Physician Assimilation in Medical Schools: Dualisms of Biomedical and Biopsychosocial Ideologies in the Discourse of Physician Educators

ABSTRACT

Although health communication research and popular literature on physicians have heightened awareness of the dualisms physicians face, research is yet to focus on the discourse of physician educators who assimilate students into medicine for dualisms of the biomedical (BMD) and biopsychosocial (BPS) ideologies. The study drew on a dualism-centered model to analyze the discourse of 19 behavioral science course directors at 10 medical schools for the emergence of dualisms in instantiations of BPS ideologies and for the management of dualism in discourse that instantiated both BMD and BPS ideologies as part of the curriculum. Dualism emerged in the BPS ideologies of “patient-centeredness” and “cultural competence.” While a dualism between “patients’ data” and “patients’ stories” emerged in the patient-centeredness ideology, a dualism between enhancing “interaction skill” and “understanding” emerged in the cultural competence ideology. Moreover, the study found educator discourse managing dualism between BMD and BPS ideologies through the strategies of “connection” and “separation.” The study concludes with a discussion and the implications for theory and research.

Acknowledgments

The authors thank Elaine Hsieh, Michael W. Kramer, and the anonymous reviewers for their feedback on previous versions of this manuscript.

Notes

¹ The 11-minute interview was conducted with the only participant to self-describe as an “associate director.” To complement this interview, two more were conducted with “course directors” at the same medical school.

² The coding scheme contained columns for agreed-upon codes or labels and alphanumeric designations for each code (allowing reoccurring units in the transcripts to receive these designations rather than labels). The scheme also contained spaces to record the location of identified units such as transcript page numbers and new emergent codes.

³ To demonstrate the confirmability of the dualisms, we located exemplars from the verbatim transcripts. These exemplars are presented free of linguistic disfluencies so as to improve comprehension and readability.

⁴ In interview excerpts throughout the article, “P” refers to participant and “I” refers to interviewer.