UC San Diego

This dissertation examines how the medical profession adapts to social change by implementing reform at the medical school. The organization of the medical profession has changed rapidly over the past 60 years from a provider -driven to a buyer-driven system. Moreover, broader cultural shifts in the United States towards individualism and choice and away from traditional institutions of authority have reduced the medical profession's authority and autonomy. While medical sociology has documented how these changes impact practicing physicians, there has been little work to study how medical students are prepared to be practitioners in this environment. In this dissertation I reorient scholarly understandings of medical education from being nearly completely student-focused to looking instead at the environment the students are embedded in and how it is intentionally designed to produce a certain type of doctor. I argue that understanding what sort of doctor the medical school seeks to produce is key to understanding how the medical profession is adapting in harmony with larger changes in society. Through ethnographic research at a highly ranked medical school in the United States, this dissertation examines the process of epistemic boundary setting that is at the heart of learning the practices of doctoring and colleagueship central to being a physician. I show that faculty members are far more central to preclinical medical training than previously portrayed. I show how faculty members directly mediate the process of medical students taking on the physician's identity through being taught to execute the practices of doctoring and colleagueship. Because the faculty members situate their rationales for practice in the larger context of health care provision and their lived experience of the changes of the past 60 years, medical education serves as a window into contemporary professional practice and a venue in which to explore current physicians' opinions of what future physicians need to know in order to be successful in practice. The findings of this dissertation contribute to scholarship in medical sociology, sociology of medical education, and interdisciplinary studies of science and technology--- particularly the study of medical knowledge, epistemic cultures, and the reproduction of medical culture