Author: Meza J and Provenzano A Publication Year: 2015
Summary: This paper explores how competence in medical learners is socially created within the power structures embedded in medical education.
Description: Introduction: This paper explores how competence of medical learners is socially constructed within power structures embedded in medical education. This social dynamic is contrasted with professionalism and its context dependent definition in medical education compared to more common conceptualizations for the medical profession in general.

Methods: Anthropological, ethnographic methods were used to collect data, primarily participant observation and ethnographic interviewing. The fieldwork site was a teaching hospital where the same “team” of attending physicians and residents were observed on both inpatient and outpatient settings. The theoretical frameworks included Paolo Friere, Pierre Bourdieu / Jean-Claude Passeron.

Results:
1. Competence is a result of acquiring a diagnostic “gaze” and once achieved, results in autonomy and authority within the medical hierarchy.
2. Professionalism in the context of medical education modulates the entire hierarchical structure and protects vulnerable individuals from harm due to potential misuse of power.

Discussion: The relationship between power, competence, and professionalism needs to be considered by educators because learners will hide important information unless their need for safety is addressed.

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