This ethnographic project is about migrant doctors’ negotiations of medical work in hospital settings that are similar, yet simultaneously unfamiliar, to those they have previously known, foregrounding the social labour involved in moving medical practices from one clinical context to another.
The research was for my PhD at the Centre for Health and Society, University of Melbourne, Australia and was supervised by Marilys Guillemin (principal supervisor), Johannes Wenzel, Susan Elliott and Hans Baer.
The stories in the thesis take place in hospitals on the metropolitan fringes of a large city in Australia. Working from the assumuption that doctors with overseas (i.e. non-Australian/New Zealand) medical qualifications have developed a different set of practices to ‘locals’ because they have received their education and training in medical places ‘elsewhere’, I argue that overseas doctors negotiate these various differences with modes of adjustment. I examine adjustment as an embodied, sensory and situated process that entails constant threading between the overseas doctors’ past and the environment they find themselves part of, revealing something of both along the way. The overseas doctors’ new environment is one that includes an evolving arrangement of people and paperwork, registration and assessment procedures, and buildings and tools. Whilst adjustment to these human and non-human aspects of a doctor’s ecological terrain is an everyday event in medicine, I suggest that it is made more obvious by international migration, by practitioners who do not take their new environments for granted.
For overseas doctors, subtle variation can mean an exciting, yet more often unsettling world of difference. This research highlights the contextual nature of medical practice, exploring its embeddedness within a multifarious environment. At the same time, the thesis departs from the majority of literature on overseas doctors, and skilled migrants more generally, that regards their skills as too context specific, thus requiring their integration into a nationally distinct system through the acquisition of nationally distinct practices. With this thesis I contribute an empirically and theoretically rich analysis that provides a more nuanced perspective of this political issue in Australia (and other ‘receiving countries’). It is a thesis that will be of interest to migration and organisational researchers, medical educationalists, sociologists and anthropologists of science and medicine, individuals and organisations concerned with the steadily growing number of overseas doctors working in hospitals around the world, and last, but not least, overseas doctors themselves.
I have worked, and continue to work, in collaboration on this research with Marilys Guillemin, Clare Delany and Thomas Fuller in writing some of the publications and undertaking some of the projects below.
From this research:
Harris, Anna and Guillemin, Marilys (2015) Notes on the medical underground: Migrant doctors at the margins. Health Sociology Review. You can access the article here.
Harris, Anna and Fuller, Thomas (2014) The night-side of hospitals, Places (The Design Observer). Access the article here.
Harris, Anna and Delany, Clare (2013) International medical graduates in transition Clinical Teacher 10 (3): 328 – 332. Access the article here.
Harris, Anna (2013) Encountering the familiar unknown: The hidden work of adjusting medical practice between local settings. Journal of Contemporary Ethnography (early online view). Access the article here.
Harris, Anna and Guillemin, Marilys (2012) Developing sensory awareness in qualitative interviewing: A portal into the otherwise unexplored. Qualitative Health Research 22 (5): 689 – 699. Access the article here.
Harris, Anna (2013) Degrees of difference: The politics of classifying international medical graduates. Health Sociology Review, 22(2): 210 – 220. Access the article here.
Harris, Anna (2011) In a moment of mismatch: Overseas doctors’ adjustments in new hospital environments. Sociology of Health and Illness 33 (2): 308 – 320. Access the article here.
Harris, Anna (2011) In a moment of mismatch: Overseas doctors’ adjustments in new hospital environments, In Body Work in Health and Social Care: Critical Themes, New Agendas, edited by Julia Twigg, Carol Wolkowitz, Rachel Lara Cohen and Sarah Nettleton, pp 134 – 146. Wiley-Blackwell: London
Harris, Anna, Delany, Clare and Fuller, Thomas (2012), Transition in practice: A critical reflection group for new doctors: A facilitator’s manual, Centre for Health and Society, The University of Melbourne, Melbourne. ISBN no. 9780734047700. Access the manual here.
Harris, Anna (2010) Learning the System … In the Words of Overseas Doctors, Centre for Health and Society, The University of Melbourne, Melbourne. ISBN no. 0734041764, 9780734041760. Access the booklet here.
Harris, Anna (2011). Doctors from overseas are being wasted, The Age April. Access the article here.
Harris, Anna (2011). Sick system for foreign doctors, Courier Mail 23rd March. Access the article here.
Harris, Anna (2010) Overseas doctors in Australian hospitals: an ethnographic study of how degrees of difference are negotiated in medical practice, Unpublished doctoral dissertation, University of Melbourne. Access the thesis here.
Harris, Anna and Delany, Clare (2012) Form follows function: Industrial design principles and clinical communication curriculum, Communicating Health Symposium, University of Melbourne, Melbourne, Australia, 4 December
Harris, Anna and Delany, Clare (2011) Incorporating critical reflection into the orientation of international medical graduates, AMEE (The Association for Medical Education in Europe), Vienna, Austria, 27 – 31 August
Harris, Anna (2010) Overseas doctors in Australian hospitals: negotiating degrees of difference, 2010 meeting of the Society for Social Studies of Science: STS in Global Contexts, Tokyo, Japan, August 25 – 29
Harris, Anna and Fuller, Thomas (2010) Expand your horizons: a lecture series by international medical graduates, ANZAME (The Association for Health Professional Education) Conference: Overcoming Barriers, Re(E)forming Professional Practice, Townsville, Australia, 13 – 16 July
Delany, Clare, Zion, Deborah, Harris, Anna, Bishop, Elizabeth (2010) Practicing medicine globally: Does ethics education match the ethical issues encountered by International Medical Practitioners in Australia?, 10th World Congress of Bioethics, International Association of Bioethics, Singapore, 28 – 31 July
Harris, Anna (2008) Negotiating meanings in intercultural, inter-professional clinical settings, Intercultural Clinical Communication in Health Professional Education Symposium, Melbourne Australia, 8 February
Harris, Anna (2008) Everyday negotiations of difference in an Australian hospital: the case of international medical graduates, TASA (The Australian Sociological Association) / SAANZ (Sociological Association of Aotearoa / New Zealand) Conference: Re-imagining Sociology, Melbourne, Australia, 2 – 5 December
Harris, Anna (2008) International Medical Graduates in Australian hospitals: an anthropological perspective, 13th Ottawa (Ozzawa) International Conference on Clinical Competence, Melbourne Australia, 5 – 8 March
Harris, Anna (2007) Sunday lunches in the hospital cafeteria: the social networks of International Medical Graduates, TASA / SAANZ Conference 2007: Public Sociologies: Lessons and Trans-Tasman Comparisons, Auckland, New Zealand, 4 – 7 December
Harris, Anna (2007) Artist as medical ethnographer, TASA Health Section Conference, Beechworth, Australia, 22 – 24 June
Harris, Anna (2007) Doctors without borders: a study of the working experiences of International Medical Graduates, Southern Health IMG Mini-Conference, Melbourne, Australia
Harris, Anna (2006) Mobile doctors: A hospital ethnography, TASA Conference 2006: Sociology for a Mobile World, Perth, Australia, 4 – 7 December
Harris, Anna (2006) Foreign Bodies: A Hospital Ethnography, Australian Anthropological Society Annual Conference, Beyond Science and Art: Anthropology and the Unification of Knowledge, Cairns, Australia, 27 – 29 September
Seminars and other presentations:
Harris, Anna, Hayes, Barbara, Warmington, Sally (2010) Doctors studying doctors, Centre for Health and Society, University of Melbourne, Melbourne, Australia
Harris, Anna (2010) Workplace learning: an ecological perspective, Medical Education Unit, University of Melbourne, Melbourne, Australia
Harris, Anna (2009) Expand Your Horizons: a lecture series by international medical graduates, DHS, A World of Expertise: Supporting International Medical Graduates in Victoria, Melbourne, Australia, 5 August (presentation to policy makers)
Delany, Clare, Bishop, Elizabeth, Zion, Deborah, Harris, Anna (2009) Ethics, culture and professional practice: developing a medical ethics education program for international medical graduates, DHS, A World of Expertise: Supporting International Medical Graduates in Victoria, Melbourne, Australia, 5 August (presentation to policy makers)
Photo by Thomas Fuller.