Orienting to Medicine: Scripting Professionalism, Hierarchy, and Social Difference at the Start of Medical School
Nascent medical students’ first view into medical school orients them toward what is considered important in medicine. Based on ethnography conducted over 18 months at a New England medical school, this article explores themes which emerged during a first-year student orientation and examines how these scripts resurface across a four-year curriculum, revealing dynamics of enculturation into an institution and the broader profession. We analyze orientation activities as discursive and embodied fields which serve “practical” purposes of making new social geographies familiar, but which also frame institutional values surrounding “soft” aspects of medicine: professionalism; dynamics of hierarchy and vulnerability; and social difference. By examining orientation and connecting these insights to later, discerning educational moments, we argue that orientation reveals tensions between the overt and hidden curricula within medical education, including what being a good doctor means. Our findings are based on data from semi-structured interviews, focus groups, and participant-observation in didactic and clinical settings. This article answers calls within medical anthropology and medical education literature to recognize implicit values at play in producing physicians, unearthing ethnographically how these values are learned longitudinally via persisting gaps between formal and hidden curricula. Assumptions hidden in plain sight call for ongoing medical education reform.
KeywordsMedical education Hidden curriculum Orientation Professionalism Hierarchy Difference
The authors wish to acknowledge Matthew Sattler for his involvement in data collection that contributed to this article. We thank the Center for Applied and Professional Ethics and colleagues who comprise the Medical Humanities Working Group of The Leslie Center for the Humanities, both at Dartmouth College, for their support of this research and their constructive engagement with earlier drafts of this article.
This study was supported by a grant from the Leslie Center for the Humanities at Dartmouth College, with additional support from the Institute of Applied and Professional Ethics, also at Dartmouth College.
Compliance with Ethical Standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by Dartmouth College’s Institutional Review Board, Committee for the Protection of Human Subjects (Study Number #23832).
was obtained from all individual participants included in the study. In accordance with our approved IRB protocol, verbal consent was obtained after reading of an information sheet and discussion of the research goals with potential study participants.
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