Balmer Dorene F, Richards Boyd F, Varpio Lara
Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin Street, A188.03, Houston, TX, 77030, USA.
Columbia University Medical Center, New York, NY, USA.
Adv Health Sci Educ Theory Pract. 2015 Oct;20(4):1073-85. doi: 10.1007/s10459-015-9588-y. Epub 2015 Jan 30.
Using Bourdieu's theoretical model as a lens for analysis, we sought to understand how students experience the undergraduate medical education (UME) milieu, focusing on how they navigate transitions from the preclinical phase, to the major clinical year (MCY), and to the preparation for residency phase. Twenty-two medical students participated in this longitudinal case study. Students had similar preclinical and post-MCY experiences but different MCY experiences (rotational vs. longitudinal tracks). We interviewed students every 6 months in the preclinical phase, mid-way through MCY, and 7-8 months before graduation (101 total interviews). We inductively created codes, iteratively revised codes to best-fit the data, and thematically clustered codes into Bourdieu-informed categories: field (social structures), capital (resources) and habitus (dispositions). We found that students acclimated to shifts in the UME field as they moved through medical school: from medical school itself to the health system and back. To successfully navigate transitions, students learned to secure capital as medical knowledge and social connections in the preclinical and preparation for residency phases, and as reputable patient care and being noticed in the clinical phase. To obtain capital, and be well-positioned for the next phase of training, students consistently relied on dispositions of initiative and flexibility. In summary, students experience the complex context of medical school through a series of transitions. Efforts to improve UME would be well-served by greater awareness of the social structures (field) that students encounter, the resources to which they afford value (capital), and the dispositions which aid acquisition of these resources (habitus).
以布迪厄的理论模型为分析视角，我们试图了解学生如何体验本科医学教育（UME）环境，重点关注他们如何从临床前阶段过渡到主要临床年（MCY），以及再到住院医师培训准备阶段。22名医学生参与了这项纵向案例研究。学生们在临床前和MCY后的经历相似，但MCY期间的经历不同（轮转式与纵向式）。我们在临床前阶段、MCY中期以及毕业前7 - 8个月每隔6个月对学生进行一次访谈（共101次访谈）。我们归纳生成编码，反复修订编码以使其最贴合数据，并将编码按主题聚类为受布迪厄理论启发的类别：场域（社会结构）、资本（资源）和惯习（倾向）。我们发现，随着学生在医学院学习进程的推进，他们适应了UME场域的转变：从医学院本身到卫生系统，再回归医学院。为了成功应对这些转变，学生们学会在临床前阶段和住院医师培训准备阶段获取医学知识和社会关系等资本，在临床阶段获取良好声誉的患者护理成果并受到关注。为了获取资本并为下一阶段的培训做好准备，学生们始终依赖主动性和灵活性的倾向。总之，学生们通过一系列转变体验医学院的复杂环境。若能更深入了解学生所遇到的社会结构（场域）、他们所重视的资源（资本）以及有助于获取这些资源的倾向（惯习），将有助于改善UME。
