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Cullum RJ, Shaughnessy A, Mayat NY, Brown ME. Identity in lockdown: supporting primary care professional identity development in the COVID-19 generation. EDUCATION FOR PRIMARY CARE 2020; 31:200-204. [PMID: 32589524 DOI: 10.1080/14739879.2020.1779616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The current COVID-19 pandemic has dramatically impacted undergraduate medical studies. Whilst challenges for knowledge and clinical skills are being actively addressed, wider considerations such as the impact on professional identity development have been mostly neglected thus far. A robust professional identity is linked to professional behaviour and has been shown to reduce burnout and be an important factor for general practice career choice amongst medical students. The Communities of Practice Model is a sociocultural approach that conceptualises the formation of professional identity through student engagement within a community. We argue the current suspension of clinical placements holds the potential to negatively influence such identity acquisition. In this commentary we explore how the Communities of Practice Model may inform professional identity development of medical students within the COVID-19 environment, considering digital communities and volunteering roles within primary care. We further encourage educators and institutions to consider professional identity in future planning to address the challenges posed by the current situation, both in terms of placement loss but also changes in the way primary care is delivered. Such considerations will be essential if we are to avoid problems relating to poor medical student professional identity development in future.
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Affiliation(s)
| | | | - Nabilah Y Mayat
- Medical Student, Barts and the London School of Medicine and Dentistry , London, UK
| | - Megan El Brown
- Health Professions Education Unit, Hull York Medical School , York, UK
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Vakayil V, Chandrashekar M, Hedberg J, Bauman BD, Malik S, Yerxa D, Hendrickson LG, Kernahan P, Hadley ME, Harmon JV. An Undergraduate Surgery Interest Group: Introducing Premedical Students to the Practice of Surgery. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:339-349. [PMID: 32494212 PMCID: PMC7231780 DOI: 10.2147/amep.s245234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Early exposure and surgical mentorship can augment interest in surgery. We evaluate the effect and feasibility of offering education and mentorship opportunities in surgery to premedical students at our institution through an undergraduate surgery interest group (USIG). MATERIALS AND METHODS We conducted a 1-year assessment of our USIG and reviewed its organizational structure, funding resources, media promotion, and educational activities. Our USIG hosted introductory-level surgical skills workshops, guest lectures by surgeons, and various facility tours. To assess participants' interests, as well as the influences on them to pursue a surgical profession, we analyzed pre- and post-event questionnaires. Similar questionnaires were completed by medical students in our medical student surgery interest group to compare any differences in perception between premedical and medical students. RESULTS Our USIG currently has 378 undergraduate student members, with a higher proportion of women than in our medical student surgery interest group (P < 0.003). Neurosurgery was the most popular career choice among undergraduate participants. Participants reported the highest satisfaction with suturing and high-fidelity trauma surgery skills workshops. Undergraduate participants indicated that their intrinsic interest in the sciences is the highest motivation to pursue a surgical profession. Resident lifestyle and social obligations of a surgical career were actually positive influences for undergraduate participants; in contrast, medical students viewed those variables as negative factors. CONCLUSION Our USIG was met with enthusiasm by premedical students and faculty alike. Participation strengthened premedical students' interest in pursuing surgery and increased their understanding of the surgical profession. Early mentorship may positively influence premedical students' perception of surgical careers. USIG is economically feasible and time-efficient; we encourage other academic institutions and educators to consider investing in similar interest groups.
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Affiliation(s)
- Victor Vakayil
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Jack Hedberg
- College of Biological Sciences, University of Minnesota, St. Paul, MN, USA
| | - Brent D Bauman
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Shray Malik
- College of Biological Sciences, University of Minnesota, St. Paul, MN, USA
| | - Derek Yerxa
- College of Biological Sciences, University of Minnesota, St. Paul, MN, USA
| | - Lois G Hendrickson
- Owen H. Wangensteen Historical Library of Biology and Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Peter Kernahan
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- Owen H. Wangensteen Historical Library of Biology and Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Megan E Hadley
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - James V Harmon
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Richard-Lepouriel H, Bajwa N, de Grasset J, Audétat MC, Dominicé Dao M, Jastrow N, Nendaz M, Junod Perron N. Medical students as feedback assessors in a faculty development program: Implications for the future. MEDICAL TEACHER 2020; 42:536-542. [PMID: 31958383 DOI: 10.1080/0142159x.2019.1708875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Little is known about simulated students' ability in assessing feedback received in Objective Structured Teaching Encounters (OSTEs). We aimed to assess to which extent students' perceptions matched objective analysis regarding quality of received feedback, to explore what elements of feedback they emphasized and what they learned about feedback.Methods: In this mixed-method study, 43 medical students participated as simulated residents in five OSTEs at Geneva University Hospitals. They assessed quality of feedback from faculty using a 15-item questionnaire and gave written/oral comments. Videotaped feedbacks were assessed using an 18-item feedback scale. During four focus groups, 25 students were asked about what they learned as feedback assessors.Results: 453 students' questionnaires and feedback scale were compared. Correlations were moderate for stimulating self-assessment (0.48), giving a balanced feedback (0.44), checking understanding (0.47) or planning (0.43). Students' feedback emphasized elements such as faculty's empathy or ability to give concrete advice. They reported that being a feedback assessor helped them to realize importance of making the learner active and that giving effective feedback required structure and skills.Conclusion: Medical students may identify quality of feedback. Involving them in OSTEs could be interesting to train them to become valid raters of supervisors' teaching skills.
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Affiliation(s)
- H Richard-Lepouriel
- Psychiatric Specialties Service, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - N Bajwa
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - J de Grasset
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - M C Audétat
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - M Dominicé Dao
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Division of Primary Care Medicine, Department of Community Care, Primary Care and Emergency, Geneva University Hospitals, Geneva, Switzerland
| | - N Jastrow
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - M Nendaz
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Service of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - N Junod Perron
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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54
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Crabtree BF, Miller WL, Howard J, Rubinstein EB, Tsui J, Hudson SV, O'Malley D, Ferrante JM, Stange KC. Cancer Survivorship Care Roles for Primary Care Physicians. Ann Fam Med 2020; 18:202-209. [PMID: 32393555 PMCID: PMC7213992 DOI: 10.1370/afm.2498] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/27/2019] [Accepted: 08/13/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Despite a burgeoning population of cancer survivors and pending shortages of oncology services, clear definitions and systematic approaches for engaging primary care in cancer survivorship are lacking. We sought to understand how primary care clinicians perceive their role in delivering care to cancer survivors. METHODS We conducted digitally recorded interviews with 38 clinicians in 14 primary care practices that had national reputations as workforce innovators. Interviews took place during intense case study data collection and explored clinicians' perspectives regarding their role in cancer survivorship care. We analyzed verbatim transcripts using an inductive and iterative immersion-crystallization process. RESULTS Divergent views exist regarding primary care's role in cancer survivor care with a lack of coherence about the concept of survivorship. A few clinicians believed any follow-up care after acute cancer treatment was oncology's responsibility; however, most felt cancer survivor care was within their purview. Some primary care clinicians considered cancer survivors as a distinct population; others felt cancer survivors were like any other patient with a chronic disease. In further interpretative analysis, we discovered a deeply ingrained philosophy of whole-person care that creates a professional identity dilemma for primary care clinicians when faced with rapidly changing specialized knowledge. CONCLUSIONS This study exposes an emerging identity crisis for primary care that goes beyond cancer survivorship care. Facilitated national conversations might help specialists and primary care develop knowledge translation platforms to support the prioritizing, integrating, and personalizing functions of primary care for patients with highly complicated issues requiring specialized knowledge.
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Affiliation(s)
- Benjamin F Crabtree
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey .,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Jenna Howard
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Jennifer Tsui
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Denalee O'Malley
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Jeanne M Ferrante
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Abstract
The purpose of this study is to give clarity to the concept of professional identity, drawing from health-related fields to help provide a common language and understanding for research and practice. Professional identity, professionalism, professional socialization, and other related terms are often used without a clear definition or with conflicting definitions. This can lead to misunderstandings and assumptions that complicate research and confuse educators and professionals in guiding novice members. Concept analysis. Initially, 737 articles were identified by searching CINAHL, PubMed Central, Google Scholar, Academic Search Complete, PsyINFO, and SocINDEX for the period 2000 to 2019. Finally, 68 studies met the inclusion criteria, 60 of which are discussed in this concept analysis. This concept analysis uses the method described by Walker and Avant. This concept analysis clarifies the definition of professional identity, using literature from health and related professions, as containing the attributes: skills and functions; knowledge values and ethics; personal identity; group identity; and the influence of the context of care. A more clear definition of professional identity will help researchers to have more precision in their analyses and provide mentors and educators with a clear goal.
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Affiliation(s)
- Anita Fitzgerald
- School of Nursing, California State University, Long Beach, California
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56
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Rodrigues dos Santos M, Mendes CSN. Traditional & complementary medicine legislation in Portugal—Progress, challenges and flaws. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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57
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Rodrigues dos Santos M, Mendes C. The future of osteopathy in Portugal – Patient safety and practice standards. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Adams J, Ari M, Cleeves M, Gong J. Reflective Writing as a Window on Medical Students' Professional Identity Development in a Longitudinal Integrated Clerkship. TEACHING AND LEARNING IN MEDICINE 2020; 32:117-125. [PMID: 31729253 DOI: 10.1080/10401334.2019.1687303] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Phenomenon: Integral to the formation of a professional identity is the concept of professional identity construction, an essential part of becoming a competent physician. In this framework, identity is dynamic and shaped by experiences and relationships. Minimal work has addressed the impact that clinical care settings and relationships with patients have in the construction of professional identity for medical students. This study explores how patient interactions and intentional curriculum design support professional identity construction in students participating in a longitudinal integrated clerkship focused on care for the underserved. Approach: This qualitative analysis investigated students' professional identity construction as detailed in 45 reflective essays from 15 students while enrolled in an 11-month longitudinal integrated clerkship (LIC) in a safety-net hospital system. Researchers used an inductive analytic approach. Findings: Students provided rich and complex descriptions of their experiences. Six themes emerged: care for the underserved; therapeutic alliance; humility and gratitude; altruism; resilience; and aspirations. Insights: Professional identity construction was observable through students' reflective essays. Student interactions with patients provided rich material for professional identity construction, and role models in patient care enhanced this process. This study suggests that clinical learning in a safety-net hospital system, coupled with an LIC curriculum that prioritizes continuity with vulnerable patients, faculty role models, and ongoing reflection, supported the professional identity construction of students as patient-centered caregivers providing equitable care and advocacy for the underserved, described here as an Equity Identity.
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Affiliation(s)
- Jennifer Adams
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Mim Ari
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Michelle Cleeves
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Jennifer Gong
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
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López Cabrera MV, Olivares Olivares SL, Heredia Escorza Y. Professional Culture in Medical Schools: A Medical Educator Interpretation. MEDICAL SCIENCE EDUCATOR 2020; 30:281-286. [PMID: 34457668 PMCID: PMC8368445 DOI: 10.1007/s40670-019-00896-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Besides sharing knowledge, values, and attitudes, the members of a profession share a way of understanding how to perceive life, also known as professional identity. The formation of this identity is related to the acquisition of multiple roles, responsibilities, and collaboration, defining their professional culture. The medical educator is a professional who is committed to student development, who is a leader in his field, and who is active in academic or clinical activities, demonstrating the commitment to the community. The objective of this study was to explore the professional culture through the perception of the medical educator identity. A qualitative method was implemented by applying a content analysis strategy. A sample of 39 medical educators participated in structured interviews. Answers transcription was analyzed unitizing assumptions, effects, enablers, and barriers through the professional culture model: individualism, balkanized, collegiality per project, and extended collaboration. The definition of the medical educator was associated with 44% to individualism, 31% balkanized, 13% collegiality per project, and 13% extended collaboration. Generally, contributions from Basic Science educators are more individual, and the projects in the university are part of the operation planned for the short and medium term. Clinical Science educators are used to working in medical specialty groups, and some of them are involved in strategical social projects that provide care for the community. A cultural change transitioning from a highly autonomous strategy toward meaningful collaborative projects can help physicians and health professionals to develop a shared vision of what it means to be a medical educator. The medical school should provide a sense of collegial community environment to set common goals and expectations with adequate resources, and leadership is the standard.
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Affiliation(s)
- Mildred Vanessa López Cabrera
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Morones Prieto 3000 Pte col. Los Doctores, 64710 Monterrey, Mexico
| | - Silvia Lizett Olivares Olivares
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Morones Prieto 3000 Pte col. Los Doctores, 64710 Monterrey, Mexico
| | - Yolanda Heredia Escorza
- Tecnologico de Monterrey, Av. Eugenio Garza Sada 2501 Sur, Tecnológico, 64849 Monterrey, N.L Mexico
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60
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Esteves JE, Zegarra-Parodi R, van Dun P, Cerritelli F, Vaucher P. Models and theoretical frameworks for osteopathic care – A critical view and call for updates and research. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2020.01.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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61
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Tagawa M. Scales to evaluate developmental stage and professional identity formation in medical students, residents, and experienced doctors. BMC MEDICAL EDUCATION 2020; 20:40. [PMID: 32041597 PMCID: PMC7011234 DOI: 10.1186/s12909-020-1942-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 01/21/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND To respond to the growing need to cultivate medical trainees with professional identity, it is necessary to evaluate professional identity formation (PIF) in medical trainees to understand their state of PIF and apply this to medical education. Previous qualitative studies indicated that Kegan's human development model could explain medical trainees' PIF. I proposed a development scale (DS) to quantitatively evaluate the degree of maturation and socialization as a physician; however, one scale is not enough to illustrate the helical and complex process of development. METHODS Using Kegan's model as the conceptual framework, scales that evaluate stage 2, 3, and 4, and higher stage-specific attributes were developed using data collected in a self-administered questionnaire (322 respondents), reliability analysis, group comparison, and analysis of individual DS scores. The respondents were 4th- and 6th-year medical students and 2nd-year residents at Kagoshima University, and experienced medical doctors (instructors). RESULTS In addition to the DS, one self-administered questionnaire consisting of 27 items for stage 2, 3, 4, and higher stage-specific attribute scales was created. Students had the highest mean score in stage 2, and instructors had the highest mean score in stage 4 and higher stage scales. Individual analysis indicated that there were respondents with varied attributes in each group, that the average medical student might have inclusion preference typically seen at stage 3, and that the average instructor might have independent preference typically seen at stage 4 more than inclusion preference. CONCLUSIONS Combining multiple stage attribute-specific scales and DS scores could quantify the complexity and divergent processes of PIF. These scales could provide meaningful information about individuals, groups, and education in terms of professional development that is different from assessment data of medical knowledge or professional skills.
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Affiliation(s)
- Masami Tagawa
- Center for Innovation in Medical and Dental Education, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
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Anderson H, Birks Y, Adamson J. Exploring the relationship between nursing identity and advanced nursing practice: An ethnographic study. J Clin Nurs 2020; 29:1195-1208. [DOI: 10.1111/jocn.15155] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/04/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Helen Anderson
- Department of Health Sciences Faculty of Sciences University of York York UK
| | - Yvonne Birks
- Social Policy Research Unit University of York York UK
| | - Joy Adamson
- York Trials Unit Department of Health Sciences University of York York UK
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63
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Yoo DM, Kim DH. The relationship between students' perception of the educational environment and their subjective happiness. BMC MEDICAL EDUCATION 2019; 19:409. [PMID: 31703671 PMCID: PMC6839184 DOI: 10.1186/s12909-019-1851-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/23/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND Happiness, a subjective judgment about one's quality of life, is influenced by environmental factors and should be considered as an important goal of medical education, which should support each learner's development as a person as well as a professional. However, although several studies have reported on the correlation between Dundee Ready Educational Environment Measure (DREEM) scores and students' academic achievement, few have investigated the relationship between DREEM scores and students' subjective happiness. This study examined different perceptions of the educational environment between phases of the curriculum and determined which DREEM subscales affect the overall level of happiness. METHODS We used the Korean version of the DREEM questionnaire and a single item measure of happiness on a scale of 0 to 10. First we analyzed student perceptions of the educational environment according to their demographic characteristics using independent sample t-tests and one-way analysis of variance. A multiple regression analysis was performed to reveal which subscales affect the overall level of happiness while controlling for grade point average (GPA) and other demographic characteristics. RESULTS The subjects were 239 medical school students across all stages of the curriculum. The students' overall perception was more positive for the educational environment during Phase 3 (clerkship) than Phase 1 (pre-medical). Among the DREEM subscales, this difference was especially prominent in Students' Perception of Learning and Students' Academic Self-Perceptions. In contrast, no difference in the subjective perception of happiness was found between phases. The effect of GPA on happiness became insignificant under the control of other variables, but the influence of the Students' Social Self-Perceptions (SSSP) subscale remained significant. CONCLUSIONS The students' overall perception of the educational environment was more positive during the clerkship period than in the pre-medical period. Based on our finding that the SSSP correlates significantly with subjective happiness, we suggest that institutions promote not only students' academic development but also their happiness by fostering an appropriate educational environment.
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Affiliation(s)
- Dong-Mi Yoo
- Department of Medical Education, College of Medicine, The Catholic University of Korea, Banpo-daero 222, Seocho-gu, Seoul, 06591 Republic of Korea
| | - Do-Hwan Kim
- Department of Medical Education, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763 Republic of Korea
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Zyblewski SC, Callow L, Beke DM, Jain P, Madathil SB, Schwartz S, Tabbutt S, Bronicki RA. Education and Training in Pediatric Cardiac Critical Care: International Perspectives. World J Pediatr Congenit Heart Surg 2019; 10:769-777. [PMID: 31663839 DOI: 10.1177/2150135119881369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric cardiac intensive care is an evolving and maturing field. There have been advances in education and training in recent years, specifically progress toward standardization of curricula, competencies, and certifications. International partnerships have fostered similar advancements in less resourced countries. For all disciplines and levels of expertise, simulation remains a versatile and effective modality in education. Although there is improved standardization for the training of physicians and nurses, the certification process remains undetermined.
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Affiliation(s)
- Sinai C Zyblewski
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Louise Callow
- Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Dorothy M Beke
- Cardiac Intensive Care, Boston Children's Hospital, Boston, MA, USA
| | - Parag Jain
- Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | - Steven Schwartz
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Tabbutt
- Division of Critical Care Medicine, Benioff Children's Hospital, University of California, San Francisco, CA, USA
| | - Ronald A Bronicki
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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65
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Britton C, Di Napoli R. Professional transition and identity formation of surgical care practitioners: a phenomenological interpretation of their lived experiences. J Perioper Pract 2019; 30:229-239. [PMID: 31573384 DOI: 10.1177/1750458919875588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgical care practitioners are non-medical members of the surgical team, who provide direct surgical care to patients, delegated by consultant surgeons. The surgical care practitioners' professional role is within the new non-medical or nursing workstream, practising under the medical model of care in response to staff shortages and the rising expectations that are affecting the National Health Service. This article seeks to contribute to a better understanding of the phenomenon of the emergent professional identity of surgical care practitioners. Six surgical care practitioners were purposively sampled for in-depth, semi-structured interviews whereupon their concepts of professional transition and professional identity formation from their individual points of view were explored using a phenomenological approach. Transcripts and reflective texts were subject to repeated interpretation in a hermeneutic circle of understanding. Interpretation of the results in context allowed for a discussion informed by self-interpreted constructions and revolved around eight cluster themes that emerged explicating how surgical care practitioners experienced professional transition and professional identity formation. In addition, a notion of 'journey' in the development of professional identity (narratives about professional identity formation: the hero's journey) was embedded in the reflections of the participants and their narratives produced rich accounts of the phenomenon under investigation.
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Affiliation(s)
- Carolina Britton
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - R Di Napoli
- Department of Surgery and Cancer, Imperial College London, London, UK.,Centre for Innovation and Development of Education, St George's, University of London, London, UK
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Stubbing EA, Helmich E, Cleland J. Medical student views of and responses to expectations of professionalism. MEDICAL EDUCATION 2019; 53:1025-1036. [PMID: 31509286 DOI: 10.1111/medu.13933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/12/2019] [Accepted: 06/06/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT To earn society's trust, medical students must develop professional values and behaviours via a transformative process, from lay person to doctor. Yet students are expected to epitomise the values and behaviours of a doctor from the outset of medical school, leading them to feel 'judged all the time' (in terms of their professionalism). Our aim, therefore, is to extend knowledge exploring the expectations communicated to and perceived by medical students and to provide a conceptually framed understanding of students' associated emotional tensions. METHODS We used a qualitative exploratory case study methodology within a constructivist paradigm to explore the messages communicated about professionalism and students' perceived expectations of professionalism in one medical school. Data were collected in the form of: (i) regulatory and medical school documents, and (ii) focus groups with 23 participants in their first 2 years at medical school. We used thematic analysis for data interpretation and two theoretical lenses, Amalberti et al.'s framework of system migration for health care and Sinclair's adaptation of Goffman's dramaturgical theory, to critically analyse the results. RESULTS We found messages and perceived expectations of knowledge and competence, and the need to ensure trust. We also identified that the expectations of patients, doctors, society, family and friends are just as, if not more, influential than policy and regulatory expectations for early years' medical students. Moreover, we found tensions, with students feeling that the expectations of them from others were unrealistic for their level of training. With this came a sense of pressure to meet expectations that participants responded to by acting as if already competent. CONCLUSIONS Our findings suggest that external forces (expectations) drive early years' students to act as if competent. Although this is part of student identity formation it could also have implications for patient safety and therefore necessitates recognition and support from educators.
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Affiliation(s)
- Evangeline A Stubbing
- Centre for Healthcare Education Research and Innovation, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Esther Helmich
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jennifer Cleland
- Centre for Healthcare Education Research and Innovation, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Maile E, McKimm J, Till A. Exploring medical leader identity and its formation. Leadersh Health Serv (Bradf Engl) 2019; 32:584-599. [PMID: 31612786 DOI: 10.1108/lhs-12-2018-0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE "Becoming" a doctor involves the acquisition of medical knowledge, skills and professional identity. Medical professional identity formation (MPIF) is complex, multi-factorial and closely linked to societal expectations, personal and social identity. Increasingly, doctors are required to engage in leadership/management involving significant identity shift. This paper aims to explore medical professional identity (MPI) and MPIF in relation to doctors as leaders. Selected identity theories are used to enrich the understanding of challenges facing doctors in leadership situations and two concepts are introduced: medical leader identity (MLI) and medical leader identity formation (MLIF) and consideration given to how they can be nurtured within medical practice. DESIGN/METHODOLOGY/APPROACH A rapid conceptual review of relevant literature was carried out to identify a set of relevant concepts and theories that could be used to develop a new conceptual framework for MLI and MLIF. FINDINGS MLIF is crucial for doctors to develop as medical leaders, and, like MPIF, the process begins before medical school with both identities influenced, shaped and challenged throughout doctors' careers. Individuals require support in developing awareness that their identities are multiple, nested, interconnected and change over time. ORIGINALITY/VALUE This paper draws on concepts from wider literature on professional identity, in relation to how doctors might develop their MLI alongside their MPI. It offers a new perspective on MPI in the light of calls on doctors to "become and be healthcare leaders" and introduces the new concepts of MLI and MLIF.
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Affiliation(s)
- Emily Maile
- Health Education England East Midlands, Nottingham, UK
| | - Judy McKimm
- School of Medicine, Swansea University , Swansea, UK
| | - Alex Till
- Health Education England North West, Manchester, UK and School of Medicine, Swansea University , Swansea, UK
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Lewin LO, McManamon A, Stein MTO, Chen DT. Minding the Form That Transforms: Using Kegan's Model of Adult Development to Understand Personal and Professional Identity Formation in Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1299-1304. [PMID: 31460919 DOI: 10.1097/acm.0000000000002741] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The formation of a physician's professional identity is a dynamic process shaped by and intertwined with the development of that person's larger adult identity. Constructive-developmentalist Robert Kegan's model of adult development describes four mental lenses used for meaning-making and the trajectory through which they transform over time. These lenses determine the way people take in and integrate complex influences into forming their adult identities.When people use a particular lens to construct meaning, Kegan describes them as being "subject" to that lens: The lens "has them," and they are unaware of the ways it shapes their world. Transformations occur when individuals are able to take a lens to which they were subject and regard it objectively. Kegan's lenses that are relevant to medical educators are called instrumental-focused on rules and rewards; socialized-attending to social norms and expectations; self-authoring-seeking to build internal values; and self-transforming-seeing gaps in one's closely held value systems and being open to those of others.When individuals have difficulty facing current challenges, they begin to grow a more complex lens. Subsequent lenses bring the ability to deal with more complexity but also bring their own challenges. Familiarity with Kegan's model can help educators provide more effective support to groups of learners as well as individuals, support learners' transformational growth through the challenging situations inherent in medical education, and supply a common language for many important areas of medical education, including competencies and entrustable professional activities, remediation, leadership development, and curriculum planning.
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Affiliation(s)
- Linda Orkin Lewin
- L.O. Lewin is professor of pediatrics, Emory University, Atlanta, Georgia; ORCID: http://orcid.org/0000-0001-6028-3960. A. McManamon is assistant professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. M.T.O. Stein is assistant professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. D.T. Chen is associate professor of biomedical ethics, public health sciences, and psychiatry and neurobehavioral sciences, and director of the iTHRIV Scholars curriculum, University of Virginia, Charlottesville, Virginia; ORCID: http://orcid.org/0000-0003-1081-1053
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Rees CE, Kent F, Crampton PES. Student and clinician identities: how are identities constructed in interprofessional narratives? MEDICAL EDUCATION 2019; 53:808-823. [PMID: 31094022 DOI: 10.1111/medu.13886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/30/2018] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT Although the literature on professional identity formation in medical education is increasing, it is scant by comparison on student and clinician identities within interprofessional contexts. We therefore adopt a novel discursive approach to identities to explore how soon-to-become graduates and workplace-based clinicians construct their own and others' identities in interprofessional student-clinician (IPSC) interaction narratives. METHODS We conducted a qualitative narrative interview study with 38 students and 23 clinicians representing the fields of medicine, midwifery, nursing, occupational therapy, paramedicine and physiotherapy. Through framework analysis, we identified the breadth of student and clinician identity constructions across 208 IPSC interaction narratives, and explored how common constructions differed by narrative and narrator. Through in-depth positioning analysis, we explored how student and clinician identities are discursively positioned within two selected IPSC interaction narratives. RESULTS We identified 11 common constructions of student identities and eight common constructions of clinician identities across all 208 narratives. We found differences in identity constructions across positively versus negatively evaluated narratives, and student versus clinician narrators, highlighting the rhetorical nature of narratives. Our in-depth positioning analysis of two narratives illustrates how one student and one clinician discursively positioned theirs and others' identities during interprofessional interactions, and how identities vary depending on narrators' evaluations of their stories. Although both positioning analyses illustrate how the narrators' language serves to reproduce the common societal discourse of interprofessional conflict, the clinician narrative also draws on the competing discourse of interprofessional collaboration. CONCLUSIONS Although some of the identities support previous uniprofessional research, our findings illustrate greater breadth and depth in terms of student and clinician identities within interprofessional contexts. We encourage educators to embed identities curricula into existing workplace learning for students and clinicians to help them make sense of their developing professional and interprofessional identities. Workplace educators should facilitate meaningful IPSC interactions to promote interprofessional learning and collaboration.
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Affiliation(s)
- Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Fiona Kent
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Paul E S Crampton
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Health Professions Education Unit, Hull York Medical School, York, UK
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Goss AL, Viswanathan VB, DeLisser HM. Not Just a Specimen: A Qualitative Study of Emotion, Morality, and Professionalism in One Medical School Gross Anatomy Laboratory. ANATOMICAL SCIENCES EDUCATION 2019; 12:349-359. [PMID: 30739388 DOI: 10.1002/ase.1868] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
Medical schools are increasingly integrating professionalism training into their gross anatomy courses, teaching ethical behavior and humanistic attitudes through the dissection experience. However, many schools continue to take a traditional, technical approach to anatomical education while teaching professionalism in separate courses. This interview-based study explored how students viewed the body donor and the professional lessons they learned through dissection at one such medical school. All students oscillated involuntarily between seeing the cadaver as a specimen for learning and seeing the cadaver as a person, with some students intentionally cultivating one of these ways of seeing over the other. These views shaped students' emotional and moral responses to the experiences of dissection. The "specimen" view facilitated a technical, detached approach to dissection, while the "person" view made students engage emotionally. Further, students who intentionally cultivated a "specimen" view generally felt less moral distress about dissection than students who intentionally cultivated a "person" view. The concept of respect gave students permission to perform dissections, but "person-minded" students developed more complex rules around what constituted respectful behavior. Both groups of students connected the gross anatomy experience to their professional development, but in different ways. "Specimen-minded" students intentionally objectified the body to learn the emotional control physicians need, while "person-minded" students humanized the body donor to promote the emotional engagement required of physicians. These findings support efforts to integrate professionalism teaching into gross anatomy courses, particularly content, addressing the balance between professional detachment and concern.
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Affiliation(s)
- Adeline L Goss
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - Vidya B Viswanathan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Horace M DeLisser
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Ryan AT, Fisher C, Chiavaroli N. Medical students as interpreters in health care situations: “… it's a grey area”. Med J Aust 2019; 211:170-174. [DOI: 10.5694/mja2.50235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022]
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Volpe RL, Hopkins M, Van Scoy LJ, Wolpaw DR, Thompson BM. Does Pre-clerkship Medical Humanities Curriculum Support Professional Identity Formation? Early Insights from a Qualitative Study. MEDICAL SCIENCE EDUCATOR 2019; 29:515-521. [PMID: 34457509 PMCID: PMC8368951 DOI: 10.1007/s40670-018-00682-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is a lack of consensus about the outcomes of medical humanities training. In this qualitative study, the authors analyzed pre-clerkship small group discussions to assess the nature of learning in medical humanities. Twenty-two medical students (12 females and 10 males) in three humanities small groups consented to participate. The authors used inductive thematic analysis to qualitatively analyze the text from 13 weeks of curriculum. Findings indicate that students reflect about negotiating the clinician-patient relationship within the stressful environment characteristic of today's healthcare systems, that they worry about sacrificing their personal values in pursuit of honoring professional expectations, and that they encounter and commonly confront ambiguity. These themes were used to develop a descriptive framework of humanities small groups as a structure and safe space for the early development of professional identity.
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Affiliation(s)
- Rebecca L. Volpe
- Department of Humanities, Penn State College of Medicine, 500 University Drive, H134, Hershey, PA 17011 USA
| | - Margaret Hopkins
- Department of Humanities, Penn State College of Medicine, 500 University Drive, H134, Hershey, PA 17011 USA
| | - Lauren Jodi Van Scoy
- Pulmonary, Allergy and Critical Care Division, Penn State College of Medicine, Hershey, PA USA
| | - Daniel R. Wolpaw
- Department of Humanities and Medicine, Penn State College of Medicine, Hershey, PA USA
| | - Britta M. Thompson
- Department of Medicine and Woodward Center for Excellence in Health Sciences Education, Hershey, PA USA
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Kumar Ghosh S, Kumar A. Building Professionalism in Human Dissection Room as a Component of Hidden Curriculum Delivery: A Systematic Review of Good Practices. ANATOMICAL SCIENCES EDUCATION 2019; 12:210-221. [PMID: 30376608 DOI: 10.1002/ase.1836] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 05/05/2023]
Abstract
The core values in medical practice which are essential for the humane outlook of a physician are clubbed within the domain of medical professionalism. Professionalism along with other discipline-independent skills (human skills) is propagated implicitly in medical schools as components of a "hidden curriculum." Evidence suggests a strong association between "hidden curriculum" delivery and development of professionalism in the human dissection room. In this review article, the authors have tried to highlight a few exclusive practices adopted by medical schools which enhance the implementation of the "hidden curriculum" within the practice of human dissection and successfully inculcate the key components of professionalism such as integrity, respect, and compassion among students. These distinctive concepts are aimed at humanizing the experience of anatomical dissection by revealing the identity of the donors along with their personal details either through display of video clips of donor interviews, interactions with the family members of the donor over a meal or recognition of the donor as a mentor and organizing memorial services in honor of donors after conclusion of the dissection in the presence of their family members. The resounding success of these good practices in building professionalism among medical students from the onset of the academic curriculum has signaled a new chapter in anatomical sciences education. It has become imperative to recognize the visionary efforts of a select few medical educators and begin incorporating these recent trends into the delivery of the "hidden curriculum" within the evolving gross anatomy education model.
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Affiliation(s)
- Sanjib Kumar Ghosh
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - Ashutosh Kumar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
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Tagawa M. Development of a scale to evaluate medical professional identity formation. BMC MEDICAL EDUCATION 2019; 19:63. [PMID: 30819174 PMCID: PMC6394027 DOI: 10.1186/s12909-019-1499-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/20/2019] [Indexed: 05/26/2023]
Abstract
BACKGROUND Medical educators now focus on professional identity formation (PIF), which is a process of psychological development and socialization in the community of practice. This study aimed to develop an instrument to evaluate PIF that can be applied to a large group of medical trainees. METHODS A self-administered questionnaire was created with items on priorities, behavior standards, attitudes, and emotional control of well-developed physicians, in addition to items on their background and experience in playing the role of a physician. The participants were divided into four respondent groups: 4th- and 6th-year medical students and 2nd-year residents at Kagoshima University, and experienced medical doctors (instructors). RESULTS Using factor analysis of data from 318 respondents and respondent group comparison, a developing scale (DS) with 15 items was created. The DS has a five-factor structure and evaluates self-control as a professional (factor 1), awareness of being a medical doctor (factor 2), reflection as a medical doctor (factor 3), execution of social responsibility (factor 4), and external and internal self-harmonization (factor 5). The mean DS score of the instructors was significantly higher than that of the residents (p < 0.01), the mean score of residents and instructors was significantly higher than that of students (p < 0.01), and the mean score of instructors was significantly higher than that of all other respondents (p < 0.01). Respondent group, but not gender, was a significant variable of the DS. The DS and scores of factors 2 and 4 correlated with 6th-year medical students' experience in playing the role of a physician during clinical training, and scores of factors 3 and 4 correlated with 2nd-year residents' experience in playing the role of a physician. There was no significant difference between the mean DS score of 4th- and 6th-year medical students, which might due to less clinical experience among 6th-year medical students or a limitation of the scale to evaluate pre-clinical medical students. CONCLUSIONS The DS could be a useful indicator of medical trainees' personal and professional development and socialization. Experience in playing the role of a physician might facilitate medical trainees' PIF.
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Affiliation(s)
- Masami Tagawa
- Center for Innovation in Medical and Dental Education, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
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Matsui T, Sato M, Kato Y, Nishigori H. Professional identity formation of female doctors in Japan - gap between the married and unmarried. BMC MEDICAL EDUCATION 2019; 19:55. [PMID: 30755206 PMCID: PMC6373051 DOI: 10.1186/s12909-019-1479-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/29/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND During professional identity formation (PIF), medical students and young doctors enter the process of socialization in medicine with their preexisting personal identities. Here, the authors focused on how gender influences both the professional and personal identities of doctors. The authors' particular research question was how the professional and personal identities of female doctors are formed in Japan, a patriarchal and highly masculinized country, especially before and after marriage and childbirth. METHODS Narrative inquiry was used as the research methodology. The authors purposively sampled 10 unmarried and 15 married Japanese female physicians with varying lengths of full-time work experience and conducted individual semi-structured face-to-face interviews between July 2013 and February 2015. The authors recorded, transcribed and anonymized the narrative data and extracted themes and representative narratives related to the formation of professional and personal identities. Based on these, the authors developed the master narrative for the whole study. RESULTS The PIF process by which female physicians integrate personal and professional identities was profoundly affected by gender stereotypes. Further, participant narratives revealed the existence of conflict between married and unmarried female doctors, which created a considerable gap between them. CONCLUSIONS Female physicians lived with conflicting emotions in a chain of gender stereotype reinforcement. To overcome these issues, we propose that it is necessary to depart from a culture that determines merit based on a fixed sense of values, and instead develop a cultural system and work environment which allows the cultivation of a professional vision that accepts a wide variety of professional and personal identities, and a similarly wide variety of methods by which the two can be integrated.
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Affiliation(s)
- Tomoko Matsui
- Department of General Medicine/Family and Community Medicine, Nagoya University Graduate School of Medicine, 65-banchi, Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Motoki Sato
- Department of General Medicine Nagoya University, Nagoya University Hospital, Nagoya, Japan
| | - Yoko Kato
- Department of Psychology, Sugiyama Jogakuen University, City, Nisshin, Japan
| | - Hiroshi Nishigori
- Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Schei E, Knoop HS, Gismervik MN, Mylopoulos M, Boudreau JD. Stretching the Comfort Zone: Using Early Clinical Contact to Influence Professional Identity Formation in Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519843875. [PMID: 31065588 PMCID: PMC6487753 DOI: 10.1177/2382120519843875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/20/2019] [Indexed: 05/06/2023]
Abstract
PURPOSE To explore first-year medical students' affective reactions to intimate encounters with severely sick patients in their homes, within a curricular innovation targeting the development of a patient-centered professional identity. BACKGROUND Early patient encounters create complex emotional challenges and constitute fertile ground for professional identity formation. The literature indicates that students often learn, largely through the hidden curriculum, to avoid and suppress emotion. This can culminate in mental health problems and loss of empathy. METHOD A qualitative descriptive analysis of 28 randomly selected, mandatory, reflective essays focused on a home visit to a previously unknown patient, in an unsupervised group of 4 students, within the context of a structured course called Patient Contact-PASKON. RESULTS Students described a wide range of affect-laden responses, positive and negative, elicited by the home visits. The observations were typically related to loss of control, struggles to behave "professionally," and the unmasking of stereotypes and prejudices. CONCLUSIONS Medical students' initial clinical encounters elicit emotional responses that have the potential to serve as triggers for the development of emotional maturity, relational skills, and patient-centered attitudes. Conversely, they can foreground uncertainty and lead to defensive distancing from patients' existential concerns. The findings point to a role for structured educational strategies and supervision to assist students in the emotion work necessary in the transition from a "lay" to a "medical" identity.
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Affiliation(s)
- Edvin Schei
- Department of Global Public Health and Primary Care, Center for Medical Education, University of Bergen, Bergen, Norway
- Edvin Schei, Department of Global Public Health and Primary Care, Center for Medical Education, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway.
| | | | | | - Maria Mylopoulos
- Department of Paediatrics, The Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - J Donald Boudreau
- Department of Medicine, Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, QC, Canada
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Mulder H, Ter Braak E, Chen HC, Ten Cate O. Addressing the hidden curriculum in the clinical workplace: A practical tool for trainees and faculty. MEDICAL TEACHER 2019; 41:36-43. [PMID: 29490529 DOI: 10.1080/0142159x.2018.1436760] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The hidden curriculum, commonly described in negative terms, is considered highly influential in medical education, especially in the clinical workplace. Structured approaches to address it are limited in number and scope. METHODS AND RESULTS This paper presents a practical, value-neutral method called REVIEW (Reflecting & Evaluating Values Implicit in Education in the Workplace), to facilitate reflection and discussion on the hidden curriculum by faculty members and trainees. REVIEW approaches the hidden curriculum as a reflection of the professional microculture of a clinical team. This microculture results from collective problem solving and mutual negotiation when facing different, often conflicting, demands and interests, and their underlying values in daily clinical practice. Using this nonjudgmental conceptual framework, REVIEW employs a series of 50 culture statements that must be prioritized using Q-sort methodology, reflecting how the culture in a particular clinical context (e.g. ward or department) is perceived by faculty members and trainees. This procedure can be done individually or in groups. Most important is the resulting team discussion after the exercise - a discussion about perceptions of actual team culture and the culture desired by the team. DISCUSSION AND CONCLUSIONS Our early experiences suggest that REVIEW can be a useful tool for addressing the hidden curriculum.
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Affiliation(s)
- Hanneke Mulder
- a Center for Research and Development of Education , University Medical Center Utrecht, Utrecht University , The Netherlands
| | - Edith Ter Braak
- b Unit for Postgraduate Medical Education , University Medical Center Utrecht, Utrecht University , The Netherlands
| | - H Carrie Chen
- c Department of Pediatrics , Georgetown University School of Medicine , Washington , DC , USA
| | - Olle Ten Cate
- a Center for Research and Development of Education , University Medical Center Utrecht, Utrecht University , The Netherlands
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Bell SK, Langer T, Luff D, Rider EA, Brandano J, Meyer EC. Interprofessional Learning to Improve Communication in Challenging Healthcare Conversations: What Clinicians Learn From Each Other. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:201-209. [PMID: 31306279 DOI: 10.1097/ceh.0000000000000259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Although contemporary health care involves complex interactions among clinicians of varying professions, opportunities to learn together are relatively few. The authors assessed participants' views about the educational value of learning with colleagues of mixed health care professions in communication and relational skills training focused on challenging conversations. METHODS Between 2010 and 2013, 783 participants enrolled in 46 workshops hosted by the Institute for Professionalism and Ethical Practice at Boston Children's Hospital, Boston, USA. Participants received pre-, post-, and 3-month follow-up questionnaires with quantitative and qualitative questions about their experiences learning with clinicians of varying professions ("interprofessional learning"). Descriptive statistics and chi-square tests were used to compare participant groups. Responses to open-ended questions were coded according to standard principles of content analysis. RESULTS Seven hundred twenty-two (92%) participants completed surveys. Previous interprofessional learning was reported by 60% of respondents, but generally comprised <30% of their education. Clinicians with <3 years of work experience were least likely to have previous interprofessional learning. Nearly all (96%) participants reported interprofessional colleagues contributed valuably to their learning. Asked specifically what they learned, participants described five themes: Stronger Teamwork, Patient-Centered Focus, Specific Communication Skills, Content-Specific Knowledge, and Shared Global Values. After 3 months, 64% of respondents reported that workshop participation helped make their interactions with interprofessional colleagues more collaborative. DISCUSSION Communication skills training for challenging health care conversations is a valuable opportunity for interprofessional learning and generates sustained positive attitudes about collaboration. Clinicians learn from their colleagues a deeper understanding of each other's professional roles, challenges, and unique contributions; specific communication approaches; and a sense of belonging to a collaborative community reinforcing the patient at the center of care.
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Affiliation(s)
- Sigall K Bell
- Dr. Bell: Associate Professor, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, and Associate Professor, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA. Dr. Langer: Research Associate, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA, and Attending in Pediatric Neurology, Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Dr. Luff: Associate Director, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA. Dr. Rider: Director of Academic Programs, Assistant Professor, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA, Director of Academic Programs, Assistant Professor, Department of Pediatrics, Harvard Medical School, Boston, MA, and Director of Academic Programs, Assistant Professor, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA. Dr. Brandano: Senior Clinical Coordinator, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA, and Senior Clinical Coordinator, Department of Psychology, Simmons College, Boston, MA. Dr. Meyer: Senior Attending Psychologist, Associate Professor, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA, and Senior Attending Psychologist, Associate Professor, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston MA
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Professionalism and its role in the formation of medical professional identity. Med J Islam Repub Iran 2018; 32:130. [PMID: 30815425 PMCID: PMC6387805 DOI: 10.14196/mjiri.32.130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Indexed: 11/18/2022] Open
Abstract
Background: The honorable medical profession is on the verge of being reduced to a business. Evidence suggests that professionalism is fading and today's doctors are faced with value-threatening problems and gradually begin to forget their main commitment as medical professionals. Many of the problems faced by doctors are rooted in non-professionalism. Mere education in the science and practice of medicine produces an inefficient medical workforce and leads to the formation of a distorted professional identity. In the past decade, educational innovations targeting the formation of desirable professional identities have been presented and are considered a vital part of medical education for the development of professionalism. The present study was conducted to examine the relationship between the formation of professional identity and professionalism. Professionalism education is essential in the formation of a desirable professional identity. Methods: This review article was done in 2015 through searching databases, such as PubMed, Elsevier, Google Scholar, Ovid, SID, and IranMedex, using keywords of professionalism and professional identity, and medical education. Among the 55 found articles, 30 were assessed and selected for review. Results: The formation of professional identity is a process with the following domains: professionalism, and development of a personal (psychosocial) and a cultural identity, which is derived from the unification of professional, personal, and ethical development. The main components required for the formation of a desirable identity are, therefore, rooted in the dimensions of professionalism and professional development. The need for teaching professionalism has a reciprocal relationship with the formation of professional identity. Conclusion: There is a reciprocal relationship between formation of a desirable professional identity and development and strengthening of professionalism. Modern medical education should be designed to develop professional identity, and professionalism acts as an essential part of its curricula throughout the entire course of a doctor's education, with the aim of acquiring a desirable professional identity.
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De Grasset J, Audetat MC, Bajwa N, Jastrow N, Richard-Lepouriel H, Nendaz M, Junod Perron N. Medical students' professional identity development from being actors in an objective structured teaching exercise. MEDICAL TEACHER 2018; 40:1151-1158. [PMID: 29683013 DOI: 10.1080/0142159x.2018.1457212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Medical students develop professional identity through structured activities and impromptu interactions in various settings. We explored if contributing to an Objective Structured Teaching Exercise (OSTE) influenced students' professional identity development. METHODS University clinical faculty members participated in a faculty development program on clinical supervision. Medical students who participated in OSTEs as simulated residents were interviewed in focus groups about what they learnt from the experience and how the experience influenced their vision of learning and teaching. Transcripts were analyzed using the Goldie's personality and social structure perspective model. RESULTS Twenty-five medical students out of 32 students involved in OSTEs participated. On an institutional level, students developed a feeling of belonging to the institution. At an interactional level, students realized they could influence the teaching interaction by actively seeking or giving feedback. On the personal level, students realized that errors could become sources of learning and felt better prepared to receive faculty feedback. CONCLUSION Taking part in OSTEs as a simulated resident has a positive impact on students' vision regarding the institution as a learning environment and their own role by actively seeking or giving feedback. OSTEs support their professional identity development regarding learning and teaching while sustaining faculty development.
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Affiliation(s)
- Jehanne De Grasset
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
| | - Marie-Claude Audetat
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
- b Unit of Development and Research in Medical Education, Faculty of Medicine , University of Geneva , Genève , Switzerland
| | - Nadia Bajwa
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
- b Unit of Development and Research in Medical Education, Faculty of Medicine , University of Geneva , Genève , Switzerland
| | - Nicole Jastrow
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
| | | | - Mathieu Nendaz
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
- b Unit of Development and Research in Medical Education, Faculty of Medicine , University of Geneva , Genève , Switzerland
| | - Noelle Junod Perron
- a Institute of Primary Care , Geneva University Hospitals , Genève , Switzerland
- b Unit of Development and Research in Medical Education, Faculty of Medicine , University of Geneva , Genève , Switzerland
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Ray RA, Young L, Lindsay D. Shaping medical student's understanding of and approach to rural practice through the undergraduate years: a longitudinal study. BMC MEDICAL EDUCATION 2018; 18:147. [PMID: 29929521 PMCID: PMC6013947 DOI: 10.1186/s12909-018-1229-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/18/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Over the last two decades medical schools have increased rural practice learning opportunities for students in an effort to improve recruitment to the rural workforce. James Cook University's (JCU) medical school was established in northern Australia in 2000 with a specific focus on meeting the health needs of people in rural and remote areas. As part of a longitudinal study this paper explores the situational and motivational learning factors contributing to the development of JCU's medical students' understanding of and approaches to rural medical practice. METHODS After completing each consecutive, compulsory rural clinical placement in Year Two, Four and Six of their MBBS program, JCU medical students were asked to complete a survey about their rural learning experiences. The survey consisted of a combination of single choice, Guttman and Likert scales and open response questions. Data from two open response questions were coded and thematically analysed. Content analysis enabled the predominant value of each theme to be calculated. RESULTS Collation of the survey data revealed 680 answers to both questions resulting in 1322 comments for analysis. Nine themes were categorized into clinical practice issues and person issues. The evolution of scope of practice across the years, the importance of inspirational mentors, access to urban areas and a sense of community were key findings. Positive rural clinical placement experiences inclusive of supportive ongoing learning opportunities and rural community living contribute positively to medical students' interest in future rural medical practice. However, the ability to work for periods of time in both rural and urban settings suggested a possible need for a new additional model of practice. CONCLUSION Clear links between a sense of community and belonging both professionally and socially as well as combined rural-urban practice options were important factors in the education and development of future rural practitioners. Ways to establish and support practice models incorporating both rural and urban locations needs to be investigated.
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Affiliation(s)
- Robin A. Ray
- College of Medicine and Dentistry, James Cook University, Townsville, 4811 Australia
| | - Louise Young
- College of Medicine and Dentistry, James Cook University, Townsville, 4811 Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, 4811 Australia
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Findyartini A, Sudarsono NC. Remediating lapses in professionalism among undergraduate pre-clinical medical students in an Asian Institution: a multimodal approach. BMC MEDICAL EDUCATION 2018; 18:88. [PMID: 29716581 PMCID: PMC5930750 DOI: 10.1186/s12909-018-1206-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/20/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND Fostering personal identity formation and professional development among undergraduate medical students is challenging. Based on situated learning, experiential learning and role-modelling frameworks, a six-week course was developed to remediate lapses in professionalism among undergraduate medical students. This study aims to explore the students' perceptions of their personal identity formation and professional development following completion of the course. METHODS This qualitative study, adopting a phenomenological design, uses the participants' reflective diaries as primary data sources. In the pilot course, field work, role-model shadowing and discussions with resource personnel were conducted. A total of 14 students were asked to provide written self-reflections. Consistent, multi-source feedback was provided throughout the course. A thematic analysis was conducted to identify the key processes of personal and professional development among the students during remediation. RESULTS Three main themes were revealed. First, students highlighted the strength of small group activities in helping them 'internalise the essential concepts'. Second, the role-model shadowing supported their understanding of 'what kind of medical doctors they would become'. Third, the field work allowed them to identify 'what the "noble values" are and how to implement them in daily practice'. CONCLUSION By implementing multimodal activities, the course has high potential in supporting personal identity formation and professional development among undergraduate pre-clinical medical students, as well as remediating their lapses in professionalism. However, there are challenges in implementing the model among a larger student population and in documenting the long-term impact of the course.
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Affiliation(s)
- Ardi Findyartini
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nani Cahyani Sudarsono
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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83
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Kelly AM, Mullan PB. Designing a Curriculum for Professionalism and Ethics Within Radiology: Identifying Challenges and Expectations. Acad Radiol 2018; 25:610-618. [PMID: 29580789 DOI: 10.1016/j.acra.2018.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 12/17/2022]
Abstract
Although professionalism and ethics represent required competencies, they are more challenging than other competencies to design a curriculum for and teach. Reasons include variability in agreed definitions of professionalism within medicine and radiology. This competency is also framed differently whether as roles, duties, actions, skills, behavior, beliefs, and attitudes. Standardizing a curriculum in professionalism is difficult because each learner's (medical student/resident) professional experiences and interactions will be unique. Professionalism is intertwined throughout all (sub) specialties and areas and its teaching cannot occur in isolation as a standalone curriculum. In the past, professionalism was not emphasized enough or at all, with global (or no) assessments, with the potential effect of trainees not valuing it. Although we can teach it formally in the classroom and informally in small groups, much of professionalism is witnessed and learned as "hidden curricula". The formal, informal, and hidden curricula often contradict each other creating confusion, disillusion, and cynicism in trainees. The corporatization of medicine pressurizes us to increase efficiency (throughput) with less focus on aspects of professionalism that add value, creating a disjoint between what we do in practice and preach to trainees. Progressively, expectations for our curriculum include providing evidence for the impacts of our efforts on patient outcomes. Generational differences in the perception of professionalism and the increasingly diverse and multicultural society in which we live affects our interpretation of professionalism, which can add to confusion and misunderstanding. The objectives of this article are to outline challenges facing curriculum design in professionalism and to make suggestions to help educators avoid or overcome them.
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84
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Ahmad A, Bahri Yusoff MS, Zahiruddin Wan Mohammad WM, Mat Nor MZ. Nurturing professional identity through a community based education program: medical students experience. J Taibah Univ Med Sci 2018; 13:113-122. [PMID: 31435313 PMCID: PMC6694961 DOI: 10.1016/j.jtumed.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/10/2017] [Accepted: 12/14/2017] [Indexed: 01/15/2023] Open
Abstract
Objectives Community-based education (CBE) has an impact on the types of medical students produced at the end of medical training. However, its impact on professional identity development (PID) has not been clearly understood. This study thus explores the effect of the CBE program on PID. Methods A qualitative phenomenological study was conducted on a group of Universiti Sains Malaysia medical students who had finished the Community and Family Case Study (CFCS) program. Data were gathered through focused group discussions and student reflective journals. Participants were sampled using the maximal variation technique of purposive sampling. Three steps of thematic analysis using the Atlasti software were employed to identify categories, subthemes, and themes. Results Personal, role, social, and research identities were generated that contribute to the PID of medical students through the CFCS program. The results indicate that the CFCS program nurtured personal identity through the development of professional skills, soft skills, and personal values. Pertaining to role identity, this is related to patient care in terms of primary care and interprofessional awareness. Pertaining to social identity, the obvious feature was community awareness related to culture, society, and politics. A positive outcome of the CFCS program was found to be its fostering of research skills, which is related to the use of epidemiology and research methods. Conclusion The findings indicate that the CFCS program promotes PID among medical students. The current data highlight and provide insights into the importance of integrating CBE into medical curricula to prepare future doctors for their entry into the profession.
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Affiliation(s)
- Anisa Ahmad
- Medical Education Department, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Muhamad S Bahri Yusoff
- Medical Education Department, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Mohd Z Mat Nor
- Medical Education Department, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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85
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Skjeggestad E, Gerwing J, Gulbrandsen P. Language barriers and professional identity: A qualitative interview study of newly employed international medical doctors and Norwegian colleagues. PATIENT EDUCATION AND COUNSELING 2017; 100:1466-1472. [PMID: 28283216 DOI: 10.1016/j.pec.2017.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore how language barriers influence communication and collaboration between newly-employed international medical doctors and Norwegian health personnel. METHODS Interviews were conducted with 16 doctors who had recently started working in Norway and 12 Norwegian born health personnel who had extensive experience working with international medical doctors. Analyses were consistent with principles of systematic text condensation. RESULTS All participants experienced that language barriers caused difficulties in their everyday collaboration. Furthermore, the participants' descriptions of "language barriers" encompassed a wide range of topics, including semantics (e.g., specialized professional vocabulary, system knowledge), pragmatics (e.g., using language in doctor-patient and interprofessional interactions), and specific culturally sensitive topics. All participants described that language barriers provoked uncertainty about a doctor's competence. CONCLUSION Newly employed international medical doctors and their colleagues are concerned by ineffective communication due to language barriers. Experiences of language barriers threaten professional identity as a competent and effective doctor. PRACTICE IMPLICATIONS Newly employed doctors who are non-native speakers could benefit from support in understanding and handling the array of barriers related to language.
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Affiliation(s)
- Erik Skjeggestad
- HØKH, Health Services Research Unit, Akershus University Hospital, Pb.1000, 1478 Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.
| | - Jennifer Gerwing
- HØKH, Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway; HØKH, Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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86
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McLean M. From being a nurse to becoming a 'different' doctor. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:667-689. [PMID: 27473857 DOI: 10.1007/s10459-016-9700-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
Using interpretative phenomenological analysis to make meaning of the experiences of three highly qualified registered nurses who had enrolled in an undergraduate medical programme, this study provides insight into their personal journeys of wanting to become 'different' doctors. In so doing, they conceptualised their future selves as adding clinical reasoning and diagnostic skills to the patient-centred caring ethic of their nursing practice, becoming a multi-skilled community member or helping to fix the health care culture. By customising their identities, e.g. by splinting (aligning with their stronger nursing identity), by enriching current nursing practice with newly acquired theory as medical students or by patching a perceived deficiency (i.e. patient-centredness) in medicine, they tailored their identities. Their journeys had, however, not been the natural progression they had anticipated, threatened by perceived and/or real intrinsic (e.g. working as nurses whilst studying medicine) and extrinsic (e.g. interprofessional rivalry) factors. Rather than being accepted as legitimate newcomers to the medical profession, the women sometimes felt like intruders. Some nursing colleagues accused them of desertion. In response, they generally withheld their identities as nurses or medical students, compartmentalising their group membership. This study has highlighted the role of personal (e.g. prior experience; agency; resilience; personality) and contextual factors in 'becoming' a doctor. A recommendation emerging from this study is the need for interprofessional learning in the medical curriculum to cultivate a health care culture of collaboration rather than competition. Future research is required in terms of how allied health professionals transition to medicine.
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Affiliation(s)
- Michelle McLean
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
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87
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Schrewe B, Bates J, Pratt D, Ruitenberg CW, McKellin WH. The Big D(eal): professional identity through discursive constructions of 'patient'. MEDICAL EDUCATION 2017; 51:656-668. [PMID: 28488302 DOI: 10.1111/medu.13299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/08/2016] [Accepted: 01/23/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Professional identity formation has become a key focus for medical education. Who one becomes as a physician is contingent upon learning to conceptualise who the other is as a patient, yet, at a time when influential ideologies such as patient-centred care have become espoused values, there has been little empirical investigation into assumptions of 'patient' that trainees take up as they progress through their training. METHODS Our team employed a critical discourse analysis approach to transcripts originally produced from a micro-ethnography of medical student learning on an acute care in-patient paediatric ward. The dataset included 20 case presentations and 14 sign-over rounds taken from a 3-week observation period. We paid specific attention to how trainees used language to talk about, refer to and categorise patients. RESULTS Identified discourses included patient-as-disease-category, patient-as-educational-commodity and patient-as-marginalised-actor. These discourses conceptualise 'patient' as an entity that is principally biomedical, useful for clinical learning and spoken for and about. Medical student participation in these discourses contributes to an identity that allows them to move further into the professional medical world they are joining. CONCLUSIONS We contend that as learners participate in these discourses, they are also performatively produced by them. By making these discourses visible, we can consider how to minimise unintended effects such discourses may cause. Our findings, although limited, offer a glimpse of the effects that those assumptions may have as we look to align better the formation of professional medical identity with the ideals of patient-centred care and socially responsible health care systems.
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Affiliation(s)
- Brett Schrewe
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanna Bates
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dan Pratt
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claudia W Ruitenberg
- Department of Educational Studies, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - William H McKellin
- Department of Anthropology, University of British Columbia, Vancouver, British Columbia, Canada
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Morgan DJ, Leppin A, Smith CD, Korenstein D. A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient-Clinician Interaction. J Hosp Med 2017; 12:346-351. [PMID: 28459906 PMCID: PMC5570540 DOI: 10.12788/jhm.2738] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Overuse of medical services is an increasingly recognized driver of poor-quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce overuse and improve care. We used an iterative, expert-informed, evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient-clinician interaction as the nexus of decisions regarding inappropriate care. This interaction is influenced by other utilization drivers, including healthcare system factors, the practice environment, the culture of professional medicine, the culture of healthcare consumption, and individual patient and clinician factors. The variable strength of the evidence supporting these domains highlights important areas for further investigation. Journal of Hospital Medicine 2017;12:346-351.
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Affiliation(s)
- Daniel J. Morgan
- VA Maryland Healthcare System, University of Maryland School of Medicine and Centers for Disease Dynamics, Economics and Policy, Baltimore, MD, USA
| | - Aaron Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | | | - Deborah Korenstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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89
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Developing Professional Identity in Undergraduate Pharmacy Students: A Role for Self-Determination Theory. PHARMACY 2017; 5:pharmacy5020016. [PMID: 28970428 PMCID: PMC5597141 DOI: 10.3390/pharmacy5020016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/10/2017] [Accepted: 03/21/2017] [Indexed: 11/16/2022] Open
Abstract
Professional identity development, seen as essential in the transition from student to professional, needs to be owned by the universities in order to ensure a workforce appropriately prepared to provide global health care in the future. The development of professional identity involves a focus on who the student is becoming, as well as what they know or can do, and requires authentic learning experiences such as practice exposure and interaction with pharmacist role models. This article examines conceptual frameworks aligned with professional identity development and will explore the role for self-determination theory (SDT) in pharmacy professional education. SDT explains the concepts of competence, relatedness and autonomy and the part they play in producing highly motivated individuals, leading to the development of one’s sense of self. Providing support for students in these three critical areas may, in accordance with the tenets of SDT, have the potential to increase motivation levels and their sense of professional identity.
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90
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Warmington S, McColl G. Medical student stories of participation in patient care-related activities: the construction of relational identity. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:147-163. [PMID: 27235124 DOI: 10.1007/s10459-016-9689-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/20/2016] [Indexed: 05/10/2023]
Abstract
Professional identity formation is acknowledged as one of the fundamental tasks of contemporary medical education. Identity is a social phenomenon, constructed through participation in everyday activities and an integral part of every learning interaction. In this paper we report from an Australian ethnographic study into how medical students and patients use narrative to construct their identities. The dialogic narrative analysis employed focused on the production of meaning through the use of language devices in a given context, and the juxtaposition of multiple perspectives. Two stories told by students about their participation in patient care-related activities reveal how identities are constructed in this context through depictions of the relationships between medical students, patients and clinical teachers. These students use the rhetorical functions of stories to characterise doctors and patients in certain ways, and position themselves in relation to them. They defend common practices that circumvent valid consent processes, justified by the imperative to maximise students' participation in patient care-related activities. In doing so, they identify patients as their adversaries, and doctors as allies. Both students are influenced by others' expectations but one reveals the active nature of identity work, describing subtle acts of resistance. These stories illustrate how practices for securing students' access to patients can influence students' emerging identities, with implications for their future disclosure and consent practices. We argue that more collaborative ways of involving medical students in patient care-related activities will be facilitated if students and clinical teachers develop insight into the relational nature of identity work.
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Affiliation(s)
- Sally Warmington
- Faculty of Medicine, Dentistry and Health Sciences, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Geoffrey McColl
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Parkville, VIC, 3010, Australia
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Abstract
Medical education fails to prepare young doctors for the nature of the work they will encounter. Doctors face a rapidly changing medical landscape, which relies more and more upon interprofessional collaboration to optimise patient outcomes and upon non-clinical skills to provide care efficiently and cost effectively. The current response to change is a reactive and resource-intensive effort, where established doctors are directed towards new ways of working. A better response would be interprofessional clinical and non-clinical training, incorporating a philosophy and style that accommodate innovation, communication and change. This preparative training should be overseen by a single educational enterprise that links undergraduate and postgraduate instruction. Improved training might enable better design of the healthcare system from within.
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Affiliation(s)
- Josephine S Thomas
- Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, University of Adelaide, Australia
| | - Toby R Gilbert
- Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, University of Adelaide, Australia
| | - Campbell H Thompson
- Royal Adelaide Hospital, Adelaide, Australia
- School of Medicine, University of Adelaide, Australia
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92
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Clandinin DJ, Cave MT, Berendonk C. Narrative inquiry: a relational research methodology for medical education. MEDICAL EDUCATION 2017; 51:89-96. [PMID: 27807868 DOI: 10.1111/medu.13136] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/22/2016] [Accepted: 05/27/2016] [Indexed: 06/06/2023]
Abstract
CONTEXT Narrative research, an inclusive term for a range of methodologies, has rapidly become part of medical education scholarship. CONCEPTS In this paper we identify narrative inquiry as a particular theoretical and methodological framework within narrative research and outline its characteristics. We briefly summarise how narrative research has been used in studying medical learners' identity making in medical education. USES OF NARRATIVE INQUIRY We then turn to the uses of narrative inquiry in studying medical learners' professional identity making. With the turn to narrative inquiry, the shift is to thinking with stories instead of about stories. CONCLUSIONS We highlight four challenges in engaging in narrative inquiry in medical education and point toward promising future research and practice possibilities.
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Affiliation(s)
- D Jean Clandinin
- Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | - Marie T Cave
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Brown RMA, Donaldson JF, Warne-Griggs MD, Bagby Stone S, Campbell JD, Hoffman KG. Journeying to the White Coat Ceremony: A description of the people, situations and experiences that inform student visions of the physician they hope to become. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2017; 4:2382120517725506. [PMID: 29349340 PMCID: PMC5736282 DOI: 10.1177/2382120517725506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
Little is known about the experiences that influence entering medical students' internal concepts of themselves as future physicians. During orientation to medical school, students were asked to write stories in response to the cue, "Tell a story about a person or experience that inspired you to consider a career of service in medicine." Qualitative methodology was employed to analyze 190 student stories. Thematic analysis identified descriptive details about content and allowed comparison between the students' and School's expectations. Inspirational settings, contexts, and individuals were identified. Nine different inspirational events were described. Student and School expectations for the kinds of physicians they hoped to become were generally consistent. The study demonstrates that students do indeed bring to medical school visions of the kinds of physicians they hope to become. Linking that vision with medical school activities including the White Coat Ceremony provides a bridge between medical school and students' earlier lives, thus explicitly linking orientation to professional formation.
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Affiliation(s)
- Rachel MA Brown
- College of Medicine, Central Michigan University, Mount Pleasant MI, USA
| | - Joe F Donaldson
- Department of Education, University of Missouri, Columbia MO, USA
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Helmich E, Yeh HM, Kalet A, Al-Eraky M. Becoming a Doctor in Different Cultures: Toward a Cross-Cultural Approach to Supporting Professional Identity Formation in Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:58-62. [PMID: 27782917 DOI: 10.1097/acm.0000000000001432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Becoming a doctor is fundamentally about developing a new, professional identity as a physician, which in and of itself may evoke many emotions. Additionally, medical trainees are increasingly moving from one cultural context to another and are challenged with navigating the resulting shifts in their professional identify. In this Article, the authors aim to address medical professional identity formation from a polyvocal, multidisciplinary, cross-cultural perspective. They delineate the cultural approaches to medical professionalism, reflect on professional identity formation in different cultures and on different theories of identity development, and advocate for a context-specific approach to professional identity formation. In doing so, the authors aim to broaden the developing professional identity formation discourse to include non-Western approaches and notions.
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Affiliation(s)
- Esther Helmich
- E. Helmich is assistant professor, Center for Evidence Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands, and senior researcher, Center for Education Development and Research in Health Professions, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. H.-M. Yeh is attending physician, Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan. A. Kalet is professor of medicine and surgery and director of research on medical education outcomes, Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, New York. M. Al-Eraky is assistant professor of medical education, University of Dammam, Dammam, Saudi Arabia, and founding member, Medical Education Development Centre, Zagazig University, Zagazig, Egypt
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Kimura MN, Russell R, Scaringe J. Professional Identity at Los Angeles College of Chiropractic. JOURNAL OF CHIROPRACTIC HUMANITIES 2016; 23:61-67. [PMID: 27920620 PMCID: PMC5127915 DOI: 10.1016/j.echu.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of this article is to describe chiropractic professional identity as espoused by the Los Angeles College of Chiropractic. DISCUSSION Professional identity is a construct that begins formation prior to career selection, can be considered the backbone of health care education, and has been linked to career success. Los Angeles College of Chiropractic's professional identity is shaped by a philosophy of health care that is focused on vitalism, holism, naturalism, therapeutic conservatism, critical rationalism, phenomenology, humanism, and interprofessionalism. Other distinguishing aspects include portal-of-entry professionals with broad diagnostic skills; a focus on spine care; promotion of public-health; and delivery of manual treatments. CONCLUSION The chiropractic professional identity at the Los Angeles College of Chiropractic focuses on serving the needs of the people who entrust their health to its graduates and will continue to evolve on the basis of many factors, such as politics, social perceptions, and economic conditions.
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Affiliation(s)
| | - Robb Russell
- SCU Health System, Southern California University of Health Sciences, Whittier, CA
| | - John Scaringe
- Southern California University of Health Sciences, Whittier, CA
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Ojuka DK, Olenja JM, Mwango'mbe NJ, Yang EB, Macleod JB. Perception of medical professionalism among the surgical community in the University of Nairobi: a mixed method study. BMC MEDICAL EDUCATION 2016; 16:101. [PMID: 27039376 PMCID: PMC4818896 DOI: 10.1186/s12909-016-0622-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 03/24/2016] [Indexed: 05/17/2023]
Abstract
BACKGROUND Professionalism defines the relationship between colleagues, patients and the society as a whole. Furthermore, being a social construct, professionalism is sophisticated to be regarded simply as a single concept across different cultural contexts. This study sought to explore how professionalism is conceptualized by the clinicians, students and patients in a teaching hospital in Kenya. METHODS A sequential mixed methods study was conducted among clinicians, students and patients at Kenyatta National Hospital on the surgical wards from March 1(st)-December 31(st), 2014. The first phase of the study involved focus group discussions (FGDs) of between 10-12 persons and individual in-depth interviews of senior faculty and patients. Grounded theory method was used for collecting perceptions of participants on professionalism. These views were then coded using Atlas 5.2, allowing the development of a questionnaire that provided the survey tool for the second phase of the study. For the questionnaire, response options utilized a 4-point Likert scale with a range from "strongly agree" to "strongly disagree". Factor analysis was used to analyse the responses to the survey. Internal reliability was determined by Cronbach's α. RESULTS Sixteen FGDs and 18 in-depth interviews were held with 204 clinicians, students and patients. A further 188 participants completed the questionnaire. Respect was the most frequently mentioned or picked component of professionalism during the interview and survey respectively, with 74.5 % of participants reporting "strongly agree". Factor analysis showed that 3 factors accounted for the majority of the variance in the items analysed; respect in practice, excellence in service and concern for the patient. The Cronbach's α for this analysis was 0.927. CONCLUSION The study cohort predominantly conceptualizes professionalism as relating to respect between colleagues and toward patients. Respect, being a cultural norm, should form part of the core curriculum of professionalism in order to be relevant for the Kenyan context.
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Affiliation(s)
- Daniel Kinyuru Ojuka
- Department of Surgery, College of Health Sciences, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya.
| | - Joyce M Olenja
- School of Public Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Nimrod J Mwango'mbe
- Department of Surgery, College of Health Sciences, University of Nairobi, P. O. Box 19676-00202, Nairobi, Kenya
| | - Eunbae B Yang
- Department of Medical Education, Yonsei University, Seoul, South Korea
| | - Jana B Macleod
- Department of Surgery, School of Medicine, Kenyatta University, Nairobi, Kenya
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97
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Cruess RL, Cruess SR, Steinert Y. Amending Miller's Pyramid to Include Professional Identity Formation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:180-5. [PMID: 26332429 DOI: 10.1097/acm.0000000000000913] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
In 1990, George Miller published an article entitled "The Assessment of Clinical Skills/Competence/Performance" that had an immediate and lasting impact on medical education. In his classic article, he stated that no single method of assessment could encompass the intricacies and complexities of medical practice. To provide a structured approach to the assessment of medical competence, he proposed a pyramidal structure with four levels, each of which required specific methods of assessment. As is well known, the layers are "Knows," "Knows How," "Shows How," and "Does." Miller's pyramid has guided assessment since its introduction; it has also been used to assist in the assessment of professionalism.The recent emphasis on professional identity formation has raised questions about the appropriateness of "Does" as the highest level of aspiration. It is believed that a more reliable indicator of professional behavior is the incorporation of the values and attitudes of the professional into the identity of the aspiring physician. It is therefore proposed that a fifth level be added at the apex of the pyramid. This level, reflecting the presence of a professional identity, should be "Is," and methods of assessing progress toward a professional identity and the nature of the identity in formation should be guided by currently available methods.
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Affiliation(s)
- Richard L Cruess
- R.L. Cruess is professor of surgery and core faculty member, Centre for Medical Education of McGill University, Montreal, Quebec, Canada. S.R. Cruess is professor of medicine and core faculty member, Centre for Medical Education of McGill University, Montreal, Quebec, Canada. Y. Steinert is professor of family medicine and director, Centre for Medical Education of McGill University, Montreal, Quebec, Canada
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Beck J, Chretien K, Kind T. Professional Identity Development Through Service Learning: A Qualitative Study of First-Year Medical Students Volunteering at a Medical Specialty Camp. Clin Pediatr (Phila) 2015; 54:1276-82. [PMID: 25667311 DOI: 10.1177/0009922815571108] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the experience of medical students volunteering at a camp for children with a variety of medical conditions. METHODS Rising second-year medical students who had served as counselors for 1 week at a medical specialty camp were invited to participate. We conducted a 2-part qualitative study using on-site focus groups and follow-up individual interviews. RESULTS Nine medical students participated. Students described their experience as motivating and career reinforcing. It helped them "move beyond the textbook" and deepened their commitment to serving future patients with compassion. One theme that emerged was the idea that their camp experience fostered the development of their professional identities. CONCLUSIONS A 1-week, immersive community service experience at a medical specialty camp played a role in influencing the early formative professional identities of rising second-year medical students. Medical schools could use camps as a promising community service-learning experiences to foster professional identity.
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Affiliation(s)
- Jimmy Beck
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Katherine Chretien
- The George Washington University School of Medicine and Health Sciences, Washington DC VA Medical Center, Washington, DC, USA
| | - Terry Kind
- The George Washington University School of Medicine and Health Sciences, Children's National Health System, Washington, DC, USA
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Shapiro J, Nixon LL, Wear SE, Doukas DJ. Medical professionalism: what the study of literature can contribute to the conversation. Philos Ethics Humanit Med 2015; 10:10. [PMID: 26122270 PMCID: PMC4484639 DOI: 10.1186/s13010-015-0030-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 06/23/2015] [Indexed: 05/30/2023] Open
Abstract
Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the meaning of "professionalism" itself (as well as its virtues), thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism.
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Affiliation(s)
- Johanna Shapiro
- Family Medicine and Director of the Program in Medical Humanities & Arts, University of California-Irvine, School of Medicine, 101 City Dr. South, Rte 81, Bldg 200, Ste 835, Orange, CA, 92868, USA.
| | - Lois L Nixon
- Internal Medicine, Division of Ethics and Humanities, University of South Florida School of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
| | - Stephen E Wear
- Center for Clinical Ethics and Humanities in Healthcare, Departments of Medicine, Gynecology-Obstetrics, and Philosophy, University at Buffalo SUNY School of Medicine, Buffalo, NY, USA.
| | - David J Doukas
- William Ray Moore Endowed Chair of Family Medicine and Medical Humanism, and Division of Medical Humanism and Ethics, Department of Family and Geriatric Medicine, University of Louisville, 2301S 3rd St, Louisville, KY, 40292, USA.
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McLean M, Johnson P, Sargeant S, Green P. More than just teaching procedural skills: How RN clinical tutors perceive they contribute to medical students' professional identity development. Australas Med J 2015; 8:122-31. [PMID: 26045722 DOI: 10.4066/amj.2015.2326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND On their journey to "becoming" doctors, medical students encounter a range of health professionals who contribute to their socialisation into clinical practice. Amongst these individuals are registered nurses (RNs) in clinical practice who are often employed by medical schools as clinical tutors. These RNs will encounter medical students on campus and later in the clinical setting. AIMS This qualitative study explored RNs' perceptions of their contribution to medical students' developing professional identities in order to provide a greater understanding of this process and ultimately inform future curriculum. METHODS This qualitative study took place in 2012 at one Australian medical school as part of a broader study exploring medical students' professional identity development from the perspectives of their teachers and trainers. Eight of the nine RNs involved in teaching procedural skills were interviewed. Recorded interviews were transcribed verbatim. Data were analysed inductively by the research team. RESULTS Two major themes emerged: RNs as change agents and RNs as facilitators of medical students' transition to the clinical environment. RNs as change agents related to their role modelling good practice, being patient-centred, and by emphasising factors contributing to good teamwork such as recognising and respecting individual professional roles. They facilitated students' transition to the clinical environment often through personal narratives, by offering advice on how to behave and work with members of the healthcare team, and by being a point of contact in the hospital. CONCLUSION Based on their descriptions of how they role modelled good practice and how they facilitated students' transition to clinical practice, we believe that RN clinical tutors do have the experience and expertise in clinical practice and a professional approach to patients to contribute to medical students' developing professional identities as future doctors.
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Affiliation(s)
- Michelle McLean
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD Australia
| | - Patricia Johnson
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD Australia
| | - Sally Sargeant
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD Australia
| | - Patricia Green
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD Australia
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