This book concerns the reform of medical residency training. In short, the reform takes in the shift from apprenticeship-based training models of “learning-by-doing” and role modeling to structured training programs based on educational insights as competency-based training and standardized performance assessment. Up to now, many sociological accounts of medical education have narrowly focused on the world of doctors and how they are educated. This book aims to contribute to a more comprehensive understanding of current transitions in medical education. The overall research aim is to reveal how medical residency has changed due to the interplay of policy development, transitions in the medical profession, traditional values and training practices, and new ideologies.
The book discusses and relates two closely related, yet usually distinct topics. First, we explore the changing objectives and processes of medical training itself, and examine how current reforms affect the learning process of medical residents. Second, medical education is generally seen as a core institution of medical professional self-regulation. Through exploring medical training reform we seek to gauge the dynamics of present trends in medical governance.
We explore these research aims through a multiple-sited ethnographic study of medical training reform in the Netherlands. For five years, we traveled around
and participated in various sites that enacted the reform of medical training:
the Ministry of Health, medical associations, the clinic, local meetings of clinical teachers, medical residents and educationalists, conferences pertaining to the reform and scientific conferences on medical education. We ‘acted with’, observed and interviewed local and national actors. Drawing on theoretical insights of medical sociology, the sociology of professions, science and technology studies and political sciences the book reveals the multiple ontologies of medical training reform, and provides in-depth insight in the processes and mechanisms of changes in medical governance more in general.

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