Key Literature in Medical Education Podcast Review
Reviewer: Linda Snell
Date broadcast:
The dual nature of medical enculturation in postgraduate medical training and practice Reference:
Jill Gordon1, Pippa Markham1, Wendy Lipworth1, Ian Kerridge1, Miles Little1. The dual nature of medical
enculturation in postgraduate medical training and practice. Med Educ. 2012 Sept;46(9):894–902.
Author Institutions:
1
Centre for Values, Ethics and the Law in Medicine, Faculty of Medicine, University of Sydney, Sydney,
New South Wales, Australia
PubMed URL
Tags
Clinical domain
Professional
Educational domain
Educational research
Residency
Background
Organizational enculturation is ‘the process in which newcomers learn how to get
things done’ and develop the values of the profession. Little is known about
enculturation into the profession in the postgraduate / residency years.
In interviews done for another study on values-based medicine as an approach to
health care some statements suggested participants were aware of processes of
enculturation
Purpose
To examine the interview transcripts from a previous study of doctors’ professional
and personal values, to identify specific aspects of their experiences to help
understand the enculturation processes
Type of paper
Research: Qualitative, based on interviews
Key Points on the Methods
22 participants, purposive sampling, recruited by snowball approach, wide range of
demographics, specialty, practice. Semi structured interviews by 2 interviewers.
Asked to “describe episodes that had stayed in their minds because of their moral
dimensions, to reflect on the influence of colleagues, patients, educational programs
and health services. Participants were not asked specifically about their experiences
of enculturation, but relevant statements began to emerge throughout the
interviews.”
Data analyzed qualitatively using dialectical empiricism to categorize themes and
concepts
Key Outcomes
Three areas emerged:
1. epistemic (acquiring knowledge and skill),
2. interpersonal (relating to patients, families, colleagues and administrators)
3. personal (achieving work–life balance).
In each, medical enculturation was achieved by two overlapping processes a. ‘absorption’, implicit incorporation of cultural norms, practices and beliefs, (tacit)
b. ‘assimilation’, a deliberative process which involves the choice to adopt or reject
institutional norms or to align one’s behavior with that of another person or group
(explicit)
Absorption and assimilation on a continuum, individuals move back and forth
Key Conclusions
Doctors’ behavior was shaped unconsciously by institutional norms and traditions,
and, by contrast, they were also creating meaning through their interpretation of the
social environment, including the behavior of others.
These findings are important for ensuring acquisition of professional behaviors
especially when trainees reach the clinical workplace, and underscore importance of
role modeling and the hidden curriculum.
Faculty development programs could encourage clinical teachers to more clearly
identify these three areas and stimulate residents to reflect on them.
Spare Keys – other take home points for clinician
educators
An example of making full use of study data, especially in qualitative
studies where analysis when issues arise during the analysis so new
questions asked
The scholarship of integration
structural functionalism (Sociology): addresses the question of social organization
(structure) and how it is maintained (function).
symbolic interactionism (Sociology): focus on social interaction and related concepts
of self-awareness/reflexive thinking, symbols, and negotiated order