Thread by @Megan_EL_Brown

You use it, I use it, but how much do you really know about socialisation (or socialization for my friends across the Atlantic)?

Buckle up, it’s #MedEd #TheoryThursdays time!

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Some of you might be surprised I’m covering socialisation. Many don’t discuss socialisation as a theory or pay it the attention theory needs in MedEd

But it is a theory – in fact, socialisation is a **set of theories** that can help us explain how the status quo is reproduced

Socialisation theories are usually mid-range, as they explore connections between the status quo (+the values/ideas which constitute this), and the social processes (often interactions, shaped by variables such as gender/class/ethnicity) that bring people in line with these ideas

In Med Ed, we usually discuss socialisation when we talk about professional identity (though this isn’t the only way of talking about socialisation and some work also focuses on learning, and on professional behaviour).

Socialisation is commonly defined within med ed as:

Many of you will be familiar with Cruess et al.’s model of socialisation and perhaps specifically this diagram, listing the factors they say contribute to socialisation and the process of becoming a dr

(It’s been cited over 650 times!)

Perhaps unsurprisingly given its name, socialisation comes from the field of Sociology

But – get this – it’s fallen out of favour in Sociology!

This sort of blew my mind, as it’s such a popular theory in MedEd. I did some detective work to try and find out why

There are different theories of socialisation that influence what socialisation can tell us.

There are two common ways of discussing socialisation:

1.Functionalist socialisation

2.Post-functionalist socialisation

The most popular is functionalist socialisation – and this is usually how socialisation is discussed in Med Ed.

It has important limitations which have led to the demise of the theory's use within Sociology.

Functionalist socialisation...what the heck is functionalism?

Functionalists see society as a structure with interrelated parts. Individuals are integrated into society through socialisation. This allows society to function as there's agreement with the status quo

This is usually how Med Ed discusses socialisation.

Medical students have to internalise medical values + norms to integrate into the profession, which (it’s supposed) allows the profession to function successfully.

This often reproduces the status quo of the profession.

BUT there are important critiques of functionalist socialisation:
1. Implies participants are passive – culture is downloaded society --> individuals
2. Values and norms are fixed when they can change
3. No attention to conflict between influences
4. Heterogeneity unacknowledged

Critically, functionalist socialisation doesn’t recognise or consider the impact of power – how reproducing the status quo can be a tool for oppression of some groups and identities

Enter… post-functionalist socialisation (post = after, so “after socialisation which focusses on functionalism”).

This is a theory of socialisation introduced in response to these critiques within Sociology.

It’s rare that we consider socialisation this way in Med Ed.

Guhin et al. have led the exploration of a post-functionalist approach.

They recommend the following:

(Further info, see: Guhin, J., Calarco, J.M. and Miller-Idriss, C., 2021. Whatever happened to socialization?. Annual Review of Sociology, 47, pp.109-129.)

This is a big change in how we discuss and use socialisation theory within Med Ed

Socialisation is not a-theoretical. It is a group of theories, each conceptualised differently.

We need to be mindful of this, and clear which perspective we’re studying socialisation from + why

The “Boring bits” for both functionalist and post-functionalist socialisation:

What’s the evidence for socialisation?

Socialisation is widely researched within Med Ed – usually from a functionalist perspective, but increasingly research focusses on power and how power influences identity as a healthcare professional

Though “post-functionalist socialisation” isn’t always mentioned, research illustrates the value of exploring socialisation as heterogenous + involving power

E.g., Wyatt et al. explored how Black trainees navigate identity within a context that stereotypes them + discriminates

The authors document how Black trainees moderate their presentation to gain acceptance within a profession with a racist history. Tensions in identity are discussed, including institutional silence on violence against Black people contributing to racial identity invisibility

Though this study doesn’t explicitly use a socialisation theory (it is a grounded theory study), the way in which power, conflict, agency, and oppression are focussed on/discussed provide one example of an area ripe for further exploration using post-functionalist socialisation

Using established theory, now we have evidence of this mechanism through a grounded theory approach is important – we can use post-functionalist socialisation as a transferable way of further challenging mechanisms that maintain the status quo + oppression across contexts

It might seem pedantic to ask researchers to label their approach to socialisation as “functionalist” or “post-functionalist”

Why does all this matter again?

We have outlined important critiques of functionalist socialisation

As those within MedEd recognise the inequalities baked into our systems, we need approaches to exploring experiences within racist + inequitable systems. Such research is a foundation for challenging status quo

We have an ethical duty to recognise + challenge oppression. Using theory which allows us to explore the experiences of healthcare professionals through a critical lens with an explicit focus on power is the 1st step in acting to change oppressive social systems within medicine

So that’s socialisation… I’m not sure about you, but I knew less about socialisation than I thought I did!!

Next week – one for all the educators in the house: Cognitive Load Theory

C U L8R SK8R 🛹✌️