Lima Barreto, Vitor Hugo; (2018) Discourse analysis of general practice in medical education: a comparative study of undergraduate medical education policy in the UK and Brazil. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Introduction: Despite increasing research on medical education, the field of medical education policy, including general practice teaching, has been overlooked. Discourse analysis has recently been introduced to investigate education policy in medical education. This research analyses general practice development in undergraduate medical education policy in both the UK and Brazil. In the UK, general practice is consolidated as an academic field of medical knowledge, whilst in Brazil, it is being established. The historical context of the specialty in each country and the participation of general practitioners in medical schools are considered. Two main dimensions of medical education are emphasized: the alignment with health care systems and the outlook for medical care workforce. The aim of this research was to depict the discursive continuities and discontinuities characterizing general practice knowledge in undergraduate medical education policy in two distinctive contexts. // Method: Foucauldian discourse analysis was used to investigate the representation of general practice as a field of medical knowledge in undergraduate medical education policy in a comparative study design. This research method offers a critical perspective of power relations in policy documents by exploring what is made thinkable and legitimate. It supports the analysis of the assumptions of truth that delineate the frontiers of general practice.// Results: General practice knowledge holds a discursively fragile position in both countries, a consequence of the differences in discursive polarities. The polarities consisted of (a) academic and non-academic knowledge and (b) specialist and non-specialist knowledge in the UK; and (a) public and private health care and (b) generalist and specialist knowledge in Brazil. The similarities included a close relationship between medical education and national health systems. In the UK, the biomedical discourse directs the portrayal of general practice, whereas in Brazil, the counter-discursive element opposed to this biomedical discourse predominates. // Conclusion: The predominant discourses in medical education policy places general practice knowledge in a fragile position compared to other medical fields. A policy focused on the reflexive cycle between academy and practice and between general and specific knowledge could help strengthen general practice knowledge in undergraduate medical education. This could produce stronger, more stable and authoritative thinking in this area of medical science.

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