Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland.
Medical Education Unit, University College Cork, Cork, Ireland.
Med Educ. 2019 Jan;53(1):56-63. doi: 10.1111/medu.13758. Epub 2018 Nov 15.
Historically, primary care (community and family) medicine has often been viewed as lower status than secondary care (hospital) practice. Current evidence suggests this pattern continues to impact medical practice and education. Medical education has however, yet to fully reflect this power dynamic, with undergraduate training in many institutions maintaining the hegemonic position of secondary care as the prime context for learning.
In this paper, we present primary and secondary care as conflicting paradigms of medical practice. Using a sociocultural lens drawing on Figured Worlds theory, implications for medical education are explored.
We outline the two paradigms as having distinct epistemologies, identities and practices. Tensions at the primary-secondary care interface can, from a sociocultural perspective, be seen to impact developing identity and day-to-day clinical practice issues such as patient safety. We offer possibilities for engaging with paradigm conflict in meaningful ways and suggest potential changes for future educational policy and practice.
从历史上看，初级保健（社区和家庭）医学的地位往往低于二级保健（医院）实践。目前的证据表明，这种模式仍在影响医疗实践和教育。然而，医学教育尚未充分反映这种权力动态，许多机构的本科培训仍将二级保健置于主导地位，作为学习的主要环境。
在本文中，我们将初级保健和二级保健视为医疗实践的两种相互冲突的范式。我们运用社会文化视角，借鉴图式世界理论，探讨了其对医学教育的影响。
我们将这两种范式描述为具有不同的认识论、身份和实践。从社会文化的角度来看，初级保健和二级保健之间的紧张关系会对正在形成的身份认同和日常临床实践问题（如患者安全）产生影响。我们提出了以有意义的方式参与范式冲突的可能性，并为未来的教育政策和实践提出了一些潜在的改变。
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