Clinical experience : an ethnography of medical education

Abstract

This thesis reports an ethnographic study of undergraduate nodical students at Edinburgh University, in their first year of clinical studies. It explores various aspects of their 'clinical experience' in the course of that year. The thesis is organized in four parts. Part I provides the context for the research. The conduct of the study is reported, and the methods used (participant observation, interviews and self-administered questionnaire) are discussed. The medical school, the undergraduate curriculum and the work of the fourth (first clinical) year are also outlined. Part II examines two major concepts - 'student culture' and 'professional segmentation'. The variety of medical and educational experiences that students encounter, and the students' understandings of segmentation within the medical school are examined. This part of the thesis also explores how students use their understanding of such diversity in organizing their own careers in the medical school. The argument is also illustrated with case studies of individual clinical attachments. Part III is focused on the social Interaction of clinical teaching - between doctors, students and patients. The management of clinical information in such encounters is discussed. The argument proceeds with a consideration of theconditions for the successful accomplishment of bedside teaching, and of contingencies which can undermine such accomplishment. Part IV develops the analysis begun in Parts II and III. The management of medical knowledge is analysed further: the 'classic case', 'clinical experience' and clinicians' appeals to indeterminate knowledge are documented. These topics are linked with the theme of Part II, as it is argued that divergencies in personal knowledge are grounded in processes of segmentation in the medical profession and the medical school. Thus the themes of 'professional segmentation' and 'clinical experience' are reunited in the concluding section of the thesis.