manipulation by commercial interests in medical evidence-based practice (Greenhalgh, Howick, and Maskrey 2014). It ignores the limits of randomized controlled trials and their resulting national guidelines, which have been shown to impede patient care (Roland and Guthrie 2016) when followed too strictly. An appeal to data is an appeal to science, and to masculinist authority, in effect, a bullying stratagem that silences those who value other ways of knowing. This appeal glosses over or attempts to licence the absence of critique. Data are never neutral, but instead ‘framed technically, economically, ethically, temporally, spatially and philosophically’ (Kitchin 2014, 23). Data are always selected, selective and driven by rhetoric. This understanding needs to be at the fore of any kind of evidence-based practice, so it is framed as just one way to operate, not the way.

• 4. The clinical teacher as omnipotent viewer

The clinical teacher is an ‘interventionist practitioner’ (McLean Davies et al, 93) who knows (based on data), sees (data) and acts (guided by data), in ‘conditions of visibility and accountability’ (Schulman 2005, 11). This figure takes the epistemological stance that was is known is what can be seen and counted. Preoccupations with this figure therefore ignore or debase what is tacit, in favour of an illusion of absolute control. Clinical teaching in higher education is predicated on perceived needs for ‘penetrating the often closed classroom door’ (Dinham 2012, 9) and ‘probing conversations’ (Kriewaldt and Turnidge 2013, 106) in which teachers must explain themselves.

These phallogocentric metaphors intensify the masculinist thrust of clinical discourse. They demonstrate how the desired wholesale ‘deprivatisation’ (Kriewaldt and Turnidge 2013, 105) of teaching via the clinical metaphor, equates it, as a feminized profession, with the mystery of ‘woman’, and in medical terms, with women’s sexuality. This medical notion of woman as mystery to be penetrated was denounced as patriarchal by second wave feminism (Greer 1971, 39) yet it is unashamedly reproduced through the discourse of clinical education. It is also evident in the subtext of Foucault’s archaeology of the clinic, in which the mysterious patient becomes ‘endlessly open’ (1989/2003, xx) to medical knowledge.

Meanwhile, research has suggested the productive impossibilities of articulating practice (Sellar 2009), positing good reasons for teachers’ inability to, at times, articulate explanations for their teaching. The clinical teacher as all-seeing and all-knowing makes recourse to masculinist mores, to abjectify what is culturally constructed as feminine, or cast it as unacceptable, in the dark (with attendant racial meaning). Teaching, in the clinical mode, must be stripped bare and exposed to surveillance in the governmental regimes of neoliberal education.

The master of clinical teaching at the University of Melbourne uses a diagnostic tool to analyse teachers’ performance, recording and datifying every word they say, generating infographics to represent, for example, words per minute (University of Melbourne 2017), as if this is what practice can legitimately be reduced to: a measurable object of scrutiny for science, the kind of project critiqued by Foucault (1989/2003). Aspects of teaching that are relational, emotional, affective or intuitive are further abjectified by clean, precise, exact, perfect visibility. Yet what is visible is only ever what is able to be perceived, by a figure discursively embodied as white, male, rational, scientific and able bodied. The clinical teacher as omnipotent viewer takes up a scopophilic position via the masculine power described by Hall, adopting a way of looking that eroticises control, with pleasure to be found in subjugating what must be explicitly revealed, whether by students or teachers (McKnight and Whitburn 2017).

• 5. The clinical teacher as competitive capitalist

Teacher identities have previously been discursively recognized as multiple with teachers in pre service courses encouraged to think about their own professional identities as both unique and socially constructed. Judith Sachs, for example, writes of entrepreneurial teacher identity emerging from managerialist discourse and activist identity emerging from democratic discourse, but teachers not necessarily locating themselves with either (2003). Teachers have been able to formulate their own ideas about how they would like to be perceived as teachers, as they negotiate university and school demands and experiences; this has changed, however, as neoliberalism attempts to position them more trenchantly (Doecke and McKnight 2003). The clinical teacher graduate is branded, much like Sach’s entrepreneurial teacher, as controlling, regulative and led by standards. We already know this contracting of professional identity into compliance is part of the hidden agenda of medical clinical education (Lempp and Searle 2004) yet this has not been discussed in education’s translation of the metaphor.

This branding occurs in the context of a suite of products, including visible learning (Hattie 2008), that make pseudoscientific (Bergeron 2017) claims to superior outcomes, based on limited, solely quantitative data. The adulation of science glamorizes these proprietary impulses in education and promotes the cult of the scientific guru (Eacott 2017). In both clinical teaching and visible learning teachers are chastised for critiques and whipped into alignment, or they risk being branded as unprofessional teachers (McKnight 2016). The romanticising of ward rounds, in which ‘everyone is visible, nobody could hide’ (Schulman 2005, 5) in the education literature demonstrates how routinized and standardized, evidence-based ways of acting can be idealized: reviewing all the literature on ward rounds from 2000 to 2014 (Walton et al. 2016) shows they involve abuses of power and silencing of patients. While education might long to adopt the ward round as part of medical branding, this desire simultaneously denies the messy realities of actual medicine, and its desires, ironically, to be more like constructivist education, especially in relation to teaching (McKnight and Morgan 2019). Or perhaps it could be argued that educators are actually importing the hierarchies of medicine but disguising them as efficiencies and scientific rigour to shore up pseudoscience.

The branded clinical teacher and the branded clinical university academic, in a competitive marketplace, may both be loath to publicly engage with (and thereby disseminate) critiques of both clinical teaching and evidence-based medicine. The ‘clinical teacher’ as competitive capitalist must retain some leverage over the mere ‘teacher’ or lose a competitive edge in the marketplace. The clinical teacher’s worth, therefore, is linked to the denial of reflexivity and the ardent support of entailments validating the metaphor.

Conclusion: the absence of critique

We wonder at the absence of politically critical reflexivity around the gendered metaphor of clinical teaching and the statements it makes. We have sought to further the study of the disciplinary work in which scientific metaphor engages (McKnight and Whitburn 2017), specifically in relation to what is both accommodated and denied (Hall 1997), and in relation to feminist critiques of the positivist science (Harding 1986) integral to the clinical metaphor. We suggest that this recursive educational appeal to authority via scientific discourse, echoing appeals of the early twentieth century and post WWII eras, is a product of neoliberal dominance in education under late capitalism. This appeal is made as humans experience another industrial (data) revolution (Kitchin 2014) and a time of uncertainty following the turn of the century.

Scientism also forms a convenient response to upheavals such as the 2008 global financial crash, the twin populist shocks of 2016s Brexit and Trump and the COVID pandemic during which the power of science (and in particular epidemiology) has become ever more worshipped. Simultaneously, the development of platform capitalism has transformed labour markets, and AI advances rapidly, threatening even more disruption. In this era of disorder, when truth and certainty are under threat, ‘clinical teaching’ attempts to reinforce hierarchies, to keep people in their places, to homogenize epistemologies and to validate authoritarian regimes of data collection and analysis. ‘Clinical teaching’s proponents deploy it as a potentially normalizing force that hitches a feminized profession to the masculinist and patriarchal constructs of medicine. The ‘clinical’ metaphor offers a hidden curriculum of seductive, overlapping and intermingling teacher figurations imbued with masculinist power: the master, the doctor, the omnipotent viewer, the statistician and the competitive capitalist. We call for further critical engagement and empirical work to explore how teachers might take up and resist these subjectivities.

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Additional information

Notes on contributors

Lucinda McKnight

Lucinda McKnight is a research fellow at Deakin University, Melbourne. She is also a qualified health and fitness professional. She has a published track record of research in the use of scientific metaphor in education.

A. Morgan

Andy Morgan is a British Australian medical doctor and adjunct senior lecturer in general practice at Monash University, Melbourne. He has an MA in Clinical Education from the Institute of Education, UCL, London. His research interests are in consultation skills and patient-centred care. He is a former fellow of the Royal College of General Practitioners, and current fellow of the Australian Royal College of General Practitioners.