Communicating Professional Identity in Medical Socialization: Considering the Ideological Discourse of Morning Report

In this study, the authors investigate how medical ideology and physician professional identity are socially constructed during morning report, a formal teaching conference considered to be a cornerstone of medical education. Analysis of transcripts from 20 meetings reveals physician identity is developed through ideological discourse that produces and reproduces systems of domination that privilege scientific medicine and marginalize humanistic approaches. Findings indicate how, in a socialization context uniquely focused on discourse, communication functions to construct a professional identity grounded in the principles of the biomedical model. Although medical residents deviate from traditional ideology by articulating the voice of the lifeworld, faculty physicians counter these moves by asserting the voice of medicine. The authors draw conclusions regarding identity formation and the socialization practices of medical education.

[1]  S. Kleinman,et al.  Managing emotions in medical school: Students' contacts with the living and the dead. , 1989 .

[2]  F. Hafferty,et al.  Cadaver stories and the emotional socialization of medical students. , 1988, Journal of health and social behavior.

[3]  H. Waitzkin.  Medicine, superstructure and micropolitics. , 1979, Social science & medicine. Medical psychology & medical sociology.

[4]  K. Tracy,et al.  The identity work of questioning in intellectual discussion , 1994 .

[5]  S. Wartman.  Morning report revisited , 1995, Journal of general internal medicine.

[6]  G Bordage,et al.  Morning report: focus and methods over the past three decades. , 2000, Academic medicine : journal of the Association of American Medical Colleges.

[7]  C. Geertz.  The interpretation of cultures: Selected essays , 1975 .

[8]  E. Mishler,et al.  Discourse Of Medicine Dialectics Of Medical Interviews , 2017 .

[9]  Thomas R. Lindlof.  Qualitative Communication Research Methods , 1994 .

[10]  Grant Mccracken.  The long interview , 1988 .

[11]  E. Tyson,et al.  The culture of morning report: ethnography of a clinical teaching conference. , 1997, Southern medical journal.

[12]  Kathleen J. Krone,et al.  Exploring the emergent identities of future physicians: Toward an understanding of the ideological socialization of osteopathic medical students , 2001 .

[13]  A. Arluke.  Roundsmanship: inherent control on a medical teaching ward. , 1980, Social science & medicine. Medical psychology & medical sociology.

[14]  R. Broadhead.  The Private Lives and Professional Identity of Medical Students , 1983 .

[15]  R. Curtis.  The Saturated Self: Dilemmas of Identity in Contemporary Life , 1992 .

[16]  Anselm L. Strauss,et al.  Basics of qualitative research : techniques and procedures for developing grounded theory , 1998 .

[17]  D. Cali,et al.  The Medical Interview as Rhetorical Counterpart of the Case Presentation , 1999 .

[18]  E. Goffman.  Interaction Ritual: Essays on Face-To-Face Behavior , 1967 .

[19]  Frederick Ericksan.  Appropriation of voice and presentation of self as a fellow physician: Aspects of a discourse of apprenticeship in medicine , 1999 .

[20]  Eric W. Rothenbuhler,et al.  Ritual Communication: From Everyday Conversation to Mediated Ceremony , 1998 .

[21]  D. Mumby.  Power and Politics , 2001 .

[22]  E. Goffman.  The Presentation of Self in Everyday Life , 1959 .

[23]  M. Manen.  Researching Lived Experience: Human Science for an Action Sensitive Pedagogy , 1990 .

[24]  Jonathan Silverman,et al.  Skills for Communicating with Patients , 1998 .

[25]  Patricia Geist,et al.  The demise of dialogue: A critique of medical encounter ideology , 1993 .

[26]  F. Hafferty,et al.  The hidden curriculum, ethics teaching, and the structure of medical education , 1994, Academic medicine : journal of the Association of American Medical Colleges.

[27]  A. Strauss,et al.  The discovery of grounded theory: strategies for qualitative research aldine de gruyter , 1968 .

[28]  Tait Shanafelt,et al.  Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program , 2002, Annals of Internal Medicine.

[29]  B. Beagan.  Neutralizing differences: producing neutral doctors for (almost) neutral patients. , 2000, Social science & medicine.

[30]  A sociology of health , 1988 .

[31]  John C. Turner,et al.  The social dimension: Social identification and psychological group formation , 1984 .

[32]  Daniel Field,et al.  Domination and the Arts of Resistance: Hidden Transcripts. , 1992 .

[33]  M. Harrison.  A woman in residence , 1982 .

[34]  M. Shapiro.  Getting Doctored: Critical Reflections on Becoming a Physician , 1987 .

[35]  H. Tajfel,et al.  The Social Identity Theory of Intergroup Behavior. , 2004 .

[36]  K. Gergen,et al.  Social Construction: Knowledge, Self, Others, and Continuing the Conversation , 1994 .

[37]  A. Beisecker,et al.  Patient Power in Doctor-Patient Communication: What Do We Know? , 1990 .

[38]  K. Sepkowitz,et al.  Resident expectations of morning report: a multi-institutional study. , 1999, Archives of Internal Medicine.

[39]  D. Wear.  Professional development of medical students: problems and promises , 1997, Academic medicine : journal of the Association of American Medical Colleges.

[40]  C. S. Beck,et al.  "How can I Put this?" Exaggerated Self-Disparagement as Alignment Strategy during Problematic Disclosures by Patients to Doctors , 1997 .

[41]  E. Eisenberg.  Building a Mystery: toward a New Theory of Communication and Identity , 2001 .

[42]  W. Owen.  Interpretive themes in relational communication , 1984 .

[43]  Anselm L. Strauss,et al.  Boys in White: Student Culture in Medical School. , 1962 .

[44]  Kristin M. Langellier,et al.  Breast Talk in Breast Cancer Narratives , 1998, Qualitative health research.