A TH’EGRY OF THE INTERNSHEP IN
PROFESSIONAL TRAINING

Thesis for the—Degree of DH. D.
MICHIGAN STATE UNIVERSITY

Ronald G. Rex
1961

awn-:13 This is to certify that the
thesis entitled
A THEORY OF THE INTERNSHIP IN PROFESSIONAL

TRAINING '

 

presented by

Ronald G- Rex .

has been accepted towards fulfillment
of the requirements’for

Ph. D. degree in? Education}. '

/ '
m 5/! 4' ,-

Major professor

Date August 1961

0-169

 

   
     

  

LIBRARY

Michigan State
University

 

 

 

 

 

ABSTRACT
A THEORY OF THE INTERNSHIP IN PROFESSIONAL TRAINING
by Ronald G. Rex

An internship is a method for preparing one who aspires to
entering professional practice. It is a training method different from
apprenticeship or on-the-job-training.

As a means of training, the internship has been proposed in
all of the established professions. The acceptance and use of the
concept in professional training has, however, been less than universal.

Analysis of the literature concerning internship as it applies
in various professional fields reveals that there is no stable defi-
nition of the purposes and conditions which constitute an internship.
There is no substantial body of experimental evidence which supports
or refutes the contention that an internship is an essential experience
in the preparation of a professional practitioner.

There is no theory concerning the internship as a training
method and consequently there is no conceptual structure around which
research efforts might be built.

This study was designed for the purpose of developing a theory
of internship. The concept was accepted as a sociological reality with
psychological concomitants. The socio-psychological implications of
such an eXperience were therefore used as guides for unique identifying
experiences provided in the internship and for the subsequent learning

which results.

Ronald G. Rex
A "closed system-element" reduction approach was used for the
purpose of isolating the various experience elements to be found in
the internship. The internship was ultimately presented as a closed
system of specialized experiences in which an incumbent might be
offered three dimensions on which to seek for personal identity.
The experience was seen as providing Opportunities which would allow

an intern to deveIOp an identification gf_self ig_a_professional

 

 

setting; an identification g£_role in.a professional setting; and an

 

 

identification 9: community in'alpgofessional setting.

 

Further analysis of these dimensions resulted in calling
attention to the unique elements of which all of these were composed
when viewed as closed systems.

Identification 2: self ig_a_professional setting appeared

 

 

to involve a widening perception of: 1. personal capacity, 2. aspir-
ation level, 3. tendency toward specialization, h. commitment to pro—
fessional service. These become the basis-for establishing a set of
personal values in relation to professional practice.

Identification of role in a professional setting involves

 

 

 

a widening perception of: l. generalized expectations, 2. self-other
perceptions, 3. situation analysis, h. specific expectations. These
fuse and become the basis for a set of status values emerging from
the experience.

Identification of community in a professional setting involves

 

a widening perception of: l. ethical standards, 2. rights and obli-
gations, 3. a sense of authority and autonomy, h. professional

limitations. These provide the basis for a set of professional

values emerging from the experience.

I'll... I. .l I

Ronald G. Rex

The composite identifications resulting from the fusion of
these elements should provide an intern an orientation to personal,
interactional and positional attitudes and values. These in turn should
prompt and support behavior and performance patterns which are at once
in keeping with the public image of the practitioner and with the image
which exists within the profession itself.

The theory provides, it is felt, a conceptual framework on which

empirical research can proceed.

DEDICATION

This manuscript is dedicated to Sue and Sandra whose

patience and assistance made completion possible.

A THEORY OF THE INTERNSHIP IN PROFESSIONAL TRAINING

By
J

1,
Ronald G/ Rex

A THESIS

Submitted to
Michigan State university
In partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
College of Education

1961

ACKNOJLEDGEMENT

To Professors William V. Hicks, Bernard Corman, Ted Ward,
Orden Smucker and Stanley Wronski grateful acknowledgement is give

for assistance and counsel in preparing this dissertation.

ii

n

TABLE OF CONTENTS

Chapter
I. INTRODUCTION . . .

II. THE NATURE OF THE PROFESSIONS IN MODERN
SOCIETY. . . . . . . . . . . . .

III. THE INTERNSHIP AS AN ELEMENT OF PROFESSIONAL
TRAINING . . . . . . . . . . . . . .

IV. IDENTITY OF SELF IN A PROFESSIONAL SETTING .
V. IDENTITY OF ROLE IN A PROFESSIONAL SETTING .

VI. IDENTITY OF COMMUNITY IN A PROFESSIONAL
SETTING. . . . . . . . . . . . .

VII. A CONSOLIDATED THEORY OF INTERNSHIP

BIBLIOGRAPHY .

iii

Page

DJ
(1)

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81+

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‘lqll :lr Ill... .,

CHAPTER I

INTRODUCTION: THE NEED FOR A THEORY OF THE nINTERNSHIP"

 

 

 

This study was prompted by the existence Of a series of
rather contradictory ideas about the internship as a means of training,
and by a desire to reduce these conflicts.

It is commonly held, by many of those concerned with training
in most of the professional fields, that an internship experience can
become a significant method for fusing theoretical and practical education.
Yet within each profession there are camps which support broader intern-
ship experiences at the same time that other camps attempt to restrict
or to eliminate the internship altOgether.

In viewing the proposals for internship presented by its
proponents in the fields of medicine, law, education, theology, archi-
tecture and other similar professional areas, it is relatively easy to
determine that differing sets Of purposes or antithetical aims are used
to justify the internship. In addition, very little substantial evidence
concerning the educational effectiveness Of the experience is available.
The collection of evidence which can be accumulated across several
professional fields consists chiefly Of Opinions drawn from educators
or students who have been closely associated with intern prOgrams Of one
kind or another.

The confusion as to its purpose and the lack Of empirical
evidence as to its usefulness contributes to a certain sterility in
discussion Of the value Of the internship. It is commonly known that a

"Hawthorne effect" tends to influence perceptions and Opinions Of those

2
. . . . . l . .
participating in experimental programs. Much Of the discuss1on of
internship reflects such an effect because outside the field Of medicine,

most internship programs are more or less experimental in nature.

FLEXNER ON THE INTERNSHIP

t

All of the major professions have at one time or another
directed their attention to the internship as a means of training.2
Some of the professions have done more with the concept than have others,
but no groups has utilized it as extensively as the medical educators.

Near the turn of the century, public attention in the United
States was turned to the social service value of medicine and the pro-
fession itself became conscious Of the instability and lack Of standards
existent in the variety of ”schools” which trained doctors. A combin-
ation Of public concern as well as a growing professional conscience
~prompted the Carnegie Foundation to support a comprehensive investigation
Of medical programs, facilities, and standards Operative in the country
in 1910.

Abraham Flexner3 was commissioned to make this study and his

report and recommendations revolutionized medical training. He is

 

1F. J. Roethlishberger and W. J. Dickson, Management and the
Worker 1939, cited in Ross Stagner, Psychology 9: Industrial Conflict,
(New York: John Wiley and Sons, 1956) pp. 131-32.

 

 

 

2This attention is apparent in articles written about the
problems of educating clergyman, lawyers, engineers and pharmacists in:
Seward Hiltner, et al. "The Essentials of Professional Education,"
Journal 9: Higher Education, 25:2A5-62, May, l95h.

 

3Abraham Flexner, Medical Education in the United States and
Canada: A Report to the Carnegie Foundation for the Advancement of
Teaching (New York, 1910).

 

 

3
further credited with having an equal influence upon the professional
quality Of medical practice since that date. His findings and
recommendations served not only as a guide to the improvement of medical
education, but his analysis identified characteristics of modern pro-
fessional training which apply in many related fields.

Flexner identified three stages in the develOpment of medical
education in America. The first of these stages was the preceptorship
which was built upon principles laid down in the apprentice method.

Here an aspiring physician aligned himself with a practicing professional
and by helping the latter attend the sick and injured the apprentice
eventually learned medicine from his preceptor. Ultimately this system
gave way to a ”school" type of medical education in which the didactic
method was employed by practitioner or lecturers who talked about
medicine. This stage eventually gave way to the clinic-laboratory
approach where the medical student returned to contacts with patients

and learned medicine, under guidance, by attempting to diagnose and
prescribe treatment for the illnesses he met in the clinic. Flexner
succinctly stated the case for this last approach in saying:

The apprentice saw disease; the didactic pupil heard about it;
now once more the medical student returns to the patient whom, in
the main, he left when he parted from his preceptor.

Although Flexner was concerned about lack of scientific

preparation, 1:23 the study Of biology, anatomy, chemistry and pharma-
cology, in programs preparing medical students, he was equally concerned

about training which did not provide an Opportunity to learn the practice

of medicine by practicing. He saw in the Old preceptorship-apprenticeship

 

 

thid., p. 20.

u

arrangement certain advantages which were lacking in the didactic
methods being used by many "schools" in 1910.

In Flexner's analysis of medical education the pattern of
training in professional fields other than medicine can be identified.
Most professions began by utilizing the apprentice—preceptor method and
as the need for more trained professionals increased, an institutionalized
approach was used in which one trained practitioner utilized the didactic
method to train several aspiring professionals. This brought about
schools of‘law, schools of medicine, schools of education, and schools
devoted to other professional areas. But the establishment Of schools
took the student away from the reality Of actual field practice, and in
so doing, the value deriving from patient or client contact was lost.

Flexner's analysis also points up the basic difference between
an apprenticeship and an internship. An apprenticeship allows a

student to approach a practicing situation without prior knowledge 23

 

the field. In the process Of performing the tasks Of the apprentice he
acquires the skills and knowledge necessary to becoming a practitioner
Of his trade or craft.

An internship, on the other hand, is that kind of training
experience which follows an organized period of learning. It presupposes
the acquisition of specialized skill and knowledge which is to be used
in a practical setting. The internship is a training method which is
most apprOpriate for the preparation Of a professional person since a
profession presumes that a defined body Of theory undergirds practice.
Apprenticeship is a method of training more appropriate for occupations

which are less than professional in nature.

5

Misinterpretation of the purpose and function of these two
methods of training accounts for some of the objections to internship
expressed by writers concerned with professional training.5 The terms,
"internship" and "apprenticeship", are used almost interchangeably by
some writers who center their attention on the practical aspects of
professional training. Considering the internship as an apprenticeship
creates fear reactions that the theoretical and substantive aspects
of professional preparation are being sacrificed in favor of ”on-the-
job" training. This fear is not well founded because a trainee is
incapable of assuming intern responsibilities without the theoretical
and substantive base upon which professional practice is built.

This common confusion often prevents fair assessment of either
of the two methods in light of their intended purposes, and clouds
discussion of the effectiveness of each in situations where they are
singularly appropriate.

Since this study is designed to analyze the training utility
of the internship, a specific set of conditions and characteristics are

next set forth to define the concept unambiguously.
DEFINITION OF INTERNSHIP

The purpose of the internship appears to be that of providing

6
for the neOphyte ,an Opportunity to experience the fusion of principles

 

SL. Kandel, "An EXperiment or a Revival?" School and Society
76:75, August 2, 1952. This article is critical of the support certain
foundations have given the internship idea in teacher education. 'The
argument uses the term "internship" but seems to object to it on the basis
of conditions which describe "apprenticeship”.

6The term neOphyte literally means one without eXperience but
for purposes of this paper it will mean one without internship eXperience.

 

6

and theories appropriate to a profession as they are applied in the
solution of practical problems. This basic statement of purpose has
been put forth by representatives of many of the major professions for
the past half century. The internship is, additionally, intended to
bring the trainee into contact with practicing professionals in a

field setting, and with the clientele to whom professional services are
extended. It provides an exposure to the range of problems and conditions
normally experienced in professional field practice. In this sense it is
an arranged program, supervised and directed, in which the neOphyte
professional is sponsored by representatives of his training institution
and by members of his profession at large.

IDgically implied by the preceding definition, certain conditions
must exist in such an experience if its purposes are to be met. First
among these conditions is the necessity for the trainee to have demon-
strated adequate preparation in the academic and practical disciplines
apprOpriate to his field. He must have mastered the skills required for
practice and must have a working knowledge of the principles which
guide professionals in practice. Second, the internship eXperience must
be sponsored by an accredited and responsible training institution;
it must be a recognized part of the institutional prOgram even though
institutional facilities are not used exclusively. Third, it must be an
experience of a specified duration of time. One year in most professions
is considered to be a minimum and this may be extended considerably
depending upon the complexity and the nature of the work of the professional

practitioner.

7

Fourth, the intern experience must be one Of association
involving personal contact between the intern and practicing professionals
as well as that segment of the public normally availing themselves of
the particular professional services. It must be an experience in which
professional status is accorded the intern in the associations mentioned.
Relationships with practitioners will not demand the same degree Of
granted status as will be demanded in contacts with the public. But
it is essential that status be forthcoming from both segments if the
trainee is to make significant decisions and to assume professional
responsibility for them.

This then becomes a fifth condition necessary in internship
experiences; the Opportunity for the intern to make decisions and assume
responsibility for them. Guidance and assistance is needed in this
respect if the intern is to gain experience which goes beyond the learning
which takes place within institutional classrooms and laboratories. The
Opportunity and initiative to decide must rest with the intern.

Based on the experience of the medical profession, two other
conditions seem necessary to the definition Of an internship program.

The program should be organized around a set of principles and reco-
mmendations laid down by successful practitioners and presented through
their professional organizations. In medicine these principles have
been codified so that they might serve as guides to institutions
establishing prOgrams. Professional associations in law, education,
architecture have addressed themselves to the problem of training.

The committees and commissions in these professions seem to have exerted

less influence within their professions than has the Council on Medical

8

Education and Hospitals of the American Medical Association.

The professional organization also carries the burden of
responsibility for initiating the last of the conditions essential to a
successful internship program. The energies and influence of the
organization must be marshalled in such a way that the internship
becomes a required part of preparation for professional practice.
Licensing, certification or any other apprOpriate dispensation to
practice would be contingent upon the completion of an intern experience.
If an association of practitioners does not strongly support the
internship in principle then institutions and individuals may circumvent
this phase in training in order to speed a trainee's attainment of full

professional status.

ATTITUDES OF THE PROFESSIONS TOWARD INTERNSHIP

When a profession faces an increased service responsibility
due to increased knowledge, the total fabric of its training program is
affected. The curricular offerings provided in training schools are
assessed, the methods of teaching are reviewed, the extent of academic
requirements is evaluated, and the processes by which aspirants learn
a profession are subjected to modification or change.

The attention of those concerned with training centers not on
one of these aspects of a training program but usually upon all of them.

The internship, therefore, becomes but one small part of the conditions

 

7Council on Medical Education and Hospitals AMA Essentials
g£_an_gpproved Internship (Chicago: American Medical Association, 1958)

offers a good definitive statement concerning the aims and objectives of
medical internship.

 

 

9

reviewed in assessing the effectiveness Of training.

The work setting of a profession dictates, to a limited
degree, the tendency which a particular profession will have for
considering the internship as a favorable method. Hospitals, schools,
and social service agencies are basically different from law offices,
church communities, scientific or engineering laboratories. Training
institutions for particular professions will find that the setting for
an internship may exist intact somewhere adjacent to the institution.
The Opportunity for establishing and coordinating intern experiences
is enhanced in such cases.

within the various professions there seems to be a considerable
awareness of the possibilities of internships, for the problem of
providing practical training as well as technical and theoretical
preparation is a common concern in all fields. But attitudes toward
the internship vary both within and among the professions.

Thus, Blaustein and Porter8 present both sides of the
"practical” versus the "academic" arguments associated with the edu-
cation of lawyers. Their discussion of practical training seems to
lean more heavily on the apprenticeship concept than on the internship
concept, however.

' Harno suggests that differences of Opinion exist among leading
lawyers and legal educators concerning the ideal balance between practical
and academic training but he indicates that increasing support is growing

within the profession for some kind of institutionally sponsored intern

 

8A. P. Blaustein & Charles 0. Porter, The American Lawyer

(Chicago: University of Chicago Press, l95h)

 

10
experience for lawyers.

Bannisterlo suggests that in the field of architecture the
concern for internship is less prevalent than in some other professional
fields. He also reveals that in 1950, twenty-three per cent of the
architects in the United States had been trained through apprentice
systems in architectural offices. This indicates that the prime concern
of the profession, at this time, centers on reducing the large number of
practitioners who have no college or university background.

Education, as a profession, has been concerned with the concept
of internship since the late nineteenth century. Brown University
instituted a program in 1895 which bore many of the characteristics of
internships presently defined as experimental.ll The University of
Cincinnati inaugurated a prOgram in 1919 which has probably trained more
teachers through internship experience than any other program in the
country.12 John Dewey proposed an internship kind of experience for

13

teachers in 1905. A review Of the literature reveals more than one

 

9A1bert J Harno, legal Education in the United States (San
Francisco: Bancroft Whiting Co. ., 1953).

 

 

loTurpin C. Bannister, The Architect at Mid- -Century: Evolution
and Achievement (New York: Reinhold Publishing Co. ., 195H§,*p. 109.

 

 

 

llWalter B. Jacobs, "Practice Teaching for Secondary School
Teachers at Brown University," School and Society 3:533-36 April 8, 1916.

 

l2 3 A - I
Howard B. Jones, 'Internship in Teacher Education' (Unpublished
Ph. D dissertation, Yale University, l9h0), p. 1h.

13John Dewey, "The Relation of Theory to Practice in Education,"
The Relation of Theory_ to Practice in the Education of Teachers Third
Yearbook of the National Society for ‘the Scientific Study of Education,
Charles McMurry (ed. ) (Chicago. University Of Chicago Press, l90h)

PP- 9-30-

 

 

11

hundred fifty articles and studies which deal with the internship as
a method for teacher education.lu

Theological schools and seminaries have utilized the internship
as an integral part of undergraduate training and have found the practical
learnings of interns to be vital to the preparation of ministers.15

Schools of business have been encouraged to instigate programs
of internship for accountants and business administration trainees.l

In recent years, schools preparing state and local government
specialists have utilized the internship as a means of preparing their
trainees to assume full professional responsibility upon graduation.17

The Council on Medical Education and Hospitals is reported to

be responsible for monitoring 11,0hO intern programs in 848 hospitals

 

l“Shirley Radcliffe, Teacher Education Fifth Year Programs
(Washington, D.C.: Uhited States Department of Health, Education and
welfare, 1959). Forty-nine articles in this publication of experi—
mental programs indicate the internship to be a part of the fifth year
experience of trainees.

15Seward Hiltner, "The Essentials of Professional Education,"
Journal of Higher Education, 25 (may, 195A), pp. 2u5—52. Lists some of
the problems faced by educators in divinity schools.

Oliver C. Carmichael, Universities: Commonwealth and American,
(New York: Harper Brothers Publishers, 1959), p. 183. Traces briefly
some of the historical developments in theological education since
colonial times.

16 . . .

Frank C. Pierson and others, The Education of the American

Businessman. (New York: McGraw—Hill Book Company, 19597.

 

 

 

 

 

 

 

17Several of the apprOpriate professional journals list articles
defining this tendency. See: E. J. Rizas, ”City Hall Internships for
Management,” (Public Management, 38, January 1956, pp. 8-10); J. R.
Watson, "Internships for Public Service Training,” (State Government,
30, March 1957, pp. 67-69; K. Detzer, "Interns at City Hall," (National
Municipal Review, #7, November 1958, pp. h9h-96).

 

 

 

12

throughout the United States.18 No other profession supports so many
programs and no other professional commission is responsible for prOgrams
of this sc0pe. For the most part, internship programs in professions
other than medicine have been transitory and experimental in nature.19

Several reasons may account for this lack of application of the
internship idea despite the extensive discussion Of its usefulness in
professional journals.‘ Chief among these reasons is an apparent dearth
of information about its effectiveness as a means of training. Liter-
ature which deals with education for the various professions is replete
with reference to the internship as a means of putting "final polish"
on a professional aspirant, but evidence supporting the efficacy of the
internship is more difficult to gather.

Secondly, it appears that internship is advocated and utilized
most frequently within those professions in which the practitioner
is expected to perform services involving direct contact and interaction
with people. Medicine, theology, education, law, social and government
service, seem to be the fields in which the internship is most frequently
employed. Each of these fields is an occupation in which peogle are
initially involved in the services rendered by the calling. ese

callings contrast significantly with such professions as engineering,

 

8
l Carmichael, op, cit., p. 201.

19Education serves as a good example Of this. Paul WOOdring's
New Directions lg Teacher Education, (New York: Fund for the Advancement
of Education, 1957) lists 25 experimental programs supported by the Fund
which use the internship in one form or another. Four doctoral disser-
tations (cited later in this chapter) indicate an average of 37 teacher
education internship programs in Operation during the period at which
each of the studies were conducted, 19h0 to 1956.

 

 

13
chemistry, or architecture where social interaction is not the central
focus of the services performed. Hence the internship is viewed in the

several professions with varying egrees of interest and enthusiasm.
STUDIES OF THE EFFECTIVENESS OF THE INTERNSHIP

Since medicine is the only field which offers internships

universally, it is are that evidence of effectiveness has been most
20

frequently gathered. There are limited opportunities for gathering
data comparing the use of the internship in medicine to its use in
other occupations. Thus it is difficult to identify universal aspects
of internship as a method because the research emphasis has been placed
upon proficiency in performing a single profession's functions. In
other words, the internship has been evaluated on the basis of the
quality of lawyer, or doctor, or teacher which emerges from such an
experience. This is as it should be for a particular profession, but
it is insufficient for establishing the utility of the internship as

a general training CONCePt°

 

An analysis of the internship as a training concept appears 3'
necessary if it is to be eventually validated as an educational tool,
and if it is to be accepted more widely and put into practice in programs
of professional training.

The lack of systematic studies of the general concept is an

apparent reflection of the preoccupations of educators in the various

 

20 ,
Victor Johnson, M-D., A History of the American Medical
Association l8h7-l9h7, (Philadelphia: d. B. Saunders Company, 19K7).

 

 

1h
professional fields. Professional training for doctors, lawyers,
engineers and clergymen is provided in institutions staffed by practitioners
and specialists in the profession being taught. As practitioners and
specialists they are often teachers and educators only in a secondary
sense. Since education is so often of secondary interest to them,
they do not evidence intense concern for methods of teaching and
training. Their researches are confined to investigations and eXperi-
ments in the fields of their specialties and not in pedagOgical
practice. As a result of this set Of conditions, little research has
been conducted which would either validate or invalidate the internship
as a method of training professionals.

Investigation of the internship as a training concept seems
to have fallen to those educators who have been concerned with pedagogical
practice as a specialty. As in other professions, there have been many
suggestions for internships in education; there have been many opinions
either supporting or decrying this method Of training.

Investigators in the field of education have attempted to
accumulate information which would attest to the values of internship
programs. Since 19A0, five studies have centered on the internship in
teacher education. In each case the study has dealt with the organization
and the function of the internship and have collected Opinion on
internships developed in public schools and teacher training institutions
across the country.

Jones (1911.0)21 found that the aims of internship programs as V

interpreted by administrative Officials and interns of such programs

 

r3
1 -~ - n

c Howard R. Jones, "Internship in Teacher Education, (Un-

published Ph. D. dissertation, Yale university, l9h0).

15
were:
1. To integrate theory and practice.
2. To offer initial experiences in a professional environment.
3. To provide adequate and competent beginning supervision.
h. To provide a setting for '1earning by doing.‘

5. To provide gradual induction into the full responsibil-
ities of teaching.

Cress (19142)22 reported data gathered in 1936—1937 which
coincided with that of Jones. He added a caution concerning intern
prOgrams for teachers in which he cited the tendency to overlook the
learning aspect of internship and to use it as a method for acquiring
teachers without paying full salaries for their services.23

Stiles (19h6)2h study was centered on pre-service training of
secondary teachers. Some of his findings strengthened the contention
that internship is viewed by educators as a necessary and a coming
phase of teacher education.

BishOp (19%)25 reported on the purposes of the internship
similar to JOnes. The opinions of representatives of institutions

conducting intern programs, of a jury of educational specialists or

 

22Carl C Cress, "Examining Internships Sponsored by Public
Schools,” (Unpublished Ph. D. dissertation, Stanford University, l9h3).

231bid.

211lLindley J. Stiles, "Pre—Service Education of High School
Teachers in Universities," School Review 5h:162—65, March, 19h6.

 

 

25Clifford L. Bishop, "The Participation of Colleges and
Universities in PrOgrams of Internship Training,” (Unpublished
Dissertation, university of Colorado, lguo).

16

authorities, and of a group of public school administrators and
COOperating teachers were sampled. Positive support was given the
internship program with which the respondents had been affiliated.

Stevens (1956)26 analyzed the prevailing patterns and practices
of intern programs in Operation and concluded much the same as had
previous studies regarding the results of intern prOgrams. He enumerated
a series of factors which might account for the lack of general
acceptance of the internship as a universal teacher-training method.
Among these were: resistance to change within the profession; in-
ability to find adequate supervision; cost of maintaining programs; and
existing teacher shortages.27

Diekhoff (1959)28 prepared a report of college faculty intern-
ship programs sponsored by the Fund for the Advancement of Education.
A variety of college and university programs were outlined in this report.
Faculty and intern reactions were sampled concerning these programs as
they Operated in twenty different institutions. The response was
generally favorable and it was reported that many institutions were
retaining a form of the internship for new teachers after fund support
had been discontinued.

As it was previously pointed out, all of these studies reported

nothing more than Opinion, and expert as this opinion may be, it does

 

Elmer 8. Stevens, "A Status Study of Internship Programs in
Teacher Education," (Ph. D. Dissertation, University of Pennsylvania,
1956).

2
7Ibid.

 

John S. Diekhoff, TOmorrow's Professors: 5 Report g£_the
College Faculty Internshiqurogram. w(New York: Fund for the Advance-
ment of Education, n. d.)

 

 

17
not constitute evidence for the actual outcomes of internship experience.
It is not pOssible to gather detailed evidence concerning the educational
function of the internship, or to account for the changes which take
place in an individual undergoing such an experience. This information
is not discernible in the many studies and articles which have been
‘ published. This, in itself, becomes one of the major weaknesses of

research on the internship to date.
THE LOGICAL STRUCTURE OF THIS STUDY

It is a major contention of this study that the lack of
substantial research information concerning the internship stems
from the fact that little has been done in constructing theories which
might account for its educational function. Without such theories,
little can be done in the way of systematic investigation of the
actual effect of an internship eXperience upon an intern. Little can
be determined concerning the relationship of learnings in the intern-
ship to learnings obtained in other elements of a system of educational
experiences. Little can be done to modify or restructure intern
prOgrams in order that failures or inadequacies may be eliminated and
positive measures, supported by research findings, may be substituted
in operating programs.

A theory of internship must be based upon the purposes for
which the concept was originally develOped and it must take into
account those factors which seem uniquely appropriate in such an
experience. If the internship is truly a unique kind of experience,

then it should lend itself to this kind of analysis and theory building.

18

Since the "internship" as a general method of training is a
concept, it is not real in the sense that a specific medical internship
in a specific hospital is real. In consequence it appears that the
"internship" would defy a systematic analysis.

In a sociolOgical sense, however, the "internship” is real.

It is as real as the concept of "family", or "culture", or "institution",
or any of the other commonly accepted sociological terms, and as such
it is subject to analysis.29

One of the methods for this kind of analysis is that of
closed systems and elements.30 This is a process of isolating a concept
which seems to possess an entity and analyzing the elements of which
this concept appears to be composed. This is a process sometimes
called concept reduction.

A theory of internship can be constructed by using the closed
system-element approach. By viewing the internship as an element of a
closed system of "professional training” it is isolated so that in the
next step of concept reduction it is possible to identify it as a closed
system itself and to reCOgnize those elements of which it is composed.

In the theory under deveIOpment, the elements which will be

identified as composing the closed system of internship are intended as

 

29Gardner Murphy deals effectively with this approach to concept
analysis in Chapter 16, "Social Motivation," in Garner Lindzey, ed.,
Handbook 2: Social Psychology II, (Cambridge, Mass.: Addison—Wesley
Publishing 00., Inc., igsfij, pp. 601-633.

 

3OFlorian Znaniecki, The Method g£_SociOIOgy, (New York:
Farrar and Rinehart, Inc., l93fl), p. lh, presents the case for use of
this method in sociological analysis.

 

19

n31 They are arbitrarily selected as having an

a "set of conventions.
affinity to the nature and the purposes of the internship. As theory

they are ngt_subject to argument as to their "rightness" or "wrongness"
except where logic proves them to be inconsistent or incompatible.

They age subject to later empirical inquiry and experimental investigation
and must be tested on this basis if the theory is to be proven sound or
unsound.

As an element, the internship represents a part of a closed
system of educational eXperiences which is designed to lead an uninitiated
trainee through an organized sequence of training courses. In this
sequence, knowledge and skill are acquired and values and attitudes are
formed. The term, "organized sequence” of educational eXperience, is
used to differentiate those experiences provided in formal schooling
situations from the casual and informal learning experiences which are
a part of every person's background. Assuming that all learning is
intellectualized experience, it is necessary to set that kind of learning
which results from organized and sequentially determined eXperience
apart from the larger mass of eXperience which is a normal part of human
existence.

Viewing elementary school education, where the emphasis is
placed upon mastering the fundamentals of communication and social
adjustment, it is possible to reOOgnize one element of a closed system

of "educational experience”. The elementary school can be separately

 

1A concise and well ordered description of the purpose, the
function and the limitation of theory in the humane sciences may be
found in: Calvin Hall and Gardner Lindzey, Theories of Personality
(New York: John Wiley and Sons, Inc., 1957), p. 10.

 

20

identified as an element because it contains within it some discrete
characteristics which mark it as different from other components of an
"educational experience". Elementary education is normally offered
children who fall within certain age-group categories. It is so
structured that the individual goes to a certain place or location,
and assembled with others he is Offered a sequentially arranged set of
learning experiences. He is moved from one level of the total sequence
to another as it becomes apparent that his learning and his adjustment
to the school experience have prepared him for a more advanced series
of learning opportunities. Junior high school and senior high school
become distinct elements in this closed system of eXperiences in that
the organization, the underlying purposes and the kinds of experiences
which are provided are different from the elementary school and from
each other. Undergraduate preparation in a college or university is
in like manner another element of the total closed system. Graduate
work, if it is necessary for professional preparation, is still another
element.

The internship itself is an element of this closed system
and its classification as such can be defended on several different
counts. First, the intern is basically different from persons under-
going other elemental phases of an "educational experience". He has
demonstrated the qualities necessary for mastering the intellectual
disciplines leading up to professional practice. He is not a raw and
untried learner. He is on the threshold of professional practice;
in this respect his position is unique as he relates with his educators.
Anyone with whom he works will begin at a point at which most educators

part from their pupils.

2l

The intern experience possesses characteristics which mark
it as different from other experiences. The intern is not expected to
absorb knowledge and information and then demonstrate his mastery of
this information in the artificial testing situations common to the
classroom. He is now at the point where he must make real decisions
based upon whatever mastery of his academic background he can call forth.
More significant is the fact that in the internship position, the final
assessment of his effectiveness will not rest exclusively with teachers
or institutional representatives but also with the lay public which he
is meeting for the first time as a professional person.

The Opportunity for guided self-analysis is another significant p
unique characteristic of the internship. The extended experience
provides a setting in which the incumbent can make a continual evalu-
ation of his preparation, his work and the changes which take place
within him as he becomes a professional. Without such an eXperience,
the beginning professional thrown into field practice will find it
necessary to make such assessments without mature counsel and assistance.
The intern can begin this process with assistance at a most vital

juncture in his career.
THE INTERNSHIP IN A SOCIO-PSYCHOLDGICAI.SETTING

Every element in an "educational experience" carries with it
certain psychological and sociological concomitants.' An analysis
of these factors must be made in develOping a theory of internship.
Thus, a system of logical concept reduction has been used in

order to place the internship in a proper socio—psychological perspective.

22
The method of this reduction has been that of moving from a sociological
description of internship as a phase of "professional training” to
consideration of the psychological impact it might have upon an

32

individual. This logical approach is Opposite to the more common
pattern followed in educational theory building.

Educators are prone to utilize primary psychological orientations
in studying and devising training methods. They often use the individual
human organism as a base reference for developing theories of teaching I
and learning. Program planners analyze the physical and psychological
needs of individuals and they build their theories and programs around
the need structure of the individual organism. .They extend the
effect of these structures into the society of which the individual is
a part and they attach causal significance in terms of the effects
the structures have upon society.

This study has utilized a different approach for two reasons.
One, the internship is not a novel idea which is being proposed by a
theorist bent on providing a kind of learning not heretofore available.

It is a concept which has evolved from long social experience. It

appears to be an outgrowth of the apprenticeship and the formal "school”
systems of training. Two, the investigator believes that society

exerts certain forces upon its members in such a way that many educational
methods are really means for meeting the needs of a society rather than

the needs of the individuals being educated.

 

32Gardner Nurphy, "Social Motivation," in Lindzey, Handbook
g£_Social PsycholOgy, qp. cit., p. 630. The rationale for this method
of analysis is well develOped in this article.

 

23
This does not detract from the significance of theories of
education and learning which center on the individual. It merely pro-
poses that an approach which is initially sociOIOgical rather than
psychOIOgically based may provide some insights and some theoretical
structures which will be useful in the study of educational methods in

general, and of the internship in particular.
THE ORDER OF THIS STUDY

Construction of a theory of the internship is dependent upon
fundamental considerations which account for its existence as a concept
of training in the professions. It is, therefore, necessary to identify
some of the characteristics which mark the professions as different from
other occupational endeavors..

The accepted professions possess identifiable features which
make them similar, one to another, and these same features set them
apart from non-professional enterprises. The internship is but one part
of a series of training experiences offered professional aspirants. The
internship‘s uniqueness can be appreciated only if comparison and
contrast is made with other training eXperiences.

Chapter II, The Nature of the Professions in Mbdern Society,
will account for the growth of discrete occupational groups in a par-
ticular culture. The nature of professions and the nature of professional
activity will be identified and placed in a social perspective. The
responsibilities of the professional man will be discussed and the
implications that these responsibilities have for professional edu-

cation will be delineated.

2A

In schematically portraying the concept reduction process of
this study, attention is centered first upon the range and kinds of
social eXperiences to which people are normally exposed. They are
eXperiences which are provided in the commonly accepted institutions in
a complex society. Each of these eXperiences can be considered as a
closed system involving concommitant elements peculiar to the experience.

Following the center line and progressing through the five
concept reduction stages, stage II portrays educational experience as a
closed system and identifies the five institutional kinds of training
as elements in this closed system. Professional training is one such
element.

Stage III presents professional training as a closed system
and identifies the elements substantive disciplines (subject and courses)
and professional methods (clinics, laboratories, clerkships) as two
components of this training. The internship is conceived as a third
element for individuals training in professions where such an experience
is available.

In stage IV, the internship is presented as a closed system
and the elements, identity of self, identity of role, and identity of
c; mmunity are viewed as elements of the intership eXperience.

 

 

Stage V represents the last reduction and the areas of self,
role and community are each treated as closed systems and an analysis
is made Of their element components.

Having reduced from the context of total social eXperience to
the experiences available in a particular learning setting, it is held that
the theoretical implications of each may be derived more meaningfully
from the various elements of social composition, than from the elements
which might be prOposed from a base of need psycholOgy.

The internship is presented as having elements which are discrete
dimensions of social perception. It is viewed as a part of a closed
system of social-educational experiences in which an incumbent is exposed
to certain perceptual potentials.

The areas of self, role, and community are introduced and discussed
in detail as closed systems of experience and perception. The learning
residual in each of these areas is identified in the value composites listed
at the bottom Of the diagram.

 

25

 

SOCIAL EXPERIENCE

 

 

 

Family experiences Religious experiences

Political experie ces Econ mic experiences I

 

_ 1!(
Educational e periences

 

 

EDUCATIONAL EXPERIENCES

 

 

 

Elementary trainin Occ pational training
Secondary training College training II

Professional training

 

 

PROFESSIONAL TRAINING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Substantive discipli es Pro essional methods
III
Inte ship
INTERNSHIP
Self pe ceptions ommunity perceptions
Role perceptions IV
ROLE COMMUNITY
Capacity Generalized expectations Ethics
Aspiration Self-other perceptions Rights-obligations
Specialization Situation analysis Authority-autonomy V
Commitment Specific eXpectations Limitations

 

 

 

PERSONAL STATUS PROFESSIONAL
VALUES VALUES VALUES

 

26

Chapter III, The Internship as an Element in a Closed
System of Professional Training, will view the internship as it relates
to the total range of professional preparation. It will be presented
within a context of professional training and the features and qualities
of the concept which set it apart from other exgeriences will be
identified.

Three major experience elements are classified as composing
the internship as it has been previously defined. They are manifested
as perceptions or awarenesses which go to make up an individual's value
system. These perceptual elements are classified as: an identity of

self in_a professional setting; an identity o£_role in_a_professional

 

 

setting; and, an identity of community in a_professional setting.

 

Chapter IV will deal with identity g£_§el£_as a closed system.
It will examine the kinds of internal awarenesses and perceptions which
an individual may develop as he experiences an internship.

Chapter V will analyze the identity of ISIS as a closed
system. Here, elements will emerge from, and center on, the social-
interaction aspects of the internship. Attention will be focused
primarily on the contact situations which are the heart of the intern-
ship.

Chapter VI will investigate those elements which seem to

be most closely related to identity of community in a professional

 

setting. Community will be interpreted as meaning more than spatial
locale in this particular reference. It implies a broader acceptance
of the term community which projects the idea of "place" or "position"

as regards the professional and his professional practice.

27
Chapter VII will serve as a consolidating and as a summarizing

effort in that, self, role and community perceptions of the internship

 

will be viewed tOgether. The elements which go to make up each of the
three experiences will be viewed comparatively and their interrelation-
ship will be discussed.

This introductory chapter has presented a definition of the
internship and has pointed out its present status as a method in the
training of professionals. It has been suggested that the lack of
support for the method might be accounted for by the paucity of the
research available on the effect of internship eXperiences in the total
preparation of a professional person. lack of a theory concerning
changes which take place when an intern undergoes this phase of training
was suggested as a reason for this paucity. Such a theory must be
develOped in order to serve as a conceptual structure for research.

The outline for the building of such a theory has been

presented and the development of the theory follows.

CHAPTER II

THE NATURE OE THE PROFESSIONS IN MODERN SOCIETY

 

 

 

In develOping a theory concerning a phase of the training
offered professional aspirants, it is first necessary to view the
professions, EE£.§S° Professions possess characteristics which set them
apart from other occupations and which identify them as discrete units
of social organization.1 It is necessary to see these occupational
groups in preper perspective as they relate to the society as a whole.

Professions may, in fact, be considered elements of the closed
system of action and organization which goes to make up a society.

In order to analyze the professions it is necessary to view their
development, their function, and their Operational forms.

Professions are products of two sociological phenomena common
in human organization. They result from the tendency which societies
have toward dividing and diversifying the responsibilities for labor,
and they exist because a society tends to acquire, to classify and to
pass on knowledge.2

Professions are occupational groups which perform essential \
services for a society. They are services which are beyond the
performance level of "average men" and as such, they require specific
skills, specialized knowledge, and a particular set of attitudes and

perceptions.

 

1A' M. Carr—Saunders and P. A. Wilson, The Professions
(Oxford: The Clarendon Press, 1933), pp. 28h-287.

2
Emile Durkheim, The Division 2?. Libor it; Society, (New
York: The MacMillan Company, 1933;, pp. lh-lg.

28

 

 

THE DEVELOPMENT OF PROFESSIONS

Within Western society, the nature of professions has under-
gone constant change since EurOpe cast off the feudal systems of the
Middle Ages. Change has been characteristic of the crafts which now
compose "the professions", of the knowledge which has been accumulated
by each of the professions, of the services the professions are capable
of providing, and of the methods used in selecting, retaining, and
training entrants into the professions.3

According to historical accounts, law, medicine and theolOgy

I

were the first accepted "professions' in EurOpe. According to present
standards, none of these would have qualified as more than semi-skilled
crafts initially. But in 12th century EurOpe, these groups represented
the most advanced forms of training and involved the greatest collection
of warranted knowledge available. ractitioners of law, edicine and

theology were capable of performing services which society reCOgnized

as not available elsewhere and a particular status was accorded the

1;

groups as ”professions".

 

3A thorough account of the growth of building trades and
particularly the field of architecture supports this point in: Bannister,
op. cit., pp. 82-92. Patterns indicated here apply equally as well as
Ed the—developmental characteristics of the other professions.

hCarr-Saunders and Wilson op. cit. pp. 2c9-9h. Identify law
and medicine as areas which became EscuIZ? at a very early period and
consequently reflect more accurately the characteristics of professions
as accepted today. The authors consider the church related occupations
as not entirely professional because the motivating force is spiritual
rather than social.

0

L0

As western Europe society matured, it became more complex.
Greater division of labor, accumulating bodies of knowl ud ge, and
increased areas in which specialized services were nee ed, ultimately
generated new professions. Among these new groups can be found such
well established professions as engineering ,education, architecture,
social work, accounting and journalism. Even today certain occup ation
groups are vying for recognition as professions.

As knowledge in a particular field increases, the use of this
knowledge gives promise of new and essential services to society
through a particular occupational group. That group, rec0gnizing this,
becomes concerned with establishing itself as a profession. It becomes
concerned with setting standards which will limit and control its
members.

The qualified members of a profession are thus moved to form
associations and mutually to guarantee their own competence. . . .
Another motive is present from the beginning. . . .‘the maintenance
of a high standard of professional character and honourable
practice.‘ The responsible members of the profession in fact
desire to see a preper standard of professional conduct set up and
maintained. . .

The emerging profession becomes concerned with establishing

itself as a profession within the society which supports it.

 

The public has to be convinced that the practitioners of
the new craft possess a technique founded upon an elaborate training
and that equivalent services cannot be readered by any untrained
person who may offer to perform them. .

 

5Carr- So unders, _p_. cit. quoted in, B O. Smi.;h et al.
Readings_ in the Social Aspects of Education, (Danville, Ill.: Inter-

state Printers and Publishers, l95l l5, pp. 5A9.
6 .
Ibid.

 

3l

Once the occupational group has become established as a
professional group, it begins to put its house in order and it develOps a
series of characteristics which Flexner has defined as the "ear-marks
of a profession."

Professions involve essentially intellectual operations
with large individual responsibility; they derive their raw material
from science and learning; this material they work up to a practical
and definite end; they possess an educationally communicable
technique; they tend to self—organization; they become increasingly
altruistic in motivation.

Some of the characteristics mentioned by Flexner may occur
within an occupational group before it achieves full status as a pro-
fession. After achieving this status, however, much of the group's
collective attention will be centered upon these professional character—

stics as they relate to social function.

One of the most common referents used in setting a profession
apart from a trade or a craft is the method and the nature of training
used in professional preparation. Carr-Saunders identifies this:

A profession may be defined as an occupation based upon

specialized intellectual study and training, the purpose of which
is to, supply skilled service or advice to others.

Intellectual study and training becomes the center of pro-
fessional preparations as contrasted with training for non-professional
occupations. These conditions tend to channel certain segments within
a society toward the professions while others are channeled into non-

9

professional activities.

 

7Abraham Flexner, "What Are the Earmarks of a Profession?", in
Smith SEQ-2 9E“ cit., 1311.556.

8A. M. Carr-Saunders, Professions, Their Organization and Place~
in Society, (Oxford: Clarendon Press, 1928), p. 5.

9The psychological influences on occupational choice are a
common theme in the guidance and counseling field. c. f. Donald Super,

 

EDUCATION FOR THE PROFESSIONS

Certain individual qualities and characteristics are demanded
of the professional man; professional training is, therefore, designed
so that these qualities will be developed or instilled in those who
qualify for training. Over a period of time, a society tends to develOp
a set of expectations for its professionals and these become crystallized
when individual practitioners form into professional associations and
standardize the training and prescribe the boundaries of professional
performance.

Modern professions have performance standards which are, for
the most part, universal. That is, these prescriptions serve equally
well in identifying the role and the expectations of the doctor, the
lawyer, the teacher, or any other accepted professional practitioner.
Hiltner has stated as the generalized "characteristics of the professional
man”:

.the professional man Operates from basic principles . .
This is what a 'learned profession' means

. the professional man Operates through technical
means, but in mastery of them, not in subordination to them—-
using them to free rather than to fetter thinking and action.

. he Operates in some direct way for human welfare .
For the professional man the human welfare considerations are
an explicit part of the principles upon which he relies.

. . the professional man Operates responsibly; that is,
he has a discriminating view Of what his own principles may be
applicable to, and of where the knowledge and skills of others
are more relevant

 

The Psychology g£_Careers, (New York: Harper & Brothers, 1957) and

Anne Roe, The Psychology 2: Occupations, (New York: Chapman & Hall, 1956).
For the sociologically deterministic view, see: Emile Durkheim, Education
and Sociology, (Glencoe, Ill.: The Free Press, 1956).

 

 

 

 

33
. the professiOnal man Operates in some way as a
representative of a group which, collectively, is a 'profession.’

Part of his ethics has to do with the way in which what he does

and how he does it affects the whole group of which he is a

representative.

To develop these five characteristics Of the professional man,
it is apparent that a particular kind of learning situation must be
arranged if the initiated trainee is to become the qualified professional
practitioner.

The aspiring professional must be given the Opportunity to ‘
learn the disciplines which apply to his field. He must be exposed

to the best teaching techniques apprOpriate to each discipline and must

take from this eXperience specific knowledge of the discipline as well

 

as a command of the basic principles which guide the use Of this i
knowledge.

He.must, further, be trained in the practical or technical }
aspects of his field so that proven practices and techniques will be a
well established part of his personal reserve in the solution Of
professional problems. He must be familiar with, and skilled in the
use of, any technical processes, tools or working materials used in the p 2
modern practiCe of his craft.

The future practitioner must be cognizant of the history and
philOSOphy of his profession and must have attained a prOper perspective
Of the "human welfare” aspects of his calling. He must view his work
beyond the confines of the specific acts he will be expected to perform
and see it in relation to other practitioners in his own profession, to

other professions, and to the total pattern Of social organization.

 

lOHiltner, 92, cit., p. 250.

3h

He must be conditioned to act responsibly and to assert both
his right and authority to make decisions in his area of competence.
He must be aware of the seriousness of his professional charge, but he
must be confident, not timid, in making the decisions and performing the
tasks which society has allotted to him. He’ must realize that his
specialty exists, as such, only because it depends upon particular
talents and training. Having these, he is bound to serve by utilizing
his talents and training in the most effective manner at his command.

The fledgling professional must become aware Of his singular
role as a practitioner, but, more than this, he must learn and accept
the fact that he is a part of a collective which has brought an essential
service to society and which is now charged with the maintenance and
improvement of that service. He must embrace the traditions of his
professional group, abide by its ethics, and subscribe to its standards.
He must be alertly concerned in his own practice, and in the practice
of others, that the purposes Of the profession are being met and that
the frontiers of professional knowledge are being extended so that
services Of those practicing become increasingly more effective. “x

This places serious reaponsibilities upon those preparing to
enter professional practice. It places an equally heavy burden on
those charged with training entrants into the field. The magnitude Of
this responsibility is reflected in the extensive training time needed
in the professions and the heavy learning demands placed upon trainees.

The education of its inductees plays a large part in the
deliberations of any professional group. Selection and retention Of

trainees, measures of competence, standards Of performance, and methods

3h-a,
of training command the attention and the energies of the devoted members

of a professional group.
SOCIAL.ACCEPTANCE OF A PROFESSION

Today, many quasi-professional groups are establishing the \'l
attitudes and the means for becoming the professions of tomorrow.ll
It is not uncommon to find cOlleges and universities offering courses

and degrees in such Occupational specialty areas as: industrial
management, and supervision, labor relations, and in such technological
services as electronics, transportation, marketing and packaging.

The Occupational areas dealing with public protection, the military
services, police and fire protection agencies show signs of forming
"professional associations" and directing their attention to the pro-
fessional aspects of their calling. The occupations contained in the
broad area of mass-media communication, printers, printing lay-out per-
sonnel, radio and television technicians and many other related Occu-
pational specialties are awakening to the essential nature of their
services and are responding to the growing knowledge which is essential
to adequate performance in their fields.

As this knowledge accumulates, and becomes increasingly necessary
as a preliminary condition of entrance into the field, the Occupational
group will take on more of the characteristics of a profession.

But society, as a whole, must be willing to grant status to a

profession. The special Occupational group must be able to show that

 

l
Myron Lieberman, Education as a Profession, (Englewood Cliffs,
New Jersey: Prentice-Hall, Inc., 19565, p. 13.

 

35
the services it performs cannot be substituted by any other means and
that untrained and unprepared personnel cannot adequately perform the
service. DTTe-professional and professional training consequently be-
comes a concern Of those practicing in the field. Training responsi-
bilities will usually be assumed by some institution where departments
can provide the necessary academic disciplines and instruction. But
there still remains the basic problems Of providing a setting for
realistic practice where the trainee can utilize his skills and knowledge
under guided supervision.

The internship is such a setting. It has been introduced as
one phase in a sequence of training experiences. It is an unique kind
Of training experience in which particular types of learning and special
areas of awareness and understanding may be provided a trainee. It is
an identifiable pedagogical entity, possessing characteristics and
qualities of its own and revealing features which are worthy of study
and analysis.

The internship offers an incumbent a series of adaptive and
adjustive experiences and provides a number Of identification figures
which an individual may use as he assesses his growth toward pro-
fessional stature.

The chapter following will analyze the internship as an element

in a closed system of professional experiences. :\\h

Aub- ~r

M—p‘ #W¢H~w~‘\t ..

CHAPTER III

THE INTERNSHIP pg 511 mama: qr; PROFESSIONAL TRAINING

 

 

Professional training has been identified as a significant
element in a closed system of educational experiences apprOpriate
for a profession. Professional training will now be viewed as a closed
system Of arranged experiences and those elements Of training which
bear signs Of being identifiably different from other elements of profes-
sional training will be isolated.

The professional man in modern society is distinguishable
because he performs services of a nature unlike those performed by
members of other occupational groups, The professional has been
prepared for these tasks by an organized and sequential arrangement of
classes, courses, readings, lectures and recitations. He has been
tested and examined at varying stages of his preparation and his
learning has been assessed as a measure of his ability to advance
in his training.

In terms of preparation for professional practice, it appears
that undergraduate college work should be the first element Of training
experience identified and analyzed. Training and experience which
precedes work at the college level does not seem to bear a direct
relationship to professional training when it is recognized that of
the millions who complete elementary and secondary education each year,
only small groups enter further training for professional prepar-
ation. Even smaller numbers of these entrants complete all Of the re-

’quirements and eventually enter professional practice.

36

37

All professions agree that the undergraduate school is an EX”
important part of the education of the professional man. But among
the various professions it is not commonly agreed as to whether under-
graduate experiences should be primarily professional Or pre-professional 9”
in nature.1 I;

Medicine holds that a general education in the arts and
sciences should be acquired at the undergraduate level and most medical
schools require an earned bachelor‘s degree as a condition of admission.

Many law schools, on the other hand, recommend a bachelor's
degree, but require only two years' college work prior to admission
to professional school.

Theological schools vary and there appears to be no general
pattern of pre-professional requirements for that profession. In
many cases professional course work in theology may be taken as a part
of an undergraduate program. I

Education commonly grants a professional degree and qualifies
one for a teaching certificate upon the completion of a bachelor's
degree. As with architecture and engineering, the professional
courses are included as part of the undergraduate program. Schools of

social work and government service also fall into this category as do

schools of business and social science.

 

1An example of the contrasting viewpoints centering on this
issue may be found in: Marle Borrowman, The Liberal and Technical lg.
TEacher Education, (New York: Bureau of Publications, Teachers
College, Columbia Uhiversity, 1956). Although this survey deals with
professional education, it reflects currents of thought which apply in
other professions.

 

2Carmichae1, 92. cit., p. 201.

38

Despite these differences among professions, it is apparent
that every profession has shown interest in broadening the under-
graduate experiences Of trainees and Offering more than a specialized
sequence Of courses which should apply most directly to the future work
of the professional. The trend in most professions is toward the
requirement of a broadly conceived education Offered in undergraduate éX/I;
school and then provision for the intensive and specialized experiences
necessary for professional preparation at the graduate level.3

When a trainee enters the professional sequence apprOpriate
to his field, he begins a new phase. The divergence of purpose and
activity Of the various professional courses in medicine, law,
education from the pro-professional foundation courses makes it possible
to speak of these specialized Offerings as a new element of professional
training.

Upon completion of pre-professional and professional course
work, there are several channels through which qualified individuals
enter the professions. For many beginners, the step which follows the
completion of formal training and degree requirements is that of direct
entry into professional practice. Patterns of direct entry take on many
forms fer the several professions. These may be traditional recommend—
ations deveIOped by the profession or agencies using the services of
the professional. Beginning lawyers, architects and consulting
engineers often become affiliated.with established firms as junior

members or partners. Engineers, as well as specialists in the sciences

 

3Earl J. McGrath, Liberal Education in the Professions

(New York: Bureau of Publications, Teachers Fo'llege, Columbia
university, 1959).

 

 

39
and social sciences who are employed by industry or by government
agencies, may undergo brief orientation training programs designed to
familiarize the initiate with the specific work to be done. These pro-
fessional adjustment prOgrams are not, however, part of the regular
programs offered by established training institutions, and are not
"internships" according to the definitiOn presented previously.

Medicine, theolOgy, and education are three areas in which
internship arrangements have been commonly made at the institutional
level. These arrangements have been designed to provide the internship
as a terminating experience before conferring the full right to practice
professionally.

The internship, thus, is yet another element in the closed
system of professional training. The unique function of the intern-
ship, then, is that it serves as a final capstone to the training.

Its functions are analagous to those of the "rite of passage" in
the primitive tribe.

The internship, as a point in a training sequence, is
a terminal phase in a series of academic and professional eXperiences
provided by formalized prOgrams. It is also an initial experience
which will provide the kinds of problems and conditions which the intern
will recognize as typical of professional practice. The internship is,
in other words, a kind of middle ground. It follows after the structured
pattern of university training, a training which is ordered and
sequential and to which the intern finds it necessary to adapt. The
internship precedes full professional practice which offers a rather

random selection of problems and conditions with which the practitioner

1+0
must be able to deal. The internship lies between these two, offering
some sequence but also a random selection of problems. As such, it
involves certain aspects of training which are not apprOpriate to
either pre-intern training or post-intern practice. It is ngt_a place
to learn the basic skills, disciplines, or the principles of a pro-
fessional field. These should have been acquired prior to internship.
It now rests with the intern to put these skills and learnings into
practice in the intern situation. The internship is, however, not
a place where gvg§y_attitude and ezg£y_skill necessary for pro-
fessional practice is learned. In other words, the intern, at the
completion of his internship, is not yet a finished practitioner when
he enters professional practice. But he has a more complete and more
realistic view of himself as a beginning professional than would be
possible if he were to enter practice directly from the classrooms and
laboratories of a training institution.

One might question the real value of such an interim ex-
perience if it assumes the learning of the basic disciplines and
skills necessary for professional practice, and if it does not produce
a finished product in terms of ability to practice professionally.

It is here that the basic purpose of the experience must be viewed and
the kind of learning inherent in the internship must be assessed. It
is precisely the interim quality which becomes the real value of

the internship. The period provides an Opportunity for guided self
analysis of one's effectiveness as weighed on scales of a dual pro-
fessional performance. More specifically-~a medical intern can judge

and be judged on his success in diagnosing and curing a patient's

1+1
illness; a legal intern can judge himself and be judged in terms of the
way he plans a case or arranges a brief and carries the case to its
conclusion. A teaching intern can judge and be judged in terms of
the learning which he engenders in his pupils.

It is true, of course, that these are all highly abstract
assessments. They can be made only through exercising Opinion, and
Opinion is always subject to further analysis and review. The very
nature of professional effort and subsequent professional result is
never clear-cut and final. This is true of the efforts of professionals
as well as interns. If a patient's illness appears to be cured as a
result of a certain treatment, does it mean that no other prescription
could have succeeded? Does it mean that the same prescription and
treatment would succeed another time? If a teacher's efforts are
reflected by learning gains on the part of his pupils, does it mean
that greater gains could have not been accomplished by utilizing
different means of teaching?

The point, here, is that something more specific in terms
of possible learning must be identified with the internship if it is
to be validated as a training device. These specific learnings that
the internship provides are the following: basic insights for an
incumbent about his own motivations as a professional, about his
values as an individual practitioner and as a member of a profession,
and about his role and his position as a practitioner in a professional

community and in the larger society.

1+2
A fourth sphere of possible specific learning and one most
commonly related with professional performance is deliberately set
aside in this study as not relevant. This is the area of technical

competence.
TECHNICAL COMPETENCE AS IT RELATES TO THE INTERNSHIP

One of the areas of performance frequently mentioned as a
function of the internship, is that of developing technical competence.
It is commonly assumed that such development is an eXpected outcome
of an internship experience and it is further assumed that standard
measures of knowledge and skill can be utilized in determining the
degree of competence attained by an intern. These measures then provide
a basis for validating the internship's effectiveness.

This study is predicated on a different line of reasoning,
however. Technical competence is perceived as being a quality which

is not unique to the internship even though it is a valid measure

 

of performance. The point here is that technical competence demon-
strated in the internship is really a manifestation of pre-intern
learning and experience.

The initial definition of the internship stated that the

trainee must have mastered the skills and knowledge essential to

 

practice before internship, Technical competence will have been
assessed previously and probably will have been used as an indication
of readiness for internship. Throughout an intern eXperience a trainee
will probably sharpen his competency as a result of the cluster of

practicing Opportunities offered him. But technical competence is not

#3
the central purpose of the internship. It can be better learned or
acquired as a pre-planned, sequential arrangement in a formal school
setting.

It would appear that a fairer evaluation of the intern-
ship as an educational method would result from assessment of the
learning and perceptual possibilities which are unique to the
experience.

The basic premise that all learning is an extremely individual-
istic phenomenon cannot be ignored. Individuals learn singly-~even
though they may be assembled and taught collectively. The singular
perceptions and identities which individuals acquire only in the
internship should become the focus of an evaluative study.

Thus three dimensions of awareness have been chosen as areas
seeming to hold the greatest promise for analysis as elements of the
internship. They are areas which involve the perceptions drawn from
the self, perceptions drawn from the social interaction, and the
perceptions drawn from the professional environment in which the
internship is set.

All individuals are concerned with some fundamental questions
related to being and existence. They are concerned with knowing_

"Who am 1?", "What am I?" and "Where am 1?". This desire for personal
identification is a persistent and ongoing human attribute through all
stages of development. All learning is basically centered on these
three identifications, although increasingly the learner finds them
obscured by the demands placed on acquiring specific skills and .

detailed knowledge and by putting both of these to work.

Ah

In the internship, these identification concerns are also
central though modified somewhat by the previous experiences of the
intern. The aspiring physician has learned to identify himself as a
member of a family, as a member of a school, social and community
groups, as a citizen of a city, state and nation, a member of a church,
and so on. He has formed some Opinions about himself concerning his
effectiveness as a member of each of these groups. He will have
formed additioned impressions of himself as a speaker, a writer, a
listener, a thinker, a student, an athlete, an actor, a singer, ad
infinitum.

The medical student has undoubtedly been attempting to answer
the question, "Who am I-—-as a physician?" throughout his medical
school career.‘ But the nature of medical school is such that the

medical student identity will predominate during the formalized

 

learning period. The medical student will be more prone to think of
himself as, "John Adams-~medical student" than he will as "John Adams--
physician".

In the intern experience, he can now test and form some
perceptions of himself as Doctor John Adams. This opportunity exists
within the framework of experiences provided in the internship and
is a significant part of John Adams' preparation for future performances.
He may come to identify himself as a practicing physician and may
develop some definite awarenesses about his motivations, his values
and his capabilities for professional practice. He may learn to
differentiate between John Adams, physician, and John Adams, famiLy

member, and John Adams, citizen and John Adams, medical student. He

l+5
’may reCOgnize that as John Adams, physician, he has become a person
different from the family member, the citizen or the medical student.

The question, "What am I--as a professional?" is also answered
in the intern experience and the answer will emerge from the "Who am I?"
identification; here the prescription of performance begins. .Doubly .
einvolved are the questions: "What is expected of me?" and "what can
I expect of clients and other members of the professiOn?".

It is apparent that social contact and interaction become
important in arriving at this second identity because expectations
emerge only from such interactions. As "John Adams--medical student",
an individual may learn the disciplines Of medicine and demonstrate
that such learning has taken place. As "John Adams-—interning
physician," he may become aware of the expectations held for him and
those which he in turn may hold for others.

The question, "Where am 1?”, may also be answered as the
intern reflects on the professional environment in which his intern-
ship occurs. As in all new environments, the attention of John Adams
will probably gravitate, first, to the novel aspects of the internship
experience as they contrast with his previous eXperiences. He may
become aware of his position and status as a member of a professional
group and may consequently mediate on his privileges and responsibilities
as a member of such a group. But he may quickly find that status con-
siderations alone are an inadequate means of orienting himself as a
professional person. He may find that the experiences of his
professional predecessors, synthesized in an ethical code, begin to

guide him toward fuller awareness of his "position" in his profession

A6
and in society. _He will probably have had academic training in the
history, the philOSOphy and the ethical aspects of medical practice,
but until he finds himself a practitioner, he may not have utilized
this learning in arriving at an identification of his personal
position.

A justifiable question arises concerning the foregoing
exposition of the internship learnings as perceptions and of the
relationship of these to behavior. How does the ”Who am I", "What am
I", "Where am I" complex of perceptions relate to technical cOmpetency,
when competency is basically a reflection of knowledge and skill?

The answer lies in showing that the identity perceptions are
inseparable parts of a larger system of behavior determinants which
will ultimately affect professional performance. Granted that without
knowledge and skill no intern performance can be successful in achieving
its aims, it is argued that without clarification in the dimensions
of identification which have been posited, ultimate successful per-
formance is not likely. Technical competency is a necessary but
not sufficient condition for acceptance as a professional.

Skill and knowledge apprOpriate to a professional field
is provided in pre-intern professional training, but the identity
perceptions can be provided only in the realistic professional
practice setting of the internship, since they depend upon contacts
with clients, patients or pupils.

It is held therefore that it is unessential and inappropriate
to utilize tests of skill and knowledge for the purpose of determining

the effectiveness of an internship. At the present time, most methods

1&7

for assessing performance resolve around skill and knowledge. These
are the items which are tested when an attempt is made to assess
technical competence. It seems more fair that an attempt should be
made to test the deveIOpment and growth of identity awarenesses
in interns. This is the facet of competence which is a more
characteristic feature of the internship experience.

In the chapters which follow, attention will be drawn to

the identity areas of self, role and community. An analysis will

 

be made of the elements of which these perceptual fields are composed.

CHAPTER IV

IDENTITY OF SELF IN A PROFESSIONAL SETTING

A rationale for selecting self-identification as an element
in a closed system of the internship has been stated. The questions
now become: what are the kinds of events in the internship which
serve to alter the intern‘s perceptions of himself as a professional
person? What are the elements of self-identification in the intern-
ship, and most importantly, what are the unique Opportunities which
are afforded interns and which are not offered those who enter their
profession by other routes?

The internship prOvides an individual with a new and
different setting for the assessment of himself. It is different
from the examination and evaluation which was required in the formal
training experience provided by schools. For in the internship,
evaluation is based not upon one's ability to adapt to a predetermined
set of arranged and sequential learning experiences, but instead, it
will call upon one's personal resources to adjust to the random
demands of professional practice.

The young medical intern, for example, may serve a specified
period of time working in an emergency accident ward. The nature of
the cases will be determined by the chance occurence of particular
kinds of accidents and injuries. This contrasts to the curricula of
the school where the student might be exposed to a pre-selected
sequence: cuts and abrasions, then bone fractures, then internal
injuries, and finally, perhaps, cases of massive hemorrhage. The

1+8

l+9
random nature of the problems presented in the internship experience
is its unique characteristic. It calls for a different set of skills,
especially those of decision making.

The new setting and new order of demands are conducive to
several kinds of self-assessments in the intern: his personal
capacity for professional performance; his attitudes toward speciali-
zation within the profession; his personal commitment to the total
demands of professional practice; and finally as a kind of summation
of these assessments, his sense of personal worth in a professional

setting.
PERSONAL CAPACITY

Personal capacity for professional performance is an element
in the closed system of self perceptions develOped by interns. Every
individual brings into any situation certain preconceptions, certain
resources of knowledge upon which to draw, and certain technical
skills which may be put to use. In an internship, the training which
has preceded the experience has been designed to provide specific
skills and knowledge apprOpriate to professional practice. This
knowledge and these skills are peculiar to his chosen field of
practice and to some degree uniformly offered to all interns like
himself. In a particular profession then, interns approach their
assignments with a relatively standardized set of preparatory ex-
periences due to the order of courses offered by colleges and

universities.

50

But it is known, however, that there are great differences
in the learning rates, capacities, and potentials among various
individuals. It is not, therefore, to be expected that every intern
will enter his assignment with exactly the same amount of knowledge,
or with the same skill, or capacity to learn.1 This inherent difference
among individuals will account, in part, for differences in professional
performance throughout the internship.

It is an individual's Opportunities for discovery about his V”,
ability to perform professional tasks, to form professional judgments,
to make professional decisions which are important to the internship.

He will have an Opportunity to weigh these qualities in himself against
the demands of the job and against the seasoned judgments of the
practitioners with whom he works.

Evaluative judgments are made of an intern's capacity by 9”
those responsible for assessing such performance. But more important,
there is a process of evaluation that takes place within the individual
which will, to a large extent, influence his future attitudes toward
professional issues and his behavior in decision-making situations.
Challenges to personal security, and situations of threat and frustration
are inherently a part of the internship experience. The intern's
responses to these challenges will influence each individual's per-

ception of himself as an intern and as a future professional.

 

1

Robert Merton, George Reader and Patricia Kendall (eds.), The
Student Physician, (Cambridge, Mass: Harvard university Press, 1957,
Published by the Commonwealth Fund), p. 63. .

 

2See Theodore Sarbine, chapter 6, "Role Theory" in Lindzey,
Handbook 2: Social Psychology Vol. I, p. 225.

51

His professional maturity may be accelerated, or it may
be arrested, as he perceives his capacity for dealing with the general
range of professional performances which will be expected of him.3

Not only the quality, but the nature and the kind of services
he will be motivated to perform will be determined by the self assess-
ments made during the internship. The quality of professional
performance will presumably improve as the individual's experience
becomes extended.

Additional knowledge and skill apprOpriate to professional
practice may be learned and certainly should be expanded and brought
into perspective within such an experience. But the important focus
in becoming aware of one's personal capacity is not solely the amount of
skill and c0gnate knowledge one attains, but the way in which these
are put to use in solving professional problems. It is true that one
who possesses insufficient skill and knowledge to perform the services
expected of an intern in medicine, for example, will find the internship
to be inadequate preparation for professional practice. One can not
learn medicine and practice medicine at the same time. But it does 223

follow that superior command of chemistry, anatomy, biology, pharma—

cology and other materia medica, as well as skill in surgery and

 

diagnosis, will necessarily guarantee success in an intern experience.
If an individual is strongly motivated toward research, or

chemistry, or biological sciences, it is possible that his superior

knowledge and intense interest will inhibit rather than accelerate his

becoming a good doctor, i.e. practitioner. The intern experience, in

 

3Merton _e_t 9.2;: op. cit., pp. 203-2oh.

52
this case, may, in fact, lead to the conviction by the intern that he
does not have the capacity to succeed in the practice of medicine
because his principal motivations are not in that direction.

Similarly, the emphasis which formal training--school
subjects, classes, and courses--places upon an individual's acquisition
of facts, concepts, and technical knowledge, often make grades, class
standings, quickness in learning ends rather than means. One's
sensitivities to the intrinstic values of learning and the ultimate
use to which it must be put may be dulled.

Assessment of personal capacity leads one to some essential
questions: what are my goals in becoming a doctor, or a lawyer, or
an educator? How 522d do I want to become as a professional person?
For what level of practice am I best suited? Where will I find the.
greatest personal satisfaction in practice?. These questions relate
to the individual's level of aspiration and follow assessments of

personal capacity.
ASPIRATION

Level of aspiration is a vital element in the intern's
self-concept develOpment. It is an outgrowth of an awareness of
personal capacity which the intern develops.

A new kind of aspiration may appear as a result of an intern
experience. It is a more realistic purposing than that which spurs
an individual to enter a pre-medical training program, for example,
because he wants to be a "doctor". At best, the uninitiated bases

his choices upon images or sterotypes of action which imply to him the

53
work of the doctor. But these are poor approximations of the real work
of the practicing professional.

Studies of occupational choice reveal some interesting infor-
mation about the intensity of consideration which individuals give to
the selection of a life work.

It has been reported that many young peOple choose occupations
or professions on the basis of the socio-economic prestige of the
calling. Their choices may be influenced by the sterotyped public
image of the "average practitioner,” or by the personalized image of
a professional as presented by some person significant in the life of
the youngster. Other studies indicate some professionals were almost
entirely motivated in their initial choice of occupation by extrinsic
factors such as the influence exerted by parents, teachers or friends.

These findings lead to the inferences that most individuals
know little or nothing about actual day-to-day, hour-to-hour work of
the practicing professional. The lawyer is often perceived as being
constantly involved in tense and dramatic courtroom scenes;5 the
doctor as rushing into emergency life and death situations and performing
quick and miraculous cures; the teacher as performing inspiring and
unselfish services by cultivating the great minds of future generations.
In any event, few peOple know how a doctor divides his day between
office, house calls, and hospital. They are unaware of the routine and
often mundane work of the medical practitioner. The same is true of

the non-lawyer's view of the lawyer. The long hours of reading,

 

hRoe, op. cit., pp. 251-273, and Super, 223 cit., pp. 170-270.

5“1aw" in Vocational Information - The world Book Encyclopedia,
(Chicago: .Field Enterprises Inc., n.d.).

51+
research and meticulous preparation of briefs is not a part of the
stereotype of the American lawyer.

The aspirant to the clergy, to engineering, and to the other
professional endeavors may be equally misinformed or suffer from the
same lack of information. This is true, certainly, for all of those
who have had no more than transient contact with the practitioners
whom they hope to emulate. Some aspirants, of course, are better
oriented to professional work because they may be following in the
footsteps of family members or close family friends. Their orientation
may be more realistic than those more distant from the profession, but
even here they may be the recipients of "after hours" discussions, or
"living room" lectures directed by the significant practitioner. These
in themselves are inadequate means of conveying a real feeling for the
profession.

Some fields lend themselves to public observations more than
others; peOple often feel better informed about the work of practitioners
here. 'Individuals should have a clear conception of the teacher's work
than that of any other profession, for example. MDst individuals will,
in the course of public school training, be exposed to more teachers
than to any other professional group. But even in this case, peOple
outside the field of teaching, who have never assumed the role of the
teacher and the commitment responsibilities which accompany it, deal
in a stereotype of rather crude dimensions. The public stereotype of

the teacher is gross, unrealistic and inaccurate.

 

Among the more interesting investigations along this line,
one finds Arthur Foff's Ed. D. dissertation, Teacher Stereotypes la
the American Novel Stanford university, 1953.

 

' Variables of Personality: Clinical Studies,

55

As a person becomes increasingly immersed in the functional
aSpects of professional practice, he begins to build an aspirational
structure which is compatible with his perception of himself and his
field of experience. Although this structure is not reasonable or
realistic in all_cases, it is generally agreed that mature and
intelligent individuals ordinarily do produce aspiration patterns
commensurate with their ability and their Opportunities.7

An internship eXperience is not, however, a means to the
fipal establishment of one's aspiration structure. Flexibility and
adaptability are the core of any sound system of aspiring. There are
many hidden Opportunities and many unforseen exigencies which can
effect one's aspiration potential at a given time. Aspirations change
as experience changes even in mature individuals. The internship
should, however, become an arena in which professional aspiration
might show real growth on the basis of genuine professional experience.
Here an individual can become realistically cognizant of the kind and
quality of surgeon, or teacher, or lawyer he would like to become.

The growth of knowledge and services which characterize the
professions will quite possibly cause the intern to aspire toward one

of the fields of specialization related to his calling.
SPECIALIZATION

The tendency to specialize, that is, the reCOgnition that one

must limit himself in professional study and in the performance of

 

7Pauline Sears "level of Aspirations in Relation to Some
" Journal Qf_Social
Psychology lh:3ll-36, l9hl.

 

56
professional tasks, is another element in self-perception that may
occur in the internship.

As the breadth of professional knowledge and the sc0pe of
professional function impresses the individual, he begins to
circumscribe and limit his activities in certain areas. Kendall and
Selvinacite evidence that a relationship between native ability and
the nature and intensity of Specialization in medicine exists; but
concern here centers on the fact that in all of the major professions,
the tasks of the practitioner tends to become fragmented as expanding
knowledge and function place heavier demands upon him in terms of
training and practice.

In the internship the trainee is exposed to a variety of
experience in the many specialties within his field. In this
experience he may form some impressions of himself as a specialist.
It is probable that the previous orientations of specialty which have
been offered have done little to solidify impressions of his own
ability in special areas. These orientations will have centered more
upon principles of the specialty and will have been intended as
preparatory for his forthcoming intern experience. An awareness of
specialization in relation to perceptions of self is made possible in
the internship.'

It is possible that the kind of awareness being discussed
follows the development of a §§E§2.9£ capacity and of a lgzgl_g£_

aspiration. It is equally possible that all three may be simultaneous

 

 

8Patricia Kendall and Hanan Selvin, "Tendencies Thward
Specialization in Medical Training," in Merton, 9p, cit., pp. l53-l7h.

57

realizations at some point in the intern's assessment of his experience.
Interest in specialization may precede the testing of one's own
personal capacity, but such interest is hardly effective in motivating
one to spend the time and energy needed to prepare for the practice

of surgery, or corporate law or nuclear research. Without some firm
conclusions concerning one's capacity and level of aspiration, it is
doubtful that an intern could arrive at a very sophisticated decision
about specialization.

All of the foregoing elements of attaining an identity of
self will lead an intern toward some level of commitment to the work
of a professiOnal practitioner. Without this commitment an internship
would have little meaning as a training method. For those who are not
afforded the Opportunity to test commitment prior to practice, as in

an intern experience, the gap in preparation may be significant.
COMMITMENT

A personal commitment to professional tasks is inherent in
the internship. Mpreover, the very nature of most internships which
are organized so that simple and less challenging functions are
practiced first, makes for a gradually deepening test of the intern's
level of commitment. In medicine, for example, simple diagnosis, checks
of pulse and respiration, tests of temperature and nerve response,
are likely to be the first responsibilities of the intern. In law,
reference research, preparation of simple and rather standard briefs
and perhaps work with an experienced counselor in a courtroom are

the beginning intern experiences. The same type of initiatory

58
experiences are characteristic of other professions providing internships.
While this is not the beginning of a developing commitment in the
intern, it is that point at which the standard for testing commitment
has been changed. The test becomes increasingly demanding as the
experience is extended. Ultimately the full press of professional

9
responsibility is thrust upon the trainee and he finds it necessary
to make decisions, to direct his energies and to measure up to the
ethical standards of his profession. Throughout his entire training
experience, in pre-professional and professional training as well as
the internship, the trainee is given an Opportunity to test his personal
commitment to the professional role he plans to assume. But at each
phase of his training the nature and method of this test is altered
due to widening demands placed upon him.

The tests in the internship are of a nature different from
those in previous situations. The intern is faced with the necessity
of accomplishing effective results from his effort. He is no longer
expected to demonstrate mastery of a particular subject or skill by
repeating it back. He is no longer compared.with other students for the
purpose of determining his standing as a learner. In the advanced
stages of internship he is not even measured against a predetermined
set of standards which indicate the level and the quality of his
performance. He has gone beyond this point in his progress toward
professionalism.

In the internship, the trainee becomes his own best judge
of the quality of his work. He is put to the test of constant self

evaluation of the worth of the services he performs and the validity

59

of the judgments and decisions he makes. His indices for this evalu-
ation are the knowledge he possesses, the methods he applies and,
above all, the actual results of the application of knowledge and method.

If he continually gets unsatisfactory or inappropriate results
from his efforts, as an intern he still has some shelter and recourse
in his relation with more experienced practitioners who are his mentors.
He has the Opportunity to strengthen weaknesses in skills or fill gaps
in essential professional knowledge under guidance. But he also has an
Opportunity to decide what professional demands in general, or
specialized demands in particular are beyond his ability level or
contrary to his interests.

Commitment to a profession entails much more than a desire
to be a doctor, a lawyer, or an educator.9 It involves also a self
awareness that a professional enterprise suits an individual in terms of
the demands placed upon him, and the rewards accruing to him. An
intern's perception of rewards may change somewhat as he recognizes
new areas of personal satisfaction emerging from successful intern
performance. Where an individual may have come to this point in
training spurred by economic or prestige promises, he now stands at
a point where the social service value of his calling and his
ability to adapt to the demands of professional practice are significant

factors in increasing commitment.

 

9

An interesting study of values and commitment can be found

in: Robert C Davis, Commitment to Professional Values as Related to
Role Performance of Research Scientists, (Unpublished Ph —D Dissertation,
University of Michigan, 1955).

 

 

 

60

If he does not discover these satisfactions he may well
decide against continuance in training. There are drop—outs in all
phases of professional preparation; some by elimination, some by
voluntary withdrawal. Those who discover that their personal commit—
ment is not suited to the demands of professional service are among
these drOp-Outs. The screening that Occurs in the internship is based
on considerations more relevant and personal than at any other stage
in professional preparation.

The level of commitment demanded varies from profession to
profession. It is not common for a person trained in the practice of
medicine to depart from his calling once training is completed. On
the other hand, it is not uncommon for lawyers to enter different
fields of endeavor, although in many cases their legal background
serves them in the new area, this is especially so in the case of
lawyers who enter corporate management, politics, finance or university
work.lo

At the other extreme, teachers are prone to depart from the

11 It is true that

professional work for which they have been trained.
economic and prestige factors account, in some degree, for this

tendency. As well as the fact that women compose a majority of those

 

m$mmgggE3
llerd S. Mason, Robert J. Dressel and Robert K. Bain, "Sex
Role and Career Orientations of Beginning Teachers," Harvard Educational
Review, 29 (Fall, 1959), pp. 370-383. Discusses the contingent aspect3—'
of the teaching profession as perceived by new entrants. See also:
National Manpower Council, A_Policy for Professional and Scientific
Manpower, (New York: Columbia University Press, 1953), p. 60.

 

61
training for public school work. Family plans and contingencies Often
remove women, at least for a time, from active teaching. But studies
of the commitment of men to teaching also show rather low rates of
continuation in the profession.

Since there seems to be a higher commitment among those
completing medical training and a lower retention for those completing
teacher training, it might be construed that the rigor of training
plus the universality of the internship in medicine could in some way
be related to the greater holding power of the medical profession.

The uncommitted and the half-committed will not undergo the rigorous
demands of medical training and internship. And the internship itself
facilitates a gradual extension of commitment.13 In other professions,
training which is less demanding fails to eliminate those who are less
than fully committed.l"

The variety of experiences and the individual successes in
each of these will have significant effect upon an intern's level of
aspiration within the profession. The completion of professional
training will have been the focus of aspirations up to this point, but

now success as a ractitioner at some articularized level, will
1 )

become the center of further aspirations.

 

l21Vkison, 2p, cit.

l3Henry Hill, "wanted Professional Teachers," Atlantic, 205
(May, 1960), pp. 37-hO., An answer to critics of present teacher
certification standards. Hill implies that persons not willing to
meet standards have less than the necessary qualities to become
useful additions to a profession. '

h
1 Ibid.

62

variety Of experiences, the contacts with specializing
practitioners, and the recognition of ability or lack of ability to
perform in Specialized areas will further motivate an intern to
consider specialization within his profession. It is impossible to
say what exact form this may take. Failure could engender avoidance
of a specialized area, or it could intensify a determination to master
a specialty.

The motivations which move individuals in one direction or

15

another are not clear. Merton presents some interesting conclusions
in relation to medical students, but much more research needs to be
done here. In any event, the internship provides an arena in which the
move toward or away from specialization can be begun.

Finally, a degree of commitment is attained as an individual
views the nature of his chosen work against the backdrOp of his
energies, his abilities, his wants, and his needs. Self knowledge
about one's commitment is another realization which will emanate from
the intern experience.

All of these elements, in turn, fuse and merge into an often
complex set of personal values which serve as a guide, not only for the
future professional's behavior, but which provide a base from which
he will come to judge the acts of his fellow professionals.

The extent of commitment increases as one progresses through
professional training. Passing through the elimination procedures of
the pre-professional and professional training phases will reinforce

the desire for success among those who remain in training and they will

become increasingly committed as a result of these experiences.

1
5Merton, op. cit., p. 153-

63

The internship, itself a form of screening device, will
further this tendency. The personal satisfaction forthcoming from
successful professional performances, and the knowledge that one is
a member of an elite, will shore an individual's commitment to a calling,
and the challenges of practice may stimulate further the desire to
practice.

Personal capacity, a§piration level, tendency toward

specialization and commitment, then, constitute the elements of a

 

 

closed system of self identity awarenesses made possible by internship.
PERSONAL VALUES

The elements which have been delineated above become the
summation in a Set of personal values related to the identification
of one's self in a profession. These personal values seem to be
a most important result of the intern experience.

Gradual induction into the responsibilities of full pro-
fessional practice provides Opportunity for an intern to gauge his
personal preparation and capacity against the demands of the job.
This will provide a kind of implicit worth-index which he may use as

he progresses through his training.

CHAPTER V

IDENTITY OF ROIE IN A PROFESSIONAL SETTING

 

In addition to the changes which may take place in the self ’
perceptions of an individual undergoing an intern experience, change
may also occur in the role perceptions which may emerge from the
contact experiences with other professionals and clients. It is
probable that situations or patterned contacts may provide the intern
a basis for not only firming his Opinions of himself in a professional
setting, but also provide him.with a set of behavior referents which
will become the basis of his image of a professional in a work setting.

It is true that a young legal, medical, or education student
will gradually form some Opinions about actions apprOpriate in professional
practice as he undergoes earlier phases of his training. If his
professional goal is medicine, for example, he will know from the
beginning that a doctor diagnoses, treats, and prescribes for injuries
and ailments. If he is an aspiring lawyer, he will know that a lawyer's
work involves gathering information about a client's problem and
analyzing the various facets of this against legal precedents and
pronouncements. Similarly, the young teacher-in—training will come to
reCOgnize that his professional role is more than that of "pouring
forth" what he knows. He will begin to understand that this is but
a small part of his greater responsibility, that of arranging and
managing the most suitable conditions for learning.

The peOple with whom the aspiring professional comes in

contact in the pre-intern phases of his preparation will be those

6%

65
specializing in teaching or research in the various disciplines under—
girding professional practice. They may, but more likely may not,
be practicing professionals themselves. Certain of the professional
specialists might practice as well as teach, but professors in the
basic disciplines such as anatomy will probably devote the major
portion of their time to teaching and research and will have had only
limited experience as practitioners, if they have had any at all.

As a result, the significant people in the life of a medical
student, for example, will meet him in school settings, and, for the
most part, interact within non-practicing situations. This, in turn,
will shield the trainee from the very important contact conditions of
professional practice. The internship, however, coming at the end
of a preparatory sequence and being centered almost completely on
contact and interaction, may give the incumbent some new and vital
perspectives.

WOrk with a practicing professional, in all likelihood, will
provide a new set of referents upon which the trainee will model his
own behavior patterns. The quality of work, the enthusiasm for it and
the evidences of professionalism demonstrated by his mentors in the
internship will become fundamental to role assessments the intern
will make of himself as a practitioner. Even lack of enthusiasm,
unprofessional behavior, and inferior performance may be forces
resulting in a sharper definition Of role by the intern, though

whether the definition that results is desirable or not is difficult

to predict.

66

The significant item here is that the heart Of the intern-
ship eXperience is the Opportunity it provides for interaction with
peOple who need professional help and people who give it. Role
identification possibilities are multiplied by contact with a large
number of peOple and with professionals in a variety of positions. For
while role identification begins within the individual, such
identifications must extend beyond the strict boundaries of the self
as the significance of others in influencing one's own behavior
becomes increasingly apparent. The actions of others are equally as
important as one's own actions in the definition of a role. Merton
reflects this point in saying:

...there still remains the distinctively sociological matter
that behavior is not merely a result of the individual's personal
qualities but a resultant of these in interaction with the
patterned situations in which the individual behaves.

The contact with others then serves as the bridge necessary

for moving from the strictly internal and psychological considerations

involved in the perception of self-identity to the dynamic and inter-

 

actional considerations necessary for the perception of role-identity.
While the development of role in the internship is compatible
with general role theory, in some respects it is necessary to depart
from the usual concept of role. An internship is a specialized and
limited sociolOgical situation and consequently adjustment to classical
role theory is required. The internship is a kind of experience
Offered a select group of peOple who are training to become pro-

fessionals. It is a special training device for a special group, and

 

l
Merton, Op. cit., p. 62.

67
the concepts of role which emerge are not universal in their
appropriateness or in their utility for all peOple. The roles to be
viewed are those related to the elements of professional function and
they must be further isolated and studied. This departs from the more
universal and generalized aspects common to other sociological analyses
and centers attention exclusively on dimensions peculiar to the
internship.

Role, in the internship, is concerned with such specific
questions as: How does one behave as a doctor in a particular
situation? How does one make the decisions which might be expected
of a lawyer in a specific case? What are the limits of action and
decision within which a social worker or a teacher or a minister may
Operate and still be within the bounds of "professional" performance?

In attempting to answer these questions, the intern faces ‘
the need for skill in analyzing status situations, skill in making
adequate assessments of one‘s self in relation to others, and skill in
becoming cognizant of the role eXpectations which influence behavioral
patterns in society. This involves the interaction of perceptions
held by individuals, by specialized groups and by larger aggregates in

society.
PROFESSIONAL STATUS

Professional grOUps in a society are tacitly granted status
due to the nature of their service function. The status accorded
each of the professions may vary from society to society, and from

time to time within a particular society. Role is unequivocably

68

associated with status. Iinton states that a role "represents the
dynamic aspect of status".2

It is probable that status is a subsequent product of role-
action rather than a determinant for role-action. Sarbin emphasizes
this in saying:

...Role centers around the organized actions of a person
coordinate with a given status or position.‘ One of the some-
times confusing results thus regarding roles and positions
as being intimately related is their being treated as identical.
They are interdependent concepts, but not identical.

An individual's actions must fall within the limits Of the
expectancies of others, and the individual must be aware of these
expectancies if he is to assume a role adequately. Reinforcing this
interpretation of the interactional or self-other aspects of role,
Cottrell suggests that role is:

...an internally consistent series of conditioned responses:
by one member Of a social situation whiCh represents the stimulus
pattern for a similarly internally consistent series of conditioned
responses of the other in that situation. ,Dealing with human
behavior in terms of roles, therefore, requires that any item of
behavior must always be placed in self-other context.

Thus, out of the dynamic interaction of actions subject to

status considerations in the internship, out of behavior influenced
by the self-other perceptions of participants of a situation, the

internship may be studied as a setting for acquiring new role

identifications. If an internship is adequately supervised, if it is of

 

2Ralph Linton, The Study gf_Mln, (New York: Appleton-
Century, 1936), p. llh.

3Theodore Sarbin in Lindzey, Handbook g£_Social Psychology,
223 cit., p. 225.

"L. S. Cottrell, Jr., "The Adjustment of the Individual to
His Age and Sex Roles," Sociological Review, (July, 191+2), p. 617.

69
sufficient duration, and if the range of experience is both broad and
diverse, then it might be assumed that an intern will acquire a concept
of role which will be consistent with those of other committed
members of a profession.

As with the other outcomes of the internship, role identifi- r”
cation can be viewed as an element in the total range of internship
experience. It can also be viewed as a closed system of experience
containing its own set Of interrelated elements.

The elements appearing to be significant are the following:
generalized expectations, self-other perceptions, situation analysis

and specific expectations. All of these lead an intern to develOp a

 

set of status and role perceptions commensurate with his personal

values.
GENERALIZED EXPECTATIONS

"Generalized expectatiOns"5 mean the cluster of impressions A’l
and perceptions which an individual may have accumulated about per-
formances and behaviors to be expected from doctors, lawyers, teachers,
or other professionals.

They are "depersonalized" expectations, i.e., the term does
not refer to the eXpectations for a particular doctor, lawyer, or
teacher, but rather to expectations held for "doctors", or "lawyers",

or "teachers" as a general class. They are the expectations which the

 

5W. B. Brookover, "Research on Teacher and Administrator Roles",
Journal 93 Educational Sociology 29, (September, 1955), pp. 2-13.

 

70
layman develOps and which he uses as a referent in discussions with
various professionals except in those cases where he is considering
"my doctor" or "my lawyer", etc.

The lack of a precise definition of "generalized expectation"
is inevitable because with professionals there is such a broad variety
of involvement possibilities in interaction situations. "Generalized
eXpectations" are expressed in terms of loosely constructed maxims
which imply that doctors, or lawyers, or teachers behave in a particular
way. But "generalized expectations" are not unimportant even though
they lack precise definition.

Persons having limited contacts with professionals expect L”
performances more in keeping with these generalized expectations than
with expectations which evolve from more prolonged or intimate
experience with professionals. As a result of this tendency, it is
essential that the professional be cognizant of the public's generalized
expectations as he approaches a particular contact. For acting
contrary to the generalized expectation may alienate a patient or
client before the real process of diagnosis or counsel has begun.

Lack of client COOperation can offset or undo the most sound diagnosis
or counsel. An inappropriate mental set in a client can defeat any
honest effort on the part of a practitioner.6

During his pre-professional and professional training

eXperience, an aspirant is consistently nearing, in his behavior, the

 

6Huntington in Mgrton, 9p: cit., pp. 179-187.

71
practitioner's definition of the professional role. He will move
from the generalized public expectation that a doctor "cures an illness"
to an understanding that a doctor "tries to identify an illness,
tries to classify it and prescribe treatment, and tries to prevent
further illness recurring from the Same cause." The Spread between
these two levels Of expectation is very wide and much learning must
occur on the part of the intern before the latter is ultimately
realized and accepted with conviction.

The pre—intern experiences, centering on the academic
disciplines and the technical means of professional practice, will
often slight the personal aspect of practitioner-client relations
and the trainee may give little thought to the effect these relation-
ships may have on a specific course of professional action. Conse-
quently, it is essential that the intern become aware of the levels
of general expectation and the impersonal, but more SOphisticated,
eXpectations for professional performance.

The internship is an experience in which the trainee may
begin to perceive his role in more than general terms. If he is
assigned to an eXperienced practitioner, he will observe, through
the effects of the actions of that practitioner and the concommitant
reactions of the practitioner's patients or clients, the varying
levels of generalized role expectations and their importance for
performances. He may see in the performance of the practitioner or
in the actions of patients, behavior which may be complementary, or
which may be contrary, to his own expectations.' The learning here

will prepare the intern for the gradual induction into those phases

T2
of training in which he meets his patients or clients alone. It will
allow him to form some conclusions concerning general expectations
which are applied to the practitioners in his field and how these
expectations seem to fit him personally.

It is true that some knowledge of generalized expectations
and their relationship to professional action will have been formed
from earlier observation of other practitioners and their effect upon
patients or clients. The knowledge gained in the internship will,
naturally, be an enlargement of the understanding of generalized

expectations which the intern will have developed throughout the

 

period of his training. Although an intern's set of general ex-
pectations are refined and clarified as a result of his experience he
will still need to learn how to respect the expectations of his
clients.

An example might be found in a case where a medical intern
contacts a patient who manifests a serious skin rash. The patient
expects the doctor to treat the rash and solve his problem. His
expectations will be those of having the doctor question him as to
the time at which the rash occurred, the duration of the rash, the
extent of body coverage involved. He may also eXpect that questions
of diet and other physical details may be asked. He will expect the
doctor to make an analysis of the case and prescribe treatment.

The intern, on the other hand, will know that these initial
expectations will apply, but in addition to this, pig expectations, as
a medical practitioner, will prompt him to consider the physical, the

neurological, the emotional, the glandular, and even the social

73
implications of this rash. The rash may be a symptom of a very
complex set of affecting conditions. The patient may be suffering
from emotional stresses which have brought on glandular imbalances;
these may, in turn, have emerged from marital problems, job problems,
or financial problems, etc.

The intern's behavior, in this situation, will be motivated
by his awareness of the expectations of the patient, and also by his
own perception of the role of the practitioner. In one situation,
with one patient, it might be possible to delve into the conditions
peripheral to the actual ailment and to get more directly at the
causes of the rash. In another situation, the intern may perceive
that such probing would intensify anxiety--which may be a cause--
and he would, on this occasion, merely prescribe a lotion or a gland-
ular depressant to relieve the symptom with the intention of pursuing
the cause at another time.

This example illustrates that the public's generalized
expectations are not a sufficient basis for professional decision
making. The inadequacy of such public eXpectations in meeting the
conditions for professional practice will, hopefully, engender in the
trainee a concern to obtain deeper insights into the bases of pro-
fessional performance. This should bring about some intensive
searching on the part of the intern for an adequate perception of
himself and of others who become involved in situations requiring
professional service.

It should become apparent to an intern that generalized

expectations emerge from the perceptions the public holds for

71+
professional purpose in his field of service. These must be the
shared perceptions of both the public and the practitioners.
Beginning with the gross definition that doctors are expected to
heal, lawyers are expected to settle legal problems, and teachers
are supposed to teach, generalized expectations can be broken
down into expectations for training, for professional attitudes, for
behaviors, and for activities. These expectations will tOgether form
the public image or sterotype which will prescribe generally what a
doctor, or a lawyer, or a teacher is eXpected to do in the course of
his work.

The specialty of the practitioner will have to be appropriate
to the needs of the particular person seeking professional services,
and generalized perception of this specialty will be instrumental in
bringing a client to a practitioner. But these sterotypes are only
rough guides and demand further elaboration on the part of the
practitioner and the client if a relationship is to be maintained.

The factors which influence a client's selection and
especially the retention of a doctor or lawyer transcend the level
of generalized expectation. The kind of doctor or lawyer will be
determined by the client's ability to categorize and classify
professionals. A doctor may be perceived as: inexperienced, over-
worked, a community leader, an excellent diagnostician, a specialist
in some area of medicine or surgery. Each or any combination of
these perceptions can be influential in the selection and retention of
a professional by a client. Each will affect the specific expectations

a client will hold for the practitioner.

75
Each succeeding contact situation will involve perceptions of
a more specific nature, and these perceptions will result from the
contact and the action of the participants. The significance of these
individual self-other expectations in interaction cannot be overstressed.
A professional practitioner's success will be affected by his capacity
for understanding himself and others in interactive situations.

This is also an area in which the internship can make a contribution.
SELF-OTHER PERCEPTIONS

The emphasis shifts now beyond the rather superficial level
of generalized expectations. Each contact situation will become, in
itself, a germinating center for new role perceptions and for new
role action.

As a professional, the intern is placed in a position of
becoming an initiator of action in reference to his client. This
action will stem from personal assessment of himself and the client.
The perception he has of the assessment his client has made of him as
a professional is also significant in determining the course of action
to be taken.

Self perception, in this sense, is viewed as a dimension
different from the qualities of self discussed in the preceding
chapter. In a role situation, the term gel£_takes on a somewhat
different meaning as defined by Sarbin:

...the self is what the person 'is,‘ the role is what the
person 'does.' When interested in the self, we regard the person
as an organization of qualities. When we study roles, we regard
the person as an organization of acts. Parenthetically, direct

observation reveals only action systems resulting from the inter-
play of self and role.(

 

7Sarbin, _o_p_. cit., p. 22h.

76

There is no fixed pattern which will define the impressions
and counter-impressions which will emerge from social contact situ-
ations. Each incumbent in a position will find himself constantly
influenced by the effect of his actions, as he perceives them, on
the other. Hall and Lindzey further delineate this dual quality
of self-perception in saying:

The term self as used in modern psychology has come to have
two distinct meanings. On the one hand it is defined as in the
person's attitudes and feelings about himself, and on the other
hand it is regarded as a group of psychological processes which
govern behavior and adjustment. The first meaning may be called
the self—as-Object definition since it denotes the person's
attitudes, feelings, perceptions, and evaluations of himself as
an object. In this sense, the self is what a person thinks of
himself. The second meaning may be called the self—agfprocess
definition. The self as a doer, in the sense that it consists of
an activg group of processes as thinking, remembering, and per-
ceiving.

USing the role-self as'a base for perceiving action situ-
ations, the intern is presented the opportunity of fusing the two
self perceptions in the unique setting of the internship. Thus in the
performance of professional tasks he epitomizes both the object
and the process aspect as he becomes an agent for the solution of
professional problems.

He must take into account all of the personal aspects of the
situation, as well as the interactive aspects. He must utilize his
training and knowledge in addition to his professional judgment and
ethical values. All of these are brought to bear upon specific
situations. Above all, the intern must be able to make an adequate

analysis of a contact situation, because each professional contact

is, in a sense, unique.

 

1Hall and Lindzey, 9p, cit., p. #68.

77

It is the function of the practitioner to identify these
unique qualities and to adjust his method of action to them. The
distraught or the anxious patient; the client manifesting lack of
confidence in the practitioner; the pupil with negative sets toward
learning; these will necessitate actions different from those used
with the calm and c00perative individual who seeks the services of a
professional.

There may be consistency or similarity between cases. Virus
infections and appendectomies may follow characteristic classifi-
cation patterns, but each patient represents an individual problem
demanding an individual course of action. As such, the doctor must
view the individual and the variations inherent in a situation; he
must view the situation itself and make appropriate assessments of
it. Certain learning difficulties follow specific classification
pattern, but the teacher must be able to perceive himself and the
other in the situation and to work through these often conflicting
perceptions affecting the situation.

The counsel of mature practitioners can guide the intern in
making these judgments early in his experience. The actual contacts
and responsibility for action will cause him to accept responsibility
and to perceive and to judge later in his experience. He will develOp
the "feel" for working with people. The ability to analyze each
contact situation becomes another quality expected of the practitioner
and the Opportunity for develOping this ability seems to exist within

the intern eXperience.

78

SITUATION ANALXSIS

Situation analysis parallels concern for self-other per-
ceptions. As previously stated, the determinants of action are
centered in the perceptive abilities of the members of an inter-
acting pair. Action will stem from such perceptions but, in a
professional setting, action is also subject to the influence of the
situation itself.

The intern and his patient or client enter a contact situ-
ation with some common orientations. The purpose of the contact is
usually clear in that the two are brought together in order to solve
a problem of health, or of legal difficulty, or of some other pro-
fessional nature. Each professional and his client brings to the
situation a perception of his own responsibilities in terms of
initiating action. The patient or client is responsible for identi-
fying his problem and the professional is responsible for diagnosis or
counsel. The nature of these responsibilities fixes the positions of
the two vis-a-vis one another.

A patient or client will grant status to a professional
(or an intern) on two counts. One, from his generalized perceptions of
doctors or lawyers or teachers and their utility in his particular
case; and two, from the specific impressions he forms of the practitioner
as he observes performance of the role. This implies status gradients

9

of both a generalized and a particularized nature.

 

9Talcott Parsons, e£_al:, WOrking Pipers in_the Theory 9:
Action, (Glencoe, Illinois: The Free Press, 1953), p. H6.

 

79

There are also generalized and particularized procedural
forms present in a contact situation. Certain canons of good taste
must be observed by both the doctor and the patient in the process of
a physical examination. Both must avoid acts or procedures which will
embarrass themselves or the other person. A lawyer must likewise
observe principles of good form, such as privacy in consultation and
confidential treatment of information relevant to a case. These
constitute generalized and commonly accepted procedural forms common to
professional practice. All professions have these forms well develOped
and they are mutually understood by professional and clients.
Each new contact provides the professional an opportunity to
perform at certain particularized levels. This is the heart of the
"bedside manner" so important in medicine. Each profession has its
"bedside manner" in which the aim of the professional is that of
gaining the client's confidence. This is done in order that rec-
ommendations for problem solution or professional services rendered will

be accepted in good faith by the client. It is here that the beginners
find great difficulty in adjusting. Should an attitude of intense
personal interest and empathy characterize the professional's approach

to a client's problem, or should aloof and objective behavior be
demonstrated? Should the practitioner engage in humor and lightness, or
should seriousness be the keynote? In what manner should the practitioner
attempt to establish a climate of favorable reaction in his client?

Not only this, but also each contact and each situation may be different
in terms of the needs of the patient or client and what is required

to establish such a favorable climate.

80

Within the intern eXperience it seems likely that more
constant and apparent attention will be given to situation analysis
than may be true of later practice. This is so precisely because the
intern may lack the experience so necessary in meeting the fluctuating
needs of situations and may lack "built-in" procedures for dealing
with them. He will have had less opportunity to make routine certain
of his procedures and he will be consciously adapting to each situation
he meets. He will probably err and often be inconsistent in his
actions during the internship, but without the opportunity that the
internship provides he will be less than well prepared to assume the
responsibilities of full professional practice.

As a result of his internship, the intern may gain a valuable
backlog of experience in balancing the elements of generalized ex-
pectations, self-other perceptions, and situation analysis in
arriving at yet another element crucial in decision making. That
element can be called specific "expectations" and this is the essence

of a professional's response to the demands of each particular case.
SPECIFIC EXPECTATIONS

"Specific expectations" are the product of reciprocal
interaction. They develop as a professional and a client meet in
a face-to-face situation. From the contact, the professional may
form some specific expectations concerning the patient's or the
client's performance. The patient or client, at the same time, will
form specific expectations in the process of consultation, counsel,

or treatment. In any case, the expectations of each participant will

be based upon the consistency of his experience with the other

81

participant in terms of generalized expectations, self-other per-
ceptions and situation analysis.

It has been stressed that all of these combine to form a
climate of confidence or lack of confidence in the ability of the
practitioner. This in turn will influence the client's willingness
to follow prescription or counsel and will influence the intern's
confidence in providing such counsel or prescription. Beyond this,
however, the practitioner has even greater decisions to make. He
must first assess himself and his ability to deal with thig
particular problem. He must next be concerned with the accuracy of
his diagnosis or appropriateness of his counsel. He must consider
his impression of the patient's candor and frankness in reference
to the problem. He must make some prognosis concerning the patient
or client reaction to his solution for the problem. All of these
must he arrived at before an actual solution is prOposed.

The right and the necessity of the professional man to make
decisions relevant to the conditions with which he works has been
stressed previously and will be reinforced in the chapter following.
It is this facet of professionalism which marks such performance
as different from other forms of decision making. The center of such
decision making rests within the sphere of the situations in which
decisions are made, and the decisions are dependent upon the professional's
perception of specific expectations.

It is in the intern situation that the professional aspirant
learns to differentiate between generalized expectations and specific

expectations and to move from the former to the latter as the situational

82

conditions warrant. These actions are motivated by the perception of
specific expectation. They mark individual practitioners as different—-
one from the other--and they consequently account for the degrees
of effectiveness which they demonstrate in professional practice.

Thus in the internship, the neOphyte practitioner is given
the Opportunity to reCOgnize and analyze the dynamic interpersonal
aspects Of professional practice. The intern has an Opportunity to
reCOgnize himself as an agent and an instrument of professional
service. He may become aware of the varient influences and forces
Operating in professional contact situations and he becomes COgnizant
of the effect that he, as a person and as a professional, may have
upon these variants. The sum of what the intern may derive from the
internship might be called the ”status values" accruing from the

experience.

STATUS VALUES

Status values for the professional imply more than a
hierarchial level or rank position in a society. Since in the
internship they are arrived at realistically in action situations,
they are the product Of interactional experience.

Professional status is granted the practitioner in a very
tentative manner. The conditions of the grant include, demonstrable
proficiency in the skills apprOpriate to the field, perceptive ability
in analysis, diagnosis or recommended courses of action, and

sensitivity of the initiative expected from a professional. Failing

 

loHuntington in Merton, gp. cit., p. 187.

83
to demonstrate these qualities, the professional will perceive in
those with whom he comes in contact a diminishing grant of status.
This in turn is bound to effect his own concept of status as it
befits professionals in practice and as it applies in his own ex-
perience.

Having moved from the generalized eXpectations to the
specific expectations in terms of professional prescription, having
acquired sensitivities to self and to other expectations, and
having learned these things in a setting of a specific situation the
intern, it would seem, would be adequately prepared to meet the problems
and the uncertainties of professional practice. Thus he will have

garnered a set of status values which are essential and apprOpriate

 

to his calling.
This chapter has introduced the elements which make up a

closed system of role perceptions within the internship. The inter~

 

actional aspect Of professional practice has been cited as the area
of critical concern to the practitioners.

The elements, generalized expectations, self-other

 

perceppions, situation analysis, and specific expectations, have been

 

 

presented as perceptions which might compositely become the core of

a set of status values which the intern will need as he enters pro-

 

fessional practice.
Having looked at the self perceptions and the role per-
ceptions available within an internship, attention should now be

directed to the professional perceptions which may be provided in the

intern experience.

CHAPTER VI

IDENTITY OF COMMUNITY IN A PROFESSIONAL SETTING

An internship eXperience provides for an initiate an
Opportunity to examine a series of complex and interlocking pro-
fessional values. Some of these have been described but there is an
additional set which is derived from the impressions and convictions
concerning the "place" which he occupies as a professional. This
means that the intern will be given the Opportunity toidevelOp a sense
_of vocational and professional "location", and a sense of his
particular position in the culture and the society of which he is a
part. It is essential that these values be examined if the trainee
is to succeed in assuming a professional attitude and value system,

MacIver and Page1 define the term "community" as being
geographically centered, at least in historical social perspective.
This is logical because all of the essential identifying features of
a community seem to center on the interaction practices of peOple
who are spatially adjacent one to another. Forms of social structure
and organization, and processes for the division of labor, are mani-
festations Of a "community" in terms Of classical definition.

There is an equally important psychological configuration
which is termed "community sentiment". It is this quality which
MacIver and Page identify as the least changing of all community

characteristics because it seems to emerge from a need structure

 

l R. M. MacIver and G. H. Page, Society: An Introductory
Analysis, (New York: Rhinehart and Company, Inc., I§A9).

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85
which identifies man in a society. They say:
Community sentiment is developed by the socialization
process itself, by education in the largest sense, working through
prescription and authority, social esteem and disfavor, until
habits ans conformities become the ground of loyalties and con-
victions.
These sociologists go further in describing three significant
elements of community sentiment. They delineate a Heffeelipg as the

cohesive belonging impression engendered in community living; they

identify a role-feeling as a positional and directive awareness

 

acquired in interaction situations; and they indicate a dependenqy-

 

feeling as that inherent sense which social eXperience nurtures in
3

terms of both physical and psycholOgical needs. They state that

community sentiment:

...stimulates a common interest among the members of a
locality...It embraces both what belongs pg pg, the heritage of
tradition, the positions we occupy in the community, the familiar
features and our possessions and what we belong to, the Obli-
gations and responsibilities that hold— us within the accepted
social order.

 

Tendencies toward community "feeling" or "sentiment” seem
to be natural in the makeup of normal individuals.‘ Each person must
have himself identified as to "where he stands" in his social en-
vironment. The increasing complexity of modern society brings about
conditions which make identification with, or a feeling Of "belonging

to”, transcend the strict limitations of geographic locale.

 

2R M, MacIver and C H Page, Society: An Introductopy
Anal sis, (New York. Rhinehart and Company; Inc., l9h9). Quoted in
Blaine Mercer and Edwin Carr, Education and the Social Order, (New
York: Rhinehart and Company Inc., 1957), p. #2

 

3Ibid., pp. hel-h22.

1*Ibid., p. #22.

86
Roland Warren recognizes this condition in a paper which
attempts to define tendencies toward both locale identification and
organizational identifications.

...community can be analyzed in terms of a horizontal axis
and a vertical axis. The horizontal axis emphasizes locality.

It involves the relationship of the individual to individual or
group to group within a locality...

The vertical axis emphasizes special interests. It involves
the relationship Of individual to a local interest group and of that
local interest group to a regional, state, or national organi-
zation...its principle task is accomplishing some specific
achievement and its principal leadership role is that of the
'problem area specialist'...

 

 

The intern experience, in the light of these statements, may
be thought of as primarily oriented toward the establishment of a
set of vertical identifications. In these identifications the
individual becomes cOgnizant Of the various levels of professional
affiliation which exist within his calling, as well as the re-
lationship Of his professional position to the immediate locale.
Learning in a local and specific situation, the intern will,
nevertheless, become concerned with many elements of professionalism
which will transcend the particular setting of his internship.
Among these elements we find such generalized and inclusive concepts

as: professional ethics, professional rights and reeponsibilities,

 

sources pg professional authoripy and autonomy, and the limitations

 

23 professional practice. The internship will provide an Opportunity
for testing concepts involved in these elements in actual practice

situations and it should provide the intern with a more complete

 

SRoland warren, "Toward a Reformation of Community Theory,"
Human Organization, 15 (Summer, 1956), p. 8.

 

v
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‘ULAt.

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87
understanding and appreciation of their nature. The intern may,
therefore, acquire a set of professional values which should serve
as guides for establishing the attitudes he will carry forward into

future performance.
PROFESSIONAL ETHICS

Adherence to a set Of professional ethics is a fundamental
requirement demanded of practitioners. DeveIOping a sense of the
importance of professional ethics is probably one of the more vital
experiences a training institution can Offer a professional aspirant,
and an intern will usually bring from his prior schooling some ethical
standards which he has develOped in the process of training. In
medicine and in law, definite efforts are usually made to teach pro-
fessional ethics formally prior to contact experiences with clients.
But an understanding of the full impOrt of professional ethics is a
difficult thing to teach and it is equally difficult to learn in a
formal situation.

Ethical standards stem originally from the collective
desires of a profession to circumscribe the performance of practitioners
so that their actions will be above reproach from society-at-large.6
Codes Of ethics emerge from the collective experiences of the pro-

fession and are develOped in light of the service function which the

profession provides for the society.

 

6Flexner in Smith 33 §_l_., _op. cit., p. 556.

5 -..~

c-uy

—..v-

--~--

 

88

It is not society which provides the ethical codes of a
profession, but it is society which provides the arena in which ethical
standards are arrived at and the setting in which they must be
practiced.

It is not the individual practitioner who develops ethical
codes. Alone a practitioner needs only his judgment, his personal
morals and his conscience in arriving at a personal ethic. But a
single practitioner of any craft or skill is not a professional.
Professionalism and ethical codes are built by the collective energies
of many practitioners who are concerned about sharing knowledge and
tradition with new entrants into the field in order that the pro-
fession's purposes in providing vital services will continue to be met.7

Professional concern and effort bring about the ethical codes
which guide the performances of practitioners, but it is only in a
setting Of professional practice that the total import of these
ethical codes can become meaningful.

Teachers, for instance, are supposed to face controversial
social issues which touch their area of specialty. According to the
accepted ethical code they must be impartial and Objective in dealing
with the issues. In general, the code is a fair guide for teachers,
but the exigencies of certain cases can prove it to be a wrong course
of action. Sometimes the two sides of a controversy are not balanced

in the use of logical or empirical substantiating evidence.

 

~ 7Emile Durkheim, Professional Ethics and Civic Morals,
(Glencoe, Illinois: The Free Press, l958§, p. 6.

8

 

Lieberman, 2p. cit., p. Ah3.

 

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89
Sometimes fear, or ignorance, or superstitution, or bigotry may be
the framework upon which the case for one side Of a controversy is
built. If a teacher feels this to be true in a particular controversy
and if he follows the mandate of the ethical code, he may identify
the ignorance or bigotry which motivates a particular side and in so
doing he may be charged with less than impartial behavior. The same
charge could be leveled against him if he did not identify the
ignorance or the bigotry in an attempt to be impartial. Although the
code may be sound for general cases, the professional will find in
certain instances that sections of the code may be untenable.

The intern, consequently, begins to understand the ethics Of
his profession when he begins to work with an experienced practitioner
in situations where ethical judgments must be made. He learns by
Observing the performances of professionals with whom he comes in
contact. There are at least two inate possibilities for learning in
this respect.

The intern will utilize the ethical base which he has
acquired in pre-intern experiences as a standard against which to
measure the performances of his mentors in the internship. This may
place the intern in a position of conflict when his perceptions of
ethical action do not coincide with those which guide his mentor.

He may find as a result of these conflicts that he, being a neOphyte,
may need to modify his perceptions of the ethical issues involved in
the situation due to circumstances not spelled out in the code.

The discovery of disparities between the intern's own set

of ethical orientations and the professional actions demonstrated by

90
his colleagues or mentors, may lead to a second learning alternative.
He may find that his own ethical perceptions have been reinforced and
he will become intent upon avoiding certain courses of action because
they conflict with his standards.

In any event, the necessity to balance his own ethical
perceptions against the conditions and possibilities of professional
action, provide the intern with an Opportunity for making judgments of
an ethical nature and for testing these judgments in "live" situations.
The intern has an Opportunity to gain increasingly deeper insights into
the real meaning of an ethical code as it relates to the making of
professional decisions.

The decisions the intern makes early in his intern experience
will probably be made with closer reference to the letter of the
ethical code, because the code will appear to him as a safer reference
than his own individual perceptions in particular cases, but later
other variables will be taken into account. An illustration of the
point being made might be found in the common reaction Of professionals
toward the actual or implied criticism of other professionals.

Within most professions, it is accepted that judgment of a
fellow practitioner is unwarranted without substantial evidence. The
nature of professional work is such that failure to achieve completely
favorable results in all instances is to be eXpected. Doctors do not
cure, or save, all of their patients. lawyers do not win all of their
cases. Teachers do not fully train all of their pupils. Complete

success in professional practice is not possible.

91

Each failure on the part of a professional can be judged in
two ways. It can be judged in terms of the results of professional
action. Did the patient improve or did his condition worsen? Did
the client win his suit or case, or did he lose? Did the pupil learn
what was planned for him or did he not?

A second basis for judging prOfessional success evolves from.
the course 9: action prescribed by the practitioner. was the course
of action apprOpriate to the conditions of the case? Were all of the
available factors and means weighed in prescribing the course? Did
the practitioner exercise sound judgment in prescribing the course
of action? This second stage in judging professional action is one
which becOmes clear to an initiate after he has been exposed to the
conditions of practice.

As an intern becomes aware of the second stage in judging
professional action his interpretation of ethical codes will be
altered. In the beginning, the code itself will have sufficed in
making judgmental decisions about the work of others. But as he
becomes acquainted with the complexities Of practice he will develop
an awareness Of the right of the professional to consider his own
personal ethic as well as the code in order to arrive at a sound and
appropriate decision. The intern will learn to refrain from judging
on the basis of results rather than on the basis of course p£_action.

Since ethical codes provide a reference point in prescribing
professional performance, the intern will find himself adapting to the
code. This may entail definite changes in attitudes, habits, or

traits common to his pre—intern behavior. Treating professional

92
information as confidential may be contrary to the individual's
previous behavior pattern. Avoiding the temptation to advertise one's
professional ability, or accepting responsibility for providing pro-
fessional services to fill segments of society, these are gross
examples Of the kinds of adaptions which one must make.

The ethics which are ultimately internalized will become
the guiding forces which move the aspiring professional toward
modifying and adapting his value system and behavior patterns so that
they are in keeping with both professional prescription and his own
personal prescription.

The point is not that the experienced practitioner is
unmindful of, or prone to disregard, ethical standards. It is rather
that with experience, ethical judgments are tempered by the per-
ceptions which the professional forms concerning the nature \f his
work, and his concept of his rights and responsibilities. Most
important, the functional purpose of ethical statements may become
more evident. The doctor or lawyer guards professional information
because he becomes increasingly aware that misinterpretations or
misuse of such information can become damaging to his client, to
himself, and to the profession at large. This is an awareness which
goes beyond the formal limits of imposed rules and regulations. It
becomes internalized and a part of the total attitude which the
professional applies to the conditions of his work. It becomes, in
essence, hie responsibility to be discreet with information and it
becomes hi3 right to decide to what professional use that information

may be put.

93

Even if the internalization described above does not Occur
the intern will discover that he mpg: adapt to the standards Of his
profession in order to be accepted by those other professionals who
pass on his qualifications and eventually grant him full status.

He will also need to demonstrate his adherence to ethical standards in
order that the public will accept him. The enforcement of ethical
standards goes beyond the internal needs of a profession.

Society, although not strongly instrumental in develOping
specific ethical standards, is nonetheless functional in enforcing
those that are finally developed. A profession is concerned with the
maintenance of ethical standards for the protection of the profession
itself.9 Society is equally concerned with its own protection against
unprofessional practice once it discovers malpractice. It is not
uncommon to see the results of the stigma which the public attaches
to the physician who advertises, or declaims his colleagues, or
perfOrms service not sanctioned by the bulk of society. The same
social sanctions are applied to the lawyer who violates the canons
of legal ethics in practice, or provides his services in a question-
able manner, or for questionable causes. But confusion often occurs
when the public's and the practitioner's perceptions of ethics are
not in agreement. Conflict may occur for several reasons.

A professional group must, in the beginning, establish an
ethical code which will define and describe professional actions in
such a way that a clear course is identified in cases involving public
or individual welfare. The basic requirement is for specific and

Operational statements. This code must be understood by all

 

9Carr-Saunders, in Smith ep al., ppg cit., pp. Sh8-h9.

91+
practitioners in a professional field, and it must be understandable
when it is interpreted to the public. The rationale for the code
should be clear to the profession, though not necessarily to the public.

Lack of information on the part Of the public may be expected
when one views the number of professions and the variety Of ethical
considerations relevant to each of them.

The existence of an ethical code provides an Operational
referent from which both professionals and society-at-large can judge
professional action. The fact that such a code exists, however, tends
to bind the professional to the general tenor of the code. Ethical
standards are the first and final recourse in the assessment of pro-
fessional conduct and action.

If a practitioner ignores the ethical implications of his
actions, then the public interpretation of such action is not bound
to the ethical referent. The assessment of conduct may center on the
results of action rather than the course pf action itself. From the
foregoing discussion it can be seen that this will cause the pro-

fessional to accept end result responsibility rather than process

 

responsibility for his actions. This will take the initiative for
judging professional performance away from practitioners and place it
at the hands of a less well informed public.

Lieberman makes the point that public education today is
somewhat in this position because the ethical code for educators is not
specific, and consequently not well understood by the bulk of

IO , ,
educators. Professional actions in education are therefore, not

 

loLiberman, pp. cit., pp. hl7-h51.

{I

95
evaluated in reference to ethical codes and consequently the course
pf_action assessments are ignored in favor of result assessments.
The public exerts some undue influences in the judgment of the actions
of professionals in education because of this set of conditions.
Internships in education might offset this if trainees were imbued
with a deeper understanding Of the role and significance of ethics
in their professional work.

The internship is not a place of total learning in terms of
ethical codes. Some aspects of these professional guides are not
fully absorbed and understood even in the first few years of practice.
But seeing them applied in a functional setting can occur in the
internship. The observance of ethical standards can play an important
part in affecting the career of any professional aspirant. Some
professionals who enter practice without benefit of internship do so
without a full grasp of the ethical standards which are nominally
expected of them as regular practitioners, and the transition from
student to practitioner is more difficult as a result.

Beyond the formal requirements of an ethical code, a
practitioner must become individually resourceful in finding his
personal guidelines for professional performance. He will need as
a part of his preparation to have a well—develOped sense of rights
which he has as a professional in the conduct of his practice, and
an equally well-developed sense of responsibilities which accompany

these rights.

96

RIGHTS AND RESPONSIBILITIES

A sense of rights and reSponsibilities, becomes significant
at the point where ethical codes no longer provide a basis for dealing
with a situation.

Emerging from ethical considerations, rights and responsi-
bilities Of a professional position seem to be learned in an intern-
ship. ‘This is another area in which the total learning is not completed
within the span of the internship. But an initial awareness is possible
and the intern can build upon that awareness a system for professional
decision making.

In much Of modern role theory, the idea Of rights and Obli-
gations, or responsibilities, is attached firmly to a concept of role.
The theory presented in this paper does not detract from that
orientation, but does center upon particularized set of rights and
responsibilities which stem directly from, and are applicable to,
professional performance. For this reason they are viewed as an

element in the closed system of experiences which apply to the pre-

 

viously defined concept of professional community.

Rights and respOnsibilities might, in a limited and narrow
sense, be interpreted strictly as ethical standards. But in a broader
sense, this would be inaccurate because ethical standards, to be
effective, must be simple, direct and applicable to a hierarchy Of

characteristic professional services. Every professional experience

 

afforded an intern, on the other hand, is one in which his professional
rights and responsibilities play a part in providing a base for his

decisions.

97

The internship situation, itself, imposes certain restrictions
upon the assertion of the rights and responsibilities of the individual
involved. Rigorous demands upon time and energy as prescribed parts
of a job are common limitations. The intern works long hours; he
performs many of the difficult, unglamorous tasks which may be
associated with the profession. He is Often tested for his willing-
ness to go beyond the normal limits Of duty in doing his work. He
is paid for his services--which become increasingly professional as
his experience grows—-but the payment is fixed at a minimal level.ll

The reasoning behind this set of conditions is not complex.
It represents the utilization of the common device of compelling the
individual to sublimate and discipline his personal desires in
deference to a higher authority. The ultimate authority in this case
being the profession. Since the altruistic aims of all professions
are those Of service to society above all personal needs or desires,
the intern, in his experience is presented the Opportunity to demon-
strate these qualities in himself.

This particular limitation of the rights of the internship
exists in varying degrees within different professional training
programs. Even within a single profession various training prOgrams
may be quite different. It is, nevertheless, one widely used means

of inculcating in individuals preparing for professional practice

 

llJack Starr, "Our New Hospital Crisis," Look Magazine,
2h: (March 20, 1960), pp. 25-33. This article quotes figures
which would indicate that intern shortages may drastically reduce
this tendency in training programs. It is stated that shortages have
driven hOSpitals to place unqualified and ill-trained foreign medical
students in intern positions with little consideration for training and
much consideration for the services they may render. Other professions
have experienced this same problem from time to time.

98
a deeper sense of duty and humility to professional ideals.

The internship then, provides the setting in which an
incumbent is constantly pressed to understand his rights and
responsibilities as a professional in his contacts with clients, with
other practitioners, and with the community-at-large. He is given ‘
greater grants Of authority as he develops.

Each doctor, lawyer, teacher, as a part of his work
responsibility, will find that he exercises significant influence
and control over the lives of individuals with whom he comes in
professional contact. The power to do so becomes one Of the rights
of professional practice and it is a right granted the practitioner
when he is engaged for service.

These rights given the practitioner, may involve grants of
information, relinquishment of patient or client privacy, or enforce-
ment Of client adherence to professional suggestion. Although license
is given to the practitioner, these areas may represent inviolable
domains Of the client's life in regard to all others. The practitioner,
consequently, enters an extremely intimate relationship with many of
his clients. These rights of access, given a practitioner by his
client, carry with them broad attachments of responsibility. The
client literally puts himself in the practitioner's hands and trusts
the professional to assume responsibility for the action which follows.

The doctor is given the right to diagnose and prescribe for
an illness, but he must assume responsibility for his diagnosis and
for his prescription. The diagnosis must be as accurate as possible

and the prescription must be apprOpriate, and potentially beneficial.

99

The lawyer may be given access to knowledge about a client's financial
condition, or his mental state, or his tendency toward social deviation.
He must responsibly use this information pursuant to the performance

of professional services, and never beyond this point. A teacher
assumes the right to control the behavior and actions of his student
charges, but his responsibility binds him to direct these actions
toward the achievement Of socially useful and socially approved goals;

A practitioner's rights and responsibilities as they relate
to his clients or patients come to have real and practical meaning in
an internship situation.

Rights and responsibilities involve not only the client
relationship, but relationship with other professionals. In terms of
professional privilege and obligation, the intern stands to learn
much concerning his interaction with other members of his profession
and with other professions. He will come to recOgnize that as a
practitioner he may assume certain rights and prerogatives which will
carry concomitant obligations to other professionals. This will become
the core Of working relationships which the intern will begin to set
up with his fellow professionals.

The practitioner's awareness of rights and obligations as
these relate to his immediate community are significant facets of
professionalism. The intensive preparation and experience Of the
professional gives him an "expert" status in a community. This implies
a subsequent right to make judgments concerning community problems
centering in his area of specialty. The doctor may be asked to speak

on issues of public health, the teacher on issues of education, the

lOO
lawyer on issues of law and justice. Professionals have both the
right and the responsibility to be heard on apprOpriate issues when
their preparation qualifies them to perform services which will
inform, enlighten or caution the public. This means that the
practicing professional is responsible for extending his interests
beyond immediate practice and into the community Of which he is a
part. He has the right to be heard when he recommends or makes
pronouncements concerning public welfare, but he is responsible for
recognizing the prOper moment for his pronouncements.

The internship is not the arena in which all Of these rights
and responsibilities are learned, but it should be the place where
awarenesses and perceptions of this aspect of professional practice
takes functional form in the minds Of professional aspirants. Such
awarenesses may begin with a delineation of the rights and re-
sponsibilities of the internship, but they extend into the area of
professional autonomy and authority as the trainee is given increasing
responsibility. As the need for professional decision making is
thrust upon the intern, he begins to shift from his initial grasp of
ethics the degrees and sources Of autonomy and authority resident in

the traditions of his profession.
AUTHORITY AND AUTONOMY

Authority and autonomy in professional practice is the 7/“
central reference for the decision—making functions of the practitioner.

The professional man is identified as different from the non-professional

lOl
man in that he is capable and willing to exercise autonomy in crucial
decision making, but he is equally willing to submit to authority
when this will best facilitate sound decision making. The pro-
fessional man Operates within the Sphere of authority, both social
and professional, but he is given greater latitude in the selection
Of the authority upon which he bases his decisions. He uses this
authority, then, as a tool rather than as a limiting instrument and
it becomes the key in explaining his value to society. He is capable
of diagnosing and treating an illness; he is competent in tracing the
course of justice as an individual's actions are measured against the
law; he is free to teach and discuss those ideas which may brook
controversy but which Open new inquiries to science, philosophy or the
humanities.

What are the sources of authority from which the professional
draws his counsel? Where must he look when the burden of critical
decision rests whOlly upon him? How does he select a source of
authority which will support him in the final analysis of his decision
making? These questions are almost rhetorical in that there are no
complete and total answers. But the professional man, due to the
nature of his work and responsibilities, must be on familiar working
terms with the sources of authority for his profession if he is to
practice effectively.

One Of the major sources of authority utilized by the
professional centers in the preparatory training which qualifies him
for practice. The areas of knowledge, and the disciplines COgnate

to his field of specialty, serve as systems Of authority upon which he

102
must draw constantly in practice. The principles and theories which
he has learned; the processes of inquiry, of deduction, and of
experimentation which he has acquired; and the empirical knowledge
which he has absorbed through training and experience, serve as his
central source of authority.

Society, in terms of custom, code and law, will set up
certain limits of practice which will provide a second source of
authority. But the professional man, in the course Of most of his
normal practice, will not find these limits unduly binding. His
training and his ethical code will normally keep his actions well
within the bounds of any form of legal or cultural limitation.

In all established professions,legal agencies exercise authority in
terms of licensure or dispensation to practice. These usually
represent the minimal requirements for admission to practice and
roughly prescribe the outer limits of professional conduct. These
groups may be drawn from a profession but as such the group functions
for the society as a whole. In this respect society is the ultimate
authority as regards the judicial and the conduct aspects of pro-
fessional practice.

(The profession, itself, also serves as a source of authority.
The ethical standards which it prescribes, the traditions and ideals
which it supports will become authority referents for the professional.

But authority, without a concomitant sense of autonomy, does
not alone define the professional man. It is probable that the major
portion of professional decisions are predominantly based on autonomous

actions.

 

12See: Carr-Saunders, pp, cit., pp. hOh-h2l.

103

The internship provides opportunity to bring the elements
of authority and autonomy into play as decisions are made. The reality
of diagnosing a patient's illness and prescribing a treatment appro-
piate for it; the responsibility for preparing a case at law so that
justice to both client and society will be done; the challenge of
bringing powerful physical phenomena to bear upon the solution of human
problems in a constructive or a destructive manner; these become the
points in professional practice in which a balanced sense of pro-
fessional autonomy and authority are engaged. It is from a sense of
ethical standards, with a clear cut perception of rights and

responsibilities, practiced with an awareness of the interplay of

 

autonomy and authority that "professionalism" is learned. Learning
these, the intern must eventually come to recOgnize that any profession,
in the end, is incomplete, and is, moreover never fully prepared to
achieve its ultimate goals in any society. There are elements of
uncertainty prevalent in all professional decisions and these elements
emerge quite often from the limitations of professional knowledge

and experience.
PROFESSIONAL LIMITATIONS

Professional limitations represent an inevitable awareness
which comes with exposure to professional practice. Every professional
activity, whether it be law, medicine, education, engineering or
theology has some areas of uncertainty.13 It is this uncertainty, and

the inability of the untrained to deal with it, which creates a need

 

Renee Fox in Merton, pp: cit., pp. 207-2hl.

101+.

for the services of professional people in the first place. The
professional man is aware of the uncertainties associated with his
field, but he has prepared more intensively to deal with these un-
certainties, and he is conditioned to face them more rationally and
objectively for the purpose of reducing them to manageable form.
This does not mean that uncertainty is eliminated by the professional,
because this will never be the case with the variables of human
existence. But the professional man deals almost exclusively with
these items in his practice; as a result, he becomes increasingly
aware of the limitations of his profession in achieving the altruistic
aims which are set out for it. This in no sense makes a cynic or a
doubter of him. On the contrary, it is the rec0gnition of this un—
certainty which causes him to seek answers to questions, or hypothesize
and experiment in order to add to the stock of certain knowledge
which exists in his field. The reduction of uncertainty associated
with medicine, or law, or education, then, becomes an aim of the true
professional in these fields.

Professional limitations go beyond uncertainty, however.
In each profession there is a point at which each general practitioner
and each practicing specialist must recognize that the services of
another professional become more apprOpriate to a case or a condition.
This is a decision situation in which the practitioner must assess
his personal and professional abilities and weigh them against the
conditions which he faces. It is a time for sober and mature
reflection; a time in which the professional man honestly measures his

resources against those of one more ex;erienced, or more skillful,

or more intensively trained, and decides to consult with him or refer

lOS

the case to him for continuance. This requires sound judgment and
honest interpretation, and it must emerge from the realization that
a specialist can provide a better answer.

Such decisions must be made within all professions, and the
ultimate utility of the specialized training and practice within a
profession is dependent upon this realization in each practitioner.
The total value to each practitioner, in turn, is dependent upon
the realization that special services exist, and on his ability to
diagnose conditions and refer to the proper specialist. This implies
that preparation for professional practice requires that the aspirant
have, in addition to his own sense of professional authority and
autonomy, a sense of professional humility. This can only be gained
through experience in practice. The internship offers such

experience.
PROFESSIONAL VALUES

Professional values become the ultimate summation, then, V
of the intern experience. In terms of the sense of professional
community engendered by the eXperience, these values will ultimately
become the individualized ethic which marks the experienced practitioner.
These values will be composed of the elements which have been discussed
previously.

They will center, originally, in the formalized ethical
standards which guide all members of a profession. They will gradually

be supplemented by a growing concept of rights and obligations and a

 

concommitant recognition of authority and autonomy as it relates to

106
professional practice. Throughout the experience, the intern will

become increasin' aware of the limitations of his 'rofession and
s E,

 

 

of the uncertainty which characterizes it. He will become equally
aware of his personal professional preparation as it compares to the
specialized fields of practice within his own profession or within
other professions.

Having acquired these values, the professional is better
prepared to face the problems and make the decisions which he will incur
in practice. His sense of professional responsibility and his
perception of a professional "place" in society will be firmed by
these values. It is therefore assumed that his performance and his
service will be apprOpriate to the prescription laid down by his

profession and in keeping with established public expectations.

CHAPTER VII

§_CONSOLIDATED THEORY 92 INTERNSHIP

 

In the preceding chapters, the internship has been viewed in
terms of its origins, and its possible functions as a phase of training
for the professions.

As an educational method, it has been pointed out that the
internship has limited, and specialized qualities. It has-been further
stated that the concept seems to have received little intensive study
as an educational device. Nevertheless, it has been employed in certain
professions to a degree that there are many opinions concerning its
utility and effect.

The case for presenting a theory of internship has been
reviewed and the rationale from which such a theory should develOp
has also been identified.

This final chapter, as a summary, will recapitualte the
foregoing concepts and will attempt to integrate them into a concise

theory of the internship.

PERCEPTUAL LEARNING IN THE INTERNSHIP

Perceptual learning is usually a by-product of, rather than
a center for, the assessment of change on the part of a learner.

When an elementary school child is exposed to the multi-
plication tables or a concept in geography or new material in reading,
attention is placed upon how well he can adapt and respond to the

107

108
learning eXperience, rather than how he perceives the situation and
what meaning these perceptions have for him. Teachers assess performance
rather than perception. The logical assumption is made that one must
perceive and understand in order to perform; therefore, performance
becomes an index of perception. The next logical step is that of
setting standards of performance which will serve as comparative
measures of quality and quantity of learning. This tends to move
attention even farther away from perception in the direction of
performance.

If a teacher deals with a child experiencing learning
difficulty, the teacher will become concerned with the child's
understanding of the material to be learned. Ordinarily, however,
there is a pre-structured method for reorganizing a child's perceptions
to fit the pattern necessary for demonstrating competence in performance.
Teacher initiative is therefore directed toward perceptual re—structur-
ing rather than toward understanding on the part of the child.

All formalized educational experiences follow this general
pattern. From early elementary school through the highest level of
graduate school, an individual must be intent upon restructuring his
perceptions according to pre-established patterns.

In contrast, professional practice does 23: follow a pre- ' x/
established pattern. The nature of a particular kind of professional
practice will dictate that a limited variety of services will be
performed by the practitioner, but the order of their occurrence,
and the intensity of the practitioner's involvement occur randomly

rather than on some scheduled or ordered sequence. This imposes a

109
necessity for competence in many areas, and flexibility on the part
of the practitioner. It demands that he work from a set of basic
theories and principles rather than from a pre-established set of
solutions to a set of specific problems.

If he has acquired his prerequisite theories and principles
in an ordered fashion, it may be very difficult for the practitioner
to call them into play unless he perceives himself in his role as a
practitioner, and the professional community of which he is a part,
as interrelated facets of the total problem on which he is asked to
serve as a decision maker. It is difficult, therefore, to relate
principles and practice in a professional setting without some

experience and guidance in doing this. Beyond this it is difficult

to form professional judgments and to arrive at professional decisions

without this ability to relate theory to practice.

The responsibility for forming judgments and for making

decisions based on principles as they relate to a particular situation

is the identifying feature of the professional man. Adequate prepar-

ation to meet this responsibility will come from an intern eXperience.

The internship, by its nature and its structure, is basically

different from other formal learning situations. The arrangement of

learning eXperiences, the assessment of learning, and the use to which

that learning is put, is different and more realistic i.e. less
ordered than are the learning situations in public schools and
colleges.

The areas of learning which have been identified as most

significant in intern situations are different from those usually

llO
identified in the assessment of formal learning experiences. For
this reason, it is expected that modified analytical and evaluational
techniques will be needed to investigate the implications of this
theory.

All of the areas of learning and identification discussed,
imply perceptions made and values acquired as a result of the intern
experience. For the most part, they are elements which will be, or
should be, internalized by the incumbent so that actual determination
of their effect will not always be traceable in overt behavior. They
might, in fact, be best identified by individual self analysis. This
does not detract from their significance in an educational sense,
because some of the weaknesses of prevailing educational structure
and practice stems from its failure to account for the individual's
perception of change in himself as a result of his learning.

Attention has been given to this aspect of learning, but
such attention has usually been centered within the disciplines of
psychology and sociOIOgy and has had little influence in the edu-
cational, or more specifically, the pedagogical practice.

Getzels and Thelenl have discussed this problem in accounting
for the effects of classroom experience upon the learning of
individuals within the classroom. They have initially considered
the classroom as a "social system" involving individual, group, and

institutional referents. Their conceptual model is one which is

 

‘lJacob Getzels and Herbert Thelen, "The Classroom as a
Unique Social System" in Nelson S. Henry, The Dynamics 9: Instructional
Groups (59th Yearbook of The National Society for the Study of
Education, Part II (Chicago: University of Chicago Press, 1960),

pp. 53-82.

lll
intended to show the interrelationship of significant factors on an
action frame. This action frame accounts for the interrelationships

existing between the factors influencing the behavior of individuals

 

 

 

 

 

involved.2
ethos. apmores esvalues
/l]\l TITUTION——-)-RO ¢BXPEC ATIONS
The Class
as a—a-GR UP— =CLIMATE >INTEN IONS—>60 1

social Behav or
sy tem .

IN IVIDUAL—v-P ONALITY——>NEEDS

rganism— ' :constitution—gpotentialities

 

This three-dimension conceptual system bridges a gap which
has separated the social, interactional and psychological con-
siderations which are an integral part of any learning situation.
Theorists have traditionally considered only one dimension of
learning in interaction situations. In the schematic above, the
lower line defines the psychological complex of individual traits and
qualities. The center line accounts for the interactional factors
functioning in a classroom. The upper line identifies the sociological
group of institutional factors which influence the situation.

The model implies that there is both horizontal and vertical
relationship between each of the identified factors and tacitly
suggests that one is not more significant or predominant than another.

Horizontal flow implies that change (learning) is an

involvement of all of the factors identified in the conceptual

 

2Ibid., p. 80.

l12
schematic, and that action, or dynamics, might occur in a left to
right direction from the setting of the classroom to the observed

behavior.
A SCHEMATIC DESIGN OF THE INTERNSHIP

With modifications, the model structure utilized by Getzels
and Thelen can be adapted for the purpose of schematically identifying
change (learning) potentially resident in an intern situation. Such
a model is arranged as a refinement of the schematic presented in
Chapter I.

Utilizing a vertical rather than horizontal flow sequence
it might be assumed that learning. in the dimension of SELF, ROLE
and COMMUNITY might progress downward from these centers to the value
composites which are the summation of these elements.

Each of the items identified in the three vertical tracks
appear to be interrelated both in a horizontal as well as a vertical
relationship. The downward progression is not intended to imply a
rigid sequential order for the appearance of these identifications or
awarenesses in an intern. It is possible, for instance, to theorize
that commitment might precede all of the other items on the SELF

dimension. Commitment might even follow the limitations element in

 

 

the COMMUNITY line. The point here is not to identify sequence and

order as much as to account for those interrelated elements which go

to make up the complex of learning experiences in the internship.
Viewing the model horizontally, that is, from a comparison

of coordinate items in the three dimensions, an attempt might be made

113

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SELF ROLE COMMUNITY
Personal Generalized _‘i 7 ‘_ Ethical
~<+—————————.. _‘ ,_ .
Capacity Expectations Stan -rds
.1! . V .
Aspiration Self-other Rig ts-
-e—————————a~» ~<e————-—————4>-
Level Perceptions Obligations
if . V. .
SpeCiali- 44 __ Situation 1. ‘__ Auth rity-
zation “ ’* Analysis “ ” Auto omy
Professional SpeCific 11 ‘gProfes ional
Co itment Expectations _‘ II Limit tions

 

 

 

 
   

Status

Values Values

 

llh
to assess interrelationships as they exist in the ranges of SELF,
ROLE and COMMUNITY.

The median position of ROLE implies that the entire intern-
ship experience centers here. In other words, an intern will realize
'little in terms of professional perceptions outside the contact
situations of his experience. But with each of these identity
perceptions occuring in the ROLE dimension, certain concomittant
realizations might be expectedto occur on the SELF and on the COMMUNITY

dimensions. As an example, assume that generalized expectations

 

are to occur in the internship, a concurrent assumption could be

made that these would influence personal capacity perceptions at the

 

SELF level and ethical perceptions at the COMMUNITY level.

 

. The same interrelationships might apply to a central con-

sideration of self-other perceptions on the ROLE continum. It could

 

be eXpected that these perceptions influence the aspiration perceptions

in the SELF dimension as well as the rights-obligations identification

 

on the COMMUNITY level.

Further assumptions and hypotheses could be drawn concerning
the interrelationship of any of the elements identified in the schematic
structure. Empirical research can be designed to test the significance
of each of these theoretical variables and to verify an hypotheses of
influence of interrelationship.

It has been indicated earlier that the approach to this
theory has been centered in sociology more than in psychology. It
has been stated that the existence of the internship as a sociological
entity has prompted this approach and that by using a closed system-

element reduction process, the concept has been brought into

115
sociological perspective. It has been prOposed that the kind of
learning potentially resident in the internship is social in nature.
But it cannot be expected that a full Justification for the internship
can exist if the psycholOgical implications which exist within the
concept are ignored.

Human learning, in any form, is subject to certain influences
which are best accounted for in the "laws of learning" as defined by
psychologists. Learning is, in final account, strictly an individual
process. Perception, the heart of this theory, is a psychological
process which involves the phenomena of attention, association,
memory, discrimination, patterning and conceptualizing.3 If learning
is to take place in an internship situation then, it will call these
processes into play as the incumbent intellectualizes his experience.

When reducing an internship experience to its basic components,
it can be described as: composed of peOple, interacting in a specific
setting, for the purpose of dealing with a particular kind of problem.
Each person in such a setting will have perceptual learning Oppor-
tunities. Since concern here centers on the educative potential of the
internship, attention must be concentrated on the constant perceiver,
the intern, rather than on the transient perceiver, the patient or
client.

The internship, can be Justified however, on psychological

grounds in rec0gnizing that it is a conceptual structuring device

 

3A discussion of the mechanics of perception and understand—
ing may be found in: Lee J. j ronbach, Educational Psychology, (New
York: Harcourt, Brace and Co., 195%), pp. 277-299.

116

which centers in the individual. Study can be made of the three
perceptual areas SELF, ROLE and COMMUNITY in the light of their socio-
psychological dimensions.

The SELF perceptions gained in internship, although strongly
influenced by the social situation, will provide for an individual
an intrinsic kind of personal-worth index as he deals with pro-
fessional problems.

The ROLE perceptions will provide an awareness of the
dynamic qualities of professional practice and will serve an intern
as an index of the reciprocal qualities of professional interaction.

The COMMUNITY perceptions will provide an extrinsic index
of the relationships which exist between the individual practitioner
and the professional community of which he is a part.

The internship should serve as a "finishing experience"
which completes the training of a professional practitioner in such
a way that he knows the work of a doctor or lawyer or teacher;
he acts as a doctor, lawyer or teacher is expected to act; he thinks as
a doctor or lawyer or teacher in conjunction with his work, and he

feels as a doctor or lawyer or teacher, based on his identity perceptions.
SUGGESTIONS FOR FURTHER STUDY

The theory presented in this study has been develOped as a
means for stimulating research on the educational value of the internship.
It has been stated previously that the "rightness" or
"wrongness" of this theory can be determined only by empirical

investigation.

117

This suggests that research efforts need to be directed
towards the internship as an educational process and the various
assumptions contained within the theory need to be tested for validity.

The utility of this theory results from the composite
assumptions which have been develOped and these assumptions are
presented in such a way that the dimensions of identity and their
components are structured.

It is possible to test the theory which has been proposed in
this paper if an internship program of the kind defined in chapter one
is available. It is possible to study the various assumptions of
the theory and it is possible to verify or negate them through methods
of organized inquiry.

If empirical study is made of the internship and if the
assumptions of this theory are found to be correct, it would seem
that the internship, as an educational method, would be recognized
as an essential phase in the preparation of professionals whose
services center on interaction with peOple. This would provide
deeper insights into the complex process of preparing people for
professional practice and it would formally recognize the significance
of the perceptual aspects of learning experience. These in turn might
offer suggestions for change in pre-intern or post-intern training.
The profession in general and practitioner in particular might
benefit from changes in training procedu as made as a result of
conclusive empirical evidence.

Since the theory evolves around the perceptual potentia s

inherent in the internship, it appears that particular kinds of

118
research techniques and instruments might be more apprOpriate than
others. Perception at all levels is a particularly internal phenomenon.
For this reason, much of the investigation of intern awarenesses will
stem directly from responses elicited in the trainee. Perceptions
are not overt, and cannot be implied from behavior with any degree of
accuracy. It is, therefore, necessary to consider devices and
techniques which will identify in an intern the awarenesses and the
identities he may develOp as his experience-continues. The mere act
of identifying the elements prOposed in the theory will tend to
heighten their significance and the candidate may give greater credence
to their value in professional preparation. This in itself will
constitute learning.

Since perception is a central focus of these identity
dimensions it would seem that verbalization and record keeping might
be the two most frequently used sources of data. Depth interviews
and journals or diaries can provide information about a trainee if
an evaluator knows what he is seeking. Intern supervisors who serve
as counselors can form conclusions about an intern's awareness of the
identity elements as he assesses background and conditions in making
decisions.

Certain socio-metric techniques, role playing, and inter-
group ratings, can provide clues to the appearance and the intensity
of professional perception and awareness in interns.

Self assessment instruments utilizing forced choice items
might provide valuable data concerning the elements of SELF, ROLE

and COMMUNITY perceptions.

119

Scales designed to measure dependence-independence intensities
in decision making could be constructed. Multi-dimensional per-
ception assessments, i.e. instruments which might gather information
on several perceptual elements, might be devised and used. In this
way some recognition of the reciprocal influences of various perceptions
might be determined.

These suggestions imply,.then, that a frontier exists in the
area of the internship. The real educational effectiveness of the
method has not been determined. Its efficiency is now supported
mainly by opinion. The professions need evidence which will support
or destroy the contention that the internship provides an essential
and unique kind of experience in the training of professionals. This

theory has been designed as a part of that larger purpose.

120

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HICHIGRN STRTE UNIV LIBRRRIE

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