Standardized Credentials, Unstandardized Skills: The Variation of OB/GYN Clerkships in Practice

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 21. Medical Education

Abstract

This study examines variation in OB/GYN clerkship experiences across U.S. medical students and considers the implications of this variation for medical socialization and skill acquisition within a highly standardized credentialing system. We examine this question within the neoinstitutional theory framework (DiMaggio and Powell 1983), specifically the theory’s suggestion that isomorphic processes make organizations and organizational practices similar across organizations over time due to institutional pressures. More specifically, we examine the lack of isomorphism in OB/GYN medical school clerkship skill training. Isomorphism in credentialing is clear – the credentialing process is very standardized (Murphy 2025) with the Flaxner model of medical education and the end of clerkship exams (i.e. shelf exams) are also standardized. Yet, our study demonstrates that isomorphism is not occurring in the skills medical students learn in the hands-on educational portion of credentialing. Deemphasizing hands-on skills and learning, the actual skill of being a doctor is not embedded tightly into credentials and enables weak institutional pressures for conformity. To explain, we draw on Collins’ (1979, p. 181) classic work on credentials in which he suggests that credentials of professional groups such as doctors and lawyers are used to “reinforce a restrictive club based on genteel manners, to prevent competition, and thereby to keep fees high.” We use a longitudinal research design and interview medical students before and after their OB/GYN clerkships to understand their expectations and experiences with their OB/GYN clerkships. So far, we have completed 104 pre-clerkship interviews with U.S. medical students, and 80 of those students have also completed post-clerkship interviews. For this paper, we focus on the 80 post-clerkship interviews that describe experiences with the OB/GYN clerkships. We will report our preliminary findings and discuss our future research plans.

Authors

• Theresa Morris, Texas A&M University-College Station

• Joan H. Robinson, CUNY-City College

• Claire Anderson, Texas A&M University

• Emily Flowers, Texas A&M University