101. Exchange and Negotiated Learning in Graduate Medical Education.
- Author
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Miller, Stephen J.
- Subjects
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GRADUATE medical education , *MEDICAL education , *SOCIOLOGY , *MEDICAL students , *PROFESSIONAL education , *SOCIAL science research - Abstract
In this paper, a brief statement is made of the predilections of the two major contemporary approaches to the sociology of medical education. Though they differ, the differences are not, as they are often assumed to be, the result of method. This is not to say particular methods are not favored; rather, that the approaches are not wedded to a single method and do employ multiple-method programs of data-collecting. Differences that do exist may be attributed to variation in sociological conceptualization, in particular to differences of opinion regarding the concept "professional" and the process of "professionalization" as well as the social nature of medical schools and programs. A major point in issue is the social consequence of situational circumstances for the organization of behavior of medical students and house officers. Also, data from a current study of graduate medical education was reported. It has been implied that the sociological concern with professions, organization, and socialization would benefit from further consideration of the characteristics of the setting in which people prepare for and do work. The implication was not that environmental constants solely determine behavior nor that acquired attitudes or personal characteristics play no part in the nature and organization of professional behavior, but, rather, that the behavior of, for example, the fledgling physician during the various stages of professional preparation or, if you will, "professionalization," are influenced by immediate contingencies of file work setting as well as by the general prescriptions of the professional world. In an attempt at formulation of a multivariable model in explanation of the organization of professional behavior, Freidson conceptualizes the consequences of settings in terms: observability, those characteristics which determine if behavior is public and subject to influence; dependence, the need of others which allows for influence by them; normative expectations, those values which constitute the rationale for influence. In conclusion, the writer suggests on the basis of the research reported, that "information" regarding the circumstantial particulars of the setting is the crux of behavioral organization and that "exchange" is the mechanism facilitating the social operation of observability, dependence, and normative expectation. The manner in which interns were observed to organize their behavior was as much the result of knowledge of circumstances as of personal characteristics or previous medical education. The intern engaged in patient care is, of course, utilizing medical fact and expertise acquired in medical school. However, his technical and social performances are equally influenced by the physical and social facts of the hospital. [ABSTRACT FROM AUTHOR]
- Published
- 1966
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