Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
Sociol Health Illn. 2013 May;35(4):544-59. doi: 10.1111/j.1467-9566.2012.01512.x. Epub 2012 Oct 3.
Medical doctors in teaching hospitals aim to serve the two central goals of patient care and medical training. Whereas patient care asks for experience, expertise and close supervision, medical training requires space to practise and the 'invisibility' of medical residents. Yet current reforms in postgraduate medical training point to an increasing emphasis on the measurable visibility of residents. Drawing on an ethnographic study of gynaecology training in The Netherlands, this article demonstrates that in daily clinical routines multiple practices of residents' visibility (visibilities) coexist. The article lists four visibilities: staging residents, negotiating supervision, playing the invisibility game and filming surgical operations. The article shows how attending physicians and medical residents tinker with these visibilities in daily clinical work to provide good care while enacting learning space, highlighting the increasing importance of visualising technologies in clinical work. Moreover, the article contributes to traditional sociological accounts on medical education, shifting the focus from medical education as a social institution to the practices of medical training itself. Such a focus on practice helps to gain an understanding of how the current reform challenges clinicians' educational activities.
教学医院的医生旨在实现患者护理和医学培训这两个核心目标。虽然患者护理需要经验、专业知识和密切监督，但医学培训需要实践空间和住院医师的“隐形”。然而，目前研究生医学培训的改革越来越强调住院医师的可衡量可见性。本文通过对荷兰妇科培训的民族志研究表明，在日常临床实践中，存在着多种住院医师可见性（可见性）的共存。本文列出了四种可见性：对住院医师进行分期、协商监督、玩隐形游戏和拍摄手术。本文展示了主治医生和住院医师如何在日常临床工作中调整这些可见性，在提供良好护理的同时为学习提供空间，突出了可视化技术在临床工作中的重要性日益增加。此外，本文对传统的医学教育社会学理论做出了贡献，将重点从医学教育作为一种社会制度转移到医学培训本身的实践上来。这种对实践的关注有助于理解当前的改革如何挑战临床医生的教育活动。
