Beyond Competence: Efficiency in American Biomedicine.

Abstract

“Competence” is a longstanding value of American biomedicine. One underidentified corollary of competence is efficiency: at once a manifestation of competence, a challenge to competence, and a virtue in its own right. We will explore the social construction of efficiency in US undergraduate medical education through an analysis of its sociocultural and technological landscapes. We present qualitative data from two allopathic medical school field sites in the Midwestern United States, where medical students’ careful selection of certain learning resources and overall perspectives on the curriculum underscore their focus on efficiency and pragmatic approaches to knowledge. In the discussion, we consider the ethical implications of physician efficiency, as well as future trajectories for the study of efficiency in the medical social sciences, bioethics, and medical education. We posit that efficiency is at the theoretical heart of US medical practice and education: a finding that has wide-reaching implications for how researchers conceptualize the enterprise of biomedicine across cultural contexts and interpret the lived experiences of physicians, medical students, and other clinicians.