commentaries 5
reality, ways of knowing and phe-
nomena.8 To effectively embrace
diversity and complexity as starting
and end points for medical educa-
tion research and practice, we must
heed calls to ensure that we do so
in a democratic way.14 As medical
educators we have the means
whereby democracy can be brought
to a historically and persistently
autocratic medical culture.6 This
entails making a concerted effort to
ask more diverse questions, and
listen to more diverse voices, as we
set the agenda for educational
practice, research, and change.
REFERENCES
1 Frank AW. From sick role to prac-
tices of health and illness. Med Educ
2013;47:1825.
2 Whitehead C. Scientist or science-
stuffed? Discourses of science in
How and why social science theory can contribute to
medical education research
Caragh Brosnan
In his article From sick role to
practices of health and illness,1
Arthur Frank argues that although
social science research methods are
integral to medical education
research (MER), social science the-
ory has been under-used. He echoes
calls by others for the greater incor-
poration of theory into MER25 and
for the recognition of MER as a
social science.3 Frank1 moves this
agenda forward by providing a sum-
Newcastle, New South Wales, Australia
Correspondence: Caragh Brosnan, School of
Humanities & Social Science, University of
Newcastle, NSW 2304, Australia.
Tel: 00 61 2 4921 6348
E-mail: caragh.brosnan@newcastle.edu.au
doi: 10.1111/medu.12093
Blackwell Publishing Ltd 2013. MEDICAL EDUCATION 2013; 47: 317
North American medical educa-
tion. Med Educ 2013;47:2632.
3 Martin C. Reconstructing a lost
tradition: the philosophy of medi-
cal education in an age of reform.
Med Educ 2013;47:339.
4 Lingard L. Language matters:
towards an understanding of
silence and humour in medical
education. Med Educ 2013;47:408.
5 de la Croix A, Skelton J. The
simulation game: an analysis of
interactions between students and
simulated patients. Med Educ
2013;47:4958.
6 Bleakley A. Gender matters in
medical education. Med Educ
2013;47:5970.
7 McNaughton N. Discourse(s) of
emotion within medical education:
the ever-present absence. Med Educ
2013;47:719.
8 Rees CE, Monrouxe LV, McDonald
LA. Narrative, emotion and action:
analysing most memorable pro-
fessionalism dilemmas. Med Educ
2013;47:8096.
9 Karnieli-Miller O, Frankel RM, Inui
TS. Cloak of compassion, or evi-
mary of five key theoretical frame-
works in social science and
suggesting how they might illumi-
nate various aspects of medical edu-
cation. The theories he discusses
each represent a different paradigm;
that is, they are grounded in differ-
ing assumptions about the nature of
reality and of society. For example,
Talcott Parsons,6 a structural-func-
tionalist, understood society as con-
stituted by stable institutions and
norms; Harold Garfinkel,7 an eth-
nomethodologist, emphasised the
role of individual agency in the
creation of shared meanings about a
social situation, and Pierre Bour-
dieu8 sought to overcome this
structureagency divide by examin-
ing how practice is both shaped by
dence of elitism? An empirical
analysis of white coat ceremonies.
Med Educ 2013;47:97108.
10 Yardley S, Brosnan C, Richardson J.
The consequences of authentic
early experience for medical stu-
dents: creation of metis. Med Educ
2013;47:10919.
11 Regehr G. Its NOT rocket science:
rethinking our metaphors for re-
search in health professions edu-
cation. Med Educ 2010;44:319.
12 Mylopoulos M, Woods NN. Having
our cake and eating it too: seeking
the best of both worlds in exper-
tise research. Med Educ
2009;43:40613.
13 Bourdieu P, Chamboredon JC,
Passeron JC. The Craft of Sociology:
Epistemological Preliminaries. [Transl.
Richard Nice 1991.] Berlin; New
York, NY: Walter de Gruyter 1973;
1271.
14 Bleakley A. Social comparison, peer
learning and democracy in medical
education. Med Teach 2010;32:
8789.
and reproduces social structure. The
choice of theory to be drawn upon in
a given research project will depend
on the phenomenon to be investi-
gated, what is already known about
it, and the researchers own world-
view, and will influence the selection
of methods that can be used to
answer the research question. As
Frank explains in his discussion of
Parsons, theories are equally useful
for thinking against,1 and should
always be applied critically.
The choice of theory to be drawn upon
will depend on the phenomenon to be
investigated and the researchers own
worldview
5
commentaries
There is work within MER which
already engages with the theories
Frank1 mentions, such as studies
using Bourdieusian,9,10 Foucaul-
dian11 or narrative approaches.12
Nevertheless, there is a tendency for
studies to mention theory in passing,
as Frank1 notes, or to fail to identify a
conceptual framework at all.4,5
Drawing on Bourdieu, Frank voices
concern that what is now valued in
academia (what counts as capital in
the academic field) is shifting to-
wards volume of outputs and grant
applications, reducing the incentive
or possibility to engage in the slow,
careful process of developing more
abstract theory.1 This poses a par-
ticular challenge in MER, which is
already oriented towards applied
research9 and brief publications,5
rather than theory development.
Like Frank, I believe that such ten-
dencies should be resisted, not sim-
ply to promote the creation of
theory for its own sake, but because,
as Frank1 points out, medical
education research and policies that
are divorced from social science
theory are at risk of overlooking the
origins of the problems they are
meant to address.
There is a tendency for studies to mention
theory in passing or to fail to identify
a conceptual framework at all
Citing Weber, a founding figure of
sociology, Frank1 argues that social
scientific theory is what allows us to
connect research to the fate of our
times: it situates our understand-
ing of specific, local issues within a
broader social and historical
context. The relationship
between theory and research is
bidirectional: we can use observa-
tions drawn from specific research
projects to contribute towards a
theory of how contemporary society
works, and we can use such theory
as a lens through which to interpret
the local situation. For example, a
6 Blackwell Publishing Ltd 2013. MEDICAL EDUCATION 2013; 47: 317
study of British medical students
understandings of professionalism
might consider how their views
reflect or challenge shifts in the
professional status of medicine in
the UK and, even more broadly,
what they indicate about how the
roles of the professions in general
are seen nowadays. This, in turn,
might prompt the question of
whether national context plays a
role in shaping notions of profes-
sionalism, directing further re-
search with American medical
students, for instance. Research
into medical students experiences
of online learning might usefully
take account of theories on the
emerging relationship between new
media and youth identities, and
might also contribute to developing
these theories.
The relationship between theory and
research is bidirectional: we can use
observations to contribute towards theory,
and we can use such theory as a lens
Some medical education researchers
may question whether they should
spend time applying and devising
theories about society when all they
want to know is how to improve
medical education. The point is that
these are not separate enterprises.
We need only look at the history of
medical education in the last century
to see how social change (in terms of
public expectations of doctors, the
organisation of health care, widen-
ing participation in higher educa-
tion, and technological advances)
has impacted the structure and con-
tent of medical curricula.13 Even on a
day-to-day basis, learning does not
take place in a social vacuum: stu-
dents reactions to what they are
taught, and their judgements of what
is important in the vast amount of
material with which they are pre-
sented, are shaped by the society of
which they are part,14 by the fate of
their times. An understanding of this
social context is crucial in delivering
effective medical education.
We need only look at the history of medical
education to see how social change has
impacted the structure and content
of medical curricula
Medical educators have the tricky
task of not only tailoring education
to the learning styles of present
students, but of pre-empting and
instilling the skills that will be
required of future doctors. Here
again, social theory can be helpful,
as it provides a basis for predicting
the outcomes of various interven-
tions based on past observation,
allowing social trends to be antici-
pated to some extent. Furthermore,
medical education itself plays a sig-
nificant role in society, helping to
actually shape the fate of our times:
medical schools wield power within
universities, contribute to health
care and also influence the health
care of the future. Social science
theories provide frameworks for
exploring the ramifications of med-
ical education for other social insti-
tutions. Incorporating such
concerns into MER could poten-
tially produce more reflexive studies
by encouraging researchers to con-
sider the influences on and influ-
ences of their research.15 Akin to
reflective practice, reflexivity in
social science refers to the practice
of analysing the effects of our own
position, beliefs and interests on the
research we undertake in order to
produce more robust findings.15,16
Medical education itself plays a signif-
icant role in society, helping to actually
shape the fate of our times
If medical education researchers are
to take up the challenge of engaging
more fully with social science the-
ory, the question of how they will

learn about it must be resolved.
Although some medical education
researchers have social science
backgrounds, many come from
basic science or clinical disciplines.
As Monrouxe and Rees5 acknowl-
edge, getting to grips with unfamil-
iar research paradigms can be hard
work. They suggest greater collabo-
ration between researchers with
different disciplinary backgrounds
as one solution.5 The incorporation
of workshops and sessions on
theoretical perspectives at MER
conferences is also a positive devel-
opment. Ultimately, however, the
best way to really grasp what the
various social science theories have
to offer is to read about them. Franks
article1 is a great place to start.
REFERENCES
1 Frank AW. From sick role to prac-
tices of health and illness. Med Educ
2013;47:1825.
Doctors, science and society
Tim Swanwick
Of a pair of papers published in
this edition of Medical Education,1,2
one argues for and the other notes
the curricular predominance of
biomedical science and its failure to
realise the Flexnerian ideal of the
good doctor.3 Both papers
emphasise the need for an aware-
ness of the prevailing discourses
around medical education and
both conclude that biomedical
London, UK
Correspondence: Tim Swanwick, London
Deanery, Stewart House, 32 Russell Square,
London WC1B 5DN, UK.
Tel: 00 44 20 7866 3250;
E-mail: tim.swanwick@londondeanery.ac.uk
doi: 10.1111/medu.12051
Blackwell Publishing Ltd 2013. MEDICAL EDUCATION 2013; 47: 317
2 Bordage G. Conceptual frameworks
to illuminate and magnify. Med
Educ 2009;43:3129.
3 Monrouxe L, Rees C. Picking up
the gauntlet: constructing medical
education as a social science. Med
Educ 2009;43:1968.
4 Bunniss S, Kelly D. Research para-
digms in medical education
research. Med Educ 2010;44:35866.
5 Rees CE, Monrouxe LV. Theory in
medical education research: how
do we get there? Med Educ
2010;44:3349.
6 Parsons T. The Social System. Glencoe,
IL: The Free Press 1951.
7 Garfinkel H. Studies in Ethnometh-
odology. Englewood Cliffs, NJ: Pre-
ntice Hall 1967.
8 Bourdieu P. Outline of a Theory of
Practice. Cambridge: Cambridge
University Press 1977.
9 Albert M, Hodges B, Regehr G.
Research in medical education:
balancing service and science. Adv
Health Sci Educ 2007;12 (1):10315.
10 Brosnan C. Making sense of differ-
ences between medical schools
through Bourdieus concept of
field. Med Educ 2010;44:64552.
science should be conceptualised as
just one form of knowledge in
medical education, albeit an
important one.1,2 Taking a philo-
sophical stance, Martin asks: if
we are going to take responsibility
for the education of persons who
are to become doctors, what do we
owe these persons?1
Biomedical science should be conceptua-
lised as just one form of knowledge in
medical education, albeit an important
one
The heart of the matter, though,
must refer to what we owe soci-
commentaries 7
11 Bleakley A, Bligh J, Browne J. Med-
ical Education for the Future: Identity,
Power and Location. Dordrecht:
Springer 2011.
12 Rogers D, Lingard L, Boehler ML,
Espin S, Klingensmith M, Mellinger
JD, Schindler N. Teaching operat-
ing room conflict management to
surgeons: clarifying the optimal
approach. Med Educ 2011;45:939
45.
13 Ludmerer K. Time to Heal: American
Medical Education from the Turn of the
Century to the Era of Managed Care.
Oxford: Oxford University Press
1999.
14 Brosnan C. The significance of sci-
entific capital in UK medical edu-
cation. Minerva Rev Sci Learn Policy
2011;49 (3):31732.
15 Cribb A, Bignold S. Towards the
reflexive medical school: the hid-
den curriculum and medical edu-
cation research. Stud High Educ
1999;24 (2):195209.
16 Bourdieu P, Wacquant L. An
Invitation to Reflexive Sociology.
Cambridge: Polity Press 1992.
ety. What is the point of a doctor?
Why are doctors necessary? What
is expected of a doctor, let alone
a good one? These questions
were, of course, addressed by
Flexner,3 but they require contin-
uous rehearsal and reconsidera-
tion as medical education adapts
to the evolving needs of the
human animal within a given
socio-economic context. Indeed, it
is precisely in response to this
challenge that there has been in
recent years an introspective flurry
of activity around the defining of
the doctors role, which has man-
ifested in holistic frameworks for
medical education such as those
outlined in CanMEDS4 and
7