Repairing reforms and transforming professional practices: A mixed-methods analysis of surgical training reform

Abstract

Although much has been written on changing professionalism, only limited attention has been given to the ways in which professionals themselves give shape to new requirements in everyday professional practice. This article investigates the understudied reform of postgraduate medical education. The reform takes in a shift from apprenticeship-based training based on 'learning-by-doing' and socialization to time-restricted, streamlined, competency-based training programs based on competency-based training and standardized performance assessment. We deploy a mixed-methods study design of surgical training reform in the Netherlands (2011-12) to examine how surgeons and surgical residents give shape to changes in education as well as in the wider hospital context, and how this impact on surgical training from a micro perspective. Informed by sociological literatures on medical education and changing professionalism, this article reveals how the reform is repaired in everyday training practice. This repair work, as a form of institutional work, goes beyond restoring disrupted institutional arrangements in order to restore the status quo as is often argued. Instead, it involves acting with the reform; seeking feasible solutions that preserve old values and related practices while adopting new requirements that reconfigure institutionalized arrangements in professional training practices.