Daphne Pereira points out that expanding the circle doesn’t mean shrinking or displacing anyone else.

__________________________________________

A colleague told me her son had not been admitted to medical school. “He’s just a white kid with good grades,” she said. I hear a similar refrain from others: “I guess diversity is more important than merit nowadays.”

The disappointment is real. So is the confusion underneath it. But this view reveals something worth examining carefully: a misunderstanding about what it means to center marginalized voices in health professions education, and why that misunderstanding is itself an ethical problem.

The concept of “centering” is prevalent throughout healthcare, and crucial for dispelling this confusion. Professionals typically implement patient- and family-centered care, that involves shared decision-making for a comprehensive care plan. Centering marginalized voices asks for similar structural shifts, applied to curricula and institutional design that were built without disabled and racialized perspectives.

Dedicated admission pathways for Black and Indigenous applicants, equity streams for applicants with disabilities, anti-racism curriculum commitments, and equity-focused hiring have begun to appear at some Canadian universities. When institutions announce initiatives that center marginalized groups including disabled students (identity-first language intentional), racialized faculty, or first-generation learners, some people in dominant groups may interpret it as a zero-sum arrangement: fixed resources, limited seats, someone displaced for someone else to be centered. It may feel like musical chairs.

Image Description: An AI generated image of colorful outlines of different people standing together, showing diversity and inclusion.

But this rests on a fundamental misreading of what centering requires. Centering is not about rotation or replacement. It is about a fundamentally different architecture, one where the center is not a fixed point but an expanding circle that makes room for more voices, more bodies, more ways of knowing. It is about recognizing that the current center was never whole.

Black educator and theorist bell hooks wrote about living on the edge, about seeing “from both the outside in and the inside out.” The margins are vantage points. A disabled student navigating systems not designed for them possesses knowledge that others often lack. A racialized faculty member recognizes structural patterns that others routinely miss. A first-generation professional understands institutional hidden rules precisely because they grew up outside them. We are asking institutions to treat what has been systematically ignored not as a personal story to sympathize with, but as essential knowledge, as expertise.

Physiotherapy educator Dr. Karen Yoshida’s work provides a practical blueprint for what centering marginalized voices requires. Yoshida asked disabled people what rehabilitation was missing and learned that care plans had been designed without the knowledge needed for community living. The lesson was not about sensitivity. It was about accuracy: centering disabled perspectives was a correction to a curriculum built without them. Real centering is structural. It is not adding a disabled person to a committee without changing how committees work or hiring racialized faculty without addressing racist culture. Centering requires asking: Who have we excluded? Why? What knowledge are we missing?

The ethical stakes reach patients directly. Research consistently documents that disabled people experience higher rates of preventable complications and inferior care because healthcare systems were not designed for their needs, and because most physicians report limited confidence in providing equal care to disabled patients. Racialized patients encounter medical racism that clinical training rarely equips graduates to recognize, a gap that health care workers across Canada, the UK, and the US identify as requiring curriculum reform. When health profession programs fail to integrate these perspectives, clinicians graduate without the knowledge a diverse population requires. This is a documented pattern of harm, not a theoretical concern.

Here is why my colleague’s comment misses the point: merit was never neutral. Admissions criteria and curricula have been designed by and for particular groups of people. Expanding what counts as legitimate knowledge is not a lowering of standards. It is a correction to a definition of competence that was always narrower than it needed to be. Her son will still need to demonstrate academic ability. But merit should measure what matters: the ability to think, learn, contribute, and care for a diverse population.

Health professions educators face a genuine ethical obligation here. Protecting a center defined without disabled people, racialized clinicians, or first-generation voices is not a neutral institutional choice. It is a decision to reproduce epistemic injustice, and its consequences are measurable in patient outcomes.

When the circle expands to hold multiple standpoints, multiple bodies, multiple ways of knowing, the center does not shrink. It transforms. Health professions education becomes more rigorous when it draws on the full range of knowledge available to it; the workforce becomes more equipped, the institution stronger. Centering is not about guilt or moral pressure. It is about recognizing that the current center was never the whole story. The circle can expand, not because institutions have unlimited seats, but because centering expands what counts as knowledge. There is enough space. We just have to stop protecting old boundaries and start building new ones, guided by those who have always known what the margins can teach.

__________________________________________

Daphne Pereira is the Academic Coordinator of Clinical Education at the School of Physiotherapy, Faculty of Health at Dalhousie University.