"In Training": Systems of Power and Exploitation in the Making of the American Physician

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Genre
Thesis/Dissertation
Date
2023
Author
Healy, Megan cc
Advisor
Cabey, Vielka Whitney
Department
Urban Bioethics
Subject
Medical ethics
Education
Permanent link to this record
http://hdl.handle.net/20.500.12613/8482

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DOI
http://dx.doi.org/10.34944/dspace/8446
Abstract
Residency training marks a period of rapid learning in the career of a physician. As new physicians are swiftly acquiring medical knowledge and practicing new clinical skills, they are also undergoing intense professionalization and socialization, which influences their understanding of the healthcare system and their role within it. The working conditions of residency training and culture of medicine interact to exploit the labor of trainees. This perpetuates dominance and authority for the institutions that create and sustain these conditions. The history of the development of residency training programs, the Match, and house staff activism in the 1970s illuminate the systems of power operating within graduate medical education. This history produced the GMEA system we know today that is predicated on self-sacrifice, individualism, and deference to institutional power. As trainees are subject to the practices and beliefs that maintain this system, they internalize and normalize oppression, and in turn enact it upon others as they advance through the hierarchy themselves and acquire more material and social capital. By understanding the history of GME and interrogating these systems, we can begin to imagine a different kind of residency training that might better serve the needs of both learners and the patients they care for. Trauma informed education and critical pedagogy are two lenses that can inform future iterations of graduate medical education. These frameworks offer a different set of values, practices and systems that center healing and aspire to health justice.
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