AN ETHNOECOLOGICAL INQUIRY OF CANCER CARE EDUCATION AND PRACTICE IN THE AMERICAN MEDICAL CULTURE.

摘要

The ethnoecology of cancer care training analyzes the formation, content and context of cancer care education in relation to the overall American medical culture. The cultural context in which the perception of medical need, knowledge and care practices emerged is explored in a comparative historical analysis of the medical school curriculum's formation. The content and conduct of current cancer education in response to these historical influences is determined from the distribution of attention among cancer topics, relative to the overall medical school curriculum structure, in a particular medical school (Wayne State University Medical School) curriculum. The cooperation of an interdisciplinary Cancer Education Committee enabled review of extensive instruction and evaluation material, and the Committee's actions on those materials. Material identified as oncology-related was classified according to a Function, Academic Discipline and Body Organ Classification schema. Students' acquisition of oncology education is examined from performance scores on internal multiple choice examinations, Patient Management Problems, and NBME items.; A pervasive pattern of minimal attention to psychosocial concerns in cancer care, documented in the WSU curriculum analysis, was corroborated from responses to a national survey of medical students. The analysis of a nationally formulated model for comprehensive cancer education found the material presented as interactive cancer care knowledge posed a constricted range of concerns and an agonistic model among persons participating in the care of cancer. An observational study of the WSU oncology outpatient clinic was undertaken to explore the range and patterns of psychosocial concerns evident in interactive cancer care. The observed exchanges included an extensive range of psychosocial concerns. The lack of explicit expression of these issues, however, obscures from the participants the referential adequacy and implications of the implicit judgments made about their ability and commitment to participate in the regimens of cancer care and research. The implications of the findings from the historical and current conduct of cancer education are considered.