Rodríguez Charo, López-Roig Sofía, Pawlikowska Teresa, Schweyer François-Xavier, Bélanger Emmanuelle, Pastor-Mira Maria Angeles, Hugé Sandrine, Spencer Sarah, Lévasseur Gwenola, Whitehead Ian, Tellier Pierre-Paul
C. Rodríguez is associate professor, Area of Health Services Research, Department of Family Medicine, and director, McGill Family Medicine Educational Research Group (FMER), McGill University, and senior research scholar, Fonds de recherche du Quebec Santé, Montreal, Quebec, Canada. S. López-Roig is associate professor, Department of Health Psychology, Universidad Miguel Hernández, Elche (Alicante), Spain. T. Pawlikowska is professor and director, Health Professions Education Centre, Royal College of Surgeons in Ireland, Dublin, Ireland. F.-X. Schweyer is professor of sociology, École des Hautes Études en Santé Publique, School of Public Health, University of Rennes 1, Rennes, France, and researcher, Équipe de Recherche sur les Inégalités de Santé, Centre Maurice Halbwachs, Paris, France. E. Bélanger is postdoctoral fellow, University of Montreal, and collaborator, McGill Family Medicine Educational Research Group (FMER), Department of Family Medicine, McGill University, Montreal, Quebec, Canada. M.A. Pastor-Mira is associate professor, Department of Health Psychology, Universidad Miguel Hernández, Elche (Alicante), Spain. S. Hugé is maître de conférences associée and chair, Department of General Medicine, University of Rennes 1, Rennes, France. S. Spencer is academic clinical fellow, London School of General Practice, Queen Mary University of London, London, England. G. Lévasseur is emeritus professor, Department of General Medicine, University of Rennes 1, Rennes, France. I. Whitehead is clinical teaching fellow, Freeman Hospital, Newcastle Upon Tyne, England. P.-P. Tellier is associate professor, Department of Family Medicine, and director, Student Health Services, McGill University, Montreal, Quebec, Canada.
Acad Med. 2015 May;90(5):660-70. doi: 10.1097/ACM.0000000000000572.
To understand the influence of academic discourses about family medicine on medical students' professional identity construction during undergraduate training.
The authors used a multiple case study research design involving international medical schools, one each from Canada, France, Spain, and the United Kingdom (UK). The authors completed the fieldwork between 2007 and 2009 by conducting 18 focus groups (with 132 students) and 67 semistructured interviews with educators and by gathering pertinent institutional documents. They carried out discursive thematic analyses of the verbatim transcripts and then performed within- and cross-case analyses.
The most striking finding was the diverging responses between those at the UK school and those at the other schools. In the UK case, family medicine was recognized as a prestigious academic discipline; students and faculty praised the knowledge and skills of family physicians, and students more often indicated their intent to pursue family medicine. In the other cases, family medicine was not well regarded by students or faculty. This was expressed overtly or through a paradoxical academic discourse that stressed the importance of family medicine to the health care system while decrying its lack of innovative technology and the large workload-to-income ratio. Students at these schools were less likely to consider family medicine.
These results stress the influence of academic discourses on medical students' ability to identify with the practice of family medicine. Educators must consider processes of professional identity formation during undergraduate medical training as they develop and reform medical education.
了解有关家庭医学的学术话语对医学生本科培训期间职业身份建构的影响。
作者采用多案例研究设计，涉及国际医学院校，分别来自加拿大、法国、西班牙和英国各一所。作者在2007年至2009年间完成了实地研究，开展了18个焦点小组（共132名学生）和67次对教育工作者的半结构化访谈，并收集了相关的机构文件。他们对逐字记录进行了话语主题分析，然后进行了案例内和跨案例分析。
最显著的发现是英国学校与其他学校之间的不同反应。在英国的案例中，家庭医学被视为一门有声望的学科；学生和教师赞扬家庭医生的知识和技能，学生更常表示有意从事家庭医学。在其他案例中，家庭医学未得到学生或教师的好评。这通过公开表达或一种矛盾的学术话语表现出来，这种话语强调家庭医学对医疗保健系统的重要性，同时谴责其缺乏创新技术和高工作量与收入比。这些学校的学生不太可能考虑从事家庭医学。
这些结果强调了学术话语对医学生认同家庭医学实践能力的影响。教育工作者在发展和改革医学教育时，必须考虑本科医学培训期间职业身份形成的过程。
