Abstract
Medical educators develop student selection criteria and design curricula based on underlying assumptions about who is best suited to the profession and how these learners should be taught. Often these assumptions are not made explicit but instead are embedded in the words and phrases used to describe trainees and curricula. They may then be considered inevitable, rather than being seen as particular social constructs. Using Foucauldian critical discourse analysis methodology, the authors examined a major shift in language in the late 1950s in North American medical education texts. The discourse of the good doctor as a man of character, which had been present since the 1910 Flexner Report, was replaced by a new discourse of characteristics. Analysis of this sudden discursive shift shows a change in thinking about the medical trainee and learning environment from a personal journey of discovery to a dissectible set of component parts that could be individually measured and manipulated. Understanding the discursive effects of language that we use will allow medical educators greater insight into the implications and consequences of different constructions of important issues in medical education.
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Notes
Given the gendered nature of depictions of doctors in the medical education literature in this era, the masculine pronoun is used in this discussion.
References
Aagaard, G. N. (1962). Presidential address. Journal of Medical Education, 37, 85–89.
Bevan, A. D. (1936). The over-crowding of the medical profession. Journal of the Association of American Medical Colleges, 11, 377–384.
Bloom, S. W. (1979). Socialization for the physician’s role: A review of some contributions of research to theory. In E. C. Shapiro & L. M. Lowenstein (Eds.), Becoming a physician: Development of values and attitudes in medicine. Cambridge: Ballinger Pub. Co.
Bloom, S. W. (2002). The world as scalpel. New York: Oxford University Press.
Ceithaml, J. (1957). Appraising nonintellectual characteristics. In H. H. Gee, & J. T. Cowles (Eds.), The appraisal of applicants to medical schools. Journal of Medical Education, 32, 1–225.
Ceithaml, J. (1962). Student selection in United States Medical Schools. Journal of Medical Education, 37, 171–176.
Coggeshall, L. T. (1959). The problem of the change. Journal of Medical Education, 34(1), 1–7.
Cooke, M., Irby, D., & O’Brien, B. (2010). Educating physicians: A call for reform of medical school and residency. San Francisco: Jossey Bass.
Cronbach, L. J. (1975). Beyond the two disciplines of scientific psychology. American Psychologist, 116, 116–127.
Davidson, A. I. (1986). Archaeology, genealogy, ethics (pp. 221–233). Foucault: A critical reader.
Davison, W. C. (1946). The future of medical education. Journal of the Association of American Medical Colleges, 21, 223–235.
Flexner, A. (1910). Medical education in the United States and Canada. New York, NY: Carnegie Foundation.
FMEC. (2010). The future of medical Education in Canada. Ottawa: The Association of Faculties of Medicine of Canada.
Foucault, M. (1999). Aesthetics, method, and epistemology (R Hurley and others, Trans.). New York: The New York Press.
Frank, J. (Ed.). (2005). The CanMEDS 2005 physician competency framework. Better standard. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada.
Gee, H. H. (1957). Minutes of the 67th annual meeting. Journal of Medical Education, 32, 49–80.
Gee, H. H., & Cowles, J. T. (1957). The appraisal of applicants to medical schools. Journal of Medical Education, 32, 1–225.
Gottheil, E., & Michael, C. M. (1957). Predictor variables employed in research on the selection of medical students. Journal of Medical Education, 32, 131–147.
Hale, W. (1946). The measurement of medical aptitude. Journal of the Association of American Medical Colleges, 21(3), 147–151.
Hodges, B. D. (2009). The objective structured clinical examination: A socio-history. Berlin: LAP Press.
Hodges, B. D. (2010). A tea-steeping or i-doc model for medical education? Academic Medicine, 85, S34–44.
Hodges, B. D. (2012). The shifting discourses of competence. In B. D. Hodges, & L. Lingard (Eds.), The question of competence: Reconsidering medical education in the twenty-first century. Ithaca: Cornell University Press.
Hurd, A. W. (1949). An analysis of factors influencing student success or failure in the medical school. Journal of the Association of American Medical Colleges, 24(1), 39–41.
Hurtado, A. (1957). Impressions of the 1956 institute on the evaluation of the student. Journal of Medical Education, 32, 847–852.
Hutchins, E. B. (1964). The AAMC longitudinal study: Implications for medical education. Journal of Medical Education, 39, 265–277.
Johnson, D. G. (1965). The AAMC study of medical student attrition: Overview and major findings. Journal of Medical Education, 40, 913–920.
J.Z.B. (1958). Sputnik and medical research. Journal of Medical Education, 33(1), 108–109.
Kaufman, L. R. (1935). The foundation of medicine. Journal of the Association of American Medical Colleges, 10, 297–303.
Kelly, E.L. (1957a). Multiple criteria of medical education and their implications for selection. In H. H. Gee, & J. T. Cowles (Eds.), The appraisal of applicants to medical schools. Journal of Medical Education, 32, 1–225.
Kelly, E. L. (1957b). A critique of the interview. In Gee, H. H., & Cowles J. T. (Eds.), The appraisal of applicants to medical schools. Journal of Medical Education, 32, 1–225.
Klinger, E., & Gee, H. H. (1959). The study of applicants, 1957–1958. Journal of Medical Education, 34(4), 424–435.
Kole, D. M., & Matarazzo, J. D. (1965). Intellectual and personality characteristics of two classes of medical students. Journal of Medical Education, 40, 1130–1144.
Korman, M., Stubblefield, R. L., & Martin, L. W. (1964). Faculty and student perceptions of medical roles. Journal of Medical Education, 39, 197–202.
Kuper, A., Albert, M., & Hodges, B. D. (2010). The origins of the field of medical education research. Academic Medicine, 85(8), 1347–1353.
Ludmerer, K. M. (1999). Time to heal: American medical education from the turn of the century to the era of managed care. Oxford; New York: Oxford University Press.
McGaghie, W. C. (2002). Assessing readiness for medical education: Evolution of the medical college admission test. Journal of the American Medical Association, 288(9), 1085–1090.
Miller, G. E. (1962). The challenge to medical education. Journal of Medical Education, 37(12), 57–66.
Moon, G. R. (1934). Relation of certain factors in the student’s premedical record to success in medical school. Journal of the Association of American Medical Colleges, 9(5), 267–273.
Parker, S. (1960). The attitudes of medical students toward their patients: An Exploratory study. Journal of Medical Education, 35(9), 849–856.
Price, P. B., Taylor, C. W., Richards, J. M., Jr, & Jacobsen, T. L. (1964). Measurement of physician performance. Journal of Medical Education, 39, 203–211.
Rogers, R., Malancharuvil-Berkes, E., Mosley, M., Hui, D., & O’Garro, J. G. (2005). Critical discourse analysis in education: A review of the literature. Review of Educational Research, 75(3), 365–416.
Schlageter, C. W., & Rosenthal, V. (1962). What are “normal” medical students like? Journal of Medical Education, 37, 19–27.
Schumacher, C. F. (1964). Personal characteristics of students choosing different types of medical careers. Journal of Medical Education, 39, 278–288.
Starr, P. (1982). The Social Transformation of American Medicine. New York: Basic Books Publishers, Inc.
Strong-Boag, V. (1981). Canada’s women doctors: Feminism constrained. In S. E. D. Shortt (Ed.), Medicine in Canadian Society: Historical perspectives (pp. 109–129). Montreal & Kingston: McGill-Queen’s University Press.
Stuit, D. B. (1948). The discovery of medical talent. Journal of the Association of American Medical Colleges, 23(3), 157–162.
Taylor, G. (1948). The personal interview in the selection of medical students. Journal of the Association of American Medical Colleges, 23(3), 171–175.
Whitehead, C. (2010). Recipes for medical education reform: Will different ingredients create better doctors? A commentary on Sales and Schlaff. Social Science and Medicine, 70(11), 1672–1676.
Whitehead, C. R. (2011). The good doctor in medical education 1910–2010: A critical discourse analysis. Dissertation, University of Toronto. Available at: http://hdl.handle.net/1807/32161.
Whitehead, C. Scientist or science-stuffed? Discourses of science in North American medical education. Medical Education (accepted).
Whitehead, C. R., Austin, Z., & Hodges, B. D. (2011). Flower power: The armoured expert in the CanMEDS competency framework. Advances in Health Sciences Education, 16, 681–694.
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The authors are very grateful to Alison Thompson for her helpful suggestions and to Laura Todd for her assistance in the preparation of this manuscript.
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Whitehead, C.R., Hodges, B.D. & Austin, Z. Dissecting the doctor: from character to characteristics in North American medical education. Adv in Health Sci Educ 18, 687–699 (2013). https://doi.org/10.1007/s10459-012-9409-5
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DOI: https://doi.org/10.1007/s10459-012-9409-5