Habitualisierung im ärztlichen Feld

Background and research question
This thesis investigated residency training as an essential part of the habitualization of physicians. Using the example of surgical residency training, the formal structuring of residency training (in the form of residency training regulations) by the medical self-administration and the concrete residency training practices in the clinics were examined. Additionally, it was explored how processes of social change, such as economization, feminization and changing values, influence the process of residency training, which should actually autonomously be regulated by the medical profession. Furthermore, it was analyzed how the medical field reacts to this.

Methods
A field analysis according to the praxeological theory concepts of Pierre Bourdieu
was conducted to examine specific rules as well as habitual characteristics of the medical and surgical field. In the first step, the structural development of residency training was examined by document analysis of the residency training
regulations 1992, 2003 and 2018. In addition, expert interviews were conducted
with actors involved in the development process. In a second step, the realization
of residency training in everyday clinical practice was examined with a focus on
(organizational) cultural and micro-political aspects of analysis. For this purpose,
semi-structured qualitative interviews with clinicians from two surgical clinics
based on an interview guide were analyzed according to Udo Kuckartz´ content
analysis. Edgar H. Schein´s 3-level model for organizational culture analysis was
also used as an analysis tool.

Results
It was shown that demarcation and distinction function as essential anchors for the surgical (residency training) culture and that capital accumulation and field position are essential factors in residency training practices. Different types of trainees and (micropolitical) practices could be identified. Gender specifics didn’t appear directly, but the mention of gender-associated topics underlined deep-rooted cultural assumptions (e.g., of the culture of presence). The label of residency training as a ‘by-product’ also exerts a significant influence on the perception of residency training in total. Internal factors influencing residency training practices include the power imbalance between supervisors and residents, as well as impulses for change from the younger generation, although the latter is still less influential. External influencing factors, such as economic mechanisms in everyday clinical practice, on the other hand, limit the possibilities for further training more clearly. The training regulations are also perceived as something external, and there are divergent perspectives on them among hospital-internal and external actors in the medical field. Overall, the medical field reacts to external influences with practices of circumvention.

Conclusions
In order to be able to resolve the obstacles identified in the medical and surgical
training field, a cultural approach is required in which clinicians, medical selfgovernment actors and medical educators accepted by the field work out fieldspecific solutions. Reflecting on the field rules and habitual patterns identified in this thesis can be helpful in this regard.