Ideological reproduction and social control in medical education

This sociological study of medical school culture employed a critical framework for analysis of ideological reproduction and social control. A literature review provided a social-historical context for the empirical findings that focused on student-faculty discourse at one college of medicine during the third-year Family and Community Medicine clerkship. Data collection consisted of audio recording and observation in both classroom and clinical settings. A depth hermeneutical analysis was used to answer three research questions. For question 1, "What is the macro medical social context within which ideologies are being reproduced and received in medical education?" a literature review on recent trends in health care delivery and medical education elucidated the social-historical conditions in which ideological and social control constructs are embedded today. The principal finding was that the U.S. health system is embroiled in a revolution, characterized by the frequently contradictory ideologies of medical advocacy and business allocation. For question 2, "What are the principal ideological and social control messages being reproduced in medical education?" a discursive analysis of faculty-student dialogue was structured around eight thematic elements. Findings revealed that medical education does not prepare students to think critically about social and environmental issues that cause 85% of illness in our society, with faculty dominance often acting as a major deterrent. The principal messages being reproduced extended from a therapeutic ideology that promotes the physician's definition/control of patient problems. Also found was a deeply conflictual relationship between managed and medical care. For question 3, "How does the meaning mobilized by these ideological messages in medical education serve to establish and sustain relations of domination and social control?" an interpretive process clarified how ideology and social control sustain relations of power that systematically confound and effectively eliminate social justice in health care. Because the right to define the patient's problem gives the physician extraordinary power, the drive to reach a differential diagnosis is extremely strong, and gaining diagnostic expertise is medical education's consuming focus. As a result, students leave medical school prepared for their professional social control role, while uncritically accepting the inequitable and illness-causing social, economic, and political ideologies of our time