The “Fate of Idealism” Revisited

Abstract

This article, based on field research of a cohort of students enrolled in an innovative medical school, traces the transformation of idealism among student doctors. Our findings show that loss of idealism goes beyond a temporary diversion caused by situational demands of medical school. Rather it is inherent in the very demands of professionalization. We begin by describing students' changing perceptions of the importance of psychosocial issues in medicine. In their need to strive for competence, students turn off their emotional reactions to patients. Equally important is the students' perception of the medical profession's expectation of affective neutrality toward patients. We conclude that loss of idealism must be understood in the context of a symbolic-moral drama wherein professionalization is conceptualized as a process of differentiation and alienation from lay society and of elevation to a position of detachment and control.

The Development of Idealism in Pharmacy School

“…Most other research has identified a general pattern of diminishing idealism and increasing realism or cynicism as students approach graduation, and some researchers have concluded that this is a necessary result of the professionalization' process itself. Haas and Shaffir (1984), Moms and Sherlock (1971), Psathas (1968), and Simpson (1967and Simpson ( , 1972, suggest that the initial idealism with which students enter professional school is not temporarily suspended, but rather is lost or radically transformed. The general argument is that the transformation of idealism is inherent in the professionalization process.…”

“…The idealism described by Becker and Geer is an idealism informed by lay culture's general view of medicine ("lay idealism"); its transformation into an occupationally specific "professional idealism" occurs in the senior year, as medical students begin to consider the special fields and career options open to them after graduation. In Haas and Shaffir's (1984) study of students in an innovative medical school, the transformation occurred somewhat earlier. Exposure to clinical experiences early in the program appear to have led to the development of occupationally specific views of medicine and resulted in what might be termed "professional realism.…”

Role Fusion: The Occupational Socialization of Prison Chaplains

“…As discussed, individuals experience role strain as a result of differing role dimensions. Previous analyses described the compartmentalization or abandonment of roles as primary methods individuals use to decrease feelings of strain (Becker and Geer 1958; Haas and Shaffir 1984; Smith‐Lovin 2007; Stryker 1980). These solutions emphasize an increase in the separation of different roles and role dimensions.…”

Professional Socialization in Medicine

“…Habituation also involves the cultivation of new tastes-for instance, derogatory humor towards certain kinds of patients-that may have seemed alien or offensive prior to medical school [30], as well as new dispositions, i.e., durable and socially patterned ways of feeling, thinking, and acting [28]. Decades of research suggest a progressive decline during medical school in students' idealism about the medical profession and empathy towards patients and a concomitant increase in cynicism [10,11,[31][32][33][34][35][36][37], perhaps as a psychological coping mechanism in the face of a stressful socialization process [38]. Some see these changes as evidence of "abuse," "mistreatment," and "traumatic de-idealization" of medical students [39][40][41].…”

“…Do purported forms of moral "erosion" such as the loss of idealism and decline in empathy persist after medical school? While some suggest that this erosion is temporary and situational and declines towards graduation [10], others argue that it is long-lasting [32]. Other questions have been raised as well-for instance, about the validity of reported changes in empathy [46] or of survey measures due to changes over time in how the same students interpret the same survey questions [47].…”