Performance or Presence? Examining the Private Parts of Australian Medical Education

Abstract

Recent studies within medical education indicate that current teaching practices of intimate examination are fraught with social and ethical problems, yet medical education and the sociology of medical education have offered little understanding of the relational and ontological underpinnings of these troubling issues. This thesis seeks to address educational and conceptual limitations within research on Australian medical education, by accounting for the ways in which students learn about intimate examinations. Using qualitative methods including participant-observation, interviews, a focus group, and textual analysis of clinical examination textbooks and medical student publications, I argue that medical education needs to teach both subject-object and performative understandings of clinical relations as well as embodied empathic understandings of clinical and other relations. Drawing on Erving Goffman (1959), Arthur Frank (1995) and Donald Winnicott (1986), I establish that medical work needs to be more deeply understood as a process that requires both a specialist and objectifying movement away from common humanity, and also an embrace of and reliance upon the humble lay condition shared by doctor and patient. I explore the various education contexts in which intimate examinations are taught, including textbooks, medical classes and clinical placements, and identify instances where the classic passage-like concept of professional socialisation (e.g., Merton et al. 1957; Becker et al. 1961; Hafferty 1991) is both upheld and challenged. My findings suggest the two models of social relations surface to different extents, depending on the method of education, but that the latter is often taken for granted, its complexities, implications and challenges unrecognised. Through an examination of three educational contexts, this thesis shows how and why the fundamental principles that uphold embodied empathic relations require more attention and development. One of the significant contributions of this thesis is the development of a new socialisation model where both lay and professional values are considered important and developed equally. The insights generated from this study have the potential to inform the development of Australian medical school curriculums, and thereby to improve social relations within intimate physical examinations.