Medical Education and Curriculum Reform: Putting Reform Proposals in Context

The purpose of this paper is to elaborate criteria by which the principles of curriculum reform can be judged. To this end, the paper presents an overview of standard critiques of medical education and examines the ways medical curriculum reforms have responded to these critiques. The paper then sets out our assessment of these curriculum reforms along three parameters: pedagogy, educational context, and knowledge status. Following on from this evaluation of recent curriculum reforms, the paper puts forward four criteria with which to gauge the adequacy medical curriculum reform. These criteria enable us to question the extent to which new curricula incorporate methods and approaches for ensuring that its substance: overcomes the traditional opposition between clinical and resource dimensions of care; emphasizes that the clinical work needs to be systematized in so far as that it feasible; promotes multi-disciplinary team work, and balances clinical autonomy with accountability to non-clinical stakeholders

The meaning of quality work from the general practitioner's perspective: an interview study

BACKGROUND: The quality of health care and its costs have been a subject of considerable attention and lively discussion. Various methods have been introduced to measure, assess, and improve the quality of health care. Many professionals in health care have criticized quality work and its methods as being unsuitable for health care. The aim of the study was to obtain a deeper understanding of the meaning of quality work from the general practitioner's perspective. METHODS: Fourteen general practitioners, seven women and seven men, were interviewed with the aid of a semi-structured interview guide about their experience of quality work. The interviews were tape-recorded and transcribed verbatim. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of the statements. RESULTS: Two fundamentally different ways to view quality work emerged from the statements: A pronounced top-down perspective with elements of control, and an intra-profession or bottom-up perspective. From the top-down perspective, quality work was described as something that infringes professional freedom. From the bottom-up perspective the statements described quality work as a self-evident duty and as a professional attitude to the medical vocation, guided by the principles of medical ethics. Follow-up with a bottom-up approach is best done in internal processes, with the profession itself designing structures and methods based on its own needs. CONCLUSIONS: The study indicates that general practitioners view internal follow-up as a professional obligation but external control as an imposition. This opposition entails a difficulty in achieving systematism in follow-up and quality work in health care. If the statutory standards for systematic quality work are to gain a real foothold, they must be packaged in such a way that general practitioners feel that both perspectives can be reconciled

Analysing discourse practices in organisations

This paper addresses the issues that arise when ethnographic discourse analysis is used to describe and analyse hospital interaction among medical and non-medical staff in a metropolitan hospital, and when research analyses are reintroduced into the workplace environment. The paper considers the challenges that result from doing intervention-oriented research. The research involves analyses of discourse and talk and a related set of theoretical tools, including transcripts of talk used as data and as evidence in formal accounts, and ethnographic and discourse-analytical claims about hospital interaction that are to be shared with staff for the purpose of communication intervention and workplace change. The paper addresses the salient criticisms that were levelled at our research by senior clinician-managers of the hospital, and reasons about the divergences between sociological (ethnographic-discourse analytic) and medicalpractical understandings of research method and of hospital work. Finally, the paper attempts to reposition both our own social-scientific account and clinical staffs understandings of their work in relation to one another, in the interest of a continued dialogue. Such repositioning is central, we suggest, to maintaining not only the validity of our research but also the momentum of clinicians, and especially doctors, in their move towards hospital reform. Discourse research, we argue, is a unique device for engendering reflexivity on the part of researchers and the researched