Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6587cd75c8-6rxlm Total loading time: 0 Render date: 2025-04-24T09:36:06.760Z Has data issue: false hasContentIssue false

4 - Socialization, professionalism, and professional identity formation

from Part II - Theory

Published online by Cambridge University Press:  05 April 2016

By
Frederic William Hafferty
Edited by
Richard L. Cruess ,
Sylvia R. Cruess  and
Yvonne Steinert
Frederic William Hafferty
Affiliation:
College of Medicine, Program in Professionalism & Values, Mayo Clinic, Rochester, Minnesota, USA
Richard L. Cruess
Affiliation:
McGill University, Montréal
Sylvia R. Cruess
Affiliation:
McGill University, Montréal
Yvonne Steinert
Affiliation:
McGill University, Montréal
Get access

Summary

History is opaque. You see what comes out, not the script that produces events, the generator of history.

Introduction

In this chapter, we will examine issues of professionalism and professional identity formation through the particular lens of socialization theory. The fundamental assumption driving this chapter is my belief that current discussions about professionalism, and to a lesser extent professional identity formation, contain a bevy of unexamined assumptions about what happens to learners as they move from the social and social–psychological status of lay outsiders to full members in a particular occupational group – in this case, medicine. The largely tacit nature of these suppositions, in turn, may block or otherwise distort meaningful efforts by medical educators to optimally link medical education with the principles and practices of professionalism and identity formation. Until these disconnects and contradictions are made more explicit, efforts to develop and deploy effective educational interventions will be less than optimal.

To facilitate this examination, I treat medicine's current professionalism movement as discourse and analyze “how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label of ‘professionalism.’”2 My principal focus will be on the discourse of professionalism that has emerged since the mid 1980s, a period I consider to be the general launching point for organized medicine's modern-day professionalism movement. This discourse is marked by calls for physicians to recommit themselves to an ethic of professionalism – an ethic grounded in selfless service (e.g., altruism) and an ethic calling for the transformation of practitioners at the level of core values and self-identity. This discourse identifies medical schools as the primary change agent with medical students being the principal foci. While this discourse has evolved to include calls for changing educational institutions at the level of organizational culture, there are few details about how to link the structure, process, and content of education with the called-for changes in outcomes. Perhaps most consequentially, this discourse is awash with often inconsistent and conflicting references to professionalism across a broad variety of social–cognitive entities such as behaviors, attitudes, values, motives, and tendencies.

Type
Chapter
Information
Teaching Medical Professionalism
Supporting the Development of a Professional Identity
 , pp. 54 - 67
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

1. Taleb, NN. The Black Swan: The Impact of the Highly Improbable. New York, NY: Random House; 2007.
2. Wear, D, Kuczewski, MG. The professionalism movement: can we pause?. Am J Bioeth. 2004; 4(2): 1–10.CrossRefGoogle Scholar
3. Hafferty, FW, Castellani, B. A sociological framing of medicine's modern-day professionalism movement. Med Educ. 2009; 43(9):826–28.CrossRefGoogle Scholar
4. Hafferty, FW. Professionalism: the next wave. N Engl J Med. 2006; 355(20): 2151–52.CrossRefGoogle Scholar
5. Cohen, JJ. Professionalism in medical education, an American perspective: from evidence to accountability. Med Educ. 2006; 40(7):607–17.CrossRefGoogle Scholar
6. Horton, R. What's wrong with doctors? New York Rev Books. 2007; 54(9): 16–20.Google Scholar
7. Castellani, B, Hafferty, FW. The complexities of professionalism: a preliminary investigation. In Wear, D, Aultman, JM, eds. Professionalism in Medicine: Critical Perspectives. New York, NY: Springer; 2006:3–23.
8. Lundberg, GD. Promoting professionalism through self-appraisal in this critical decade. JAMA. 1991; 265(21):2859.CrossRefGoogle Scholar
9. Relman, AS. Shattuck lecture–the health care industry: where is it taking us? N Engl J Med. 1991; 325(12):854–59.CrossRefGoogle Scholar
10. Ring, JJ. The right road for medicine: professionalism and the new American Medical Association. JAMA. 1991; 266(12): 1694.CrossRefGoogle Scholar
11. Todd, JS. Professionalism at its worst. JAMA. 1991; 266(23): 3338.CrossRefGoogle Scholar
12. Reynolds, PP. Reaffirming professionalism through the educational community. Ann Intern Med. 1994; 120(7):609–14.CrossRefGoogle Scholar
13. Frank, JR, Jabbour, M, Tugwell, P. Skills for the new millennium: report of the Societal Needs Working Group. CanMEDS 2000 Project. Ann R Coll Physicians Surg Can. 1996; 29(4):206–16.Google Scholar
14. Wynia, MK, Latham, SR, Kao, AC, Berg, JW, Emanuel, LL. Medical professionalism in society. N Engl J Med. 1999; 341(21):1612–16.CrossRefGoogle Scholar
15. Swick, HM, Szenas, P, Danoff, D, Whitcomb, ME. Teaching professionalism in undergraduate medical education. JAMA. 1999; 282(9):830–32.CrossRefGoogle Scholar
16. Rothman, DJ. Medical professionalism–focusing on the real issues. N Engl J Med. 2000; 342(17):1284–86.CrossRefGoogle Scholar
17. Swick, HM. Toward a normative definition of medical professionalism. Acad Med. 2000; 75(6):612–16.CrossRefGoogle Scholar
18. General Medical Council. Good Medical Practice. London, UK: GMC; 2001.
19. ABIM Foundation, American Board of Internal Medicine; ACP-ASIM Foundation, American College of Physicians-American Society of Internal Medicine; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002; 136(3):243–46.CrossRef
20. Arnold, L. Assessing professional behavior: yesterday, today, and tomorrow. Acad Med. 2002; 77(6):502–15.CrossRefGoogle Scholar
21. Barondess, JA. Medicine and professionalism. Arch Intern Med. 2003; 163(2):145–49.CrossRefGoogle Scholar
22. Blank, L, Kimball, H, McDonald, W, Merino, J; ABIM Foundation; ACP Foundation; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter 15 months later. Ann Intern Med. 2003; 138(10):839–41.CrossRefGoogle Scholar
23. Inui, TS. A Flag in the Wind: Educating for Professionalism in Medicine. Washington, DC: Association of American Medical Colleges; 2003.
24. Ginsburg, S, Regehr, G, Lingard, L. Basing the evaluation of professionalism on observable behaviors: a cautionary tale. Acad Med. 2004; 79(10 Suppl):S1–S4.Google Scholar
25. Coulehan, J. Viewpoint: today's professionalism: engaging the mind but not the heart. Acad Med. 2005; 80(10):892–98.CrossRefGoogle Scholar
26. Papadakis, MA, Teherani, A, Banach, MA, Knettler, TR, Rattner, SL, Stern, DT, Veloski, JJ, Hodgson, CS. Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med. 2005; 353(25):2673–82.CrossRefGoogle Scholar
27. Stern, DT. Measuring Medical Professionalism. New York, NY: Oxford University Press; 2006.
28. Cruess, RL. Teaching professionalism: theory, principles, and practices. Clin Orthop Relat Res. 2006; 449:177–85.CrossRefGoogle Scholar
29. Cruess, RL, Cruess, SR. Teaching professionalism: general principles. Med Teach. 2006; 28(3):205–08.CrossRefGoogle Scholar
30. Wear, D, Aultman, JM, eds. Professionalism in Medicine: Critical Perspectives. New York, NY: Springer; 2006.
31. Goldie, J, Dowie, A, Cotton, P, Morrison, J. Teaching professionalism in the early years of a medical curriculum: a qualitative study. Med Educ. 2007; 41(6):610–17.CrossRefGoogle Scholar
32. ABIM Foundation, American College of Physicians, Institute on Medicine as a Profession. Advancing 21st Century Medical Professionalism: A Multi-Stakeholder Approach. Roundtable discussion. Philadelphia, PA: ABIM Foundation; 2009. Summary available from www.abimfoundation.org/~/media/Foundation/Initiatives/Multi-Stakeholders%20Meeting%20Recap.ashx?la=en.
33. Hafferty, FW. Professionalism and commercialism as antitheticals: a search for “unprofessional commercialism” within the writings and work of American medicine. In Parsi, K, Sheehan, MN, eds. Healing as Vocation: A Medical Professionalism Primer. Lanham, MD: Rowman & Littlefield; 2006:35–59.
34. Benbassat, J. Undesirable features of the medical learning environment: a narrative review of the literature. Adv Health Sci Educ Theory Pract. 2013; 18(3):527–36.CrossRefGoogle Scholar
35. Birden, H, Glass, N, Wilson, I, Harrison, M, Usherwood, T, Nass, D. Teaching professionalism in medical education: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25. Med Teach. 2013; 35(7):e1252–e1266.Google Scholar
36. Bleakley, A. Gender matters in medical education. Med Educ. 2013; 47(1): 59–70.CrossRefGoogle Scholar
37. Cruess, RL, Cruess, SR. Professionalism must be taught. BMJ. 1997; 315(7123):1674–77.CrossRefGoogle Scholar
38. Rowley, BD, Baldwin, DC Jr, Bay, RC, Cannula, M. Can professional values be taught? A look at residency training. Clin Orthop Relat Res. 2000; 378:110–14.CrossRefGoogle Scholar
39. Collier, R. Professionalism: can it be taught? CMAJ. 2012; 184(11):1234–36.CrossRefGoogle Scholar
40. Symonds, IM, Talley, NJ. Can professionalism be taught? Med J Aust. 2013; 199(6):380–81.CrossRefGoogle Scholar
41. American Medical Student Association. AMSA'S 2007 PharmFree Scorecard. Washington, DC: AMSA; 2007.
42. Goldstein, EA, Maestas, RR, Fryer-Edwards, K, Wenrich, MD, Oelschlager, AM, Baernstein, A, Kimball, HR. Professionalism in medical education: an institutional challenge. Acad Med. 2006; 81(10):871–76.CrossRefGoogle Scholar
43. Ross, S, Lai, K, Walton, JM, Kirwan, P, White, JS. “I have the right to a private life”: medical students’ views about professionalism in a digital world. Med Teach. 2013; 35(10):826–31.CrossRefGoogle Scholar
44. Association of American Medical Colleges. Medical School Graduation Questionnaire: 2013 All Schools Summary Report. Washington, DC: AAMC; 2013. [Accessed May 19, 2014.] Available from www.aamc.org/download/350998/data/2013gqallschoolssummaryreport.pdf.
45. Hafferty, FW. What medical students know about professionalism. Mt Sinai J Med. 2002; 69(6):385–97.Google Scholar
46. Smith, LG. Medical professionalism and the generation gap. Am J Med. 2005; 118(4):439–42.CrossRefGoogle Scholar
47. Irvine, D. The performance of doctors: the new professionalism. Lancet. 1999; 353(9159):1174–77.CrossRefGoogle Scholar
48. Smith, R. Medical professionalism: out with the old and in with the new. J R Soc Med. 2006; 99(2): 48–50.CrossRefGoogle Scholar
49. Christmas, S, Millward, L. New Medical Professionalism: A Scoping Report for the Health Foundation. London, UK: The Health Foundation; 2011. [Accessed May 14, 2014.] Available from www.health.org.uk/publication/new-medical-professionalism.
50. Evetts, J. A new professionalism? Challenges and opportunities. Curr Sociol. 2011; 59(4):406–22.CrossRefGoogle Scholar
51. Dyrbye, LN, Massie, FS Jr, Eacker, A, Harper, W, Power, D, Durning, SJ, Thomas, MR, Moutier, C, Satele, D, Sloan, J, Shanafelt, TD. Relationship between burnout and professional conduct and attitudes among U.S. medical students. JAMA. 2010; 304(11):1173–80.CrossRefGoogle Scholar
52. Shanafelt, TD, Boone, S, Tan, L, Dyrbye, LN, Sotile, W, Satele, D, West, CP, Sloan, J, Oreskovich, MR. Burnout and satisfaction with work-life balance among U.S. physicians relative to the general U.S. population. Arch Intern Med. 2012; 172(18):1377–85.CrossRefGoogle Scholar
53. Kligler, B, Linde, B, Katz, NT. Becoming a doctor: a qualitative evaluation of challenges and opportunities in medical student wellness during the third year. Acad Med. 2013; 88(4):535–40.CrossRefGoogle Scholar
54. West, CP, Dyrbye, LN, Rabatin, JT, Call, TG, Davidson, JH, Multari, A, Romanski, SA, Hellyer, JM, Sloan, JA, Shanafelt, TD. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med. 2014; 174(4):527–33.CrossRefGoogle Scholar
55. Hickson, GB, Pichert, JW, Webb, LE, Gabbe, SG. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors. Acad Med. 2007; 82(11):1040–48.CrossRefGoogle Scholar
56. Papadakis, MA, Paauw, DS, Hafferty, FW, Shapiro, J, Byyny, RL; Alpha Omega Alpha Honor Medical Society Think Tank. Perspective: The education community must develop best practices informed by evidence-based research to remediate lapses of professionalism. Acad Med. 2012; 87(12):1694–98.CrossRefGoogle Scholar
57. Doukas, DJ, McCullough, LB, Wear, S, Lehmann, LS, Nixon, LL, Carrese, JA, Shapiro, JF, Green, MJ, Kirch, DG; Project to Rebalance and Integrate Medical Education (PRIME) Investigators. The challenge of promoting professionalism through medical ethics and humanities education. Acad Med. 2013; 88(11):1624–29.CrossRefGoogle Scholar
58. Holden, M, Buck, E, Clark, M, Szauter, K, Trumble, J. Professional identity formation in medical education: the convergence of multiple domains. HEC Forum. 2012; 24(4):245–55.CrossRefGoogle Scholar
59. Brody, H, Doukas, D. Professionalism: a framework to guide medical education. Med Educ. 2014; 48(10):980–87.CrossRefGoogle Scholar
60. Crigger, N, Godfrey, N. From the inside out: a new approach to teaching professional identity formation and professional ethics. J Prof Nurs. 2014; 30(5):376–82.CrossRefGoogle Scholar
61. Cruess, RL, Cruess, SR, Boudreau, JD, Snell, L, Steinert, Y. Reframing medical education to support professional identity formation. Acad Med. 2014; 89(11):1446–51.CrossRefGoogle Scholar
62. Cruess, RL, Cruess, SR, Boudreau, JD, Snell, L, Steinert, Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med. 2015; 90(6):718–25.CrossRefGoogle Scholar
63. Nothnagle, M, Reis, S, Goldman, RE, Anandarajah, G. Fostering professional formation in residency: development and evaluation of the “forum” seminar series. Teach Learn Med. 2014; 26(3):230–38.CrossRefGoogle Scholar
64. Wynia, MK, Papadakis, MA, Sullivan, WM, Hafferty, FW. More than a list of values and desired behaviors: a foundational understanding of medical professionalism. Acad Med. 2014; 89(5):712–14.CrossRefGoogle Scholar
65. Lesser, CS, Lucey, CR, Egener, B, Braddock, CH 3rd, Linas, SL, Levinson, W. A behavioral and systems view of professionalism. JAMA. 2010; 304(24):2732–37.CrossRefGoogle Scholar
66. Egener, B, McDonald, W, Rosof, B, Gullen, D. Perspective: Organizational professionalism: relevant competencies and behaviors. Acad Med. 2012; 87(5):668–74.CrossRefGoogle Scholar
67. Hodges, BD, Ginsburg, S, Cruess, R, Cruess, S, Delport, R, Hafferty, F, Ho, MJ, Holmboe, E, Holtman, M, Ohbu, S, Rees, C, Ten Cate, O, Tsugawa, Y, Van Mook, W, Wass, V, Wilkinson, T, Wade, W. Assessment of professionalism: recommendations from the Ottawa 2010 Conference. Med Teach. 2011; 33(5):354–63.CrossRefGoogle Scholar
68. Birden, HH, Usherwood, T. “They liked it if you said you cried”: how medical students perceive the teaching of professionalism. Med J Aust. 2013; 199(6):406–09.CrossRefGoogle Scholar
69. Sullivan, WM, Colby, A, Wegner, JW, Bond, L, Shulman, LS. Educating Lawyers: Preparation for the Profession of Law. San Francisco, CA: John Wiley & Sons; 2007.
70. Atherton, JS. Learning and Teaching: Deep and Surface Learning. [Accessed Feb. 21, 2015.] Available from www.learningandteaching.info/learning/deepsurf.htm.
71. Wentworth, WM. Context and Understanding: An Inquiry into Socialization Theory. New York, NY: Elsevier; 1980.
72. Tierney, WG. Organizational socialization in higher education. J Higher Educ. 1997; 68(1): 1–16.CrossRefGoogle Scholar
73. Fineberg, IC, Wenger, NS, Forrow, L. Interdisciplinary education: evaluation of a palliative care training intervention for pre-professionals. Acad Med. 2004; 79(8):769–76.CrossRefGoogle Scholar
74. Polanyi, M. Personal Knowledge: Towards a Post-Critical Philosophy. London, UK: Routledge & Kegan Paul; 1958.
75. Helmich, E, Bolhuis, S, Dornan, T, Laan, R, Koopmans, R. Entering medical practice for the very first time: emotional talk, meaning and identity development. Med Educ. 2012; 46(11):1074–86.CrossRefGoogle Scholar
76. Monrouxe, LV. Identities, self and medical education. In Walsh, K, ed. Oxford Textbook of Medical Education. New York, NY: Oxford University Press; 2013:113–23.
77. Goldie, J. The formation of professional identity in medical students: considerations for educators. Med Teach. 2012; 34(9):e641–e648.Google Scholar
78. Wong, A, Trollope-Kumar, K. Reflections: an inquiry into medical students’ professional identity formation. Med Educ. 2014; 48(5): 489–501.CrossRefGoogle Scholar
79. de Vibe, M, Solhaug, I, Tyssen, R, Friborg, O, Rosenvinge, JH, Sørlie, T, Bjørndal, A. Mindfulness training for stress management: a randomised controlled study of medical and psychology students. BMC Med Educ. 2013; 13:107.CrossRefGoogle Scholar
80. Schein, EH. Organizational Culture and Leadership. edition. San Francisco, CA: Jossey-Bass; 1992.
81. Van Maanen, J, Barley, SR. Occupational communities: culture and control in organizations. In Staw, BM, Cummings, LL, eds. Research in Organizational Behavior. Volume 6. Greenwich, CT: JAI Press; 1984:265–87.
82. Hafferty, FW. Beyond curriculum reform: confronting medicine's hidden curriculum. Acad Med. 1998; 73(4):403–07.
83. Pellegrino, ED. The medical community as a moral community. Bull N Y Acad Med. 1990; 66(3):221–32.Google Scholar
84. Hafferty, FW, Franks, R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994; 69(11):861–71.CrossRefGoogle Scholar
85. Hays, K. Practicing Virtues: Moral Traditions at Quaker and Military Boarding Schools. Berkeley, CA: University of California Press; 1994.
86. Janowitz, M. The Professional Soldier: A Social and Political Portrait. New York, NY: Free Press; 1960.
87. Leahy, JF. Honor, Courage, Commitment: Navy Boot Camp. Annapolis, MD: Naval Institute Press; 2002.
88. Lipsky, D. Absolutely American: Four Years at West Point. New York, NY: Houghton Mifflin; 2003.
89. Kleinman, S. Women in seminary: dilemmas of professional socialization. Sociol Educ. 1984; 57(4):210–19.CrossRefGoogle Scholar
90. Foster, CR, Dahill, L, Golemon, L, Tolentino, BW. Educating Clergy: Teaching Practices and Pastoral Imagination. San Francisco, CA: Jossey-Bass; 2005.
91. Quine, L. Workplace bullying in junior doctors: questionnaire survey. BMJ. 2002; 324(7342):878–79.CrossRefGoogle Scholar
92. Mukhtar, F, Daud, S, Manzoor, I, Amjad, I, Saeed, K, Naeem, M, Javed, M. Bullying of medical students. J Coll Physicians Surg Pak. 2010; 20(12):814–18.Google Scholar
93. Mavis, B, Sousa, A, Lipscomb, W, Rappley, MD. Learning about medical student mistreatment from responses to the medical school graduation questionnaire. Acad Med. 2014; 89(5):705–11.CrossRefGoogle Scholar
94. Sklar, DP. Mistreatment of students and residents: why can't we just be nice? Acad Med. 2014; 89(5):693–95.CrossRefGoogle Scholar
95. Freidson, E. Professionalism: The Third Logic. Cambridge, UK: Polity; 2001.
96. Knight, JA. Medical Student: Doctor in the Making. New York, NY: Appleton-Century-Crofts; 1973.
97. Poirier, S. Doctors in the Making: Memoirs and Medical Education. Iowa City, IA: University of Iowa Press; 2009.
98. Starr, P. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. New York, NY: Basic Books; 1982.
99. Starr, P. Social transformation twenty years on. J Health Polit Policy Law. 2004; 29(4):1005–19.CrossRefGoogle Scholar
100. Niemi, PM. Medical students’ professional identity: self-reflection during the preclinical years. Med Educ. 1997; 31(6):408–15.CrossRefGoogle Scholar
101. Epstein, RM. Mindful practice. JAMA. 1999; 282(9):833–39.CrossRefGoogle Scholar
102. Sobral, DT. An appraisal of medical students’ reflection-in-learning. Med Educ. 2000; 34(3):182–87.CrossRefGoogle Scholar
103. Carr, SE, Johnson, PH. Does self reflection and insight correlate with academic performance in medical students? BMC Med Educ. 2013; 13:113.Google Scholar
104. Duke, P, Grosseman, S, Novack, DH, Rosenzweig, S. Preserving third year medical students’ empathy and enhancing self-reflection using small group “virtual hangout” technology. Med Teach. 2015; 37(6):566–71.CrossRefGoogle Scholar
105. Branch, WT. Teaching professional and humanistic values: suggestion for a practical and theoretical model. Patient Educ Couns. 2015; 98(2):162–67.CrossRefGoogle Scholar
106. Nothnagle, M, Reis, S, Goldman, RE, Anandarajah, G. Fostering professional formation in residency: development and evaluation of the “forum” seminar series. Teach Learn Med. 2014; 26(3):230–38.CrossRefGoogle Scholar
107. Harvill, LM. Anticipatory socialization of medical students. J Med Educ. 1981; 56(5):431–33.CrossRefGoogle Scholar
108. Hochschild, AR. The Managed Heart: Commercialization of Human Feeling. Berkeley, CA: University of California Press; 1983.
109. Pollak, LH, Thoits, PA. Processes in emotional socialization. Soc Psychol Q. 1989; 52(1): 22–34.CrossRefGoogle Scholar
110. Feldman, DC. Socialization, resocialization, and training: reframing the research agenda. In Goldstein, IL, ed. Training and Development in Organizations. San Francisco, CA: Jossey-Bass; 1989:376–416.
111. Egan, JM. Graduate school and the self: a theoretical view of some negative effects of professional socialization. Teach Sociol. 1989; 17(2):200–07.CrossRefGoogle Scholar
112. Goffman, E. Asylums: Essays on the Social Situations of Mental Patients and Other Inmates. New York, NY: Doubleday; 1961.
113. Morrison, L. Resocialization. In Ritzer, G, ed. Blackwell Encyclopedia of Sociology. Oxford, UK: Blackwell; 2007. Blackwell Reference Online. [Accessed May 19, 2014.] Available from www.blackwellreference.com/subscriber/uid=1714/tocnode?id=g9781405124331_chunk_g978140512433124_ss1–59.
114. Gawande, A. Complications: A Surgeon's Notes on an Imperfect Science. New York, NY: Metropolitan Books; 2002.
115. Collins, MJ. Hot Lights, Cold Steel: Life, Death and Sleepless Nights in a Surgeon's First Years. New York, NY: St. Martin's Press; 2005.
116. Hafferty, FW. Into the Valley: Death and the Socialization of Medical Students. New Haven, CT: Yale University Press; 1991.
117. Sinclair, S. Making Doctors: An Institutional Apprenticeship (Explorations in Anthropology). New York, NY: Berg; 1997.
118. Louis, KS, Leithwood, K, Wahlstrom, KL, Anderson, SE, Michlin, M, Mascall, B, Gordon, M, Strauss, T, Thomas, E, Moore, S. Investigating the Links to Improved Student Learning. New York, NY: Wallace Foundation; 2010. [Accessed May 19, 2014.] Available from www.wallacefoundation.org/knowledge-center/school-leadership/key-research/Documents/Investigating-the-Links-to-Improved-Student-Learning.pdf.
119. Nasca, TJ, Philibert, I, Brigham, T, Flynn, TC. The next GME accreditation system–rationale and benefits. N Engl J Med. 2012; 366(11):1051–56.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×