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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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102
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Chou CL, Teherani A. A Foundation for Vital Academic and Social Support in Clerkships: Learning Through Peer Continuity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:951-955. [PMID: 28353506 DOI: 10.1097/acm.0000000000001661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Most medical students on clerkships currently experience lack of continuity of patient care, disjointed learning, and frequent changes in supervisors. Clerkship programs with continuity of care, curriculum, and supervisors appear to benefit student learning and patient-centeredness. A fourth form of continuity is proposed: continuity of peers, in which a stable cohort of students frequently meets to process their experiences on clerkships. This structure builds on benefits previously seen in peer-assisted learning, including enhanced knowledge, technical skills, and collegial peer relationships. Additional advantages of peer continuity in clerkships include facilitated integration into the workplace, social support, and enhanced clinical and professional learning. Practical components required for a successful peer continuity structure include intentional formation of peer cohorts; regular meetings that cover didactic or clinical skills learning; frequent opportunities for reflection on patient care, professional development, and well-being; and skilled facilitators without evaluative roles. Theoretical support for peer continuity comes from social cognitive theory, communities of clinical practice, and social comparison theory. Therefore, in conjunction with empirical programs that have shown benefits of developing these structures, peer continuity should become a formalized educational structure in clerkships.
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Affiliation(s)
- Calvin L Chou
- C.L. Chou is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. A. Teherani is professor, Department of Medicine, and education researcher, Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, California
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103
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Alexander K, Fahey Palma T, Nicholson S, Cleland J. 'Why not you?' Discourses of widening access on UK medical school websites. MEDICAL EDUCATION 2017; 51:598-611. [PMID: 28229477 DOI: 10.1111/medu.13264] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/12/2016] [Accepted: 12/15/2016] [Indexed: 05/16/2023]
Abstract
CONTEXT In the UK, applications to medicine from those in lower socio-economic groups remain low despite significant investments of time, interest and resources in widening access (WA) to medicine. This suggests that medical schools' core messages about WA may be working to embed or further reinforce marginalisation, rather than to combat this. Our objective was to investigate how the value of WA is communicated by UK medical schools through their websites, and how this may create expectations regarding who is 'suitable' for medicine. METHODS We conducted a critical discourse analysis of the webpages of UK medical schools in relation to WA. Our conceptual framework was underpinned by a Foucauldian understanding of discourse. Analysis followed an adapted version of Hyatt's analytical framework. This involved contextualising the data by identifying drivers, levers and warrants for WA, before undertaking a systematic investigation of linguistic features to reveal the discourses in use, and their assumptions. RESULTS Discourses of 'social mobility for the individual' justified WA as an initiative to support individuals with academic ability and commitment to medicine, but who were disadvantaged by their background in the application process. This meritocratic discourse communicated the benefits of WA as flowing one way, with medical schools providing opportunities to applicants. Conversely, discourses justifying WA as an initiative to benefit patient care were marginalised and largely excluded. Alternative strengths typically attributed to students from lower socio-economic groups were not mentioned, which implies that these were not valued. CONCLUSIONS Current discourses of WA on UK medical school websites do not present non-traditional applicants as bringing gains to medicine through their diversity. This may work as a barrier to attracting larger numbers of diverse applicants. Medical schools should reflect upon their website discourses, critically evaluate current approaches to encouraging applications from those in lower socio-economic groups, and consider avenues for positive change.
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Affiliation(s)
- Kirsty Alexander
- Institute of Education in Medical and Dental Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Tania Fahey Palma
- Department of Linguistics, School of Language, Literature, Music and Visual Culture, University of Aberdeen, Aberdeen, UK
| | - Sandra Nicholson
- Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, London, UK
| | - Jennifer Cleland
- Institute of Education in Medical and Dental Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
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104
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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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105
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Sawatsky AP, Beckman TJ, Hafferty FW. Cultural competency, professional identity formation and transformative learning. MEDICAL EDUCATION 2017; 51:462-464. [PMID: 28394072 DOI: 10.1111/medu.13316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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106
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Bennett D, Solomon Y, Bergin C, Horgan M, Dornan T. Possibility and agency in Figured Worlds: becoming a 'good doctor'. MEDICAL EDUCATION 2017; 51:248-257. [PMID: 28032364 DOI: 10.1111/medu.13220] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/10/2016] [Accepted: 09/05/2016] [Indexed: 05/28/2023]
Abstract
CONTEXT Figured Worlds is a socio-cultural theory drawing on Vygotskian and Bakhtinian traditions, which has been applied in research into the development of identities of both learners and teachers in the wider education literature. It is now being adopted in medical education. OBJECTIVE The objective of this paper is to show what Figured Worlds can offer in medical education. Having explained some of its central tenets, we apply it to an important tension in our field. METHODS The assumption that there is a uniform 'good doctor' identity, which must be inculcated into medical students, underlies much of what medical educators do, and what our regulators enforce. Although diversity is encouraged when students are selected for medical school, pressure to professionalise students creates a drive towards a standardised professional identity by graduation. Using excerpts from reflective pieces written by two junior medical students, we review the basic concepts of Figured Worlds and demonstrate how it can shed light on the implications of this tension. Taking a Bakhtinian approach to discourse, we show how Adam and Sarah develop their professional identities as they negotiate the multiple overlapping and competing ways of being a doctor that they encounter in the world of medical practice. Each demonstrates agency by 'authoring' a unique identity in the cultural world of medicine, as they appropriate and re-voice the words of others. DISCUSSION Finally, we consider some important areas in medical education where Figured Worlds might prove to be a useful lens: the negotiation of discourses of gender, sexuality and social class, career choice as identification within specialty-specific cultural worlds, and the influence of hidden and informal curricula on doctor identity.
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Affiliation(s)
- Deirdre Bennett
- Medical Education Unit, University College Cork, Cork, County Cork, Ireland
| | - Yvette Solomon
- Education and Social Research Institute, Manchester Metropolitan University, Manchester, UK
| | - Colm Bergin
- Royal College of Physicians of Ireland, Dublin, Ireland
- Department of Infectious Diseases, St. James' University Hospital, Dublin, Ireland
- Department of Medicine, University of Dublin Trinity College, Dublin, Ireland
| | - Mary Horgan
- School of Medicine, University College Cork, Cork, Ireland
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
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107
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Gordon LJ. Moving beyond being a 'good doctor' to thinking about 'good doctoring processes'. MEDICAL EDUCATION 2017; 51:237-238. [PMID: 28211146 DOI: 10.1111/medu.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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108
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Balmer DF, Devlin MJ, Richards BF. Understanding the relation between medical students' collective and individual trajectories: an application of habitus. PERSPECTIVES ON MEDICAL EDUCATION 2017; 6:36-43. [PMID: 27981436 PMCID: PMC5285281 DOI: 10.1007/s40037-016-0321-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION While medical educators typically attend to group trends, groups are made up of unique individuals. An exploration of Bourdieu's concept of habitus, defined as a system of dispositions, may help medical educators think relationally about the collective trajectory of the group and the individual trajectory of each student. METHODS We built on our 4‑year, longitudinal study which reported how field, capital, and habitus worked together to explain how medical students, as a group, navigated transitions in undergraduate medical education. In this secondary analysis, we reviewed serial collections of narratives about students' peak learning experiences in medical school (19 students, 5 narratives per student), concentrating on first-person representations of self. We then explored the relation between collective and individual trajectories in three illustrative cases. RESULTS The social space of undergraduate medical education harmonized students' experience and helped explain the collective trajectory, as evidenced by students' consistent reports of taking initiative and staying open-minded. But individuals were not totally harmonized. They had unique dispositions that influenced their ability to access valued resources and shaped their behaviour. For example, Emily consistently spoke of being driven by her own goals; Zach focused on meeting expectations of authorities; Hilary routinely oriented toward abstract medical knowledge. DISCUSSION Habitus provides a useful conceptual lens for thinking relationally about collective and individual trajectories of medical students. Our work may inform faculty as they seek to situate individualized learning within standardized curricula, and is a step toward researching transitions in medical training from a holistic perspective that includes, but is not limited to, individual trajectories.
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Affiliation(s)
- Dorene F Balmer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | | | - Boyd F Richards
- Center for Education Research and Evaluation, Columbia University Medical Center, New York, NY, USA
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Irby DM, Hamstra SJ. Parting the Clouds: Three Professionalism Frameworks in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1606-1611. [PMID: 27119331 DOI: 10.1097/acm.0000000000001190] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Current controversies in medical education associated with professionalism, including disagreements about curriculum, pedagogy, and assessment, are rooted in part in the differing frameworks that are used to address professionalism. Three dominant frameworks, which have evolved in the medical education community, are described. The oldest framework is virtue based and focuses on the inner habits of the heart, the development of moral character and reasoning, plus humanistic qualities of caring and compassion: The good physician is a person of character. The second framework is behavior based, which emphasizes milestones, competencies, and measurement of observable behaviors: The good physician is a person who consistently demonstrates competence in performing patient care tasks. The third framework is identity formation, with a focus on identity development and socialization into a community of practice: The good physician integrates into his or her identity a set of values and dispositions consonant with the physician community and aspires to a professional identity reflected in the very best physicians. Although each professionalism framework is useful and valid, the field of medical education is currently engaged in several different discourses resulting in misunderstanding and differing recommendations for strategies to facilitate professionalism. In this article, the assumptions and contributions of each framework are described to provide greater insight into the nature of professionalism. By examining each discourse in detail, underlying commonalities and differences can be highlighted to assist educators in more effectively creating professionalism curricula, pedagogy, and assessment.
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Affiliation(s)
- David M Irby
- D.M. Irby is professor of medicine and of research and development in medical education, University of California, San Francisco, San Francisco, California. S.J. Hamstra is vice president, Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois
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Traynor M, Buus N. Professional identity in nursing: UK students' explanations for poor standards of care. Soc Sci Med 2016; 166:186-194. [PMID: 27567092 DOI: 10.1016/j.socscimed.2016.08.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
Research concludes that professional socialisation in nursing is deeply problematic because new recruits start out identifying with the profession's ideals but lose this idealism as they enter and continue to work in the profession. This study set out to examine the topic focussing on the development of professional identity. Six focus groups were held with a total of 49 2nd and 3rd year BSc nursing students studying at a university in London, UK and their transcripts were subject to discourse analysis. Participants' talk was strongly dualistic and inflected with anxiety. Participants identified with caring as an innate characteristic. They described some qualified nurses as either not possessing this characteristic or as having lost it. They explained strategies for not becoming corrupted in professional practice. Their talk enacted distancing from 'bad' qualified nurses and solidarity with other students. Their talk also featured cynicism. Neophyte nurses' talk of idealism and cynicism can be understood as identity work in the context of anxiety inherent in the work of nurses and in a relatively powerless position in the professional healthcare hierarchy.
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Affiliation(s)
- Michael Traynor
- Centre for Critical Research in Nursing & Midwifery, Middlesex University, The Burroughs, London, NW4 4BT, UK.
| | - Niels Buus
- Faculty of Nursing and Midwifery, Sydney University, St. Vincent's Hospital Sydney, Australia
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111
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Brosnan C, Southgate E, Outram S, Lempp H, Wright S, Saxby T, Harris G, Bennett A, Kelly B. Experiences of medical students who are first in family to attend university. MEDICAL EDUCATION 2016; 50:842-51. [PMID: 27402044 DOI: 10.1111/medu.12995] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/21/2015] [Accepted: 01/03/2016] [Indexed: 05/17/2023]
Abstract
CONTEXT Students from backgrounds of low socio-economic status (SES) or who are first in family to attend university (FiF) are under-represented in medicine. Research has focused on these students' pre-admission perceptions of medicine, rather than on their lived experience as medical students. Such research is necessary to monitor and understand the potential perpetuation of disadvantage within medical schools. OBJECTIVES This study drew on the theory of Bourdieu to explore FiF students' experiences at one Australian medical school, aiming to identify any barriers faced and inform strategies for equity. METHODS Twenty-two FiF students were interviewed about their backgrounds, expectations and experiences of medical school. Interviews were recorded, transcribed and analysed thematically. Findings illustrate the influence and interaction of Bourdieu's principal forms of capital (social, economic and cultural) in FiF students' experiences. RESULTS The absence of health professionals within participants' networks (social capital) was experienced as a barrier to connecting with fellow students and accessing placements. Financial concerns were common among interviewees who juggled paid work with study and worried about expenses associated with the medical programme. Finally, participants' 'medical student' status provided access to new forms of cultural capital, a transition that was received with some ambivalence by participants themselves and their existing social networks. CONCLUSIONS This study revealed the gaps between the forms of capital valued in medical education and those accessible to FiF students. Admitting more students from diverse backgrounds is only one part of the solution; widening participation strategies need to address challenges for FiF students during medical school and should enable students to retain, rather than subdue, their existing, diverse forms of social and cultural capital. Embracing the diversity sought in admissions is likely to benefit student learning, as well as the communities graduates will serve. Change must ideally go beyond medical programmes to address medical culture itself.
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Affiliation(s)
- Caragh Brosnan
- Faculty of Education and Arts, School of Humanities and Social Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Erica Southgate
- Faculty of Education and Arts, School of Humanities and Social Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sue Outram
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Australia
| | | | - Sarah Wright
- Toronto East General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Troy Saxby
- Faculty of Education and Arts, School of Humanities and Social Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Gillian Harris
- Faculty of Education and Arts, School of Humanities and Social Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Anna Bennett
- Centre for English Language and Foundation Studies, University of Newcastle, Australia
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, Australia
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Zaidi Z, Verstegen D, Naqvi R, Morahan P, Dornan T. Gender, religion, and sociopolitical issues in cross-cultural online education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:287-301. [PMID: 26303113 DOI: 10.1007/s10459-015-9631-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/27/2015] [Indexed: 06/04/2023]
Abstract
Cross-cultural education is thought to develop critical consciousness of how unequal distributions of power and privilege affect people's health. Learners in different sociopolitical settings can join together in developing critical consciousness-awareness of power and privilege dynamics in society-by means of communication technology. The aim of this research was to define strengths and limitations of existing cross-cultural discussions in generating critical consciousness. The setting was the FAIMER international fellowship program for mid-career interdisciplinary health faculty, whose goal is to foster global advancement of health professions education. Fellows take part in participant-led, online, written, task-focused discussions on topics like professionalism, community health, and leadership. We reflexively identified text that brought sociopolitical topics into the online environment during the years 2011 and 2012 and used a discourse analysis toolset to make our content analysis relevant to critical consciousness. While references to participants' cultures and backgrounds were infrequent, narratives of political-, gender-, religion-, and other culture-related topics did emerge. When participants gave accounts of their experiences and exchanged cross-cultural stories, they were more likely to develop ad hoc networks to support one another in facing those issues than explore issues relating to the development of critical consciousness. We suggest that cross-cultural discussions need to be facilitated actively to transform learners' frames of reference, create critical consciousness, and develop cultural competence. Further research is needed into how to provide a safe environment for such learning and provide faculty development for the skills needed to facilitate these exchanges.
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Affiliation(s)
- Zareen Zaidi
- Division of General Internal Medicine, Department of Medicine, University of Florida, PO Box 100277, Gainesville, FL, 32610-0277, USA.
| | - Daniëlle Verstegen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Page Morahan
- FAIMER Institute, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tim Dornan
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Lobato RD, Jiménez Roldan L, Alen JF, Castaño AM, Munarriz PM, Cepeda S, Lagares A. [Competency-based Neurosurgery Residency Programme]. Neurocirugia (Astur) 2016; 27:75-86. [PMID: 26944384 DOI: 10.1016/j.neucir.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED A programme proposal for competency-based Neurosurgery training adapted to the specialization project is presented. This proposal has been developed by a group of neurosurgeons commissioned by the SENEC (Spanish Society of Neurosurgery) and could be modified to generate a final version that could come into force coinciding with the implementation of the specialization programme. This document aims to facilitate the test of the new programme included in the online version of our journal. DURATION OF THE PROGRAMME Total training period is 6 years; initial 2 years belong to the surgery specialization and remaining 4 years belong to core specialty period. STRUCTURE OF THE PROGRAMME It is a competency-based programmed based on the map used by the US Accreditation Council for Graduate Medical Education (ACGME) including the following domains of clinical competency: Medical knowledge, patient care, communication skills, professionalism, practice-based learning and improvement, health systems, interprofessional collaboration and professional and personal development. Subcompetencies map in the domains of Knowledge and Patient care (including surgical competencies) was adapted to the one proposed by AANS and CNS (annex 1 of the programme). A subcompetency map was also used for the specialization rotations. INSTRUCTION METHODS Resident's training is based on personal study (self-learning) supported by efficient use of information sources and supervised clinical practice, including bioethical instruction, clinical management, research and learning techniques. EVALUATION METHODS Resident evaluation proposal includes, among other instruments, theoretical knowledge tests, objective and structured evaluation of the level of clinical competency with real or standardised patients, global competency scales, 360-degree evaluation, clinical record audits, milestones for residents progress and self-assessment (annex 2). Besides, residents periodically assess the teaching commitment of the department's neurosurgeons and other professors participating in rotations, and annually assess the overall operation of the programme. Results of evaluations are registered, together with other relevant data, in the Resident's Book. PROGRAMME'S NATIONAL COMMITTEE The creation of a Programme Committee directly attached to the SENEC (National Commission) that, aside from generating a final version of the programme, monitors its implementation (level of adherence and operation in the different departments), assumes the creation of test banks and the centralized administration of knowledge tests (in the middle of the residency and/or at the end of it) and centralizes information collected by tutors that could be used for re-accreditation of the services, is proposed.
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Affiliation(s)
- Ramiro D Lobato
- Servicio de Neurocirugía, Hospital «12 de Octubre», Facultad de Medicina, UCM, Madrid, España.
| | - Luis Jiménez Roldan
- Servicio de Neurocirugía, Hospital «12 de Octubre», Facultad de Medicina, UCM, Madrid, España
| | - José F Alen
- Servicio de Neurocirugía, Hospital «12 de Octubre», Facultad de Medicina, UCM, Madrid, España
| | - Ana M Castaño
- Servicio de Neurocirugía, Hospital «12 de Octubre», Facultad de Medicina, UCM, Madrid, España
| | - Pablo M Munarriz
- Servicio de Neurocirugía, Hospital «12 de Octubre», Facultad de Medicina, UCM, Madrid, España
| | - Santiago Cepeda
- Servicio de Neurocirugía, Hospital «12 de Octubre», Facultad de Medicina, UCM, Madrid, España
| | - Alfonso Lagares
- Servicio de Neurocirugía, Hospital «12 de Octubre», Facultad de Medicina, UCM, Madrid, España
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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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Law M, Mathai A, Veinot P, Webster F, Mylopoulos M. Exploring lesbian, gay, bisexual, and queer (LGBQ) people's experiences with disclosure of sexual identity to primary care physicians: a qualitative study. BMC FAMILY PRACTICE 2015; 16:175. [PMID: 26651342 PMCID: PMC4675062 DOI: 10.1186/s12875-015-0389-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 12/01/2015] [Indexed: 11/10/2022]
Abstract
Background It has been demonstrated that health disparities between lesbian, gay, bisexual and queer (LGBQ) populations and the general population can be improved by disclosure of sexual identity to a health care provider (HCP). However, heteronormative assumptions (that is, assumptions based on a heterosexual identity and experience) may negatively affect communication between patients and HCPs more than has been recognized. The aim of this study was to understand LGBQ patients’ perceptions of their experiences related to disclosure of sexual identity to their primary care provider (PCP). Methods One-on-one semi-structured telephone interviews were conducted, audio-recorded, and transcribed. Participants were self-identified LGBQ adults with experiences of health care by PCPs within the previous five years recruited in Toronto, Canada. A qualitative descriptive analysis was performed using iterative coding and comparing and grouping data into themes. Results Findings revealed that disclosure of sexual identity to PCPs was related to three main themes: 1) disclosure of sexual identity by LGBQ patients to a PCP was seen to be as challenging as coming out to others; 2) a solid therapeutic relationship can mitigate the difficulty in disclosure of sexual identity; and, 3) purposeful recognition by PCPs of their personal heteronormative value system is key to establishing a strong therapeutic relationship. Conclusion Improving physicians’ recognition of their own heteronormative value system and addressing structural heterosexual hegemony will help to make health care settings more inclusive. This will allow LGBQ patients to feel better understood, willing to disclose, subsequently improving their care and health outcomes.
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Affiliation(s)
- Marcus Law
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 3157, Toronto, ON, M5S 1A8, Canada. .,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Anila Mathai
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | | | - Fiona Webster
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Maria Mylopoulos
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 3157, Toronto, ON, M5S 1A8, Canada. .,The Wilson Centre, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada.
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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: 21] [Impact Index Per Article: 2.3] [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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Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study. J Racial Ethn Health Disparities 2015; 3:250-8. [PMID: 27271066 DOI: 10.1007/s40615-015-0136-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/29/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Diversification of the physician workforce continues to be a national priority; however, a paucity of knowledge about the medical school experience for African American medical students limits our ability to achieve this goal. Previous studies document that African American medical students are at greater risk for depression and anxiety. This study moves beyond these findings to explore the role of racial identity (the extent to which a person normatively defines her/himself with regard to race) and its relationship to well-being for African American medical students in their first year of training. METHODS This study used baseline data from the Medical Student Cognitive Habits and Growth Evaluation (CHANGE) Study; a large national longitudinal cohort study of 4732 medical students at 49 medical schools in the US racial identity for African American students (n = 301) was assessed using the centrality sub-scale of the Multidimensional Inventory of Black Identity. Generalized linear regression models with a Poisson regression family distribution were used to estimate the relative risks of depression, anxiety, and perceived stress. RESULTS First year African American medical students who had lower levels of racial identity were less likely to experience depressive and anxiety symptoms in their first year of medical school. After controlling for other important social predictors of poor mental health (gender and SES), this finding remained significant. CONCLUSIONS Results increase knowledge about the role of race as a core part of an individual's self-concept. These findings provide new insight into the relationship between racial identity and psychological distress, particularly with respect to a group of high-achieving young adults.
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Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:718-25. [PMID: 25785682 DOI: 10.1097/acm.0000000000000700] [Citation(s) in RCA: 481] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Recent calls to focus on identity formation in medicine propose that educators establish as a goal of medical education the support and guidance of students and residents as they develop their professional identity. Those entering medical school arrive with a personal identity formed since birth. As they proceed through the educational continuum, they successively develop the identity of a medical student, a resident, and a physician. Each individual's journey from layperson to skilled professional is unique and is affected by "who they are" at the beginning and "who they wish to become."Identity formation is a dynamic process achieved through socialization; it results in individuals joining the medical community of practice. Multiple factors within and outside of the educational system affect the formation of an individual's professional identity. Each learner reacts to different factors in her or his own fashion, with the anticipated outcome being the emergence of a professional identity. However, the inherent logic in the related processes of professional identity formation and socialization may be obscured by their complexity and the large number of factors involved.Drawing on the identity formation and socialization literature, as well as experience gained in teaching professionalism, the authors developed schematic representations of these processes. They adapted them to the medical context to guide educators as they initiate educational interventions, which aim to explicitly support professional identity formation and the ultimate goal of medical education-to ensure that medical students and residents come to "think, act, and feel like a physician."
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Affiliation(s)
- Richard L Cruess
- R.L. Cruess is professor of surgery and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. S.R. Cruess is professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. J.D. Boudreau is associate professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. L. Snell is professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Y. Steinert is professor of family medicine and director, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Wald HS. Professional identity (trans)formation in medical education: reflection, relationship, resilience. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:701-6. [PMID: 25881651 DOI: 10.1097/acm.0000000000000731] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A fundamental goal of medical education is the active, constructive, transformative process of professional identity formation (PIF). Medical educators are thus charged with designing standardized and personalized curricula for guiding, supporting, and challenging learners on the developmental professional identity pathway, including the process of socialization. The author of this Commentary provides an overview of foundational principles and key drivers of PIF supporting the being, relating, and doing the work of a compassionate and competent physician. Key elements of PIF including guided reflection, use of personal narratives, integral role of relationships and role modeling, and community of practice are viewed through various lenses of PIF theory and pedagogy. Questions informing the PIF discourse are raised, including interprofessional identity considerations. Central emergent themes of reflective practice, relationships, and resilience are described as supporting and reciprocally enhancing PIF. Overarching lessons include attending to learners' and faculty's PIF within a developmental trajectory of the professional life cycle; process and content within PIF curricula as well as learners' individual and collective voices; curricular/extracurricular factors contributing to socialization, self-awareness, development of core values, and moral leadership; integrating PIF domains within pedagogy; faculty development for skilled mentoring and reflective coaching; and implementing resilience-promoting skill sets as "protective" within PIF. Outcomes assessment including the impact of curricula on learners and on patient-centered care can be challenging, and potential next steps toward this goal are discussed.
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Affiliation(s)
- Hedy S Wald
- H.S. Wald is clinical associate professor of family medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Wald HS, Anthony D, Hutchinson TA, Liben S, Smilovitch M, Donato AA. Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:753-60. [PMID: 25901874 DOI: 10.1097/acm.0000000000000725] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Recent calls for an expanded perspective on medical education and training include focusing on complexities of professional identity formation (PIF). Medical educators are challenged to facilitate the active constructive, integrative developmental process of PIF within standardized and personalized and/or formal and informal curricular approaches. How can we best support the complex iterative PIF process for a humanistic, resilient health care professional? How can we effectively scaffold the necessary critical reflective learning and practice skill set for our learners to support the shaping of a professional identity?The authors present three pedagogic innovations contributing to the PIF process within undergraduate and graduate medical education (GME) at their institutions. These are (1) interactive reflective writing fostering reflective capacity, emotional awareness, and resiliency (as complexities within physician-patient interactions are explored) for personal and professional development; (2) synergistic teaching modules about mindful clinical practice and resilient responses to difficult interactions, to foster clinician resilience and enhanced well-being for effective professional functioning; and (3) strategies for effective use of a professional development e-portfolio and faculty development of reflective coaching skills in GME.These strategies as "bridges from theory to practice" embody and integrate key elements of promoting and enriching PIF, including guided reflection, the significant role of relationships (faculty and peers), mindfulness, adequate feedback, and creating collaborative learning environments. Ideally, such pedagogic innovations can make a significant contribution toward enhancing quality of care and caring with resilience for the being, relating, and doing of a humanistic health care professional.
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Affiliation(s)
- Hedy S Wald
- H.S. Wald is clinical associate professor of family medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island. D. Anthony is associate professor of family medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island. T.A. Hutchinson is professor of medicine and director, McGill Programs in Whole Person Care, McGill University Faculty of Medicine, Montreal, Quebec, Canada. S. Liben is associate professor of pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada. M. Smilovitch is associate professor of medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada. A.A. Donato is clinical associate professor of medicine, Jefferson Medical College, Philadelphia, Pennsylvania
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Barr J, Bull R, Rooney K. Developing a patient focussed professional identity: an exploratory investigation of medical students' encounters with patient partnership in learning. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:325-38. [PMID: 25008246 DOI: 10.1007/s10459-014-9530-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 06/19/2014] [Indexed: 05/23/2023]
Abstract
Patient encounters are central to the provision of learning opportunities for medical students and their development as medical professionals. The primary aim of the study reported in this paper was to discover how partnering medical students with patients with chronic illness in undergraduate learning influenced the development of a patient centred professional identity and professionalism. An exploratory interpretive research design was used to address the research aim within a patient partner program (P3). Three qualitative data collection methods were used: (1) focus groups (2) extended response questionnaire and (3) semi-structured interviews. Data were coded and analysed thematically. The professional identity of medical students is constructed along traditional lines in the preclinical years. Patient-partnership offers a disruption to this development by way of an intersection with patients with chronic illness which potentially allows meaningful construction of what a patient-centred identity should be. This point of reflection provides an opportunity to engage at a higher level in medical identity development and professionalism. The findings discussed in this paper further stimulate the patient-centred agenda by understanding the conflict associated with the student-patient nexus in medical education and its potential for building professionalism and a patient-centred professional identity. To continue the drive for a patient-centred professional identity there must be ongoing engagement with patients in medical education, preferably commencing early in a student's journey so that it becomes the expected norm. This study has highlighted that a true patient-centred emphasis is being encountered too late in their socialisation process.
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Affiliation(s)
- Jennifer Barr
- Launceston Clinical School, School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, TAS, 7250, Australia,
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Vivekananda-Schmidt P, Crossley J, Murdoch-Eaton D. A model of professional self-identity formation in student doctors and dentists: a mixed method study. BMC MEDICAL EDUCATION 2015; 15:83. [PMID: 25924676 PMCID: PMC4422527 DOI: 10.1186/s12909-015-0365-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 04/16/2015] [Indexed: 05/27/2023]
Abstract
BACKGROUND Professional self-identity [PSI] can be defined as the degree to which an individual identifies with his or her professional group. Several authors have called for a better understanding of the processes by which healthcare students develop their professional identities, and suggested helpful theoretical frameworks borrowed from the social science and psychology literature. However to our knowledge, there has been little empirical work examining these processes in actual healthcare students, and we are aware of no data driven description of PSI development in healthcare students. Here, we report a data driven model of PSI formation in healthcare students. METHODS We interviewed 17 student doctors and dentists who had indicated, on a tracking questionnaire, the most substantial changes in their PSI. We analysed their perceptions of the experiences that had influenced their PSI, to develop a descriptive model. Both the primary coder and the secondary coder considered the data without reference to the existing literature; i.e. we used a bottom up approach rather than a top down approach. RESULTS The results indicate that two overlapping frames of reference affect PSI formation: the students' self-perception and their perception of the professional role. They are 'learning' both; neither is static. Underpinning those two learning processes, the following key mechanisms operated: [1] When students are allowed to participate in the professional role they learn by trying out their knowledge and skill in the real world and finding out to what extent they work, and by trying to visualise themselves in the role. [2] When others acknowledge students as quasi-professionals they experience transference and may respond with counter-transference by changing to meet expectations or fulfil a prototype. [3] Students may also dry-run their professional role (i.e., independent practice of professional activities) in a safe setting when invited. CONCLUSIONS Students' experiences, and their perceptions of those experiences, can be evaluated through a simple model that describes and organises the influences and mechanisms affecting PSI. This empirical model is discussed in the light of prevalent frameworks from the social science and psychology literature.
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Affiliation(s)
| | - James Crossley
- Medical Education, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - Deborah Murdoch-Eaton
- Medical Education, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
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O'Brien BC, Hirsh D, Krupat E, Batt J, Hansen LA, Poncelet AN, Ogur B, Hauer KE. Learners, performers, caregivers, and team players: Descriptions of the ideal medical student in longitudinal integrated and block clerkships. MEDICAL TEACHER 2015; 38:297-305. [PMID: 25894329 DOI: 10.3109/0142159x.2015.1033390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Hidden curriculum literature suggests that different learning environments and curricular designs reinforce disparate values and behaviors. AIM This study explores potential differences in learning environments afforded by two clerkship models through perceptions of the ideal student. METHODS In this qualitative study, research assistants interviewed 48 third-year students and 26 clinical supervisors from three US medical schools. Students and supervisors participated in longitudinal integrated clerkships (LICs) or block clerkships. Students and supervisors described the ideal student in their clerkship. Using phenomenographic techniques, authors identified five ideal student profiles and coded students' and supervisors' descriptions for alignment with one or more profiles. RESULTS Most students in both models described an ideal student who matched a learner profile (proactive and self-directed). More LIC students described an ideal student who fit a caregiver profile (engaging with and advocating for patients) and more block students described performer (appearing knowledgeable and competent) and team-player (working well with others) profiles. Supervisors' descriptions paralleled students' descriptions but with less emphasis on caregiving. CONCLUSIONS Ideal student descriptions in LIC and block models may reflect different learning experiences and values emphasized in each model. These findings suggest implications for students' construction of professional identities that warrant further exploration.
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Affiliation(s)
| | | | | | - Joanne Batt
- a University of California , San Francisco , USA
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Aper L, Veldhuijzen W, Dornan T, van de Ridder M, Koole S, Derese A, Reniers J. "Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:77-84. [PMID: 25448312 DOI: 10.1016/j.pec.2014.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 09/02/2014] [Accepted: 09/19/2014] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Communication skills can be trained alongside clinical reasoning, history taking or clinical examination skills. This is advocated as a solution to the low transfer of communication skills. Still, students have to integrate the knowledge/skills acquired during different curriculum parts in patient consultations at some point. How do medical students experience these integrated consultations within a simulated environment and in real practice when dealing with responsibility? METHODS Six focus groups were conducted with (pre-)/clerkship students. RESULTS Students were motivated to practice integrated consultations with simulated patients and felt like 'real physicians'. However, their focus on medical problem solving drew attention away from improving their communication skills. Responsibility for real patients triggered students' identity development. This identity formation guided the development of an own consultation style, a process that was hampered by conflicting demands of role models. CONCLUSION Practicing complete consultations results in the dilemma of prioritizing medical problem solving above attention for patient communication. Integrated consultation training advances this dilemma to the pre-clerkship period. During clerkships this dilemma is heightened because real patients trigger empathy and responsibility, which invites students to define their role as doctor. PRACTICE IMPLICATIONS When training integrated consultations, educators should pay attention to students' learning priorities and support the development of students' professional identity.
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Ho MJ, Shaw K, Liu TH, Norris J, Chiu YT. Equal, global, local: discourses in Taiwan's international medical graduate debate. MEDICAL EDUCATION 2015; 49:48-59. [PMID: 25545573 DOI: 10.1111/medu.12619] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/14/2014] [Accepted: 09/09/2014] [Indexed: 06/04/2023]
Abstract
CONTEXT With the globalisation of medicine, the role of international medical graduates (IMGs) has expanded. Nonetheless, the experiences of native-born IMGs remain under-researched. In Taiwan, public controversy has unfolded around IMGs educated in Poland, calling into question the meaning(s) of equality in policy and medicine. In focusing on the return of IMGs to their countries of origin, this study adds to the growing literature concerning equality and globalisation in medical education. OBJECTIVES The primary research aim was to analyse how stakeholders in the IMG debate use equality in their arguments. The authors set out to frame the dispute within the recent history of Taiwanese medical governance. An overarching objective was to contribute a critical, historical view of how discourses of globalisation and equality construct different policy approaches to international medical education. METHODS The authors performed a critical discourse analysis of a public policy dispute in Taiwan, assembling an archive from online interactions, government reports and news articles. Coding focused on stakeholders' uses of equality to generate broader discourses. RESULTS International and domestic Taiwanese students conceived of equality differently, referencing both 'equality of opportunity' and 'equality of outcome' within localisation and globalisation frameworks, respectively. The dominance of localisation discourse is reflected in hostile online rhetoric towards Poland-educated IMGs. CONCLUSIONS Rhetorical disagreements over equality in medical education trace shifting state policies, from earlier attempts to remove barriers for IMGs to the present-day push to regulate IMGs for acculturation and quality assurance. The global Internet had a double-sided influence, facilitating both democratic political mobilization and the spread of hate speech. The policy debate in Taiwan mirrors discourses in Canada, where IMGs are likewise conceived either as globally competent physicians or as lacking in merit and technical competence. Future research could investigate the discursive formation and evidential basis of policies regulating international medical education.
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Affiliation(s)
- Ming-Jung Ho
- Department of Medical Education & Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
Much has been written about the symbolic function of the white coat: its implications of purity, its representation of authority and professionalism, and its role in consolidating a medical hierarchy. By contrast, the medical literature has paid almost no attention to the patient gown. In this article, we argue that in order to understand the full implications of the white coat in the doctor-patient relationship, we must also take into account patients' dress, and even undress. We explore contemporary artistic images of white coat and patient gown in order to reveal the power differential in the doctor-patient relationship. Artistic representations capture some of the cultural ambivalence surrounding the use of the white coat, which confers professional status on its wearer, while undermining his or her personal identity. At the other end of the sartorial spectrum, hospital gowns also strip wearers of their identity, but add to this an experience of vulnerability. Although compelling reasons for continuing to wear the white coat in circumscribed settings persist, physicians should be mindful of its hierarchical implications. Ample room remains for improving patients' privacy and dignity by updating the hospital gown.
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Affiliation(s)
- Caroline Wellbery
- Department of Family Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Melissa Chan
- Department of Family Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
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Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical education to support professional identity formation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1446-51. [PMID: 25054423 DOI: 10.1097/acm.0000000000000427] [Citation(s) in RCA: 470] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Teaching medical professionalism is a fundamental component of medical education. The objective is to ensure that students understand the nature of professionalism and its obligations and internalize the value system of the medical profession. The recent emergence of interest in the medical literature on professional identity formation gives reason to reexamine this objective. The unstated aim of teaching professionalism has been to ensure the development of practitioners who possess a professional identity. The teaching of medical professionalism therefore represents a means to an end.The principles of identity formation that have been articulated in educational psychology and other fields have recently been used to examine the process through which physicians acquire their professional identities. Socialization-with its complex networks of social interaction, role models and mentors, experiential learning, and explicit and tacit knowledge acquisition-influences each learner, causing them to gradually "think, act, and feel like a physician."The authors propose that a principal goal of medical education be the development of a professional identity and that educational strategies be developed to support this new objective. The explicit teaching of professionalism and emphasis on professional behaviors will remain important. However, expanding knowledge of identity formation in medicine and of socialization in the medical environment should lend greater logic and clarity to the educational activities devoted to ensuring that the medical practitioners of the future will possess and demonstrate the qualities of the "good physician."
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Affiliation(s)
- Richard L Cruess
- Dr. Richard Cruess is professor of surgery and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Dr. Sylvia Cruess is professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Dr. Boudreau is associate professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Dr. Snell is professor of medicine and core faculty member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada. Dr. Steinert is professor of family medicine and director, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Ten Cate O. What is a 21st-century doctor? Rethinking the significance of the medical degree. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:966-9. [PMID: 24979164 DOI: 10.1097/acm.0000000000000280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The undergraduate medical degree, leading to a license to practice, has traditionally been the defining professional milestone of the physician. Developments in health care and medical education and training, however, have changed the significance of the medical degree in the continuum of education toward clinical practice. The author discusses six questions that should lead us to rethink the current status and significance of the medical degree and, consequently, that of the physician. These questions include the quest for core knowledge and competence of the doctor, the place of the degree in the education continuum, the increasing length of training, the sharing of health care tasks with other professionals, and the nature of professional identity in a multitasking world. The author concludes by examining ways to redefine what it means to be a "medical doctor."
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Affiliation(s)
- Olle Ten Cate
- Dr. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Boudreau JD, Macdonald ME, Steinert Y. Affirming professional identities through an apprenticeship: insights from a four-year longitudinal case study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1038-45. [PMID: 24826856 DOI: 10.1097/acm.0000000000000293] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE A four-year course, entitled Physician Apprenticeship, was introduced at McGill University's Faculty of Medicine in 2005. The primary objective of the course is to assist students in their transition from laymen to physicians. The goal of this study was to understand the apprenticeship learning process, particularly its contribution to professional identity formation. METHOD For data collection, the authors used a longitudinal case study design with mixed methods. They conducted the study over a four-year curricular cycle, from 2008-2009 to 2011-2012. The case consisted of three apprenticeship groups. Students (n = 24) and teachers (n = 3) represented two subgroups for data analysis. RESULTS Physician Apprenticeship activities promoted and sustained medical professionalization in the participants. Salient features of successful apprenticeship learning were access to authentic clinical experiences as well as the provision of a safe learning environment and guided critical reflection. The latter two ingredients appear to be mutually reinforcing and contributed to the creation of meaningful student-teacher relationships. Teachers exhibited several qualities that align with a parental role. Students became increasingly aware of having entered the kinship of physicians. Teachers experienced a renewal and validation of their commitment to the ideals of medicine. CONCLUSIONS Findings strongly suggest that a longitudinal apprenticeship in an undergraduate medical program can contribute to the formation and reaffirmation of professional identity. The case study design permitted the authors to create a provisional conceptual model explicating important features of the apprenticeship learning process.
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Affiliation(s)
- J Donald Boudreau
- Dr. Boudreau is associate professor, Department of Medicine, Arnold P. Gold Foundation Professor of Medicine, and core member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Québec, Canada. Dr. Macdonald is assistant professor, Faculty of Dentistry, and core member, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Québec, Canada. Dr. Steinert is professor, Department of Family Medicine, Richard and Sylvia Cruess Chair in Medical Education, and director, Centre for Medical Education, McGill University Faculty of Medicine, Montreal, Québec, Canada
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Kristiansson MH, Troein M, Brorsson A. We lived and breathed medicine - then life catches up: medical students' reflections. BMC MEDICAL EDUCATION 2014; 14:66. [PMID: 24690405 PMCID: PMC4230426 DOI: 10.1186/1472-6920-14-66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/18/2014] [Indexed: 05/05/2023]
Abstract
BACKGROUND Reflective writing enhances personal and professional development. It is essential for the teachers to be familiar with the students' perceptions to improve the students' learning. Our aim was to deepen the understanding of the medical students' perceptions of the studies and the coming profession. METHODS Our theoretical perspective is constructivist, based upon the relativist view that individuals construct realities to understand and navigate the world. Constructivist methodologies are hermeneutic, with the focus on understanding rather than explaining. Thirty-five written reflections were collected in the first and fifth semesters at Lund University Medical School, Sweden. We used a thematic analysis, close to editing style analysis, inspired by K Malterud, who has modified Giorgi's phenomenological method. RESULTS For first-semester students the focus is on studies and methods to structure them. The fifth semester is permeated by strategies for achieving a sense of 'good enough', qualities of a good doctor and applicability. Clinical placement as a motivating element is important for both semesters. CONCLUSIONS A sense of 'good enough' is crucial for students to get by. Reflective writing can illuminate the strategies for achieving this. Clinical placement is vital for motivation.
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Affiliation(s)
- Mia Hemborg Kristiansson
- Department of Clinical Sciences, Lund University, Malmö, Family Medicine, Jan Waldenströmsgata 35, SE 205 02, Malmö, Sweden
| | - Margareta Troein
- Department of Clinical Sciences, Lund University, Malmö, Family Medicine, Jan Waldenströmsgata 35, SE 205 02, Malmö, Sweden
| | - Annika Brorsson
- Department of Clinical Sciences, Lund University, Malmö, Family Medicine, Jan Waldenströmsgata 35, SE 205 02, Malmö, Sweden
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