Doctoral Dissertation Research: Understanding Hierarchies within Internal Medicine Graduate Education

SES-1303276 PI：玛格特·杰克逊联合PI：Tania Jenkins Brown University 2012年，内科住院医师职位的55%由美国医学院(USMG)的毕业生填补。剩下的45%流向了外国医学毕业生、在美国出生的外国医学毕业生和骨科医生(DO)。这篇论文通过质疑普遍认为医生是一个铁板一块的“平等共同体”的假设来检验这45%的人的经历。随着越来越多的非美国医学毕业生填补医疗行业中不太受欢迎的职位，有可能形成一种不平等的机会结构，使这些住院医生相对于在美国接受培训的医学博士处于不利地位。通过追求医院人种学的医学社会学传统，该项目将比较两种类型的住院医生的经历-一种是迎合USMGs的，另一种是非USMGs的-以回答以下研究问题：1)医学教育是如何分层组织的，该组织如何在不同培训背景的内科住院医师中进行分层？2)研究生医学教育的职业结构如何影响内科住院医师的职业流动？这篇论文将有助于社会学理解职业分层，不像其他学者那样关注性别或种族，而是关注教育谱系(学位类型和医学院的位置)作为职业地位不平等背后的驱动力。广泛的影响：结果可能有助于我们理解与广泛的卫生保健政策以及患者和医生的经验相关的含义。例如，内科是一个关键的住院医师，因为它为毕业生提供了要么从事初级保健，要么继续进行子专业的选择。随着医疗保险扩大到数百万新患者，需要初级保健从业者。通过了解内科住院医师的经验--包括限制他们决定保持通才或专科的机会结构--可以更好地为面对这些服务日益增长的需求做好准备。

SES-1303276 PI: Margot JacksonCo-PI: Tania JenkinsBrown UniversityIn 2012, 55 percent of all residency positions in internal medicine were filled by graduates from American medical schools (USMGs). The remaining 45 percent went to foreign medical graduates, US-born foreign medical graduates and osteopaths (DOs). This dissertation examines the experiences of this 45 percent by questioning the widely-held assumption that physicians are a monolithic "community of equals." As growing numbers non-US medical graduates fill less desirable positions within the medical profession, there is the potential for an unequal opportunity structure to form, putting these residents at a disadvantage relative to US-trained MDs. By pursuing the medical sociological tradition of hospital ethnography, this project will compare the experiences of residents in two types of residency programs - one that caters to USMGs and another to non-USMGs - in order to answer the following research questions: 1) How is medical education organized hierarchically and how does this organization lend itself to stratification among internal medicine residents of different training backgrounds? and 2) How does the occupational structure of graduate medical education affect the professional mobility of internal medicine residents? This dissertation will contribute to sociological understandings of occupational stratification by focusing not on gender or race, as other scholars have done, but on educational pedigree (degree type and location of medical school) as the driving force behind inequalities in professional status.Broader impacts:The results may help us make sense of the implications associated with a wide range of health care policies and the experiences of both patients and physicians. For example, internal medicine is a pivotal residency, as it offers graduates the option of either practicing primary care or going on to subspecialize. With health insurance extending to millions of new patients, there is a need for primary care practitioners. By understanding the experiences of internal medicine residents - including the opportunity structure that constrains their decisions to remain generalists or subspecialize - there can be better preparation for facing the growing need for these services.