The sociology of medical education : the struggle for legitimate knowledge in two English medical schools
Brosnan, Caragh Jean
University of Cambridge
Faculty of Human, Social, and Political Science
Doctor of Philosophy (PhD)
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Brosnan, C. J. (2008). The sociology of medical education : the struggle for legitimate knowledge in two English medical schools (Doctoral thesis). https://doi.org/10.17863/CAM.11733
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The epistemological basis of medical education has been highly contested since the turn of the twentieth century, with 'traditional', science-based curricula gradually being replaced by 'innovative' curricula, purporting to be more holistic. Both curricular types are currently employed in the United Kingdom, amid calls for both fu11her reform and a return to traditional teaching. This thesis explores the sociological meaning and consequences of debates over knowledge in medical education by examining the construction of legitimate knowledge in two English medical schools, one 'traditional' and one ' innovative'. Part I includes a literature review and theoretical discussion. Research on medical students ' experiences shows that they learn to value scientific and clinical 'competence' rather than 'caring'. Furthermore, sociologists argue that curricular reform serves symbolic purposes in medical schools but does not effect meaningful change. However, the relationship between students and medical schools is not well understood. Pierre Bourdieu's theoretical framework is proposed as a way of reconciling the analytical schism between research focusing on either student socialisation or organisational factors. Part II presents the research findings. Data were collected via six months' paiticipant observation at the two schools, semi-structured interviews with thirty-six medical students and fifteen faculty members, and analysis of institutional documents. By analysing the schools' marketing strategies, histories and relationships to external bodies, I show that medical education operates as a field in which medical knowledge is a form of symbolic capital: medical schools compete for scientific capital on the one hand, sustained by mechanisms within the higher education field, and, on the other, for clinical capital, fostered by the healthcare field. The two schools I studied were positioned unequally and oriented towards different sides of the medical education field. Faculty members participated in the dualistic competition for knowledge-based capital, largely reproducing their own institution's construction of legitimate knowledge. Drawing on their habitus, students also perpetuated the field struggle through their choice of medical school and their perceptions of legitimate knowledge. In turn, students' practices and dispositions were shaped by their school's position in the field. Ultimately, the struggle for scientific and clinic.al knowledge precluded holistic medical education: humanistic and social knowledge were marginalised in both the 'traditional' and the 'innovative' school, having little value within the field. Educational reform is thereby limited by this competition over knowledge, which is a 'game' played to gain institutional and individual power, rather than to produce good doctors.
This record's DOI: https://doi.org/10.17863/CAM.11733