A Phenomenological Study of Italian Students' Responses to Professional Dilemmas: A Cross-Cultural Comparison

Patients' perspectives on medical students' professionalism: Blind spots and opportunities

BACKGROUND

Research has acknowledged the value of patients as essential stakeholders in medical education, yet educators have not adequately incorporated patients' perspectives into medical students' developing professionalism. Our purpose was to explore patients' perceptions of professional behaviour in medical students as a first step to considering patients' potential roles in assessing professionalism.

METHODS

Building on the existing framework of the 'disavowed curriculum', we used a constructivist grounded theory approach to interview and analyse data from 19 patients (11 W, 8 M) at one urban hospital. Each participant watched five video scenarios that depict professionally challenging situations commonly faced by medical students, after which they were asked to put themselves in the position of both the patient and the student depicted in each scenario, and to discuss what they felt would be appropriate or inappropriate behaviours from each perspective.

RESULTS

Patients' responses replicated all elements of the disavowed curriculum, including principles of professionalism, the student's affect or internal factors, and potential implications of actions. Their responses reflected avowed, unavowed and disavowed rationales. Participants also identified novel principles, including hide dissension in the ranks, respect privacy, advocate for yourself and have trust in the system. Patients conveyed an understanding of the multiple competing factors students must balance (e.g., providing optimal care while maximising educational opportunities) and appeared to empathise with some of the pressures students face.

CONCLUSIONS

Our findings point to significant blind spots in previous research based on faculty and student perspectives of professionalism. Knowing what patients perceive as important will allow educational and assessment efforts to be refined to reflect their values. Our work begins the process of understanding how best to include patients in the assessment of medical learners.

"To obey or not to obey" - Medical students' response towards professional dilemmas in a hierarchical and collectivist culture

BACKGROUND

Clinical clerkship programme in medical schools were developed to provide students with direct interactions with patients and observe clinical teachers in practice. However, professional dilemmas are prone to occur due to the nature of experiential learning. Several studies across different cultures showed that medical students responded differently towards professional dilemma.

AIMS

This study aims to explore how medical students respond to professional dilemmas occurred during their clinical clerkships and to what extent culture influences the responses.

METHOD

A qualitative descriptive approach was used in this study. We conducted four focus group discussions with final year medical students who were selected using maximum variety sampling method. Thematic analysis was conducted following the transcription of the focus groups.

RESULTS

We identified the impact of dilemmas on students' emotions and concerns, students' responses towards professional dilemmas, and factors affecting responses to dilemmas in clinical clerkship, which confirmed that cultures played roles in how students responded towards professional dilemmas.

CONCLUSION

This study has identified that culture, to some extent, influenced the way students responded to professional dilemmas. Therefore, it is paramount to develop a conducive and culturally sensitive educational environment and students' ability to learn from professional dilemma experienced in the workplace for developing their professional identity.

'Whispers and shadows': A critical review of the professional identity literature with respect to minority physicians

OBJECTIVES

Professional identity formation (PIF) is a growing area of research in medical education. However, it is unclear whether the present research base is suitable for understanding PIF in physicians considered to be under-represented in medicine (URM). This meta-ethnography examined the qualitative PIF literature from 2012 to 2019 to assess its capacity to shine light on the experiences of minoritised physicians.

METHODS

Data were gathered using a search of six well-known medical education journals for the term 'professional identit*' in titles, keywords, abstracts and subheadings, delineated with the date range of 2012-2019. All non-relevant abstracts were removed and papers were then further reduced to those that focused only on learners' experiences. This left 67 articles in the final dataset, which were analysed using a collaborative approach among a team of researchers. The team members used their professional expertise as qualitative researchers and personal experiences as minoritised individuals to synthesise and interpret the PIF literature.

RESULTS

Four conceptual categories were identified as impacting PIF: Individual versus Sociocultural Influences; the Formal versus the Hidden Curriculum; Institutional versus Societal Values; and Negotiation of Identity versus Dissonance in Identity. However, a major gap was identified; only one study explored experiences of PIF in URM physicians and there was an almost complete absence of critical stances used to study PIF. Combined, these findings suggest that PIF research is building on existing theories without questioning their validity with reference to minoritised physicians.

CONCLUSIONS

From a post-colonial perspective, the fact that race and ethnicity have been largely absent, invisible or considered irrelevant within PIF research is problematic. A new line of inquiry is needed, one that uses alternative frameworks, such as critical theory, to account for the ways in which power and domination influence PIF for URM physicians in order to foreground how larger sociohistorical issues influence and shape the identities of minoritised physicians.