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.

Higher education reform in Kyrgyzstan: the politics of neoliberal agendas in theory and practice

There would seem to be no greater field for observing the effects of neo-liberal reforms in higher education than the former Soviet university, where attempts to legitimize neo-liberal philosophy over Soviet ideology plays out in everyday practices of educational reform. However, ethnographic research about higher education in post-Soviet Central Asia suggests that its “liberalization” is both an ideological myth and a complicated reality. This chapter focuses on how and why neo-liberal agendas have “travelled” to the Central Asian republic of Kyrgyzstan, what happens when educators encounter and resist them, and why these spaces of resistance are important starting points for the development of alternative visions of educational possibility in this recently “Third-worlded” society.