How Does The Structurisation of Medical Practice Enable and Control The Ways in Which Practice is Lived and Realised?

This chapter explores and discusses how trainee/surgeon (learner/practitioner) subjectivities emerge from the intensities of affective experiencing in real encounters of practice, thus articulating important aspects of the emotional dimension of learning and practice in medical education and training. These real experiences of practice are shaped and constructed by the normative frameworks that organise and create the design and delivery of clinical care – the structurisations of practice. Examples of such include the on-call schedule, health policy, out-of-hours service arrangements. These ‘structures’ affect the thoughts, emotions and actions that emerge when dealing with unexpected clinical encounters, including the urgent and important clinical decision-making. This chapter examines how these formal structurisations of medical practice control and impel the ways in which surgeons think, problem solve and act: how they actualise their practice. The chapter concludes by querying how the affective conditions of practice are expressed in surgeons’ attitudes and behaviours. The critical discussions of this chapter are informed by pedagogies of encounter, the theoretical framework developed in Chapters 2 and 3, which explore the affective aspects of experiencing in encounters with clinical practice.