عنوان

The institutional apprenticeship of medical students in a London medical school.

TLets482051

The institutional apprenticeship of medical students in a London medical school.

[Thesis]

Sinclair, Simon Keith.

London School of Economics and Political Science (University of London)

1996

Ph.D.

London School of Economics and Political Science (University of London)

1996

The thesis provides an account of the basic medical training in England, largelyunchanged for 150 years despite many calls for reform. The three stages (preclinicaland clinical period and the pre-registration year) that students pass through aredescribed in terms of acquired professional dispositions, with historical, cultural(including linguistic) and epistemological aspects; the dramatic aspects of dispositionsgive rise to a series of roles acquired through practice. Acquisition of theseprofessional dispositions is fostered by students' aspirations and the general culture ofco-operation, rather than by the simple explicit transmission of professional values,knowledge and skills, or a lowly and autonomous group "making out". The medicalschool and teaching hospital are therefore seen as acting in many ways like a "totalinstitution", their segmentation being held together by students in practice, as well ascognitively and financially.Teaching and assessment of these roles leads, through their linguistic component(whose precise physical referents reflect the associated positivist epistemological baseand its certainty) and dramatic features, to the stable reproduction of medicalknowledge and is associated with the internal stability of the profession and of itsrelation to others. The resulting low status attached to academic disciplines (notablypsychology and sociology) and branches of medicine (notably psychiatry) tends tolimit awareness within the profession of the discordance within and betweendispositions and between roles.The high rates of mental illness within the profession may be seen as related tosuch internal psychological conflicts; these lead, in effect, to classifying sufferers asindividual psychiatric patients and so "blaming the victim". For this reason alone, itis most unlikely that students and junior doctors can effect any change in the systemof training; other factors that contribute to the system's stability are discussed

Medicine

Sinclair, Simon Keith.

London School of Economics and Political Science (University of London)

p

[Thesis]

276903

a

Y