Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
School of Culture, Media & Society, The University of the Fraser Valley, Abbotsford, BC, Canada.
Adv Health Sci Educ Theory Pract. 2023 Dec;28(5):1593-1613. doi: 10.1007/s10459-023-10238-7. Epub 2023 May 18.
New public management ideals and standards have become increasingly adhered to in health professions education; this is particularly apparent in high-stakes assessment, as a gateway to practice. Using an Institutional Ethnographic approach, we looked at the work involved in running high-stakes Objective Structured Clinical Exams (OSCEs) throughout an academic year including use of observations, interviews and textual analysis. In our results, we describe three types of 'work'-standardising work, defensibility work and accountability work-summarising these in the discussion as an Accountability Circuit, which shows the organising role of texts on people's work processes. We show how this form of governance mandates a shift towards accountability-centred practices, away from practices which are person-centred; this lens on accountability-centring during high-stakes assessments invites critique of the often-unquestioned emphasis of new public management in health professions education.
新公共管理理念和标准在卫生职业教育中越来越受到重视；在高风险评估中尤为明显，因为它是进入实践的门户。本研究采用制度人种学方法，观察、访谈和文本分析相结合，研究了一学年中进行高风险客观结构化临床考试（OSCE）所涉及的工作。在研究结果中，我们描述了三种“工作”-标准化工作、防御性工作和问责制工作-并在讨论中总结为一个问责制循环，该循环展示了文本对人们工作流程的组织作用。我们展示了这种治理形式如何要求向以问责为中心的实践转变，而不是以个人为中心的实践；这种对高风险评估中问责制中心的视角邀请人们对新公共管理在卫生职业教育中经常被忽视的强调进行批判。
