Sunnybrook Health Sciences Centre, Toronto, Canada.
Med Teach. 2013;35(1):e849-60. doi: 10.3109/0142159X.2012.748887. Epub 2012 Dec 21.
As medical education research continues to diversify methodologically and theoretically, medical education researchers have been increasingly willing to challenge taken-for-granted assumptions about the form, content and function of medical education. In this AMEE guide we describe historical, discourse and text analysis approaches that can help researchers and educators question the inevitability of things that are currently seen as 'natural'. Why is such questioning important? By articulating our assumptions and interrogating the 'naturalness' of the status quo, one can then begin to ask why things are the way they are. Researchers can, for example, ask whether the models of medical education organization and delivery that currently seem 'natural' to them have been developed in order to provide the most benefit to students or patients--or whether they have, rather, been developed in ways that provide power to faculty members, medical schools or the medical profession as a whole. An understanding of the interplay of practices and power is a valuable tool for opening up the field to new possibilities for better medical education. The recognition that our current models, rather than being 'natural', were created in particular historical contexts for any number of contingent reasons leads inexorably to the possibility of change. For if our current ways of doing things are not, in fact, inevitable, not only can they be questioned, they can be made better; they can changed in ways that are attentive to whom they benefit, are congruent with our current beliefs about best practice and may lead to the production of better doctors.
随着医学教育研究在方法和理论上的不断多样化,医学教育研究人员越来越愿意挑战医学教育的形式、内容和功能方面被视为理所当然的假设。在本 AMEE 指南中,我们描述了历史、话语和文本分析方法,这些方法可以帮助研究人员和教育工作者质疑当前被视为“自然”的事物的必然性。为什么这种质疑很重要?通过阐明我们的假设并质疑现状的“自然性”,我们就可以开始询问事物为什么会是这样。例如,研究人员可以问,目前对他们来说似乎“自然”的医学教育组织和教学模式,是为了最大程度地使学生或患者受益而发展起来的,还是为了使教师、医学院或整个医学专业获得权力而发展起来的。对实践和权力相互作用的理解是为更好的医学教育开拓新的可能性的宝贵工具。认识到我们当前的模式不是“自然”的,而是出于许多偶然原因在特定的历史背景下创造的,这不可避免地导致了变革的可能性。因为如果我们目前做事的方式实际上并不是不可避免的,那么不仅可以质疑它们,还可以使它们变得更好;可以以关注受益人的方式进行改进,与我们当前关于最佳实践的信念相一致,并可能导致产生更好的医生。