Boys in White: Student Culture in Medical School

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On the hospital wards, it could be just as challenging. There were doctors who did not want him assigned to their patients. Some would call him names. One psychotic patient attacked him, knocking him out of his chair onto the floor and then throwing a ping-pong paddle at him. But Poussaint prevailed. He developed a reputation as a good psychiatrist, doing research and getting published, a record of accomplishment that led to a position as chief resident at the UCLA Neuropsychiatric Institute, supervising some 40 trainees.

Civil rights movement. In , Poussaint made a momentous decision, putting all he had worked for at risk for a greater cause. We need help. Things are really shattered. The civil rights workers need help. We need help in desegregating the hospitals. Moses asked if Poussaint would come down for a week. He left for Jackson, Mississippi, in March Poussaint spent a few weeks volunteering and then took part in the infamous Selma marches. When organizers asked him to stay on for a two-year commitment, he gave it long thought and then agreed.

But the civil rights protests in the South, although clearly dangerous, also sparked a spirit of hope and change in the country, he said, a belief that with enough determination things were going to get better, despite the resistance and the violence. I felt that if these year-old college students could do it and take the risk, then I could take the risk in supporting them. So I did. He had good reason to be. The marches had been spurred by the killing of Jimmie Lee Jackson, a year-old deacon who had been shot and killed by a state trooper during a peaceful march in Alabama; a Boston minister, James Reeb, had been beaten to death after marching peacefully earlier in the day; and Viola Liuzzo, another civil rights activist, was murdered by the Ku Klux Klan after transporting fellow activists to the Montgomery airport.

During the marches, unarmed demonstrators were attacked by state troopers and men armed with billy clubs and tear gas. Poussaint well understood the perils inherent in an area of the country where he said people sometimes disappeared on dark country roads, never to be seen again. On one occasion he was driving some associates to Mississippi from Chicago after they had attended a medical convention at which King had spoken.

One of the people I had to take back from the meeting was a white nurse. Knowing that he was part of a mass movement for human rights, and sharing the experience with others who were as worried as he was, helped give all of them the fortitude to carry on, he said. Still, these were perilous years. As the southern field director of the medical committee, Poussaint said he had a high profile and was aware that he was under constant surveillance by state troopers at a time when lawmen might stop a black driver in Alabama for the innocuous offense of having Mississippi license plates.

They wired his car and blew him up. And you knew that at any minute you could be knocked out, shot and no one would even be prosecuted. Massachusetts, Boston and Harvard. But the beatings, threats and stress that threatened the lives of those in the civil rights movement, history has shown, were not endured in vain. After two demanding years in Mississippi, Poussaint resumed his academic medical career, joining Tufts University Medical School as director of the psychiatry program in a low-income housing development in Boston. He planned to gain more experience as a psychiatrist before heading back to New York.

But in Boston in the late s, Poussaint faced the same bigotry he had at Columbia, Cornell and in the South: He was warned to stay out of South Boston and to avoid the North End if at all possible. Even at Harvard, as an associate professor of psychiatry and an associate dean of student affairs, his efforts to diversify the medical school classrooms were met with resistance.

I had a big Afro.

In the face of this, Poussaint saw that another part of his work would involve getting black students to believe in themselves. He encouraged them to form groups to support each other, but even that became an issue.

Boys in white : student culture in medical school

Some faculty questioned why black students needed a separate black health organization, then suggested he was trying to resegregate the school. Over time, however, progress was made. In , of the medical students admitted to HMS, nearly one-quarter were from groups underrepresented in medicine, and the majority, 58 percent, were female. Poussaint did not limit his teaching, mentoring and integration efforts to the HMS Quad or its classrooms. In , Daniel Patrick Moynihan, then an assistant secretary in the U.

He felt it was critical for families to lay the groundwork for productive lives when their children are young. On one occasion he questioned why characters dressed as pirates in a Halloween scene had to have peg legs and eye patches, causing writers to rethink portrayals of the handicapped and disabled. The humor, he advised the writers, should never come from put-downs but from genuine human interactions. In another instance, he called out writers on a script that had the family frying up pork chops, he said.

They changed the dinner meal to a more healthful choice, grilled chicken. He insisted that any medical procedures on the show had to be portrayed correctly. Hihnar, "Career Interests and Expectations of U. About one-fourth prefer an individual practice without any arrangements or pooling of facilities with other physicians. Of those who want to practice absolutely alone, 79 per cent say it is because "I want to be my own boss.

Studies of this problem have been confined largely to industry and to cases where the workers have set quotas of production lower than their supervisors think they should achieve. Likewise, it has been assumed that people who enter into implicit or explicit understandings about how much work to do have given up all thought of climbing to higher positions.

In short, while students of industrial behavior and even the managers of industry have accepted the fact that levels of effort are determined by social interaction and are, in some measure, collective phenomena, both the social scientists and those who teach candidates for professions have tended to see the problem of effort and achievement in the professional school as a matter of individual quality and motivation.

We have been reluctant to apply to professional education the insights, concepts, and methods developed in study of lowlier kinds of work. This is but another instance of the highbrow fallacy in the study of human behavior; what we discover among people of less prestige, we hesitate to apply to those of higher.

Nevertheless, we did bring to our study of medical students the idea that their conduct, whatever it might be, would be a product of their interaction with each other when faced with the day-to-day problems of medical school. We were also aware that physicians engaged in various kinds of practice have some influence on the students' ideas of what kinds of things they should learn in medical schools and what kinds of careers they might aspire to, and that these ideas might not coincide with those of their teachers.

But we had no specific ideas about the results of the various experiences of the students and of the various influences upon them. We were convinced that it would be worthwhile, and a distinct innovation, to study medical students by the same methods of close day-to-day observation as have been applied in industry. As said above, it has been generally assumed that when levels of effort are set collectively they are apt to be low.

But we did not undertake this study with any such assumption. Levels of effort may be high or low; they may also be individual or collective. They may be, to be a bit tiresome about it, individual, high or Iow; they may also be collective, high or low. But what we had not foreseen, although it now seems obvious, is that in a group of professional students the collective understandings should have as much to do with the direction as with the level of their efforts. Automobile workers may determine the speed of the assembly line, but they make no attempt to alter the model of the cars they turn out.

Medical students - and probably any group of people who are themselves to be the product of the organization in which they are at work under authority - have an interest in the nature of the work done as well as in the amount. About a year after we had started the field work of our study, we wrote, for our own discussion, a memorandum entitled "Levels and Directions of Effort. When we say that modem industry has destroyed craftsmanship we mean that the skills and judgments concerning direction of effort formerly built into the man are now built into the materials, the design, the machines, and the plan of assembly.

Mass production is so called not merely to indicate that the product in toto and per manhour is colossal, but also that the items produced are so nearly identical that together they are a mass. They are, in turn, identical because power over the nature of the product is more completely concentrated in the hands of management than ever in the past.

Even so, there is a residual struggle over direction of effort, for workers will invent small short cuts in performing the most standardized and fragmented tasks and will push hard against the limits of tolerance enforced by the most meticulous "quality control" inspectors. Direction of effort has several aspects. One is the determination of the nature of one's work what a worker will put his hand to ; another is the control of the way of doing the work. It may be assumed that those in authority will always try to control direction of effort, but in varying degree.

Some are content to define the end This idea was stated explicitly by Max Weber, German economist and SOCiologist, in a monograph entitled "Zur Psychophysik der industriellen Arbeit ," published in qesammelte AUfsiitze zur Soziologie und Sozialpolitik Ttibingen, , pp. He was the first, so far as we know, who looked upon "restriction of production" as a natural and almost universal phenomenon rather than as a plot of agitators and trade union leaders. Others, as management of an automated industry, work out in great detail control over ways of working as well.

In professional educational institutions the product is, as we have said, a person - the very person who is assigned work to do. It is assumed that the teacher is "management" and will himself put forth full effort as well as define how much and what work the student should do. The latter presumably works to change himself in ways which his teachers consider desirable.

But he is only an intermediate product. The end product is the professional service which he will render to clients. Furthermore, a profession does not let the client decide exactly what service he wants, for only the profession can define his needs. While the profession may agree that only professionals may define medical or other needs, consensus may be rather less than complete as to what the needs are and how to treat them in any particular case.

Those who, as teachers, "produce" physicians are not all agreed on what to teach or how to teach it. They are not completely at one concerning the directions of their own efforts, nor could they be without destrOying a right of individual professional judgment very precious to them. In short, the joints of the medical system have a great deal of play in them. The people who work in the system have - and use - a good deal of freedom in choosing both what to do and how to do it. Their students - the people who are told what to do and how to do it - are quick to discover that they, too, can and indeed must, in some measure, decide not merely how much work to do but in what directions to exert their energies.

In shOWing how and why these well-intentioned and strongly motivated students do not and probably could not exactly follow the wishes of their teachers, we shall be contributing to an understanding of the essential nature and workings of all institutions in which some people teach others or in which some have manifest authority to control the efforts of others. The Organization. A medical school is an organized enterprise with unusual singleness of purpose.

In order to fulfil that purpose, the replenishment of the supply of physicians, it must perform other functions. Foremost among them is looking after a large number of people who need medical care; second, in our day, is medical research. The whole requires a good deal of administration. Each member of the staff combines, in his work, some or all of these four activities - teaching, the practice of medicine, research, and administration - in varying proportions.

Practically all of them teach, but not all practice medicine, do research, or engage in administration. They differ from each other in their opinions about the best combinations of these activities in the medical school, in medical curricula, and in their own careers.

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But all are strongly devoted to the purpose of training physicians. A majority of them are members of the medical profession. Practically all of the physicians are also members of some specialty. Others are members of scientific associations. The medical school is thus a very complex organization, composed of men who, in spite of devotion to one main goal, are involved in the school in quite different ways.

Because of its several functions, the school and its related hospitals, clinics, and laboratories have relations with many organizations and publics outside. Although we have not ignored these many facets of the medical school, and have taken account of them from time to time, our main emphasis remains fixed on the students in their interaction with each other and those who teach them. The following chapter will tell of our method.

The fourth chapter of this section will say something about medical schools in general and the University of Kansas Medical School in particular. Any organization - no matter what its purposes - consists of the interaction of men - of their ideas, their wills, their energies, their minds, and their purposes.

The men who thus interact are involved in the organization in varying degree, for varying periods of time, and at different stages of their careers. Some of the staff are bound to the school we studied in many ways - as patriotic sons of Kansas, as alumni of the college and medical school of the university, as practitioners of medicine, and as long-time members of the staff. They are attached not merely to medicine and medical schools but to this school above all others.

Other members are attached to medicine, science, and medical education but not to this school more than to some other where they might pursue their work. Some undoubtedly regard this school as a steppingstone in their careers. But to all, regardless of the place of the school in their careers, a study made by outsiders may appear a risky thing. Although many members of the staff of this or any large organization may be critical. The outside investigator may bring to it his own canons of criticism; or he may, by his very objectivity, appear to make light of the purposes, attachments, and the deeper sentiments of the people to whom the organization is dear.

We who study organizations do bring to our work, if we are worth our salt, a certain objectivity and neutrality.

Howard S. Becker

We assume that organizations can be compared with one another no matter how different their avowed purposes may be. We do not take it for granted that the sole purpose of an organization is what those concerned say it is. We do not expect any organization to be' the perfect instrument for attaining its purposes, whatever they may be. This attitude, necessary as it is to increase of knowledge of social organizations, contains what may appear a criticism to those deeply involved in an organization. But our purpose is not criticism, but observation and analysis.

When we report what we have learned, it is important that we do so faithfully. We have a double duty-to our own profession of social observation and analysis and to those who have allowed us to observe their conduct.

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We do not report everything we observe, for to do so would violate confidences and otherwise do harm. On the other hand, we must take care not to bias our analyses and conclusions. Finding a proper balance between our obligations to our informants and the organization, on the one hand, and our scientific duty, on the other, is not easy.

We have been at some pains to find such a balance. Yet it will appear that there is a certain bias in our account, for we look at the medical school very largely through the eyes of the students. Instead, they may find what appears to them overemphasis on the pO,ints where their work has not been fully successful, where - in spite of their best effortsthings have gone awry. We remind those teachers that throughout the book we are saying, "This is how things look and feel down under. This is how, whether anyone intends it or not, it is for the students.

There is none in which aspirations and realities are identi We interviewed at some length over fifty members of the full-time staff. While what was learned from them has been used in many ways, it seemed best to reserve systematic analysis of that material for another kind of report. To point out the disparities in any particular institution may appear to those most concerned both an exaggeration and a criticism. But the microscope - which exaggerates things - is an honored instrument. It makes hidden things clear to the eye. But it does not criticize.

Rather, it enables us to compare one thing with another. Our aim is so to bring to view and so to analyze the experience and actions of medical students in interaction with their teachers and their tasks that the reader may compare them with other situations of the same order. N one sense, our study had no design. That is, we had no well-worked-out set of hypotheses to be tested, no data-gathering instruments purposely designed to secure infonnation relevant to these hypotheses, no set of analytic procedures specified in advance.

Insofar as the tenn design" implies these features of elaborate prior planning, our study had none. If we take the idea of design in a larger and looser sense, using it to identify those elements of order, system, and consistency our procedures did exhibit, our study had a design. We can say what this was by deSCribing our original view of our problem, our theoretical and methodological commitments, and the way these affected our research and were affected by it as we proceeded.

We will, then, turn in the next chapter to a description of the point of view we finally adopted, from which this book is written, and the analytic procedures we adopted to implement it. Our research problem, as we originally saw it, had nothing to do with problems of the level and direction of effort, for this concept was developed in the course of the research and became our central focus only when we were engaged in the final analysis of our materials.

Instead, the problem we began with was to discover what medical school did to medical students other than giving them a technical education. It seemed reasonable to assume that students left medical school with a set of ideas about medicine and medical practice that differed from the ideas they entered with, ideas they could not have had in advance of the concrete foretaste of practice that school gave them.

Such changes would presumably influence the career choices. Our original focus, then, was on the medical school as an organization in which the student acquired some basic perspectives on his later activity as a doctor. It is important to note here some of the things we did not assume. For instance, we did not assume that we knew what perspectives the doctor would need in order to function effectively in practice, for we believed that only a study of doctors in practice could furnish that information and such studies were not available.

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We did not, furthermore, assume that we knew what ideas and perspectives a student acquired while in school. This meant that we concentrated on what students learned as well as on how they learned it. Both of those assumptions committed us to working with an open theoretical scheme in which variables were to be discovered rather than with a scheme in which variables decided on in advance would be located and their consequences isolated and measured.

This commitment raises both theoretical questions and questions of method. To start with the latter, we necessarily had to use methods that would allow us to discover phenomena whose existence we were unaware of at the beginning of the research; our methods had to allow for the discovery of the variables themselves as well as relationships between variables.

We were committed, therefore, to the use of unstructured techniques, particularly at the beginning. We will discuss later our choice of particular kinds of unstructured techniques. The important point is that our initial conceptions dictated techniques of this kind. The assumptions discussed so far, being negative in nature, did not say much about what kinds of concepts and theories we would make use of in our study, nor, to put it another way, did they say much about which facets of the school's social structure or the experience of individual students we would focus on.

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These questions were decided in part by major a priori theoretical commitments, which we can explain briefly here. The first of these is to a sociological mode of analysis. By this we mean simply that we were interested in prob-. This theoretical premise suggested that we look at the medical school as an organization of collective forms of social action. Since we were interested, at this time, in analyzing not only the collective forms of social action that made up the medical school as an institution, but also in the eHects on the medical student of living and working in this institution, we needed also to make some decisions in the area of social psychological theory.

Here we had more to choose from than in the area of sociological theory; although sociolOgical theory contains basic assumptions and perspectives which are fairly well agreed upon by most workers in the field, social psychology contains many competing theories whose comparative worth has never been definitively tested. Thus, choice of a point of view must necessarily be somewhat arbitrary.

One is tempted to justify the choice of a theoretical viewpoint by saying that it is most suitable for the problems under investigation. But the problems are in part defined by the theory one chooses, so that such a justification is tautological. We decided to work with a theory based on the concept of symbolic interaction, the theory first enunciated by Charles Horton Cooley, John Dewey, and George Herbert Mead 1 and since used and expanded- by many others. It assumes that human behavior is to be understood as a process in which the person shapes and controls his conduct by taking into account through the mechanism of "roletaking" the expectations of others with whom he interacts.

Sherif and M. Wilson eds. Lindesmith and Anselm L. Strauss, Social Psychology. Park, Race and Culture Glencoe, Ill. Although the decision to work with sociological theory and socialpsychological theory of the symbolic interactionist variety limited the area of things we might study and the concepts we might use to study them, it did not dictate specific concepts or objects of study.

Even with these commitments, we still faced the problem of deciding which of the many phenomena that could be studied in the medical school and in the lives of the medical students to study. Symbolic interactionist theory lacks a body of substantive propositions that would have directed our attention to particular phenomena in the way that, for instance, a psychoanalytically based theory might do.

In explaining our further theoretical specification of the problem, we are tempted to make our decisions seem more purposeful and conscious than in fact they were. We did not have a well-worked-out rationale for these choices. Rather, we went into the field and found ourselves concentrating on certain kinds of phenomena; as we proceeded, we began to make explicit to ourselves the rationale for this concentration of our interest.

The areas we found ourselves concentrating on were consistent with our general theoretical assumptions but did not How lOgically and inevitably from them. We studied those matters which seemed to be of importance to the people we studied, those matters about which they themselves seemed interested or concerned Second, we studied those matters which seemed to be the occasion of conHict or tension between the students and the other social categories of persons with whom they came into contact in the school.

We studied what was of interest to the people we were investigating because we felt that in this way we would uncover the basic dimensions of the school as a social organization and of the students' progress through it as a SOCial-psychological phenomenon. We made the assumption that, on analYSiS, the major concerns of the people we studied would reveal such basic dimensions and that we could learn most by concentrating on these concerns. This meant that we began our study by looking for and inquiring about what concerned medical students and faculty and follOWing up the connections of these matters with each other and with still other phenomena.

We studied phenomena that seemed to produce group tension and. Operationally, this meant that we were eager to uncover "sore spots," to hear "gripes" and complaints. It might seem that in doing this we were deliberately looking for dirty linen and skeletons in the family closet, but this is not the case. The point of concentrating on instances where things do not work well is that it helps one discover how things work when they do work well, and these are discoveries that are more difficult to make in situations of harmony because people are more likely to take them for granted and less likely to discuss them.

These two decisions helped us to limit the area of inquiry. Our job was to investigate the school by looking for matters that were important to participants in it in a collective way and! We did not concentrate equally on all participants but made the student our central concern and studied other aspects of the organization as they impinged on the student; we studied other participants as fully as was necessary to understand how they influenced students and why they acted in one way, rather than another, toward students.

Another theoretical choice further specified our task. We looked on the school as a social organism or system; that is, we expected the parts of it we separated analytically to be in fact connected and interdependent. Insofar as the school was a social system, we expected that the various phenomena we discovered in our research would have consequences for each other. For instance, we thought the nature of the relations between students would have effects on the relations between students and faculty and vice versa.

If we were going to look on the medical school as a social system, it seemed to us that a particular style of analysis was required. We would not be interested in establishing relationships between particular pairs or clusters of variables. Rather, we would be interested in discovering the systematic relationships between many kinds of For a more elaborate argument on the vtility of studying tension and conflict see Alvin W.

Our analysis would proceed not by establishing correlations but by building tentative models of that set of systematic relationships and revising these models as new phenomena requiring incorporation came to our attention. We did not propose hypotheses and confirm or disprove them so much as we made provisional generalizations about aspects of the school and the students' experience in it and then revised these generalizations as "negative cases" - particular instances in which things were not as we had provisionally stated them to be-showed us further differentiations and elaborations required in our model.

The decision to look on the school as a social system or, better, a complex of interwoven systems, for many systems could be found in the same data led us to pay particular attention to those phenomena which were of interest to participants in the school and productive of tension or conflict which had the further characteristic of having demonstrable connections with many other observed phenomena.

Such phenomena would aid us in building an over-all model of the organization we were studying, a model which would abstract from the mass of concrete events the recurring elements in that organization. A final theoretical predilection should be noted. We concentrated less on the variations in attitudes and action to be found among students than what was common to all students except a few known deviants. We did this because we believed that before we could understand variations in student thought and action we needed to discover the relevant dimensions along which those thoughts and actions varied, the common elements which might be thought to differ from one student to another.

This decision was later buttressed by our discovery during the field work of the tremendous homogeneity of the student body. Since the students were so homogeneous with respect to the problems we were studying, a focus on the variations between them would have yielded little. Our theoretical commitments led us to adopt as our major method of investigation participant observation;' in which the researcher participates in the daily life of the people under study either openly, in For a general desCription of this method see William Foote Whyte, "Observational Field-Work Methods," in Marie Jahoda, Morton Deutsch, and Stuart W.

Cook eds. Such a method afforded us the greatest opportunity to discover what things were of importance to the people we were studying and to follow up the interconnections of those phenomena. It allowed us to revise our model of the organization and the processes we were studying by furnishing us with instances of phenomena we had not yet made part of our over-all picture. It enabled us to return to the field for further evidence on these neW problems. We shall describe later the specific observational techniques we used and the way we have tried to solve the problem of how to analyze systematically the large amount of data collected by this method.

At this point we will discuss only certain major decisions we made about whom to observe and for how long. In a study of the development of individuals as they move through an educational institution one faces the dilemma of intensive versus extensive study. Should we follow one group of students through four years of medical school or should we study different groups of students at different levels of the school for shorter periods of time? The arguments on both sides are well known.

In the long-tenn study, one knows that the differences he detects between those entering and those leaving the school are not due to the fact that they are different people. On the other hand, he knows only one group, which may be atypical. During field work, we often heard about the vast differences, from the faculty's point of view, between one year's class and the next.

Since the major changes that concerned us were changes in attitudes and perspectives toward medicine and medical practice, and these seemed clearly tied to experiences in the medical school, we did not see the necessity of concentrating on one group of students. It was not likely that the development, let us say, of concrete attitudes about advantages and disadvantages of different specialties could be tied to extracurricular influences in such a way that the students would have developed these without the school experience.

We took the risk that there would not be differing attitudes on the same subjects when successive classes were compared as in fact there were not and decided to sample extensively and not follow one group through four years. Considerations of time and efficiency also entered into the decision; we did not feel that the added safeguards would.

We still had to decide what students to observe and for how long. We will report in detail later on the students' academic schedule. Here we need only say that during the first two years they move through the school as a unit, all taking the same classes at the same time, while during the last two years they are divided into several groups, each of which takes the same group of courses but in a different sequence. Thus the decisions about whom to observe differ for the first and last half of school.

Once we had made the general decisions discussed below, dictated by these differences in deployment of the classes, we found it necessary to make certain more specific decisions based on the knowledge of the rhythms of student life we acquired during our field work. We thus planned our later observations to include students at the time they entered school and at the time they were finishing school. Our final decisions on the allocation of observation time were these: We started with the clinical years on the premise that these might more quickly reveal the ultimately decisive influences on the students.

Whether this was, in fact, true is hard to say; it is hard to single out "ultimately decisive" influences from others less decisive. Juniors spend successive periods of three months in three main departments of the school; seniors have their year divided into four similar periods. We organized our observations so that we spent time with students in each of the departments in which they would receive training and saw something of each major training situation in the school.

Furthermore, we usually although not always observed different groups of students in these different situations instead of following one group of students through the entire sequence of courses.

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We did this so that we could achieve extensive coverage of students as well as of situations, but for reasons of expediency as well; it took the students longer to finish their training in most fields than we wished to spend in those training situations. We thought extensive coverage of both students and situations important. If we were to carry on our analysis by successive refinements of our theoretical models necessitated by the discovery of negative cases, we wanted to work in a way that would maximize our chances of discovering those new and unexpected phenomena whose assimilation into such models would enrich them and make them more faithful to the reality we had observed.

By seeing many groups. With the freshmen and sophomores the academic schedule posed different problems for us. Skipping from group to group and situation to situation in the clinical years and looking at smaller groups instead of the entire class were dictated by the fragmented character of the clinical schedule, but the schedule of the basic science years was quite different and required us to think much more about the class all the students in the same year as a unit.

In the first two years of medical school, and particularly in the first, the entire class moved together, did the same things at the same time in the same places, and reacted as more of a unit. This was somewhat less tme of the sophomore year when, although the general curriculum was the same for all, students were separated into smaller groups whose activities at particular times might differ. Consequently, in our work with students in these years, and particularly with the freshmen, we made a greater effort to cover an entire class, to talk to every member about the major events in whose significance and effect we were interested.

Many observations of both the house staff residents and interns and the faculty were made during the field work with students, but these observations were limited to what could be seen while these persons were with the students. Because we wanted to see how activities with the students fitted into their perspectives, we carried on a three-month program of field work with the house staff. Unfortunately, we made no such intensive observations of the faculty.

We have explained why we decided to use participant observation as our basic technique and to analyze the data so gathered by attempting to build and progressively refine models of the school as a social organization and of the process of development of the student moving through that organization. We now turn to a description of just how we went about gathering data and analyzing it. In participant observation, as we have said, the researcher participates in the daily lives of people he studies. We did this by attending school with the students, following them from class to laboratory to hospital ward.

In studying the clinical years, we attached ourselves to one of the subgroups of the class assigned to a particular section of the hospital and followed the members through the entire day's activities. In studying students in the first two years, we did much the same thing, but since we were then attempting to study the entire. We went with students to lectures and to the laboratories in which they studied the basic sciences, watched their activities, and engaged in casual conversation with them.

We followed students to their fraternity houses and sat with them while they discussed their school experiences. We accompanied students on rounds with attending physicians, watched them examine patients on the wards and in the clinics, and sat in on discussion groups and oral exams. We had meals with the students and took night call with them.

We observed as participants in the daily activities of the schoolwhich is to say that we were not hidden; our presence was known to everyone involved, to the students, their teachers, and their patients, Participating in the ordinary routine, we did so in the "pseudo-role" of student. Not that we posed as students, for it was made clear to everyone that we were not students: but rather that it was the students we participated with. When a lecture or class ended, we left with the students, not the teacher; we left the operating or delivery room when the student did, not when the patient or surgeon did, unless these happened to coincide.

We went with the students wherever they went in the course of the day. Since we were known to be observing participants,5 the questions naturally arose for others as to who we were, what we were observing, why, and what effect this might have on the school. Students readily accepted our explanation that we were there to gather material for a book on medical education. The best evidence that our presence did not noticeably alter their behavior lies in the fact that they were willing to engage in behavior the faculty disapproved of while in our presence.

On the other hand, we surely altered their behavior by our questions, at least in the sense that they became more seHconscious of certain aspects of their behavior. The faculty saw us in different ways; the clinical faculty often seemed almost unaware of our presence, while basic scientists were very likely to see us as potential judges of their teaching technique. In consequence, the science teachers seemed often extremely aware of our presence, while clinical men several times forgot who we were and asked us questions on medical subjects during class discussions.

Neither students nor faculty gave evidence of concern about our presence. Both groups, Raymond L. Two aspects of our participant observation are important: it was continued and it was total. When we observed a particular group of students, we observed them day after day, r. This latter was not always the case, for such a program of observation would leave little time for the recording and analysis of observations.

The children themselves are not the puzzle, nor are their families or communities. Each of us — teachers, administrators, policy makers, etc. Each of us plays a role in racism. Each of us is part of this puzzle. The first and most critical part of teaching Black boys is understanding. It's about understanding self. When we first solicited chapters for this book from parents, students, teachers, and academics, most of the 41 chapters that came back implored teachers to start by understanding themselves.

But we included seven chapters on understanding self and made note that no other piece matters quite as much. This is only the first of three blog posts, and in the others we'll share about respecting Part 2 both the multiplicity and diversity of Black boys, as well as the racial context in which they're growing up and connecting Part 3 school structures with student success.

But as we close Part 1: Understanding Self, we invite you to engage in one of the two sample exercises shared from our book below. To better get at what it really means to be White, take this challenge. Elizabeth Denevi, Chapter 7. Frankenberg, R. Minneapolis: University of Minnesota Press. How do you examine implicit bias and unpack Whiteness in your classroom and in the world at large? Did you try one of our activities? We'd love to hear about it.