Marlot Kuiper

46 Connective Routines Professionalisation starts during medical education, when students get socialized into their professional domain. In medical school, technical skills are learned in an educational context that involves other, experienced, professionals. Although it was traditionally thought that the transmission of technical skills was at the heart of the medical education system, today it is widely acknowledged that medical training is “a process of moral enculturation” (Hafferty & Franks, 1994, p. 861). Novices learn what to observe, how to interpret these observations, and what words and actions to use when assigning these both to clients and colleagues. This learning environment is also labelled a ‘community of practice’ (Maudsley & Strivens, 2000). This learning environment is of crucial importance, as professional learning depends heavily on role models where students, residents, and practicing clinicians pattern their behaviour on “individuals admired for their ways of being and acting as professionals” (Cruess et al., 2009, p. 7; Witman, 2008). Therefore, medical education not only comprises of what is taught in the formal curriculum, but all the more of what is taught in the ‘hidden curriculum’: “We [faculty] are teaching far more than we know. Every word we speak, every action we perform, every time we choose not to speak or act, every smile, every curse, every sigh is a lesson in the hidden curriculum” (Gofton & Regehr, 2006, p. 21). Furthermore, the duration of this socialization process and the long working hours in which ‘new professionals’ are separated from ‘the real world’ and get acquainted with the medical culture is often emphasized as a powerful mechanism (Freidson, 1988; Pratt et al., 2006). As training endures, medical professionals devote their attention to understanding more and more about narrower topic areas during their specialization. Today, most doctors are trained and qualified to provide only some kinds of care. Even within specialties like surgery and internal medicine, there are multiple subspecialties like vascular and abdominal surgery or haematology and nephrology. Thus, the physician workforce has differentiated into a heterogeneous group of professionals (Baker et al., 2011; Cameron, 2011; Freidson, 1994; Hall, 2005). Consequently, many different professional subdomains exist within ‘the’ medical culture, each with their own culture. Through their involvement in the practice of a sub discipline, novices construct a sense of their profession which includes its duties, its boundaries, its values and its aspirations (Lave & Wenger, 1991). Socialization within these sub specialties leads to social similarity which facilitates communication, “since socially similar actors are more likely to speak