Paper long abstract:

The paper addresses contemporary reform in postgraduate medical residency training that aims to standardize residency training practice. The reform is guided by public policy interventions to increase quality of care, objectify residents' performances, and to prepare residents for changing health care needs. The reform takes in a shift from traditional apprenticeship-based training models of "learning-by-doing" and role modeling, to formalized training programs based on the educational insights of competency-based training and standardized performance assessment. In the paper we perceive medical education as a new epistemic culture alongside the traditional professional authority-based system of training residents. Drawing on ethnographic research on residency training in the Netherlands, the paper examines how medical educational knowledge has been incorporated in medical training programs and how this has affected the training of residents.

The paper elucidates how medical education has manifested itself in medical training practice by bringing in new ways of evaluating and teaching residents. The paper shows how attending physicians enact a kind of epistemic pragmatism by embracing the newly offered instruments to objectify resident evaluation on the one hand, and re-linking them with clinical work on the other. As such, contemporary reforms have enlarged the teaching repertoires of clinical teachers.