“We lie about what we do. We lie to our students about what they're going to do”: Unstandardizing standardized ways of knowing in health professions education

Abstract

In Health Professions Education, students’ and their educators’ work in the 21st century is geared towards demonstrating “competence” in order to gain certification or licensure to practice. Drawing on two complementary Institutional Ethnographic studies, we explicate the dominance of standardization through text-mediated epistemologies or ways of knowing, for student doctors and student paramedics. We examine different lines of fault where the actual work of becoming a health professional is subsumed by an accountability focused agenda, contributing to students feeling unprepared for their (non-standard) clinical work and work settings at a time where burnout is recognized as a big issue in healthcare. We also discuss how educators are located at a line of fault between what counts institutionally as good educational knowledge/practice and teaching practices geared towards the everyday actualities of complex work and work settings. We advocate for a more generous approach to certification of health professionals, based on non-standardized patients and the realities of ever-evolving work settings that healthcare work must orient to and is organized by.

Keywords

• Health professions education
• Competency based medical education
• Institutional ethnography