Park, SE;
(2017)
The Contribution of General Practice Placements to Medical Education: An Analysis of the Construction of General Practice Placement Knowledge in Published Medical Education Research.
Doctoral thesis , UCL (University College London).
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Abstract
This thesis examines the dominant discourses within research texts about undergraduate general practice placements. This makes visible what is said to be taught and learnt in placements; how research about placements is justified; and how these characterisations produce particular ways of being and knowing for subjects. Analysis examines rules of acceptability and discursive assumptions, exploring the ‘thinkable’ and ‘unthinkable’. This process uses categories of object, subject position, concept and strategy, to build a map of ways in which texts characterise placements; how this produces particular ways of being and relations between students, patients, GPs and researchers; how these link with ways of conceptualising learning; and how overall strategies produce power relations. Two ways of characterizing placements are identified. A ‘gaze of discovery’ views placements as opportunistic experiential learning with patients, producing possibilities for patients as ‘educator’ and ‘contextualised disease’; GP-teacher as ‘facilitator’; and student as ‘participatory learner’ or ‘intruder’. A more dominant ‘gaze of deciphering’ treats placements as pre-determined curricula compartments using mind-body and knowledge-skills-attitude distinctions to imagine different learning in different spaces. Placements are treated as basic, early or filling gaps in hospital-based curricula. This produces patient as ‘subject with x’; student as ‘learner of curriculum’; and GPs as ‘teacher or clinician’ and ‘not knowing’. Evaluation is the dominant way of justifying research, positioning placements as innovative (and thereby un-established) and researcher as ‘evaluator’, distinct from clinician-teacher. Other texts justify research as ‘making voices heard’, some legitimising co-construction of knowledge with participants, and an integrated position for the researcher-practitioner. Overall, strategies position placements as supplementary and different to hospital teaching. Justifying research as evaluation produces challenges for the legitimacy of the field, in relation to other research. While teaching is treated as exchange of existing knowledge, research is positioned as informing teaching practice, legitimising its value through production of new knowledge.
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