Caragh Brosnan

Making sense of differences between medical schools through Bourdieu’s concept of ‘field’

Medical Education 2010: 44: 645–652

The consequences of authentic early experience for medical students: creation of mētis

Context  Authentic early experience (AEE) describes experiences provided to new medical students to undertake ‘human contact’ to enhance learning. Although the concept of AEE is not new, and was commonplace prior to the Flexner Report of 1910, little is known about how or why meaning and knowledge are constructed through early student placements in medical, social and voluntary workplaces. Variance among settings means AEE is a collection of non‐uniform, complex educational interventions which require students to make repeated transitions between different workplaces and their university institution. The purpose of this paper is to develop theory in this context.

Authentic early experience in Medical Education: a socio-cultural analysis identifying important variables in learning interactions within workplaces

This paper addresses the question ‘what are the variables influencing social interactions and learning during Authentic Early Experience (AEE)?’ AEE is a complex educational intervention for new medical students. Following critique of the existing literature, multiple qualitative methods were used to create a study framework conceptually orientated to a socio-cultural perspective. Study participants were recruited from three groups at one UK medical school: students, workplace supervisors, and medical school faculty. A series of intersecting spectra identified in the data describe dyadic variables that make explicit the parameters within which social interactions are conducted in this setting. Four of the spectra describe social processes related to being in workplaces and developing the ability to manage interactions during authentic early experiences. These are: (1) legitimacy expressed through invited participation or exclusion; (2) finding a role—a spectrum from student identity to doctor mindset; (3) personal perspectives and discomfort in transition from lay to medical; and, (4) taking responsibility for ‘risk’—moving from aversion to management through graded progression of responsibility. Four further spectra describe educational consequences of social interactions. These spectra identify how the reality of learning is shaped through social interactions and are (1) generic-specific objectives, (2) parallel-integrated-learning, (3) context specific-transferable learning and (4) performing or simulating-reality. Attention to these variables is important if educators are to maximise constructive learning from AEE. Application of each of the spectra could assist workplace supervisors to maximise the positive learning potential of specific workplaces.

‘Quackery’ in the Academy? Professional Knowledge, Autonomy and the Debate over Complementary Medicine Degrees

In 2012, the group ‘Friends of Science in Medicine’, mostly comprising academic doctors and scientists, lobbied to remove teaching in complementary and alternative medicine (CAM) from Australian universities. Seemingly inspired by an earlier UK-based campaign, the group approached vice-chancellors and the media, arguing that CAM degrees promoted ‘pseudo-science’ and ‘quackery’. Although epistemological disputes between biomedicine and CAM are well documented, their emergence in a higher education context is less familiar. This article explores the position-taking of those on each side of the debate, via a thematic analysis of stakeholders’ views as reported in news articles and other outlets. Bourdieu’s concepts of capital and autonomy are used to sketch out the stakes of the struggle. It is argued that the debate is significant not only for what it reveals about the current status of CAM professions in Australia, but for what it suggests more broadly about legitimate knowledge in the university.

Regional Influences on Chinese Medicine Education: Comparing Australia and Hong Kong

High quality education programs are essential for preparing the next generation of Chinese medicine (CM) practitioners. Currently, training in CM occurs within differing health and education policy contexts. There has been little analysis of the factors influencing the form and status of CM education in different regions. Such a task is important for understanding how CM is evolving internationally and predicting future workforce characteristics. This paper compares the status of CM education in Australia and Hong Kong across a range of dimensions: historical and current positions in the national higher education system, regulatory context and relationship to the health system, and public and professional legitimacy. The analysis highlights the different ways in which CM education is developing in these settings, with Hong Kong providing somewhat greater access to clinical training opportunities for CM students. However, common trends and challenges shape CM education in both regions, including marginalisation from mainstream health professions, a small but established presence in universities, and an emphasis on biomedical research. Three factors stand out as significant for the evolution of CM education in Australia and Hong Kong and may have international implications: continuing biomedical dominance, increased competition between universities, and strengthened links with mainland China.

Enacting the ‘neuro’ in practice: Translational research, adhesion and the promise of porosity

This article attends to the processes through which neuroscience and the neuro are enacted in a specific context: a translational neuroscience research group that was the setting of an ethnographic study. The article therefore provides a close-up perspective on the intersection of neuroscience and translational research. In the scientific setting we studied, the neuro was multiple and irreducible to any particular entity or set of practices across a laboratory and clinical divide. Despite this multiplicity, the group’s work was held together through the ‘promise of porosity’ – that one day there would be translation of lab findings into clinically effective intervention. This promise was embodied in the figure of the Group Leader whose expertise spanned clinical and basic neurosciences. This is theorized in terms of a contrast between cohesion and adhesion in interdisciplinary groupings. We end by speculating on the role of ‘vivification’ – in our case mediated by the Group Leader – in rendering ‘alive’ the expectations of interdisciplinary collaboration.

Some like it hot: medical student views on choosing the emotional level of a simulation

Medical Education 2011: 45: 354–361

Experiences of medical students who are first in family to attend university

Students from backgrounds of low socio‐economic status (SES) or who are first in family to attend university (FiF) are under‐represented in medicine. Research has focused on these students’ pre‐admission perceptions of medicine, rather than on their lived experience as medical students. Such research is necessary to monitor and understand the potential perpetuation of disadvantage within medical schools.

Epistemic cultures in complementary medicine: knowledge-making in university departments of osteopathy and Chinese medicine

ABSTRACT There is increasing pressure on complementary and alternative medicine (CAM) to follow the evidence-based approach promoted in allied health and medicine, in which the randomised control trial represents the evidence gold standard. However, many CAM advocates see these methods as undermining the holism of CAM practice. This paper explores how such tensions are managed in CAM university departments – settings in which particular forms of knowledge and evidence are given ‘official’ imprimatur by CAM educators and researchers. By comparing two types of CAM, the paper also unpacks differences within this broad category, asking whether CAM academic disciplines comprise different ‘epistemic cultures’ (Knorr-Cetina, K. (1999). Epistemic cultures: How the sciences make knowledge. Cambridge, MA: Harvard University Press). Interviews were conducted with 20 lecturers in Chinese medicine and osteopathy, across five Australian universities, and augmented with observation in two degree programs. Findings reveal contrasting ontological and epistemological perspectives between the two academic fields. Chinese medicine lecturers had largely adopted bioscientific models of research, typically conducting laboratory work and trials, although teaching included traditional theories. Osteopathy academics were more critical of dominant approaches and were focused on reframing notions of evidence to account for experiences, with some advocating qualitative research. The study illustrates CAM’s ‘epistemic disunity’ while also highlighting the particular challenges facing academic CAM.

Some like it hot: Medical student views on choosing the emotional level of a simulation

Medical Education 2011: 45: 354–361