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Adapting the forms of yesterday to the functions of today and the needs of tomorrow: a genealogical case study of clinical teaching units in Canada

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Abstract

Emergent discourses of social responsibility and accountability have in part fuelled the expansion of distributed medical education (DME). In addition to its potential for redressing physician maldistribution, DME has conferred multiple unexpected educational benefits. In several countries, its recent rise has occurred around the boundaries of traditional medical education practices. Canada has been no exception, with DME proliferating against a backdrop of its longstanding central node, the clinical teaching unit (CTU). The CTU first appeared just over 50 years ago with its position in Canadian health care largely taken-for-granted. Given the increasing prominence of DME, however, it is timely to reconsider what the place of tertiary centre-based practices such as the CTU might be in shifting medical education systems. From a genealogical perspective, it becomes clear that the CTU did not just “happen”. Rather, its creation was made possible by multiple interrelated cultural, social, and political changes in Canadian society that, while subtle, are powerfully influential. Making them visible offers a better opportunity to harmonize the benefits of longstanding entities such as the CTU with novel practices such as DME. In so doing, the medical education field may sidestep the pitfalls of investing significant resources that may only produce superficial changes while unwittingly obstructing deeper transformations and improvements. Although this work is refracted through a Canadian prism, reconceptualizing the overall design of medical education systems to take advantage of both tradition and innovation is a persistent challenge across the international spectrum, resistant to tests of time and constraints of context.

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Acknowledgments

This work emerged from research supported by a Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship-Master’s Award. The authors are grateful to Dr. Brian Hodges for his initial reading and suggestions for the manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, Centre for Health Education Scholarship, The University of British Columbia, JPPN 3300, 910 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada

    Brett Schrewe

  2. Faculty of Education, The University of British Columbia, Vancouver, BC, Canada

    Daniel D. Pratt

  3. Department of Anthropology, The University of British Columbia, Vancouver, BC, Canada

    William H. McKellin

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  1. Brett Schrewe
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Correspondence to Brett Schrewe.

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Schrewe, B., Pratt, D.D. & McKellin, W.H. Adapting the forms of yesterday to the functions of today and the needs of tomorrow: a genealogical case study of clinical teaching units in Canada. Adv in Health Sci Educ 21, 475–499 (2016). https://doi.org/10.1007/s10459-015-9608-y

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