Abstract
Medical educators aim to train physicians with sound scientific knowledge, expert clinical skills and an ability to work effectively with patients, colleagues and health systems. Over the past century, educators have devoted considerable thought and effort to how medical education might be improved. Analysing the language used to describe these initiatives provides insight into assumptions and practices. The authors conducted a Foucauldian critical discourse analysis of prominent recurrent themes in the North American medical education literature. The assembled archive of texts included works of Abraham Flexner, articles from the journal Academic Medicine (including its predecessor journals) and major medical education reports. A series of recurring themes were identified, including the need to avoid over-specialization, the importance of generalism, and the need to broaden criteria for medical student selection. Analysis of these recurring themes allowed identification of a prominent and recurrent discourse of ‘new.’ This discourse places focus on the future, ignores the ongoing historical nature of issues, suggests a sense of urgency and enables the proposal of modest solutions. It emphasizes changes for individual future doctors, thereby limiting consideration of institutional and systemic factors. Using the image of a carousel, the regular return of themes can be seen as carousel ponies circling around repeatedly in medical education. Identification of this medical education carousel provides an opportunity for medical educators to understand the historical nature of calls for change, and to consider what kinds of reform might be required if they wish to avoid this repetition in the future.
Similar content being viewed by others
References
(The) GPEP (General Professional Education of the Physician) Panel. (1984). Physicians for the 21st Century, The GPEP Report. Washington, DC: Association of American Medical Colleges.
Association of American Medical Colleges. MCAT2012 for students. Available at: https://www.aamc.org/students/applying/mcat/mcat2015/. Accessed on September 24, 2012.
Barker, F. D. (1927). Determining the Fitness of the Premedical Student. Bulletin of the Association of American Medical Colleges, 2(1), 16–20.
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. (1988). Structure and idealogy in medical education: an analysis of resistence to change. Journal of Health and Social Behavior, 29(4), 294–306.
Bodenheimer, T., Wagner, E. H., & Grumbach, K. (2002). Improving primary care for patients with chronic illness: the chronic care model, part 2. Journal of the American Medical Association, 288, 1775–1779.
Carraccio, C., Wolfsthal, S. D., Englander, R., Ferentz, K., & Martin, C. (2002). Shifting paradigms: from Flexner to competencies. Academic Medicine, 77(5), 361–367.
Casberg, M. A. (1950). Medical Education Takes Inventory. Journal of the Association of American Medical Colleges, 25(5), 305–311.
Ceithaml, J. (1962). Student Selection in United States Medical Schools. Journal of Medical Education, 37, 171–176.
Christakis, N. A. (1995). The similarity and frequency of proposals to reform US medical education. Journal of the American Medical Association, 274(9), 706–711.
Clawson, D. K. (1990). The education of the physician. Academic Medicine, 65, 84–88.
Eva, K. W., Rosenfeld, J., Reiter, H. I., & Norman, G. R. (2004). An admissions OSCE: the multiple mini-interview. Medical Education, 38, 314–326.
Fleming, W. C., & Prestwood, A. R. (1970). Self-involvement: today’s health science student. Journal of Medical Education, 45(3), 182–184.
Flexner, A. (1910). Medical Education in the United States and Canada. (New York, NY.: Carnegie Foundation).
Flexner, A. (1925). Medical education; a comparative study. New York: The Macmillan company.
FMEC. (2010). The Future of Medical Education in Canada. Ottawa: The Association of Faculties of Medicine of Canada.
Foucault, M. (1980). Power/knowledge: Selected interviews and other writings, 1972-1977. C Gordon (Ed.). Toronto: Random House of Canada.
Foucault, M. (1999). Aesthetics, Method, and Epistemology (R Hurley and others, Trans.). New York: The New York Press.
Fox, H. M. (1951). Teaching Integrated Medicine. Journal of Medical Education, 26(6), 421–429.
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., et al. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet, 376(9756), 1923–1958. doi:10.1016/S0140-6736(10)61854-5.
Funkenstein, D. H. (1955). Some Myths about Medical School Admissions. Journal of Medical Education, 30(2), 81–88.
Gee, H. H., & Cowles J. T (Eds.) (1957). The Appraisal of Applicants to Medical Schools. Journal of Medical Education, 32, 1–225.
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–S44.
Irby, D. M., Cooke, M., & O’Brien, B. C. (2010). Calls for reform of medical education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Academic Medicine, 85(2), 220–227.
Jones, D. S., Podolsky, S. H., & Greene, J. A. (2012). The burden of disease and the changing task of medicine. The New England Journal of Medicine, 366(25), 2333–2338.
Kelly, E. L. (1957). Multiple criteria of medical education and their implications for selection. (In H. H. Gee, & J. T. Cowles (Eds.) (1957). The appraisal of applicants to medical schools. Journal of Medical Education, 32, 1–225).
Kuper, A., Albert, M., & Hodges, B. D. (2010). The origins of the field of medical education research. Academic Medicine, 85(8), 1347–1353.
Lape, E. E. (1937). Medical education as discussed in “American Medicine”. Journal of the Association of American Medical Colleges, 12(6), 357–375.
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.
Lupton, D., & McLean, J. (1998). Representing doctors: Discources and images in the Australian press. Social Science and Medicine, 46, 947–958.
Martin, C. F. (1927). Some aspects of medical education and procedure. Bulletin of the Association of American Medical Colleges, 2(2), 152–185.
McCaghie, W. C. (2002). Assessing readiness for medical education: Evolution for the medical college admission test. Journal of the American Medical Association, 288(9), 1085–1090.
Mitchell, J. (1970). The Circle Game. On Ladies of the Canyon [CD]. Los Angeles: A&M Studios.
Niland, P., & Lyons, A. C. (2011). Uncertainty in medicine: meanings of menopause and hormone replacement therapy in medical textbooks. Social Science and Medicine, 73, 1238–1245.
Page, R. C. (1952). The doctor for tomorrow’s needs. Journal of Medical Education, 27(2), 91–98.
Phillips, N., & Hardy, C. (2002). Discourse analysis: Investigating processes of social construction. Thousand Oaks, CA: Sage Publications.
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.
Smyth, F. S. (1962). The place of the humanities and social sciences in the education of physicians. Journal of Medical Education, 37(5), 495–499.
Turner, E. L. (1958). The education of a physician in the United States: The current scene. Journal of Medical Education, 33(3), 259–271.
Upshur, R. E. G. (2003). Are all evidence-based practices alike? Problems in the ranking of evidence. Canadian Medical Association Journal, 169(7), 672–673.
What Medical Students Think About the Medical School. (1945). Journal of the Association of American Medical Colleges, 20(5), 296–302.
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. (in press). Scientist or science-stuffed? Discourses of science in North American medical education. Medical Education.
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.
Whitehead, C., Kuper, A., & Webster, F. (2012). The conceit of curriculum. Medical Education, 46, 534–544.
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Whitehead, C.R., Hodges, B.D. & Austin, Z. Captive on a carousel: discourses of ‘new’ in medical education 1910–2010. Adv in Health Sci Educ 18, 755–768 (2013). https://doi.org/10.1007/s10459-012-9414-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10459-012-9414-8