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Ditwiler RE, Hardwick D, Swisher LL. "Definitely a Dark Time:" professional and ethical issues in post-acute care physical therapy during the COVID-19 pandemic. Physiother Theory Pract 2024:1-18. [PMID: 38420945 DOI: 10.1080/09593985.2024.2321216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Disproportionate effects of the SARS-CoV-2 (COVID-19) pandemic on older adults in post-acute care settings created many professional and ethical challenges for patients and healthcare providers. OBJECTIVE The purpose of this study was to examine the professional and ethical issues of physical therapists (PTs) and physical therapist assistants (PTAs) in providing facility-based post-acute care in residential settings (skilled nursing facilities, inpatient rehabilitation facilities, and long-term acute care hospitals) during the COVID-19 pandemic. METHODS A qualitative descriptive research design was used to explore professional and ethical issues during the COVID-19 pandemic. PTs and PTAs described their experiences during semi-structured interviews conducted virtually. Interview data was analyzed with reflexive thematic analysis. RESULTS Thematic analysis produced 4 themes: facility-wide battle against infection and death, doing the best you can to provide care amidst COVID-19 constraints, promoting ethical good and doing the right thing, and a dark intense time. CONCLUSIONS Professional and ethical constraints on providing care faced by PTs and PTAs during the COVID-19 pandemic can inform current and future clinical practice. Although some of the challenges faced by PTs and PTAs were unique to COVID-19, many problems represent preexisting systemic and organizational issues that were exacerbated by the pandemic.
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Affiliation(s)
- Rebecca Edgeworth Ditwiler
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Dustin Hardwick
- School of Physical Therapy, University of the Incarnate Word, San Antonio, TX, USA
| | - Laura Lee Swisher
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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McMains KC, Durning SJ, Norton C, Meyer HS. The Making of an Educator: Professional Identity Formation Among Graduate Medical Education Faculty Through Situated Learning Theory. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:254-260. [PMID: 37201556 DOI: 10.1097/ceh.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Professional identity formation (PIF) is a foundational element to professional medical education and training. Given the impact of faculty role models and mentors to student and trainee learning, mapping the landscape of PIF among faculty takes on increased importance. We conducted a scoping review of PIF through the lens of situated learning theory. Our scoping review question was: How is situated learning theory used to understand the process of PIF among graduate medical educators? METHODS The scoping review methodology described by Levac et al served as the architecture for this review. Medline, Embase, PubMed, ERIC, CINAHL, PsycINFO, and Web of Science Core Collection were searched (from inception) using a combination of terms that describe PIF among graduate medical educators. RESULTS Of the 1434 unique abstracts screened, 129 articles underwent full-text review, with 14 meeting criteria for inclusion and full coding. Significant results organized into three main themes: importance of using common definitions; evolution of theory over time with untapped explanatory power; identity as a dynamic construct. DISCUSSION The current body of knowledge leaves many gaps. These include lack of common definitions, need to apply ongoing theoretical insights to research, and exploration of professional identity as an evolving construct. As we come to understand PIF among medical faculty more fully, twin benefits accrue: (1) Community of practices can be designed deliberately to encourage full participation of all graduate medical education faculty who desire it, and (2) Faculty can more effectively lead trainees in negotiating the ongoing process of PIF across the landscape of professional identities.
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Affiliation(s)
- Kevin C McMains
- Dr. McMains : Professor, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. Durning : Director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, and Professor, Department of Medicine. Norton : Instruction Librarian, Division of Library Services, National Institutes of Health Library, Bethesda, MD. Dr. Meyer : Assistant Professor, Department of Medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD
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Baskwill A, Hay P, Calleri F, Fiddes L, Barnett R, Fogarty S. The paradox of the impact of the COVID-19 pandemic on massage therapists in Australia and Canada: The reporting of a qualitative strand of a mixed methods study. J Bodyw Mov Ther 2023; 35:371-377. [PMID: 37330795 PMCID: PMC10148715 DOI: 10.1016/j.jbmt.2023.04.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 03/12/2023] [Accepted: 04/22/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION In both Australia and Canada, healthcare providers considered essential were allowed to operate during the COVID-19 pandemic. The impact of the global pandemic on professional identity included opportunities for role expansion, a focus on ethical principles and social accountability, and professional pride. These results were found only for those considered to be essential and do not likely resonate with those classified as non-essential, such as massage therapists, leaving a gap in understanding. MATERIALS AND METHODS This qualitative strand of a sequential explanatory mixed methods study used qualitative description. Individuals who expressed interest were purposefully selected, based on age, gender, type of practice, and experience with the four key phenomena of interest. Data collected through semi-structured interviews was analyzed using qualitative content analysis. Member checking enhanced the trustworthiness of the results. RESULTS Thirty-one (16 Australian and 15 Canadian) participants were interviewed. The main theme described was the pandemic paradox. At some point during the pandemic, most participants were labelled by government agencies as a non-essential service. However, participants reported feeling both essential and non-essential. Two subthemes were also described: factors contributing to creating the paradox and consequences of the paradox. CONCLUSION A number of pre-existing factors around professional identity, such as patient relationships combined with the conditions instituted to manage the COVID-19 pandemic included designating health care services as essential or non-essential, created the paradox experienced by respondents and the subsequent experience of moral distress. Further research into moral distress experienced by massage therapists is needed.
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Affiliation(s)
- Amanda Baskwill
- Faculty of Health Sciences and Wellness, Humber College, Canada; School of Health, Human and Justice Studies, Loyalist College, Canada.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Australia; Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Campbelltown, NSW, Australia
| | - Felicia Calleri
- Faculty of Health Sciences and Wellness, Humber College, Canada
| | | | | | - Sarah Fogarty
- School of Medicine, Western Sydney University, Australia
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Brown MEL, Lim JH, Horsburgh J, Pistoll C, Thakerar V, Maini A, Johnson C, Beaton L, Mahoney C, Kumar S. Identity Development in Disorientating Times: the Experiences of Medical Students During COVID-19. MEDICAL SCIENCE EDUCATOR 2022; 32:995-1004. [PMID: 35936649 PMCID: PMC9340721 DOI: 10.1007/s40670-022-01592-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Professional identity development is a central aim of medical education, which has been disrupted during COVID-19. Yet, no research has qualitatively explored COVID-19's impact across institutions or countries on medical students' identities. Kegan proposes a cognitive model of identity development, where 'disorientating dilemmas' prompt student development. Given the potential of COVID-related disruption to generate disorientating dilemmas, the authors investigated the ways in which COVID-19 influenced students' identity development. METHODS The authors conducted an international qualitative study with second year medical students from Imperial College London, and third year students from Melbourne Medical School. Six focus groups occurred 2020-2021, with three to six students per group. Authors analysed data using reflexive thematic analysis, applying Kegan's model as a sensitising theoretical lens. RESULTS COVID-19 has resulted in a loss of clinical exposure, loss of professional relationships, and a shift in public perception of physicians. Loss of exposure to clinical practice removed the external validation from patients and seniors many students depended on for identity development. Students' experiences encouraged them to assume the responsibilities of the profession and the communities they served, in the face of conflicting demands and risk. Acknowledging and actioning this responsibility facilitated identity development as a socially responsible advocate. CONCLUSIONS Educators should consider adapting medical education to support students through Kegan's stages of development. Measures to foster relationships between students, patients, and staff are likely necessary. Formal curricula provisions, such as spaces for reflection and opportunities for social responsibility, may aid students in resolving the conflict many have recently experienced. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01592-z.
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Affiliation(s)
- Megan E. L. Brown
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Jun Hua Lim
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Jo Horsburgh
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Chance Pistoll
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Viral Thakerar
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Arti Maini
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Caroline Johnson
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Laura Beaton
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Claire Mahoney
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Sonia Kumar
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
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Mema B, Helmers A, Anderson C, Min K(K, Navne LE. Who am I? Narratives as a window to transformative moments in critical care. PLoS One 2021; 16:e0259976. [PMID: 34780546 PMCID: PMC8592467 DOI: 10.1371/journal.pone.0259976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022] Open
Abstract
Critical care clinicians practice a liminal medicine at the border between life and death, witnessing suffering and tragedy which cannot fail to impact the clinicians themselves. Clinicians' professional identity is predicated upon their iterative efforts to articulate and contextualize these experiences, while a failure to do so may lead to burnout. This journey of self-discovery is illuminated by clinician narratives which capture key moments in building their professional identity. We analyzed a collection of narratives by critical care clinicians to determine which experiences most profoundly impacted their professional identity formation. After surveying 30 critical care journals, we identified one journal that published 84 clinician narratives since 2013; these constituted our data source. A clinician educator, an art historian, and an anthropologist analyzed these pieces using a narrative analysis technique identifying major themes and subthemes. Once the research team agreed on a thematic structure, a clinician-ethicist and a trainee read all the pieces for analytic validation. The main theme that emerged across all these pieces was the experience of existing at the heart of the dynamic tension between life and death. We identified three further sub-themes: the experience of bridging the existential divide between dissimilar worlds and contexts, fulfilling divergent roles, and the concurrent experience of feeling dissonant emotions. Our study constitutes a novel exploration of transformative clinical experiences within Critical Care, introducing a methodology that equips medical educators in Critical Care and beyond to better understand and support clinicians in their professional identity formation. As clinician burnout soars amidst increasing stressors on our healthcare systems, a healthy professional identity formation is an invaluable asset for personal growth and moral resilience. Our study paves the way for post-graduate and continuing education interventions that foster mindful personal growth within the medical subspecialties.
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Affiliation(s)
- Briseida Mema
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Andrew Helmers
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cory Anderson
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada
| | - Kyung–Seo (Kay) Min
- History of Art Department, Johns Hopkins University, Baltimore, MD, United States of America
| | - Laura E. Navne
- The Danish Center for Social Science Research, VIVE, Copenhagen, Denmark
- The Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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