The professional socialisation of medical students through the preclinical to clinical transition

Abstract

This thesis explores the professional socialisation of medical students through the preclinical to clinical transition of medical education. The research is based in a traditionally structured medical programme. Early clinical experiences are provided for students during their early years of teaching. Twenty-one students were interviewed in their third year and fourth year, before and after their shift into the clinical environment, and participant observation was also undertaken. The findings of this study are that in medical students’ preclinical years human dissection teaches students to manage their emotions, and that students are separating from the lay world. Early clinical experiences in the preclinical years appear fragmented compared to the medical practice of doctors but, introduce students to aspects of medical work, patients and the patient case history. As students shift into their first full-time clinical year, they shape earlier knowledge to make it meaningful to its new context. Medical students ‘medicalise’ patients through the patient case history, but they also ‘personalise’ diseases as they associate patients with diseases. By learning in the clinical environment and being associated with medical teams, students observe and undertake parts of medical work, in an apprentice-style way. Finally, while students learn medical language and the patient case history, their experiences with patients requires them to be with patients in a way that is beyond the disease-based approach of medicine. This thesis concludes that while the biomedical science shapes students’ early medical education, it is in the clinical environment that students learn to be doctors. This includes the biomedical-based practice of the patient case history, and physical examination, as well as how to be with patients when what is required from the student is not to ‘do’ but to ‘be with’ the patient.