臺灣醫師世家的生涯代間傳遞

Intergenerational Career Transmission in a Taiwanese Medical Family

10.6251/BEP.202012_52(2).0003

顏姿吟(Tzu-Yin Yen)；連廷嘉(Ting-Chia Lien)

生涯代間傳遞 ； 整合歷程系統 ； 醫師世家 ； intergenerational career transmission ； integrative process systems ； medical family

教育心理學報

52卷2期（2020 / 12 / 01）

287 - 310

繁體中文

本研究從代間的親子互動，探討醫師家庭世代間生涯代間傳遞的內涵。研究參與者是一個臺灣醫師世家的三代家庭成員，其中祖父與父親為醫師、孫子為醫學生，採用敘說研究的方法進行質性訪談，以「整合歷程系統」觀點，運用「類別－內容」方式分析家庭互動對個體自我生涯抉擇與代間傳遞的影響因素。結果發現：（1）臺灣社會對醫師生涯偏愛有文化特殊性，醫師世家子女之生涯抉擇歷程是社會、時間，與空間等三維影響的結果。（2）生涯代間傳遞包含社會模式與親代模式等二模式相互影響：社會模式中，社會塑造卓越意義，影響個體的認同。子女覺知父母價值觀後、或認同此「社會卓越」後，直接或間接抉擇醫師生涯；親代模式中，父母接受「社會卓越」後，認同與凝聚家庭共有意義，不斷迂迴傳遞職業正向訊息，孕育自家之助人利他的「獨家意義」，影響並穩固子女認真學習生涯所需技能，更加速生涯抉擇的時機點。親子相互影響，不能忽視彼此的力量。社會模式建構的「社會卓越」與親代模式建構的「獨家意義」，二者都會影響價值觀的傳遞。最後，根據研究結果進行討論並提出建議以供諮商工作、與未來相關研究參考。

In Taiwan, medical doctors have enjoyed privileged socioeconomic status since the Japanese colonial period. Although the prestige of doctoral professions has been challenged by changes in the medical environment and the introduction of the National Health Insurance program, most elite students are still expected to pursue a career in medicine and commit to it. The annual lists of students admitted to medical schools are widely discussed in the media, and they have also become something that high school rankings are based on. These medical students are often found to share similar backgrounds. In addition, there are numerous parent-child or sibling combinations in the field of medicine and even medical families that have produced multiple generations of medical doctors. In such instances, human capital, including property and nonmonetary rewards, is transferred within the family. Although no obvious barriers exist, the path to becoming a medical doctor requires more than well-defined interests or values. Individuals must ace the college entrance test, attend a competitive medical school, acquire comprehensive and systematic knowledge and skills, and pass a series of licensing examinations. Throughout the long and stressful process, the role of intergenerational transfer and the selection of information should not be underestimated. Studies have indicated that within the multigenerational transmission process, individuals' development as well as families' interaction patterns must be identified. Moreover, in the East-Asian social context of Taiwan, in addition to the person's personality characteristics, career decision making often reflects occupational prestige and parental expectations. Therefore, both psychological factors and sociocultural contexts must be considered to understand individuals' career choices. This study applied the ＂Integrative process systems perspective＂ to investigate the influence of a Taiwanese three-generation medical family on its offspring's career development in the family's interaction. Employing narrative inquiry as the method, this study explored the experiences of members across time and space with integrated and dynamic characteristics. Serial interviews were conducted with the grandfather and father, who were doctors, and with the son, who was still a student currently majoring in medicine. They were asked to talk about the family's interaction as well as career choice, including their impressive familial stories, their experiences of career exploration, tendencies toward a specific occupation in different stages of development, the timepoint of commitment, the reason and meaning of becoming a doctor, and the family's interaction patterns before and after members become a doctor. The category-content method was then used to analyze the factors of family interaction affecting an individual's career decision making and intergenerational transmission. With the participants' emotions, meanings, needs, perceptions, and awareness of situations, this study attempted to disclose an individual's identity under ＂who I was,＂ ＂who I am,＂ and ＂who I will be＂ and also to reveal familial and social cultures. The purpose was to present the process of intergenerational career transmission on the medical family and outline the complete construction. In this study, the researcher was responsible for interviews, data transcription, analysis, and interpretation. To avoid the subjective bias of the researcher and establish credibility, a co-analyzer was invited to examine the process and product of the inquiry, determining validity in terms of logicality and persuasiveness. The results of the study revealed that intergenerational career transmission in the medical family was a process of interplay between family subsystems, embedded in social culture, which strived for harmonies between the maintenance of consistency and introduction of change. Individual family members were also mutually influenced by each other. The transfer of cognition and feeling led to the son's decision to follow in the footsteps of his grandfather and father. In other words, intergenerational career transmission had characteristics of systems, processing, and integration. It was a continually changing, adapting, and spreading process. 1. A cultural trait of Taiwanese society is that a career in medicine is highly preferred. The career-selection process for the son was influenced by society, time, and the environment. Society attributes prominent significance to the profession of medical doctor, building the stage for an individual's career-selection process. Identifying with the significance of social prominence, the family created an environment of self-discipline that valued academic achievement and strictly regulated the scope and time for an individual's career exploration. The family gradually conformed to mainstream values and encouraged their children to strive for a career in medicine. 2. Intergenerational career transmission included the influence between two interplaying models: a social model and a parental model. Moreover, parents and their offspring were mutually influenced by each other at the family level. Each factor cannot be separated, and all should be considered in the context. 3. In the social model, the establishment of highly praised social prominence affected individuals' identification with a career in medicine. Children's career choice was influenced directly by accepting the viewpoint of social prominence or indirectly by the awareness of their parent's values. In the parental model, parental identification with social prominence led to the formation of familial meanings. The parents continually implied the positive information of the doctoral profession and proceeded to develop the family's ＂unique meaning＂ of altruism. This unique meaning encouraged the children to acquire competencies required in the field, accelerated the career-selection process, and brought forward the timepoint of commitment. Both ＂social prominence＂ in the social model and ＂unique meaning＂ in the parental model affected the transmission of values interactively. 4. The Taiwanese medical family was a marital-and-maternal-oriented system based on boundaries, rules, and career achievements. The family reinforced the unity of husbands and wives. Both spouses in each generation cooperated in domestic life but stressed the maternal career. The husbands were the role models for the children but spent most of their time at work. On the other hand, the wives assumed more responsibility for caring for and parenting the children. Well-demarcated boundaries and precise rules between subsystems and individuals in the family system, accompanying the family's emphasis on the children's academic achievement, promoted their offspring's pursuit of a career in medicine. Based on these findings, this study produced several discussions and provided suggestions for those working in counseling practice or related research. Career choice is not a simple process of matching an individual with an occupation and was influenced by the systematic context, the individual himself or herself, and the relationship. Therefore, in addition to an individual's independence and autonomy, local counseling practitioners should consider the impacts of social culture, internal and external familial resources, and the awareness of an individual's experiences in each stage of development. This study mainly focused on the phenomenon of intergenerational career transmission in a medical family. Thus, career decision making regarding a career in medicine was emphasized in the interviews. Apart from this topic, wives in the system were found to have quit their own careers immediately and fully support their husbands' careers after marriage. The family also used different parenting styles depending on the sex of the children. Moreover, a third-generation daughter did not choose a career in medicine. From the perspective of a family system, the following questions are raised: what is the career-selection process of these nonmedical profession members? Is there any difference between sons and daughters? In the process, how did mental functioning and accommodation work? Future research should investigate the sex difference, mental functioning and accommodation of nonmedical profession members, and career-selection process of children who have not pursued a career in medicine.

1. 王秀槐, H.-H.,陳珍德, J.-D.(2019)。問世間「生涯」為何物？臺灣大學生生涯概念原型分析研究。教育科學研究期刊，64(2)，39-68。
   連結：
2. 吳淑禎, S.-C.(2018)。生涯韌力：大學青年的生涯逆境知覺及其因應策略之研究。教育科學研究期刊，63(3)，197-230。
   連結：
3. 顏姿吟, T.-Y.(2017)。家族生涯價值觀代間傳遞之個案研究：一個醫師世家的初探。輔導季刊，53(2)，35-47。
   連結：
4. Alderfer, C.(2004).A family therapist’s reaction to the influences of the family of origin on career development: A review and analysis.The Counseling Psychologist,32,569-577.
5. Bowen, M.(1978).Family therapy in clinical practice.Basic Books.
6. Brown, D.(Ed.),Brooks, L.(Ed.)(1996).Career choice and development.Jossey-Bass.
7. Chen, Y.-C.(2019).Study of the factors affecting the career development of new-immigrant-children university students in Taiwan.International Journal of Higher Education,8(6),192-202.
8. Durlauf, S. N.(Ed.),Blume, L. E.(Ed.)(2008).The new palgrave dictionary of economics.Palgrave Macmillan.
9. Goldenberg, I.,Goldenberg, H.(2008).Family therapy: An overview.Thomason Learning.
10. Grusec, J. E.,Goodnow, J. J.(1994).Impact of parental discipline methods on the child’s internalization of values: A reconceptualization of current points of view.Developmental psychology,30,4-19.
11. Guba, E. G.,Lincoln, Y. S.(1989).Fourth generation evaluation.Sage.
12. Hatch, J. A.(Ed.),Wisniewski, R.(Ed.)(1995).Life history and narrative.The Falmer Press.
13. Kerr, M. E.,Bowen, M.(1988).Family evaluation: An approach based on Bowen theory.Norton & Co..
14. Laband, D. N.,Lentz, B. F.(1983).Occupational inheritance in agriculture.American Journal of Agricultural Economics,65(2),311-314.
15. McLeod, J.(2011).Qualitative research in counseling and psychotherapy.Sage Publications.
16. Paryente, B.,Orr, E.(2010).Identity representations and intergenerational transmission of values: The case of a religious minority in Israel.Papers on Social Representations,19,23.1-23.36.
17. Pinsof, W. M.(2005).The integrative psychotherapy alliance: Family, couple and individual therapy alliance scales: Revised-short form.The Family Institute at Northwestern University.
18. Pinsof, W. M.(Ed.),Lebow, L. L.(Ed.)(2005).Family psychology: The art of the science.Oxford University Press.
19. Radford, J.(Ed.)(1998).Gender and choice in education and occupation.Routledge.
20. Riessman, C. K.(1993).Narrative analysis.Sage Publications.
21. Super, C. M.(1976).Environmental effects on motor development case of African infant precocity.Developmental Medicine and Child Neurology,18(5),561-567.
22. van Ecke, Y.,Chope, R. C.,Emmelkamp, P. M.(2006).Bowlby and Bowen: Attachment theory and family therapy.Counseling and Clinical Psychology Journal,3(2),81-108.
23. Wang, Y.-C.,Shelley Tien, H.-L.,Wu, C.-L.(2018).The relation of career adaptability to work-family experience and personal growth initiative among taiwanese working parents.Journal of Employment Counseling,55(1),27-40.
24. 季瑋珠, W.-C.,楊志良, C.-L.(1985)。醫學生社會化影響因素之探討。中華民國公共衛生學會雜誌，5，3-23。
25. 金樹人, S.-R.(2011).生涯諮商與輔導.東華書局=Don-Hwa Publication.
26. 張苙雲, L.-Y.(2009).醫療與社會：醫療社會學的探索.巨流=Chuliu.
27. 許芳菊, F.-C.,黃勝雄, S.-H.(2001)。e 世代醫學生價值觀大調查。康健雜誌，6，74-81。
28. 陳君愷, C.-K.(2010)。日治時期臺人「習醫偏執」所反映的社會意義及其影響。文化實踐與社會變遷，1，127-195。
29. 黃光國（編）, K. K.(ed.)(2009).儒家關係主義－哲學反思、理論建構與實徵研究.心理=Psychological Publishing.
30. 黃孝鏘, H.-C.,謝小芩, H.-C.,秦燕, Y.,黃蒂, T.,洪德茂, T.-M.(1993)。醫學中心住院醫師、實習醫師生活、學習、工作現況及其從醫動機之探討。公共衛生，20(3)，277-283。
31. 黃毅志, Y.-J.(1997)。臺灣地區社會科學研究的收入測量問題之初步探討：以臺灣地區社會變遷調查為例。中研院調查研究，4，39-65。
32. 葉光輝, K.-H.(1999)。家庭中的循環衝突。應用心理研究，2，41-82。

1. (2023)。直視壓迫：以社會支配論分析《日常對話》。輔導季刊，59(4)，1-14。