The institutional apprenticeship of medical students in a London medical school

• Main Author: Sinclair, Simon Keith
• Published: London School of Economics and Political Science (University of London) 1996
• Subjects: 610; Medicine
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.482051

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