The University of Southampton
University of Southampton Institutional Repository

The demise of 'the firm' and the impact on apprenticeship style learning in the UK context

The demise of 'the firm' and the impact on apprenticeship style learning in the UK context
The demise of 'the firm' and the impact on apprenticeship style learning in the UK context
‘The firm’ is ubiquitous within clinical teaching in the UK context – it is the key mechanism and organisational unit for apprenticeship style learning for undergraduate medical students and junior doctors. Despite its centrality within medical education, it has rarely attracted sociological scrutiny. Medical staff, in particular, tend to take ‘the firm’ for granted, for they themselves have undergone training within it. The term and its usage, however, effectively hide historical, speciality and local variations of ‘the firm’ and mask the way in which the concept and its real life organisational practices have changed over time [1].

Within the medical education literature, clinical attachments have received relatively little scrutiny [2]. Bleakley attributes this to the prevalence of “the psychological model of pedagogy that focuses upon transmission of knowledge and skills from one individual to another” ([2], p.9). Social scientist have sought to highlight the social and contextual dimensions of learning [3] and the importance of informal and implicit aspects of the ‘hidden curriculum’ that are oftentimes more powerful than the ‘manifest’ or official curriculum [4], [5].

What is important to note is that the apprenticeship model does not solely or primarily depend on explicit instruction. Rather, knowledge is (also) transmitted through informal learning that relies on time spent together (context, shared language and experiences, observation, implicit rather than direct communication) and the formation of relationships of trust (that allows for mutual dependability and support) which in turn facilitate – or hinder – the transmission of how things are done in a particular set up [6]. The hierarchical nature of the firm is also likely to have given rise to some forms of exploitation. As noted above, the nature of ‘the firm’ remains under-researched – historically and in its current (and relatively recent) form.

Through various changes in the NHS and the phased introduction of the European Working Time Directive medical firm structures are currently in flux and some argue that they have become eroded [7]. Medical schools and deaneries (in charge of postgraduate training) throughout the UK are struggling to identify ways to address these changes, especially in terms of the firm’s educational function.

The presentation is based on interview data with clinical teachers who have trained and worked in firm structures throughout their careers. Our analysis of this data will seek to define what ‘the firm’ was in the context of different specialties and it traces its development (or demise). Without an appreciation of how ‘the firm’ operated in terms of benefits and disadvantages to the various stakeholders and how it developed over time – as a work unit and as site and mechanism for teaching / training – any account of current changes will be severely limited, as will attempts to design new ways of working and teaching to make up for its dissolution.
Timm, A.
28485de4-3234-48f2-9ac7-9b262d366a54
Hill, F.
4a93e3c7-75bd-46b5-bef9-a93f64590d8d
Timm, A.
28485de4-3234-48f2-9ac7-9b262d366a54
Hill, F.
4a93e3c7-75bd-46b5-bef9-a93f64590d8d

Timm, A. and Hill, F. (2009) The demise of 'the firm' and the impact on apprenticeship style learning in the UK context. Research in Medical Education – Chances and Challenges International Conference. 20 - 25 May 2009. 1 pp . (doi:10.3205/09rme68).

Record type: Conference or Workshop Item (Paper)

Abstract

‘The firm’ is ubiquitous within clinical teaching in the UK context – it is the key mechanism and organisational unit for apprenticeship style learning for undergraduate medical students and junior doctors. Despite its centrality within medical education, it has rarely attracted sociological scrutiny. Medical staff, in particular, tend to take ‘the firm’ for granted, for they themselves have undergone training within it. The term and its usage, however, effectively hide historical, speciality and local variations of ‘the firm’ and mask the way in which the concept and its real life organisational practices have changed over time [1].

Within the medical education literature, clinical attachments have received relatively little scrutiny [2]. Bleakley attributes this to the prevalence of “the psychological model of pedagogy that focuses upon transmission of knowledge and skills from one individual to another” ([2], p.9). Social scientist have sought to highlight the social and contextual dimensions of learning [3] and the importance of informal and implicit aspects of the ‘hidden curriculum’ that are oftentimes more powerful than the ‘manifest’ or official curriculum [4], [5].

What is important to note is that the apprenticeship model does not solely or primarily depend on explicit instruction. Rather, knowledge is (also) transmitted through informal learning that relies on time spent together (context, shared language and experiences, observation, implicit rather than direct communication) and the formation of relationships of trust (that allows for mutual dependability and support) which in turn facilitate – or hinder – the transmission of how things are done in a particular set up [6]. The hierarchical nature of the firm is also likely to have given rise to some forms of exploitation. As noted above, the nature of ‘the firm’ remains under-researched – historically and in its current (and relatively recent) form.

Through various changes in the NHS and the phased introduction of the European Working Time Directive medical firm structures are currently in flux and some argue that they have become eroded [7]. Medical schools and deaneries (in charge of postgraduate training) throughout the UK are struggling to identify ways to address these changes, especially in terms of the firm’s educational function.

The presentation is based on interview data with clinical teachers who have trained and worked in firm structures throughout their careers. Our analysis of this data will seek to define what ‘the firm’ was in the context of different specialties and it traces its development (or demise). Without an appreciation of how ‘the firm’ operated in terms of benefits and disadvantages to the various stakeholders and how it developed over time – as a work unit and as site and mechanism for teaching / training – any account of current changes will be severely limited, as will attempts to design new ways of working and teaching to make up for its dissolution.

This record has no associated files available for download.

More information

Published date: 22 May 2009
Venue - Dates: Research in Medical Education – Chances and Challenges International Conference, 2009-05-20 - 2009-05-25

Identifiers

Local EPrints ID: 142123
URI: http://eprints.soton.ac.uk/id/eprint/142123
PURE UUID: c09ed0c7-9fe3-44ff-b1dd-e3603fecc31c

Catalogue record

Date deposited: 30 Mar 2010 15:37
Last modified: 14 Mar 2024 00:39

Export record

Altmetrics

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×