Lost in translation? Paradigm conflict at the primary-secondary care interface

Med Educ. 2019 Jan;53(1):56-63. doi: 10.1111/medu.13758. Epub 2018 Nov 15.


Context: Historically, primary care (community and family) medicine has often been viewed as lower status than secondary care (hospital) practice. Current evidence suggests this pattern continues to impact medical practice and education. Medical education has however, yet to fully reflect this power dynamic, with undergraduate training in many institutions maintaining the hegemonic position of secondary care as the prime context for learning.

Methods: In this paper, we present primary and secondary care as conflicting paradigms of medical practice. Using a sociocultural lens drawing on Figured Worlds theory, implications for medical education are explored.

Conclusions: We outline the two paradigms as having distinct epistemologies, identities and practices. Tensions at the primary-secondary care interface can, from a sociocultural perspective, be seen to impact developing identity and day-to-day clinical practice issues such as patient safety. We offer possibilities for engaging with paradigm conflict in meaningful ways and suggest potential changes for future educational policy and practice.

MeSH terms

  • Education, Medical, Undergraduate / methods*
  • Humans
  • Learning*
  • Patient Safety
  • Primary Health Care*
  • Secondary Care*
  • Social Theory