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Science Philosophy and Practice: Professionalization

Science Philosophy and Practice: Professionalization

Introduction

A profession is any field of study in which specialized knowledge is acquired after intensive academic instruction is applied with rigorous standards. Such fields include medicine, law, applied science research, teaching, and engineering. The concept of a profession has evolved over centuries, as training has progressed from informal and formal apprenticeships to highly structured academic training programs with meticulous licensing standards. Each discipline, particularly medicine and science, has structured the training and education programs deemed necessary to meet contemporary standards and legitimize their place in the highest ranks of society.

Current standards for physicians include medical training at the undergraduate and/or graduate level, passage of licensure examinations, internships, residencies, and continuing education. Science and engineering professionals must complete specific undergraduate and graduate training, pass licensure examinations in many fields, and experience continuing education as well. These standards vary from country to country and sometimes within a specific country.

Historical Background and Scientific Foundations

Medical or scientific training, until the rise of formal education, took place through apprenticeships and individual experiments. Medical practitioners fell into four basic categories: midwives (exclusively women), physicians (university trained), surgeons, and apothecaries (both apprenticeship trained). Each practitioner provided a different service to the public and was trained by his or her predecessor. In many fields, fathers passed on knowledge to sons. Craftsman organizations date back thousands of years in India, ancient Greece had organizations segregated by skill, while the formal guild system began in Europe during the eleventh and twelfth centuries. Formal trade organizations formed in the Muslim world as early as the ninth century.

Structured guilds in Europe first appeared in Germany in the tenth century. While some, such as those in Florence, Italy, were created to help merchants gain economic advantage, craft guilds emerged as groupings of artisans designed to fix prices, set quality standards, and control the numbers of artisans producing a particular product or offering a service. Guild members frequently swore an oath when joining the organization to band together with fellow artisans with absolute loyalty.

Membership within guilds was divided into three levels: masters, journeymen, and apprentices. Guilds acted as social service organizations for members, ensuring pensions, aiding widows, and providing assistance when sales were low. Prohibiting new members from joining a guild was the primary method of control over a certain field. Apothecaries formed guilds in some areas in Europe in the seventeenth century, while Amsterdam had a surgeon's guild in the sixteenth century, and physician guilds persist into the twenty-first century as economic alliances. Midwife guilds are noted in the Old Testament of the Bible, in Exodus, although such guilds were less commonplace than artisan, physician, surgeon, or apothecary guilds.

Guilds enforced extended apprenticeships for members; because many practitioners passed their skills on to sons, the extended apprenticeship also served to maintain the father's authority and status as shop or service master. The transition from apprentice to journeyman could take more than a decade in some fields; modern apprenticeships in trades take between three and five years, while current physician training has new medical school graduates undergoing an internship program of one year before moving on to residency, which can last several years more, depending on specialization.

Journeymen in guilds did not own their shops or practices, but were employees or contract workers. Beyond journeymen, masters owned their own shop—an apothecary might learn as an apprentice in his father's shop, rise to journeyman to work for other shops in the region, and then settle back to be the master of his father's store after his father's retirement or, more likely, death. The Royal College of Surgeons of Edinburgh was founded in 1505; the college began as a craft guild and accepted for membership only those persons who had apprenticed for more than six years with a master surgeon and who passed an extensive examination.

The rise of universities as training centers in the sciences and medicine developed during the Renaissance and through the Enlightenment. Medical training centers in the Middle East had been in place from the tenth century through the thirteenth and fourteenth centuries. In Europe, universities offered medical and scientific training programs that were increasingly formalized by the 1700s; the first medical college in the United States, the Academy and College of Philadelphia, opened in 1765, while the London Hospital Medical College in England opened in 1785.

Professional societies and universities developed contemporaneously; guilds in medicine and science were slowly replaced with associations and societies such as the Royal Medical Society in England, established in 1734, the Conseil de l'Ordre des Médecins, established in 1845 in France, the American Medical Association, established in 1847, and later, the German Bundesärztekammer in 1947. Less concerned with economic protectionism, these new professional societies offered guidelines and regulations for training in the respective fields, professional oversight of members to maintain rigorous standards, licensure and examination protocols, and censure for those members who did not uphold the ethics code determined for the profession by the society.

Such associations also served to limit the number of practitioners in the respective fields, to reduce competition and control price structures for services. These associations often worked in concert with university training programs, and the give and take between universities and professional associations persists into the twenty-first century. In the engineering profession, associations such as Skule, established in Canada in 1885, and Verein Deutscher Ingenieure in Germany, founded in 1856, marked divisions between different types of engineers, created educational frameworks to qualify for

examinations, and structured examinations for each subfield within engineering, controlling the use of the various engineering titles (i.e., Professional or Chartered Engineer), and working with universities and engineering firms to establish internships and training guidelines.

Examinations were developed both by universities and professional societies to standardize the profession, select applicants for university training, and limit those who wished to be fully licensed and practice their skills. Licensure and certification examinations have taken many forms; in the United States, the Medical College Aptitude Test (MCAT) was first offered in 1928, largely to improve attrition rates in medical colleges, which ranged from 5% to as high as 50%. Within two decades the MCAT helped improve the pool of medical school candidates, and attrition rates settled to a steady 7%. The MCAT persists today as an examination used for qualification to enter medical school.

Both entrance examinations to begin study and examinations for licensure were shaped and driven by professional associations and university systems. While the Graduate Record Examination (GRE) is used for entrance into arts and sciences programs in the United States, and the MCAT is used for medical school, many licensure exams serve as exit exams, to ensure a certain level of ability and knowledge in professionals in fields such as nursing (NCLEX-RN), engineering (NCEES), and medicine (state boards). The ability to work as a professional in these fields depends on passage of such licensure examinations; failure to pass means exclusion from the field.

Modern Cultural Connections

The status of women in the professions of science and medicine has been a source of contention since the development of guilds, associations, and courses of higher education. Women were routinely excluded from medical and scientific guilds, with the exception of midwifery; nonmedical guilds, such as textile guilds, occasionally permitted women to enroll as members, and women could at times inherit membership from their fathers or husbands, but such exceptions were rare. In general women were excluded in the belief that they would neglect their domestic roles if they became guild members.

In science and medicine, women began to make inroads by the mid-1800s. Elizabeth Blackwell (1821–1910) graduated in 1849 from medical school in Geneva, New York, the first woman ever to do so in the United States. Marie Curie (1867–1934), a Polish immigrant to France, eventually became the first female professor at the Sorbonne and the only two-time Nobel sciences winner. As Donna M. Hughes notes in her article “Women, Science, and the Women's Movement” in Sisterhood is Forever: The Women's Anthology for the New Millennium, “Women were active in science and engineering in the late 1800s and early 1900s: their numbers rose with the suffrage wave of the Women's Movement … Women's participation rose again during World War II, when men were called to military service—but after the men returned, women were demoted or dismissed.”

Women's participation is lowest in the field of engineering, the highest in biological science; women's participation in graduate-level medicine and science was greatest in the 1880s to 1920s, and did not resume similar levels in the United States until the 1990s. Outright gender discrimination in college entrance policies, restrictions on research assistantships and internships, and a post-World War II (1939–1945) resurgence in identifying women with domestic roles contributed to the retraction of women in graduate-level science programs and careers.

Many female professional organizations arose to counteract these limitations; the American Association of University Women encompasses all female university professionals, while the Society of Women Engineers provides professional direction and networking for female engineers.

Professional science and engineering has been affected strongly by military and corporate research interests over the past 50 to 60 years. The defense industry, pharmaceutical companies, and biomedical engineering corporations work in tandem with many major research universities, offering substantial grant dollars and research funding for both applied and pure research. Professional associations have struggled with these outside interests, as the funders often place demands on the research methods, evaluation of outcomes, and funding allocation—all issues that provoke critics to charge that such interference reduces autonomy. As federal research dollars decrease, more university professors and professional scientists turn to outside sources, leaving professional organizations to find balance in regulating their profession in the face of possible conflicts of interest.

See Also Science Philosophy and Practice: Research Funding and the Grant System; Science Philosophy and Practice: Science Communications and Peer Review; Science Philosophy and Practice: Scientific Academies, Institutes, Museums, and Societies.

bibliography

Books

Bynum, William. Science and the Practice of Medicine in the Nineteenth Century. Cambridge: Cambridge University Press, 1994.

Conrad, Lawrence I., et al. The Western Medical Tradition. Cambridge: Cambridge University Press, 2006.

Duffy, John. From Humors to Medical Science: A History of American Medicine. Champlain, IL: University of Illinois Press, 1993.

Grant, Edward. The Foundations of Modern Science in the Middle Ages. New York: Cambridge University Press, 1996.

Kimball, Bruce A. The “True Professional Ideal” in America: A History. Cambridge, MA: Blackwell Publishers, 1992.

Lane, Joan. A Social History of Medicine: Health, Healing, and Disease in England, 1750–1950. New York: Routledge, 2001.

Morgan, Robin. Sisterhood Is Forever: The Women's Anthology for the New Millennium. New York: Washington Square Press, 2003.

Porter, Roy. Disease, Medicine, and Society in England, 1550–1860. Cambridge: Cambridge University Press, 1995.

Starr, Paul. The Social Transformation of American Medicine. New York: Basic Books, 1982.

Periodicals

Stevens, Rosemary A., Ph.D., M.P.H. “Themes in the History of Medical Professionalism.” Mount Sinai Journal of Medicine 69 (2002): 357–362.

Waddington, Ivan. “Professionlisation.” British Medical Journal 301 (1990): 688–690.

Melanie Barton Zoltán

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