The Student-Physician: Introductory Studies in the Sociology of Medical Education PDF
Preview The Student-Physician: Introductory Studies in the Sociology of Medical Education
The Student-Physician Renée C. Fox Mary E. W. Goss Mary Jean Huntington Patricia L. Kendall William Martin Robert K. Merton Margaret Olencki CONTRIBUTORS George G. Reader, M.D. Natalie Rogoff Hanan C. Selvin Wagner Thielens, Jr. A REPORT FROM THE BUREAU OF APPLIED SOCIAL RESEARCH COLUMBIA UNIVERSITY The Student-Physician INTRODUCTORY STUDIES IN THE SOCIOLOGY OF MEDICAL EDUCATION EDITED BY Robert K. Merton George G. Reader, M.D. Patricia L. Kendall Published for The Commonwealth Fund BY HARVARD UNIVERSITY PRESS Cambridge, Massachusetts 1957 © 1957 BY THE COMMONWEALTH FUND Library of Congress Catalog Card No. 57-12526 Printed in the United States of America For approximately a quarter of a cen- tury THE COMMONWEALTH FUND, through its Division of Publica- tions, sponsored, edited, produced, and distributed books and pamphlets germane to its purposes and opera- tions as a philanthropic foundation. On July 1, 1951, the Fund en- tered into an arrangement by which HARVARD UNIVERSITY PRESS became the publisher of Commonwealth Fund books, assuming responsi- bility for their production ana dis- tribution. The Fund continues to sponsor and edit its books, and co- operates with the Press in all phases of manufacture and distribution. Published for The Commonwealth Fund BY HARVARD UNIVERSITY PRESS CAMBRIDGE, MASSACHUSETTS Distributed in Great Britain BY OXFORD UNIVERSITY PRESS, LONDON TO DAVID PRESWICK BARR, M.D. PREFACE The continuing growth of the professions in American society has brought with it an extended and deepened interest in the purposes, substance, and organization of professional education; for it is plainly in the professional school that the outlook and values, as well as the skills and knowledge, of practitioners are first shaped by the profession. This critical interest in professional education appears especially marked in medicine. Understandably, the prime emphasis in cur- rent re-examinations of medical education has been upon matters of what is being taught, what should be taught, and how it might most effectively be taught. This is not, however, the emphasis in this volume. There is no intent here to appraise current medical curricula or to advocate changes in them. Instead, the focus is upon the educative process in the medical school, upon the ways in which its social structure, like that of other organizations, largely forms the behavior of its members and so affects the mak- ing of the medical man. In our ongoing studies, the medical school is conceived as a social environment in which the professional culture of medicine is variously transmitted to novices through distinctive social and psychological processes. The school is regarded as a decisive mid- dle term between the native and previously trained capacities of selected individuals and the emergence of the professional self, vii viii Preface the identification of these individuals, by themselves and by so- ciety, as medical doctors. It is the aim of these studies to find out in detail how this comes about: how the aspirant, with his charac- teristic anticipations, fears, hopes, and abilities emerges as a so- cially certified physician, outfitted with a definition of his profes- sional status (what it means to be a doctor), with attitudes toward that status ( dispositions to regard some of his roles as indispensa- ble and others as secondary), with a self-image (a conception of how he measures up to the requirements of the physician's status ), and with a set of professional values ( in terms of which he relates himself as a physician to others in the society ). How does it hap- pen, for example, that some students emerge from a medical school with one conception of their roles as physicians, and others with appreciably different conceptions? In short, to what degree and through what processes does the medical school shape the profes- sional self of the student, so that he comes to "think, feel, and act like a doctor?" There is, in this sociological view of medical education, some- thing more than a passing resemblance to the renewed emphasis in medicine itself upon regarding the patient as a person greatly affected by his social environment, rather than as simply a disease entity or a case of sickness. Just as the patient is recognized as more than a disease entity, so the medical student must be recog- nized as more than a passive receptacle into which new knowledge is being poured. The physician of today is reminded that a sick person is often an anxious person, that his anxieties and difficulties, as well as his potentials for recovery, may be significantly affected by his social ties, by his situation within the family and workplace and in other groups important to him. In much the same terms, the development of the medical student must be considered in the light of his social and psychological environment, of his position within significant groups which makes it more difficult, or less, for him to cope with the stresses of his environment and to acquire the knowledge and values of medicine. The collection of papers in this volume constitute a first set of reports on continuing studies in the sociology of medical education begun some years ago by the Bureau of Applied Social Research of Columbia University in collaboration with the students and Preface ix faculties of the schools of medicine of Cornell University, the Uni- versity of Pennsylvania, and Western Reserve University. They are introductory reports, based upon only a fraction of the ma- terials now in hand. Other studies will be published in the form of short monographs, of the kind briefly described in Appendix B, each of which, though prepared in conjunction with the rest, can nevertheless stand alone as a study of a selected problem. It is our belief that such periodic reports of special studies are better suited to this early stage of development in the sociology of medical edu- cation than a single comprehensive book. Until investigation has resulted in serried ranks of special monographs on distinct prob- lems in this field, it would be premature to attempt even a limited synthesis of what is currently known. That these studies could have been conducted at all is owing to the active participation and collaboration of many. We gratefully acknowledge the collégial help given us by the students, faculties, and administrations of the schools of medicine at Cornell, Penn- sylvania, and Western Reserve. In particular, we wish to thank the following who have taken most active part in these studies: at Cornell, Dr. Joseph C. Hinsey, Dr. E. Hugh Luckey; at Pennsyl- vania, Dr. John McK. Mitchell, Dr. Kenneth E. Appel, Dr. John P. Hubbard, Dr. William B. Kennedy; at Western Reserve, Dr. Joseph T. Wearn, Dr. T. George Bidder, Dr. John L. Caughey, Jr., Dr. Thomas Hale Ham, and Dr. John W. Patterson. The concept of a dualism in the underlying assumptions by which men live we owe to Robert S. Lynd, as this is set forth in his Knowledge for What? To the Commonwealth Fund we are greatly indebted for grants which have made these studies possible. In dedicating this volume to Dr. David Preswick Barr, we join with many others to pay our tribute to his continued vision and leadership in medical education. R. κ. M. G. G. R.
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