Outcome-based medical education (OBME) has become the dominant reform paradigm across health professions, promising transparency, equity, and accountability. Yet beneath its procedural appeal lies a deeper ideological transformation that curriculum theorists in education have long identified. This essay interprets OBME as a manifestation of neoliberal rationality, tracing how the managerial logic of New Public Management has reconstituted medical education as a domain of audit. Portfolios, milestones, and entrustment ratings—originally tools for formative assessment—now function as technologies of visibility through which learning is rendered measurable, comparable, and governable. Drawing on Foucault’s analyses of disciplinary power and governmentality, Lyotard’s concept of performativity, and Deleuze’s notion of societies of control, the paper situates OBME within a wider moral economy of measurement in which legitimacy derives from demonstrable performance rather than interpretive judgment. This critique is informed by a substantial body of curriculum theory—including the work of Biesta, Pinar, Aoki, and Schwab—that has long challenged the reduction of education to measurable outcomes. Empirical evidence reveals the ambivalence of this transformation: while OBME improves procedural reliability and institutional alignment, it has not demonstrated consistent improvements in patient outcomes or long-term professional competence, and ethnographic studies document assessment fatigue, instrumental learning, and erosion of professional identity. In contrast, longitudinal integrated clerkships exemplify pedagogical designs that preserve relational continuity, narrative coherence, and civic engagement—features largely invisible to audit metrics. The essay concludes that a post-neoliberal pedagogy must reclaim three neglected dimensions of professional formation: relationality, duration, and civic purpose. Such a reframing would preserve accountability while resisting epistemic reduction, restoring education’s capacity to cultivate judgment under uncertainty.
Aaron Lawson McLean (Thu,) studied this question.