Assembling practice in clinical placements at a new medical school

• Main Author: Booth, Jeremy
• Other Authors: Nettleton, Sarah
• Published: University of York 2017
• Subjects: 301
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.727344

Sociological studies of undergraduate medical education classically concentrated on students and tutors in the clinical environment and paid scant attention to course structures, systems of assessment or the institutional context in which medical education is embedded (Merton, Becker, Foucault, Atkinson, Bosk). Like them, this thesis offers a close ethnographic focus on the clinical experience, but combines it with a sociology of associations that explores the network of institutions and processes that impinge on it. Employing an ‘extended case method’ it focuses on the creation of a new medical school, and building on previous studies applies new materialist perspectives to explore the development and processes of regulation, the organization of supervision and assessment, and the embodied nature of practice (Burawoy). After an analysis of the original aims and development of the GMC’s Tomorrows’ Doctors it examines the school’s early years, focusing on the assessment of professionalism. It shows how the need to transfer information between the school and the NHS shaped assessment, and explores the clinical legitimation of the types of assessment to inform a discussion of their exchange-value and use-value. It presents the results of observations in clinical placements through Foucault’s perspective of the gaze and the ‘implicit labour of language’ in the assembly of practice, and by treating the senses used in patient consultations as mediators. It shows how patient-centered practice continues to reproduce a traditional individualized medicine and its hierarchy, and argues that patients in the community of practice serve as exemplars for comparison, learning, and the definition of the field of medicine itself. Following Kuhn’s assertion that scientific communities are best discovered by examining patterns of education and communication, this broader perspective makes an original contribution to the sociology of knowledge as well as to the fields of professional education and healthcare provision.