They shared a common fate and daily life as medical students, struggling with the same exams, the unclear relevance of the hard work, their own identity issues, competition, peer perfectionism, and in some cases social isolation. Students saw potential connections between the hierarchy and perfectionism experienced in medical school, and the stereotypical ideal of physicians as somehow superior. Another aspect of this alienating experience was the loss of individuality and independent thinking:.
But you see students who just seem to be muddling along all alone. Maybe if they had someone to talk to…? Though all students acknowledged that there were problems, most also gave examples and arguments that allowed the first year of medical school to be seen as just what they needed to become good physicians.
The arguments fell into three categories: trust in the wisdom of the system, the protective function of knowledge, and the need to grow up and take responsibility. Students voiced many arguments and interpretations in support of the usefulness and adequacy of the education they received.
The profession is so big, and you choose specialty so late, that lots of information has to come in a relatively short time. And that information has sort of a given answer A7f. Poor pedagogy was acknowledged, but not seen as representative of the system. Not everything needs to be clinically relevant. The informants trusted the basic fairness of the system, that hard work would pay off, and that the relevance of subjects taught would become apparent with time.
You learn it later. You find out later what is important A1m. Many students saw the lack of supervision and interaction with staff as a manifestation of freedom and responsibility. Students should teach themselves how to be critical to the knowledge transmitted, and to see what the more or less important parts were. Then I think one sort of has to take the initiative and filter out what one thinks is less important and put in what is more important. Handling student life without being seen by teachers was a way of growing up.
Students readily agreed on the characteristics of a good physician, underscoring the humanistic ideals while also pointing out the importance of knowledge. When asked how the university supported their development towards these competences, two partly contradictory discourses, one critical and the other apologetic, emerged. The critical discourse focused on a lack of clinical contextualization, poor pedagogy, lack of critical thinking, and isolation and intimidation. The apologetic discourse highlighted trust that the system would provide the competence they needed, that basic knowledge is needed before clinical practice, and that lack of close supervision confers freedom and responsibility.
The discourses of criticism and apology seem to reveal a balancing act where the medical students, who may see themselves as fortunate champions of the prestigious and highly competitive race to enter medical school, strive to maintain a positive self-image by constructing interpretations and adaptive strategies that ameliorate the experience of partly disappointing learning trajectories, whose usefulness in relation to their professional goals and ideals is dubious.
Curricula, largely structured around acquisition of measurable knowledge and skills, disregard insights from education research showing that adult learners need to be engaged in supervised practice, feedback and guided reflection, for factual knowledge to evolve into practice competence [ 32 — 39 ].
On the other hand, research suggests that experiential learning, such as early patient experiences, by providing relevance and motivation, helps students understand basic science better and develop clinical skills quicker [ 42 ]. A learning environment lacking personal supervision and guidance is a risk factor for mental health problems, such as burnout and depression [ 25 , 43 , 44 ].
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Teaching and assessments perceived as lacking in relevance and meaning, of the kind indicated by our results, increase the likelihood of burnout [ 25 ]. Motivated and intelligent persons who expect to derive a certain fulfillment from work are those who are more likely to become disappointed, helpless, and hopeless, and eventually burn out [ 45 ]. Burnout, with its typical alienation and cynicism, may be a link to understanding the stunting of empathy and moral reasoning that occurs in many medical students, often starting in the first year [ 46 , 47 ]. We have no data on the mental health of our informants.
The apologetic discourse suggests that their morale was upheld by compensatory mechanisms. Secondary socialization is the formational processes that transform lay youths to professionals, through tacit and largely unconscious mechanisms of adaptation whereby newcomers relinquish aspects of their former selves and adopt norms that dominate their new environment [ 5 ].
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Driven by hunger, a fox tried to reach some grapes hanging high on the vine but was unable to, although he leaped with all his strength. By denying that he has a problem, he avoids the painful emotions and threatened self-image associated with helplessness, bad luck and unsatisfied appetite. Residual frustrations are balanced by trust in the wisdom of the system: everything will become meaningful at a later stage.
In this lies a tacit devaluation of themselves as too inexperienced or ignorant of clinical practice to exert judgment about the relevance of the education they receive.
here Medical studies are expected to demand sacrifice, and it has been shown that students admitted to medical school undergo anticipatory socialization, adjusting their values and dispositions in the time between admission and entry [ 50 ]. Students arriving at university fresh from secondary education are used to learning by memorization [ 51 , p. Moreover, the prestigious reputation of medical studies with its connotations of science, academia, and altruism conveys authority and high moral and intellectual standards, making it even more unlikely that the medical novice should perceive medical education as deficient, or herself as apt to evaluate it [ 4 , p.
The result is cognitive dissonance , the discomfort experienced when a person holds contradictory ideas or beliefs [ 52 ]. In this case, the students reduce dissonance by negating that the disconnectedness, irrelevance and factual overload they experience is real, or a real problem. The results are based on interviews with a small number of students, and have limited generalizability. What becomes visible through the discourse of our informants are unintended learning processes whereby students alter their views of science, learning, and medicine as such, by partaking in and approving of routine life in medical school, where well founded critical impulses are dampened by rationalization.
The result are professional identities and perspectives awash in unacknowledged, and not entirely benign [ 53 ], perceptions of knowledge, quality, value and competence. National Center for Biotechnology Information , U. Journal List Med Educ Online v. Med Educ Online. Published online Aug 1. Edvin Schei , a Ruth E.
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Ruth E. Author information Article notes Copyright and License information Disclaimer. ABSTRACT Background : Traditional preclinical curricula based on memorization of scientific facts constitute learning environments which may negatively influence both factual understanding and professional identity development in medical students. Design : Focus group interviews with thematic text analysis.
Study aim Based on the above literature, we theorized that the discourse of contemporary medical students at the end of year 1, i.
Material and methods Participants and data collection Participants were recruited among medical students towards the end of year 1. Ethics The study was approved by the Norwegian Centre for Research Data, the data protection official for research for Norwegian universities. Results The findings are presented without comments, followed by a theoretical discussion.
A2m Ambivalence and two discourses When asked whether and how the medical school helped them develop what they needed to fulfill these ideals of their future professional role, two different discourses emerged, one critical and one apologetic. B7f Students mostly agreed on the descriptions, examples, and reflections given by peers, whether the implications were critical or apologetic, but often a critical comment was balanced by an apologetic one, and vice versa.
The critical discourse The critical discourse exhibits four lines of reasoning: disconnected knowledge, poor pedagogy, lack of reflection, and isolation and intimidation from lack of contact with faculty and staff. Poor pedagogy Students agreed that many lecturers came ill prepared and unmotivated for teaching, dishing out information on powerpoint slides at high speed without contextualizing the facts or activating the students. A7m Ethics teaching was the exception: In ethics, the difference was that you were activated and made to think yourself, and then you remember more B2m.
Isolation and intimidation Students described themselves as experiencing no personal contact with faculty members, feeling invisible and anonymous. A3f Students saw potential connections between the hierarchy and perfectionism experienced in medical school, and the stereotypical ideal of physicians as somehow superior. The apologetic discourse Though all students acknowledged that there were problems, most also gave examples and arguments that allowed the first year of medical school to be seen as just what they needed to become good physicians.
Trust the wisdom of the system Students voiced many arguments and interpretations in support of the usefulness and adequacy of the education they received. Discussion Students readily agreed on the characteristics of a good physician, underscoring the humanistic ideals while also pointing out the importance of knowledge.
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The fox and the grapes — dissonance and rationalization Driven by hunger, a fox tried to reach some grapes hanging high on the vine but was unable to, although he leaped with all his strength. Critical remarks The results are based on interviews with a small number of students, and have limited generalizability. Conclusion What becomes visible through the discourse of our informants are unintended learning processes whereby students alter their views of science, learning, and medicine as such, by partaking in and approving of routine life in medical school, where well founded critical impulses are dampened by rationalization.
Disclosure statement No potential conflict of interest was reported by the authors. Al-Isra Private Univ. Soliman Fakeeh college Dr. Vasantrao Pawar Med. Medical College, Baroda Gov.