Medical error:a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error

Introduction: There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice. Discussion: This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed. Conclusion: A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors.

Education and racism:a study of the teachers' and the pupils' relations in the schooling of black boys

This thesis examines the teachers' and the pupils' relations in the schooling of black boys. The study using the methodology of participant observation focusses on one school (Kilby) in an area of black population in an English city. The thesis’s intentions are two fold: firstly, in order to examine these relations, two major aspects of their interaction are addressed, that of the absence of teachers from conventional 'race-relations' research, and, the identification and examination of the anti-school pupils' sub-cultures. Two substantive questions are asked: what is the response of the teachers to the schooling of black pupils? and, what is the meaning of the pupils' resistance to schooling? Secondly, in attempting to answer these questions and offer a critique of the dominant 'race-relations' culturalist explanation of black youth's response to schooling, a theoretical framework has been developed which takes account of both the 'economic' and the 'sociological' perspectives. Methodology allowed and pointed to the importance of examining the teachers' ideologies and practices as well as those of the black boys. It is argued that a class analysis of the racially structured British society is more adequate than the conventional ethnic approach in explaining the black boys' location within Kilby School. Hence, it is posited that the major problem in the schooling of black youth is not that of their culture but of racism, which pervasively structures the social reality at Kilby school. Racism is mediated both through the existing institutional framework that discriminates against working-class youth and through the operation of race specific mechanisms, such as the process of racist stereotyping. It is thus further argued that the Kilby school teachers are of central causal significance to the - problems that the boys encounter. Furthermore, it is in response to these racist ideologies and practices that both West Indian and Asian pupils develop specific forms of collective resistance, which are seen to be linked to the wider black community, as legitimate strategies of survival.