Abstract:The contemporary discussion about the transformation of the training of health professionals has focused primarily on the change in method. This article discusses this issue in the light of Pierre Bourdieu's theoretical contributions -habitus, field, symbolic capital, symbolic violence and reproduction. The conclusion is drawn that pedagogical change alone is not enough to change the profile of medical graduates.
PALAVRAS-CHAVE:-Educação Médica;-Formação de Recursos Humanos;-Ensino.
RESUMOA discussão contempor… Show more
“…Symbolic capital is defined within a specific field, is constituted of what is recognized as important in that field, and is therefore indicative of prestige or high status [14, 20]. Symbolic capital is useful for analysing specific values of prestige and status within medicine [4, 22, 23].…”
Background
Many western countries have problems recruiting and retaining medical specialists. In Sweden there is a lack of primary care doctors and psychiatrists. Despite much research on the topic the shortage remains. We therefore set out to analyse choice of medical speciality using Bourdieu’s theoretical concepts; cultural capital, social background and perceived status.
Methods
A cross-sectional questionnaire-based study of 399 alumni from the Medical School at Karolinska Institutet, Stockholm was performed. The response rate was 72% (
n
= 286); 262 of the respondents were in training to become specialists. Specialties were categorized as primary care, psychiatry, internal medicine, and surgical and hospital service specialties. To study the associations between medical specialties and cultural capital, we used multinomial regression analyses. Variables that showed a significant association with medical specialties were included in an adjusted multivariable model. These results were presented as odds ratios: the odds that a particular speciality is chosen in comparison to a choice of surgery as a speciality, based on perceptions of
high status
.
Results
The results were analysed using Bourdieu’s theoretical concepts of cultural capital, in the form of educational capital and social prestige. We found distinctive differences in perceived status for the examined speciality groups, ranging from 70% high status for surgery down to 6% high status for geriatrics and primary care. Perceived status was also associated with respondents’ own speciality choice, presented as an odds ratio. Our data did not show any associations between speciality choice and educational capital. We also included sociodemographic data.
Conclusion
The field of medicine is according to Bourdieu an arena for power struggles. Knowledge of the distinctive differences in perceived status between medical specialties can be an asset particularly in relation to recruitment and retainment of specialist doctors. Our results could be used to identify specialities where perceptions of low status may be contributing to a shortage of specialists.
“…Symbolic capital is defined within a specific field, is constituted of what is recognized as important in that field, and is therefore indicative of prestige or high status [14, 20]. Symbolic capital is useful for analysing specific values of prestige and status within medicine [4, 22, 23].…”
Background
Many western countries have problems recruiting and retaining medical specialists. In Sweden there is a lack of primary care doctors and psychiatrists. Despite much research on the topic the shortage remains. We therefore set out to analyse choice of medical speciality using Bourdieu’s theoretical concepts; cultural capital, social background and perceived status.
Methods
A cross-sectional questionnaire-based study of 399 alumni from the Medical School at Karolinska Institutet, Stockholm was performed. The response rate was 72% (
n
= 286); 262 of the respondents were in training to become specialists. Specialties were categorized as primary care, psychiatry, internal medicine, and surgical and hospital service specialties. To study the associations between medical specialties and cultural capital, we used multinomial regression analyses. Variables that showed a significant association with medical specialties were included in an adjusted multivariable model. These results were presented as odds ratios: the odds that a particular speciality is chosen in comparison to a choice of surgery as a speciality, based on perceptions of
high status
.
Results
The results were analysed using Bourdieu’s theoretical concepts of cultural capital, in the form of educational capital and social prestige. We found distinctive differences in perceived status for the examined speciality groups, ranging from 70% high status for surgery down to 6% high status for geriatrics and primary care. Perceived status was also associated with respondents’ own speciality choice, presented as an odds ratio. Our data did not show any associations between speciality choice and educational capital. We also included sociodemographic data.
Conclusion
The field of medicine is according to Bourdieu an arena for power struggles. Knowledge of the distinctive differences in perceived status between medical specialties can be an asset particularly in relation to recruitment and retainment of specialist doctors. Our results could be used to identify specialities where perceptions of low status may be contributing to a shortage of specialists.
“…Em uma graduação que privilegia a prática profissional na formação, o contato com os modelos de médicos ao longo do curso é fator de aprendizagem e conformação do habitus médico. Assim, o aluno seguirá as regras e os princípios regulatórios de um modelo bem organizado de formação, em que os conhecimentos, as experiências, as atitudes e os valores estarão sob a perspectiva de uma identidade médica em construção, atuando em diferentes situações, profissionais ou não 23 .…”
Resumo: Introdução: A prática médica é atravessada por um conjunto de ideais, valores e comportamentos compartilhados e transmitidos entre as especialidades e os diferentes perfis profissionais, exercendo influência significativa durante a graduação, especialmente por um currículo oculto. Método: Buscou-se levantar e caracterizar intersecções entre cultura, formação e prática médica no processo de anatomização do corpo. Foram realizadas entrevistas semiestruturadas com professores médicos de um curso de Medicina. Resultado: São apresentadas as discussões geradas a partir da análise do corpo anatomizado como habitus e suas repercussões para o entendimento da influência da cultura médica na formação. Conclusão: A anatomização do corpo humano está diretamente ligada ao modelo de saúde biologicista, e a perspectiva da saúde integral depende de mudanças na forma de se encarar e ensinar o corpo.
“…In this section, we will present several lines of potential research and underscore that they should be placed into the greater context of the sociology of medical education and medical sociology in general. Concluding Part IV, we briefly provide the example of Pierre Bourdieu's concepts (applied to medical education) as a means to understand, through research, the otherwise fog-covered relationships between medical students, professors, teaching institutions, medicine as an institution-at-large and how these relationships are reinforced to maintain, rather than transform, a medical-social structure mismatched to the Age of NCDs [148,149].…”
Section: Tollo Causa: Research Questions and Future Directionsmentioning
confidence: 99%
“…"Changing medical training means building a different field with different social agents, it means forming new ways of thinking, new ways of operating, it means changing considering the social structure that perpetuates itself in the action of and readjustment of the individuals themselves, who act according to the incorporated models and arrangements" [149].…”
The epidemic of socially-rooted, lifestyle-driven non-communicable diseases (NCDs; also referred to as socially-transmitted conditions) has now overtaken infectious diseases as the leading cause of human mortality. Despite this reality, physician education, training and practice within industrialized nations is heavily slanted toward the biopharmaceutical (and away from the psychosocial) aspects of prevention and treatment. As we underscore, the current state of physician training and practical application of guidelines pertaining to lifestyle is paltry and untenable. However, the solution is not a few more hours of nutritional biochemistry to check off the curricula box. Physician readiness for the current NCD crisis will require a philosophical shift in medicine-at-large, including candidate pooling. Recent elections in the United States and Europe have cast a spotlight on the public health consequences of political authoritarianism. However, we highlight that authoritarianism-and its related facets of social dominance orientation and Machiavellianism-are not exclusive to political candidates. Here, we open a dialogue on authoritarianism in westernized medicine as a starting point in order to encourage the development of critical research and to explore its potential as a barrier to patient care. We suggest that authoritarianism and its prejudices act as a border wall to the World Health Organization's broad vision of global health, cultural competency and patient autonomy. Moreover, the evidence reviewed here would suggest that in the context of the NCDs crisis, westernized medicine is long overdue a Flexner Report for the 21st Century.
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