Bennett Deirdre, Solomon Yvette, Bergin Colm, Horgan Mary, Dornan Tim
Medical Education Unit, University College Cork, Cork, County Cork, Ireland.
Education and Social Research Institute, Manchester Metropolitan University, Manchester, UK.
Med Educ. 2017 Mar;51(3):248-257. doi: 10.1111/medu.13220. Epub 2016 Dec 29.
Figured Worlds is a socio-cultural theory drawing on Vygotskian and Bakhtinian traditions, which has been applied in research into the development of identities of both learners and teachers in the wider education literature. It is now being adopted in medical education.
The objective of this paper is to show what Figured Worlds can offer in medical education. Having explained some of its central tenets, we apply it to an important tension in our field.
The assumption that there is a uniform 'good doctor' identity, which must be inculcated into medical students, underlies much of what medical educators do, and what our regulators enforce. Although diversity is encouraged when students are selected for medical school, pressure to professionalise students creates a drive towards a standardised professional identity by graduation. Using excerpts from reflective pieces written by two junior medical students, we review the basic concepts of Figured Worlds and demonstrate how it can shed light on the implications of this tension. Taking a Bakhtinian approach to discourse, we show how Adam and Sarah develop their professional identities as they negotiate the multiple overlapping and competing ways of being a doctor that they encounter in the world of medical practice. Each demonstrates agency by 'authoring' a unique identity in the cultural world of medicine, as they appropriate and re-voice the words of others.
Finally, we consider some important areas in medical education where Figured Worlds might prove to be a useful lens: the negotiation of discourses of gender, sexuality and social class, career choice as identification within specialty-specific cultural worlds, and the influence of hidden and informal curricula on doctor identity.
“具象世界”是一种借鉴维果茨基和巴赫金传统的社会文化理论，已被应用于更广泛教育文献中关于学习者和教师身份发展的研究。目前它正被引入医学教育领域。
本文旨在展示“具象世界”理论能为医学教育提供什么。在解释了其一些核心原则后，我们将其应用于我们这个领域的一个重要矛盾点。
医学教育工作者的许多做法以及监管机构所执行的规定，其背后都有这样一种假设，即存在一种统一的“好医生”身份，必须灌输给医学生。虽然在选拔医学生时鼓励多样性，但使学生专业化的压力促使他们在毕业时形成标准化的职业身份。我们通过两名低年级医学生撰写的反思文章片段，回顾“具象世界”的基本概念，并展示它如何能阐明这种矛盾的影响。采用巴赫金的话语分析方法，我们展示了亚当和莎拉在医疗实践中遇到多种重叠且相互竞争的医生角色时，是如何发展他们的职业身份的。他们在医学文化世界中通过“塑造”独特身份来展现能动性，因为他们借鉴并重新诠释他人的话语。
最后，我们思考医学教育中一些重要领域，在这些领域“具象世界”可能会成为一个有用的视角：关于性别、性取向和社会阶层话语的协商，在特定专业文化世界中作为身份认同的职业选择，以及隐性和非正式课程对医生身份的影响。
