All relationships within a hospital are based on the authority of one person over another. When medical students first arrive on a hospital ward, they immediately find themselves enmeshed in a pre-existing, well-defined system of hierarchical work relations. Taking their place alongside (or more likely in back of) staff physicians, residents and interns, students join the medical sector of the ward community, which – apart from patients – otherwise consists almost exclusively of people whose work supports the doctors in their therapeutic activities.

Part of the task for any newcomer seeking entry to an established group is to identify, and be identified with, the prevailing culture. Medical education, like other professional socialization experiences, seeks to assimilate individuals into the system by imbuing them with a sense of group solidarity, obeisance, and esprit de corps. The wards in which doctors in training gradually learn to be part of the medical team provide the most powerful structure for this aspect of the socialization process.

Idealistically, and perhaps naively, it is often assumed that, in addition to the acquisition of knowledge and skills, during their apprenticeship on the wards, medical trainees will be exposed to the attitudes and values of senior physicians who, through instruction and example, will nurture those attributes society expects from the medical profession, e.g., compassion, integrity, and a sense of professional ethics. Although this idealistic portrayal of life on the wards sometimes does occur, the history of the emergence of the teaching hospital attests to the hurdles to be overcome and idealism's subsequent rarity.