The Good Doctor in Medical Education 1910-2010: A Critical Discourse Analysis

Ideas of what constitutes a good doctor underlie decisions about medical student selection, as well as curriculum design and the structure of medical education at both undergraduate and postgraduate levels of training. Factors at play include knowledge paradigms (what does a good doctor need to know), identity paradigms (who can become a good doctor) and notions about the relationship of doctors to society (the social responsibility or social accountability of the good doctor). As with any social phenomenon, constructs of the good doctor are historically derived and socially negotiated. Ideas about the good doctor tend to be considered as ‘truths’ in any era, with little attention to or understanding of the assumptions that underpin any particular formulation. In this thesis, I explore and dissect the dominant constructs of the good doctor in North American medical education between 1910 and 2010. Drawing upon Foucauldian critical discourse analysis, I focus particular attention on discursive shifts in the conception of the good doctor over the past century. This analysis reveals a series of discursive shifts in the framing of the good doctor in medical education between 1910-2010. Abraham Flexner promoted the construct of the good doctor as a scientist physician who was also a man of character. In the post-Flexnerian transformation of medical education, science became curricular content while the discourse of character remained. In the late 1950s a sudden discursive shift occurred, from the character of the good doctor to characteristics. With this shift, the student was dissected as an object of study. Further discursive shifts incorporated discourses of performance and production into constructs of the good doctor as roles-competent. This research explores the implications and consequences of these various discursive framings of the good doctor.Ph