Maria Athina Martimianakis

Sociological interpretations of professionalism

Context  Professionalism is a hot topic in medical education, yet there is debate about what professionalism actually is. The reason is that medical educators primarily frame professionalism as a list of characteristics or behaviours. However, many sociologists of the professions favour more explanatory theories that incorporate political, economic and social dimensions into understanding of the nature and function of professionalism.

Cognition before curriculum: rethinking the integration of basic science and clinical learning.

Purpose Integrating basic science and clinical concepts in the undergraduate medical curriculum is an important challenge for medical education. The health professions education literature includes a variety of educational strategies for integrating basic science and clinical concepts at multiple levels of the curriculum. To date, assessment of this literature has been limited. Method In this critical narrative review, the authors analyzed literature published in the last 30 years (1982–2012) using a previously published integration framework. They included studies that documented approaches to integration at the level of programs, courses, or teaching sessions and that aimed to improve learning outcomes. The authors evaluated these studies for evidence of successful integration and to identify factors that contribute to integration. Results Several strategies at the program and course level are well described but poorly evaluated. Multiple factors contribute to successful learning, so identifying how interventions at these levels result in successful integration is difficult. Evidence from session-level interventions and experimental studies suggests that integration can be achieved if learning interventions attempt to link basic and clinical science in a causal relationship. These interventions attend to how learners connect different domains of knowledge and suggest that successful integration requires learners to build cognitive associations between basic and clinical science. Conclusions One way of understanding the integration of basic and clinical science is as a cognitive activity occurring within learners. This perspective suggests that learner-centered, content-focused, and session-level-oriented strategies can achieve cognitive integration.

Cracks and crevices: Globalization discourse and medical education

Globalization discourse, and its promises of a ‘flat world’, ‘borderless economy’ and ‘mobility of ideas and people’, has become very widespread in all fields. In medical education this discourse is underpinned by assumptions that medical competence has universal elements and that medical education can therefore develop ‘global standards’ for accreditation, curricula and examinations. Yet writers in the field other than medicine have raised a number of concerns about an overemphasis on the economic aspects of globalization. This article explores the notion that it is time to study and embrace differences and discontinuities in goals, practices and values that underpin medical competence in different countries and to critically examine the promises–realized or broken–of globalization discourse in medical education.

Humanism, the Hidden Curriculum, and Educational Reform: A Scoping Review and Thematic Analysis.

Background Medical educators have used the hidden curriculum concept for over three decades to make visible the effects of tacit learning, including how culture, structures, and institutions influence professional identity formation. In response to calls to see more humanistic-oriented training in medicine, the authors examined how the hidden curriculum construct has been applied in the English language medical education literature with a particular (and centering) look at its use within literature pertaining to humanism. They also explored the ends to which the hidden curriculum construct has been used in educational reform efforts (at the individual, organizational, and/or systems levels) related to nurturing and/or increasing humanism in health care. Method The authors conducted a scoping review and thematic analysis that draws from the tradition of critical discourse analysis. They identified 1,887 texts in the literature search, of which 200 met inclusion criteria. Results The analysis documents a strong preoccupation with negative effects of the hidden curriculum, particularly the moral erosion of physicians and the perceived undermining of humanistic values in health care. A conflation between professionalism and humanism was noted. Proposals for reform largely target medical students and medical school faculty, with very little consideration for how organizations, institutions, and sociopolitical relations more broadly contribute to problematic behaviors. Conclusions The authors argue that there is a need to transcend conceptualizations of the hidden curriculum as antithetical to humanism and offer suggestions for future research that explores the necessity and value of humanism and the hidden curriculum in medical education and training.

The world as the new local clinic: A critical analysis of three discourses of global medical competency

The effects of globalization on health are the focus of administrators, educators, policy makers and researchers as they work to consider how best to train and regulate health professionals to practice in a globalized world. This study explores what happens to constructs such as medical competence when the context of medical practice is discursively expanded to include the whole world. An archive of texts was assembled (1970-2011) totaling 1100 items and analyzed using a governmentality approach. Texts were included that articulated rationales for pursuing global education activities, and/or that implicitly or explicitly took a position on medical competencies in relation to practicing medicine in international or culturally diverse contexts, or in dealing with health issues as global concerns. The analysis revealed three distinct visions, representative of a primarily western mentality, for preparing physicians to practice in a globalized world: the universal global physician, the culturally versed global physician and the global physician advocate. Each has its own epistemological relationship to globalization and is supported by an evidence base. All three discourses are active and productive, sometimes within the same context. However, the discourse of the universal global physician is currently the most established. The challenge to policy makers and educators in evolving regulatory frameworks and curricula that are current and relevant necessitates a better understanding of the socio-political effects of globalization on medical education, and the ethical, political, cultural and scientific issues underlying efforts to prepare students to practice competently in a globalized world.

Medical education… meet Michel Foucault

There have been repeated calls for the greater use of conceptual frameworks and of theory in medical education. Although it is familiar to few medical educators, Michel Foucaults work is a helpful theoretical and methodological source.

Pressures to "Measure Up" in Surgery Managing Your Image and Managing Your Patient

Objective:To identify pressures created by surgical culture and social setting and explore mechanisms for how they might impact operative decision-making. Background:Surgeons apply judgments within a powerful social context and are constantly socialized and influenced by communicative exchanges. In this study, the authors characterized the nature of the surgical social context, focusing on the interactions between external social influences and the cognitive ability of the surgeon to respond to uncertain, unexpected, or critical moments in operations. Methods:The authors reviewed the sociological and psychosocial literatures to examine concepts in identity construction, socialization process, and image management literatures and synthesized a conceptual framework allowing for the examination of how social factors and image management might impact surgical performance. Results:The surgeons professional identity is constructed and negotiated on the basis of the context of surgical culture. Trainees are socialized to display confidence and certainty as part of the “hidden curriculum” and several sociocultural mechanisms regulating “appropriate” surgical behavior exist in this system. In the image management literature, individuals put on a “front” or social performance that is socially acceptable. Several mechanisms for how image management might impact surgical judgment and decision-making were identified through an exploration of the cognitive psychology literature. Conclusions:Sociopsychological literatures can be linked with decision-making and cognitive capacity theory. When cognitive resources reach their limit during critical and uncertain moments of an operation, the consumption of resources by the pressures of reputation and ego might interfere with the thought processes needed to execute the task at hand. Recognizing the effects of external social pressures may help the surgeon better self-regulate, respond mindfully to these pressures, and prevent surgical error.

Understanding the needs of department chairs in academic medicine.

Purpose The challenges for senior academic leadership in medicine are significant and becoming increasingly complex. Adapting to the rapidly changing environment of health care and medical education requires strong leadership and management skills. This article provides empirical evidence about the intricate needs of department chairs to provide insight into the design of support and development opportunities. Method In an exploratory case study, 21 of 25 (84%) department chairs within a faculty of medicine at a large Canadian university participated in semistructured interviews from December 2009 to February 2010. The authors conducted an inductive thematic analysis and identified a coding structure through an iterative process of relating and grouping of emerging themes. Results These participants were initially often insufficiently prepared for the demands of their roles. They identified a specific set of needs. They required cultural and structural awareness to navigate their hospital and university landscapes. A comprehensive network of support was necessary for eliciting advice and exchanging information, strategy, and emotional support. They identified a critical need for infrastructure growth and development. Finally, they stressed that they needed improvement in both effective interpersonal and influence skills in order to meet their mandate. Conclusions Given the complexities and emotional burden of their role, it is necessary for chairs to have a range of supports and capabilities to succeed in their roles. Their leadership effectiveness can be enhanced by providing transitional processes and supports, development, and mentoring as well as facilitating the development of communities of peers.

Understanding the Challenges of Integrating Scientists and Clinical Teachers in Psychiatry Education: Findings from an Innovative Faculty Development Program

ObjectiveMedical schools and departments of psychiatry around the world face challenges in integrating science with clinical teaching. This project was designed to identify attitudes toward the integration of science in clinical teaching and address barriers to collaboration between scientists and clinical teachers.MethodsThe authors explored the interactions of 20 faculty members (10 scientists and 10 clinical teachers) taking part in a 1-year structured faculty development program, based on a partnership model, designed to encourage collaborative interaction between scientists and clinical teachers. Data were collected before, during, and after the program using participant observations, surveys, participant diaries, and focus groups. Qualitative data were analyzed iteratively using the method of meaning condensation, and further informed with descriptive statistics generated from the pre- and postsurveys.ResultsScientists and clinicians were strikingly unfamiliar with each other’s worldviews, work experiences, professional expectations, and approaches to teaching. The partnership model appeared to influence integration at a social level, and led to the identification of departmental structural barriers that aggravate the divide between scientists and clinical teachers. Issues related to the integration of social scientists in particular emerged.ConclusionCreating a formal program to encourage interaction of scientists and clinical teachers provided a forum for identifying some of the barriers associated with the collaboration of scientists and clinical teachers. Our data point to directions for organizational structures and faculty development that support the integration of scientists from a wide range of disciplines with their clinical faculty colleagues.

Setting the standard: Medical Education's first 50 years.

By understanding its history, the medical education community gains insight into why it thinks and acts as it does. This piece provides a Foucauldian archaeological critical discourse analysis (CDA) of the journal Medical Education on the publication of its 50th Volume. This analysis draws upon critical social science perspectives to allow the examination of unstated assumptions that underpin and shape educational tools and practices.