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Al-Sabiry M, Barnhoorn P, Slootweg I, van Mook W, Numans M. Which 'end' do you have in mind? Clinical supervisors' perceptions of Professional Identity Formation outcomes in GP residency. MEDICAL TEACHER 2024; 46:1236-1242. [PMID: 38295758 DOI: 10.1080/0142159x.2024.2308070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Professional Identity Formation (PIF) is crucial for high-quality patient care and physician well-being. Few empirical studies examined PIF in residency from the perspective of supervisors. In GP residency, residents are supervised with an 'end in mind' that remains unexplored. To encourage supervisors to reflect on their teaching behaviours, this study investigated GP clinical supervisors' perceptions of PIF outcomes in GP residency. METHODS Applying qualitative description, focus group interviews were conducted between spring and autumn 2019. Using a semi-structured interview guide, supervisors' perceptions of PIF outcomes were explored. In an iterative coding process applying constant comparison, a thematic analysis was performed of focus group transcripts. RESULTS We conducted eight focus groups with 55 supervisors at four training institutes across the Netherlands. Half of the supervisors were female. GP supervisors tend to address the 'poor GP' when prompted to address the 'good GP'. PIF outcomes in GP residency should revolve around taking ownership in patient care, self-care and the persistence of GP as a profession. CONCLUSION PIF can be challenged by a lack of positive language. Supervisors' strong beliefs regarding ideals of the profession potentially compromise PIF when they do not resonate with residents' beliefs, resulting in poor educational alliance.
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Affiliation(s)
- Miami Al-Sabiry
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
| | - Pieter Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
| | - Irene Slootweg
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre, the Netherlands
- School of Health Professions Education, Maastricht University, the Netherlands
| | - Mattijs Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
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Rozario SY, Farlie MK, Sarkar M, Lazarus MD. The die-hards, negotiators and migrants: Portraits of doctors' career pathways through specialisation. MEDICAL EDUCATION 2024; 58:1071-1085. [PMID: 38468409 DOI: 10.1111/medu.15368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Global workforce shortages in medical specialties strain healthcare systems, jeopardising patient outcomes. Enhancing recruitment strategies by supporting professional identity (PI) development may be one way to address this workforce gap-yet little research has explored this topic. The goal of the current study was to explore specialty-specific recruitment through considering PI. As proposed causes of workforce shortages in anatomical pathology (AP) bear similarities to many other specialties, this study uses the field of AP as a model for specialist PI development and asks: (1) why, how and when do doctors choose to pursue AP training and (2) what can be learned from this for recruitment to AP and other specialties? METHODS A qualitative research approach was undertaken using narrative inquiry. Interviews with junior doctors interested in AP, AP registrars and AP consultants from Australia and New Zealand were interpreted as stories via 're-storying'. Narrative synthesis of participants' collective stories identified chronological key events (i.e. 'turning points') in choosing AP. RESULTS Narrative synthesis resulted in identification of three portraits entering medical specialist training: (1) die-hards, deciding upon initial exposure; (2) negotiators, choosing after comparing specialties; and (3) migrants, seeking to move away from non-pathology specialties. The negotiators and migrants cemented their decision to pursue AP as a postgraduate doctor, whereas the die-hards made this decision during medical school. CONCLUSIONS Given the similarities in portrait traits between AP and other specialties across the literature, our results suggest ways to support specialty recruitment using PI development. We propose a medical specialist recruitment framework to support the PI development of doctors with die-hard, negotiator and migrant traits. Use of this framework could enhance current specialty-specific recruitment approaches, particularly in fields challenged by workforce shortages.
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Affiliation(s)
- Shemona Y Rozario
- Centre of Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Melanie K Farlie
- Department of Physiotherapy, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Education Academy, Monash University, Melbourne, Victoria, Australia
| | - Michelle D Lazarus
- Centre of Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Prentice S, Mullner H, Benson J, Kay M. Family medicine and general practitioner supervisor wellbeing: a literature review. BJGP Open 2024:BJGPO.2023.0230. [PMID: 38479758 DOI: 10.3399/bjgpo.2023.0230] [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: 11/20/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Research examining general practice supervisor wellbeing has often been conducted within the context of trainee wellbeing and educational outcomes. AIM To consolidate the current literature regarding the wellbeing of GP supervisors through a 'supervisor-wellbeing' lens. DESIGN & SETTING Literature review of original research studies on Embase, Ovid MEDLINE, and Ovid PsycINFO from inception to December 2022. METHOD The Embase, Ovid MEDLINE, and Ovid PsycINFO databases were systematically searched from inception to December 2022. Original research studies were eligible if they explored any aspect of wellbeing or burnout (that is, construct conceptualisations, risk and protective factors, implications, or interventions) among GPs involved in educating GP trainees. Reporting quality of included studies was assessed using the QualSyst tool. Results from included studies were narratively synthesised. RESULTS Data from 26 independent samples were reviewed. Burnout was generally conceptualised using the Leiter and Maslach model. Wellbeing was poorly defined in the literature, largely being conceptualised in personal psychological terms and, to a lesser extent, professional satisfaction. Risk and protective factors were identified and grouped as individual (for example, satisfaction with capacity to teach) and external (for example, autonomy, collegial relationships, resource availability) factors. GP supervisors' wellbeing appeared to affect their job performance and retention. This review identified only two studies evaluating interventions to support GP supervisors' wellbeing. CONCLUSION The present review highlights a lack of conceptual clarity and research examining interventions for GP supervisor wellbeing. It provides guidance for future research designed to maximise the wellbeing of GP supervisors and support the wellbeing of trainees.
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Affiliation(s)
- Shaun Prentice
- School of Psychology, The University of Adelaide, Adelaide, South Australia
- General Practice Training Research Department, Royal Australian College of General Practitioners, Adelaide, South Australia
| | - Helen Mullner
- General Practice Training, Royal Australian College of General Practitioners, Adelaide, South Australia
| | - Jill Benson
- General Practice Training, Royal Australian College of General Practitioners, Adelaide, South Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Margaret Kay
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland
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Rodríguez C, Archibald D, Grad R, Loban K, Kilpatrick K. Professional identity work of nurse practitioners and family physicians in primary care in Quebec and Ontario - a study protocol. BMC PRIMARY CARE 2024; 25:178. [PMID: 38773473 PMCID: PMC11107061 DOI: 10.1186/s12875-024-02415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Solo medical practices in primary healthcare delivery have been abandoned in favor of interdisciplinary teamwork in most Western countries. Dynamics in interdisciplinary teams might however be particularly difficult when two or more autonomous health professionals develop similar roles at the practice level. This is the case of family physicians (FPs) and nurse practitioners (NPs), due to the fact that the latter might accomplish not only the traditional role proper to a nurse, but also several medical activities such as requesting diagnostic exams and prescribing medical treatments. The tensions that this overlap might generate and their implications in regard of the development of professional identities, and consequently of the quality of health care delivered, have been suggested, but rarely examined empirically. The goal of this study is to examine identity work, i.e., the processes of (re)construction of professional identities, of NPs and FPs working together in primary care interdisciplinary teams. METHODS A longitudinal, interpretive, and comparative multiple (n = 2) case study is proposed. Identity work theory in organizations is adopted as theoretical perspective. Cases are urban primary care multidisciplinary teams from two different Canadian provinces: Quebec and Ontario. Participants are NPs, FPs, managers, and patients. Data gathering involves audio-diaries, individual semi-structured and focus group interviews, observations, and archival material. Narrative and metaphor techniques are adopted for analyzing data collected. Within- and cross-case analysis will be performed. DISCUSSION For practice, the results of this investigation will: (a) be instrumental for clinicians, primary care managers, and policy decision-makers responsible for the implementation of interdisciplinary teamwork in primary healthcare delivery to improve decision-making processes and primary care team performance over time; (b) inform continuing interdisciplinary professional development educational initiatives that support competency in health professionals' identity construction in interdisciplinary primary care organizations. For research, the project will contribute to enriching theory about identity construction dynamics in health professions, both in the fields of health services and primary care education research.
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Affiliation(s)
- Charo Rodríguez
- Department of Family Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Côte-des-Neiges Road, 3rd floor, suite 300, room 328, Montreal, QC, H3S 1Z1, Canada.
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
| | - Douglas Archibald
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Roland Grad
- Department of Family Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Côte-des-Neiges Road, 3rd floor, suite 300, room 328, Montreal, QC, H3S 1Z1, Canada
| | - Katya Loban
- Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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Sarraf-Yazdi S, Pisupati A, Goh CK, Ong YT, Toh YR, Goh SPL, Krishna LKR. A scoping review and theory-informed conceptual model of professional identity formation in medical education. MEDICAL EDUCATION 2024. [PMID: 38597258 DOI: 10.1111/medu.15399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Professional identity formation (PIF) is a central tenet of effective medical education. However, efforts to support, assess and study PIF are hindered by unclear definitions and conceptualisations of what it means to 'think, act, and feel like a physician'. Gaps in understanding PIF, and by extension, its support mechanisms, can predispose individuals towards disengaged or unprofessional conduct and institutions towards short-sighted or reactionary responses to systemic issues. METHODS A Systematic Evidence-Based Approach-guided systematic scoping review of PIF theories was conducted related to medical students, trainees and practising doctors, published between 1 January 2000 and 31 December 2021 in PubMed, Embase, ERIC and Scopus databases. RESULTS A total of 2441 abstracts were reviewed, 607 full-text articles evaluated and 204 articles included. The domains identified were understanding PIF through the lens of pivotal theories and characterising PIF by delineating the underlying factors that influence it and processes that define it. CONCLUSIONS Based on regnant theories and frameworks related to self-concepts of identity and personhood, the relationships between key PIF influences, processes and outcomes were examined. A theory-backed integrated conceptual model was proposed to delineate the interconnected relationships among these, aiming to untangle some of the complexities inherent to PIF, to shed light on existing practices and to identify shortcomings in our understanding so as to develop mechanisms in support of its multifaceted, interlinked components.
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Affiliation(s)
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Chloe Keyi Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - You Ru Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Suzanne Pei Lin Goh
- Duke-NUS Medical School, National University of Singapore, Singapore
- KK Women's and Children Hospital, Singapore
| | - Lalit Kumar Radha Krishna
- Duke-NUS Medical School, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, United Kingdom Cancer Research Centre, University of Liverpool, Liverpool, UK
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore
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Robinson MA, Bowen JL, Aylor M, van Schaik S. Having a Voice: Resident Perceptions of Supervision, Decision-Making and Patient Care Ownership. Acad Pediatr 2024; 24:519-526. [PMID: 37951350 DOI: 10.1016/j.acap.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Heightened resident supervision due to patient safety concerns is increasingly common in pediatrics and may leave residents with fewer opportunities for independent decision-making, a diminished sense of autonomy, and decreased engagement. This may ultimately threaten their development into competent clinicians. Understanding how pediatric residents experience supervision's influence on their involvement in decision-making, engagement in patient care, and learning is crucial to safeguard their transition to independent practice. In relation to supervision, our research investigated: 1) how residents navigated their involvement with clinical decision-making and 2) how opportunities to make clinical decisions influenced their engagement in patient care and learning. METHODS From 2019-2020, we recruited 38 pediatric residents from three different programs for a qualitative interview-based study. Through a constructivist stance, we explored clinical decision-making experiences and performed thematic analysis using an iterative and inductive process. RESULTS We identified three themes: 1) Residents perceived having autonomy when they had space to make independent decisions, regardless of supervisor's presence; 2) Patient care ownership resulted from having a voice in a variety of contributions to patient care; and 3) Supervisors' behaviors modulated patient care ownership and thereby residents' sense of feeling heard, their engagement in patient care, and their learning. CONCLUSIONS Our results suggest that focusing on patient care ownership may better fit with current learning environments than aiming for independence and autonomy. They provide insight on how, in the pediatric learning climate of enhanced supervision, supervisors can preserve resident engagement in patient care and learning by augmenting patient care ownership and ensuring residents have a voice.
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Affiliation(s)
- Margaret A Robinson
- Division of Pediatric Critical Care Medicine (MA Robinson and S van Schaik), Department of Pediatrics, University of California, San Francisco, Calif.
| | - Judith L Bowen
- Elson S. Floyd College of Medicine (JL Bowen), Washington State University, Spokane, Wash
| | - Megan Aylor
- Department of Pediatrics (M Aylor), Oregon Health and Science University, Portland, Ore
| | - Sandrijn van Schaik
- Division of Pediatric Critical Care Medicine (MA Robinson and S van Schaik), Department of Pediatrics, University of California, San Francisco, Calif
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Shim S, Kim H, Lee YM. Scoping review: exploring residents' views of supervisor entrustment and its effect on learning and professional development. KOREAN JOURNAL OF MEDICAL EDUCATION 2024; 36:81-98. [PMID: 38462244 PMCID: PMC10925806 DOI: 10.3946/kjme.2024.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 03/12/2024]
Abstract
This scoping review aimed to systematically explore the complex and nuanced perceptions of residents entrusted with significant responsibilities by their supervisors in the clinical context. We conducted a comprehensive search strategy targeting six major electronic databases. Data were extracted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist and a scoping review protocol. Resident perceptions regarding entrustment and its impact on learning and professional development were categorized. This review elucidated the role of supervisor entrustment in shaping residents' clinical performance, notably influencing autonomy, self-confidence, responsibility for patients, learning needs and goals, uncertainty management, and professional identity formation. Residents identified factors that promote and hinder performance and entrustment development resulting from supervisor entrustment and distinguished between appropriate supervision and over- or under-supervision. Our review suggests that residents' perceptions of supervisor entrustment, as bestowed by supervisors, serves as a catalyst for enhancing autonomy, thereby exerting a significant influence on clinical performance, and fostering the development of a professional identity. However, residents' views on appropriate supervision differ in some ways from supervisors' perspectives. Further research is needed to bridge the gap between residents' expectations of autonomy and what they are given, and to explore the intricate relationship between autonomy and entrustment.
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Affiliation(s)
- Sunhee Shim
- Department of Medical Education, Korea University College of Medicine, Seoul, Korea
| | | | - Young-Mee Lee
- Department of Medical Education, Korea University College of Medicine, Seoul, Korea
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Farrell LM, Cuncic C, MacDonald S, Wright BJ, Eva KW, Goldszmidt MA. Thresholds of becoming: an exploration of threshold concepts as a means to support professional identity formation in competency-based curricula. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:349-359. [PMID: 37258942 DOI: 10.1007/s10459-023-10245-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
Inherent in every clinical preceptor's role is the ability to understand the learning needs of individual trainees, enabling them to meet their potential. Competency-based medical education frameworks have been developed to this end, but efforts to identify behaviours and activities that define competence are based on mapping knowledge, skills and ability, which can be difficult to integrate into a comprehensive picture of who the trainee is becoming. Professional identity formation, in contrast, prioritizes attention to who trainees are becoming, but provision of detailed guidance to preceptors on how to best support this form of development is challenging. The tension that results limits our ability to optimally support learners as strengths in competency development may mask professional identity development gaps and vice versa. To address this tension, this paper examines how the theory of threshold concepts - troublesome ideas that, once appreciated, fundamentally change how you understand and approach a particular activity - can shine light on professional identity formation and its relationship with developing competence. The recognition and identification of threshold concepts is offered as a means to improve our ability to identify, discuss and support behaviours and actions that impact the learner's capacity to act competently as they develop their identity at various stages of training.
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Affiliation(s)
- Laura M Farrell
- Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Medical Sciences Building, 3800 Finnerty Road, Victoria, BC, V8P5C2, Canada.
| | - Cary Cuncic
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Shavaun MacDonald
- Department of Medicine, University of British Columbia, Victoria, Canada
| | - Bruce J Wright
- Island Medical Program, Faculty of Medicine, University of British Columbia, Victoria, Canada
- Division of Medical Sciences, University of Victoria, Victoria, Canada
| | - Kevin W Eva
- Centre for Health Education Scholarship and Professor Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Mark A Goldszmidt
- Department of Medicine, Division of General Internal Medicine and Research Scientist, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
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Nie T, Zhao X, Zheng Y. Organizational compassion and employee adversarial growth under various job control. Front Psychol 2023; 14:1294224. [PMID: 38173856 PMCID: PMC10761422 DOI: 10.3389/fpsyg.2023.1294224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Adversity can bring stress and challenges to an individual's life, but many people who experience adversity also have positive changes. The formative mechanisms of individual adversarial growth have received widespread attention. Methods A two-wave survey of 421 Chinese employees who experienced adversity during the COVID-19 epidemic was used to examine the influence mechanism of organizational compassion on adversarial growth and the moderating effect of job control. Results Through correlation analysis, hierarchical regression, and bootstrap test on the cross-sectional data, the study has verified organizational compassion, work passion, self-worth, and adversarial growth form a chain mediating relation. Job control negatively moderates the indirect effect of organizational compassion on adversarial growth through work passion and self-worth, that is, the positive effect of organizational compassion on employee adversarial growth through work passion and self-worth is more pronounced under lower job control. Discussion Organizational compassion can increase employee adversarial growth by enhancing their work passion and self-worth. Organizations should also pay more attention to those employees with lower job control who are in adversity, they are more likely to benefit from the organization's care and compassion.
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Affiliation(s)
| | | | - Yanying Zheng
- School of Business, Macau University of Science and Technology, Macau, China
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Sanatani M, Muir F. Oncology residents' experiences of decision-making in a clinical learning environment: a phenomenological study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1371-1390. [PMID: 37076598 DOI: 10.1007/s10459-023-10223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/05/2023] [Indexed: 05/03/2023]
Abstract
Oncology residents routinely engage in ethically complex decision-making discussions with patients, while observing and interacting with their teaching consultant. If clinical competency in oncology decision-making guidance is to be taught deliberately and effectively, it is necessary to understand resident experiences in this context to develop appropriate educational and faculty development initiatives. Four junior and two senior postgraduate oncology residents participated in semi-structured interviews during October and November 2021 which explored their experiences of real-world decision-making scenarios. Van Manen's phenomenology of practice was used in an interpretivist research paradigm. Transcripts were analysed to articulate essential experiential themes, and composite vocative narratives were created. Three essential themes were identified: (1) residents often endorsed different decision-making approaches than supervising consultants, (2) residents experienced inner conflict, and (3) residents struggled to find their own approach to decision-making. Residents experienced being torn between a perceived obligation to defer to consultant directives, and a desire for increasing ownership of decision-making while not feeling empowered to discuss their opinions with the consultants. Residents described their experiences around ethical position awareness during decision-making in a clinical teaching context as challenging, with experiences suggesting moral distress combined with inadequate psychological safety to address ethical conflicts and unresolved questions of decision ownership with supervisors. These results suggest the need for enhanced dialogue and more research to reduce resident distress during oncology decision-making. Future research should be aimed at discovering novel ways in which residents and consultants could interact in a unique clinical learning context including graduated autonomy, a hierarchical gradient, ethical positions, physician values, and sharing of responsibility.
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Affiliation(s)
- Michael Sanatani
- Division of Medical Oncology, Department of Oncology, Schulich School of Dentistry & Medicine, Western University, Room A3-915, 800 Commissioners Road East, London, ON, Canada.
| | - Fiona Muir
- School of Medicine, University of Dundee, Dundee, Scotland
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Krishna LKR, Pisupati A, Teo KJH, Teo MYK, Quek CWN, Chua KZY, Venktaramana V, Raveendran V, Singh H, Hui SLWC, Ng VWW, Ting OY, Loh EKY, Yeoh TT, Owyong JLJ, Ong EK, Phua GLG, Hill R, Mason S, Ong SYK. Professional identity formation amongst peer-mentors in a research-based mentoring programme. BMC MEDICAL EDUCATION 2023; 23:787. [PMID: 37875886 PMCID: PMC10598986 DOI: 10.1186/s12909-023-04718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Mentoring plays a pivotal yet poorly understood role in shaping a physician's professional identity formation (PIF) or how they see, feel and act as professionals. New theories posit that mentoring nurtures PIF by functioning as a community of practice through its structured approach and its support of a socialisation process made possible by its assessment-directed personalized support. To test this theory and reshape the design, employ and support of mentoring programs, we evaluate peer-mentor experiences within the Palliative Medicine Initiative's structured research mentoring program. METHODS Semi-structured interviews with peer mentors under the Palliative Medicine Initiative (PMI) at National Cancer Centre Singapore were conducted and triangulated against mentoring diaries to capture longitudinal data of their PMI experiences. The Systematic Evidence-Based Approach (SEBA) was adopted to enhance the trustworthiness of the data. SEBA employed concurrent content and thematic analysis of the data to ensure a comprehensive review. The Jigsaw Perspective merged complementary themes and categories identified to create themes/categories. The themes/categories were compared with prevailing studies on mentoring in the Funnelling Process to reaffirm their accuracy. RESULTS Twelve peer-mentors participated in the interviews and eight peer-mentors completed the mentoring diaries. The domains identified were community of practice and identity work. CONCLUSIONS The PMI's structured mentoring program functions as a community of practice supporting the socialisation process which shapes the peer-mentor's belief system. Guided by a structured mentoring approach, stage-based assessments, and longitudinal mentoring and peer support, peer-mentors enhance their detection and evaluation of threats to their regnant belief system and adapt their self-concepts of identity and personhood to suit their context. These insights will help structure and support mentoring programs as they nurture PIF beyond Palliative Medicine.
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Affiliation(s)
- Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, 169857, Singapore.
- Health Data Science, Institute of Population Health, University of Liverpool, Brownlow Street, Liverpool, L69 3GF, UK.
- Palliative Care Institute, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK.
- The Palliative Care Centre for Excellence in Research and Education (PalC), Dover Park Hospice, 10 Jln Tan Tock Seng, Singapore, 308436, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Kelly Jia Hui Teo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Mac Yu Kai Teo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Vaishnavi Venktaramana
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Vijayprasanth Raveendran
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Harpreet Singh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Sabine Lauren Wong Chyi Hui
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Victoria Wen Wei Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Ong Yun Ting
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Eleanor Kei Ying Loh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Ting Ting Yeoh
- Division of Oncology Pharmacy, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Rd, Singapore, 574627, Singapore
- Office of Medical Humanities, SingHealth Medicine Academic Clinical Programme, Singapore, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Ruaraidh Hill
- Health Data Science, Institute of Population Health, University of Liverpool, Brownlow Street, Liverpool, L69 3GF, UK
| | - Stephen Mason
- Palliative Care Institute, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK
| | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
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12
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Readlynn JK, Goulet D, Pahwa AK. Supporting improvement to help learners reach their potential. J Hosp Med 2023; 18:948-952. [PMID: 37449869 DOI: 10.1002/jhm.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Jennifer K Readlynn
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Delaney Goulet
- Department of Medicine, Washington State University Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Amit K Pahwa
- Departments of Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Chen YY, Ko PCI, Chi CY, Chong KM, Chen YP, Huang CH. Association between independent practice time and patient outcomes in the emergency department: a retrospective study of residents in three urban hospitals in Taiwan. BMC Emerg Med 2023; 23:103. [PMID: 37679682 PMCID: PMC10483807 DOI: 10.1186/s12873-023-00877-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The purpose of the study was to investigate the relationship between the independent practice time of residents and the quality of care provided in the Emergency Department (ED) across three urban hospitals in Taiwan. The study focused on non-pediatric and non-obstetric complaints, aiming to provide insights into the optimal balance between resident autonomy and patient safety. METHODS A comprehensive retrospective study was conducted using de-identified electronic health records (EHRs) from the hospital's integrated medical database (iMD) from August 2015 to July 2019. The independent practice time was defined as the duration from the first medical order by a resident to the first modifications by the attending physician. The primary outcome was revisits to the ED within 72 h following discharge. Statistical analysis was conducted using RStudio and pyGAM. RESULTS The study identified several factors associated with shorter independent practice times (< 30 minutes), including older patient age, male sex, higher body temperature, higher heart rate, lower blood pressure, and the presence of certain comorbidities. Residents practicing independently for 30-120 minutes were associated with similar adjusted odds of patient revisits to the ED (OR 1.034, 95% CI 0.978-1.093) and no higher risk of 7-day mortality (OR 0.674, 95% CI 0.592-0.767) compared to the group with less autonomy. However, independent practice times exceeding 120 minutes were associated with higher odds of revisiting the ED within 72 h. For the group with 120-210 minutes of independent practice time, the OR was 1.113 (95% CI: 1.025-1.208, p = 0.011). For the group with > 210 minutes, the OR was 1.259 (95% CI: 1.094-1.449, p = 0.001), indicating an increased risk of adverse outcomes as the independent practice time increasing. CONCLUSIONS The study concludes that while providing residents an independent practice time between 30 to 120 minutes may be beneficial, caution should be exercised when this time exceeds 120 minutes. The findings underscore the importance of optimal supervision in enhancing patient care quality and safety. Further research is recommended to explore the long-term effects of different levels of resident autonomy on patient outcomes and the professional development of the residents themselves.
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Affiliation(s)
- Yi-Ying Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No 7, Chung Shan S Rd (Zhongshan S Rd), Zhongzheng District, Taipei City, Taiwan
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No 7, Chung Shan S Rd (Zhongshan S Rd), Zhongzheng District, Taipei City, Taiwan
| | - Chien-Yu Chi
- Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Douliu City, Taiwan
| | - Kah Meng Chong
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No 7, Chung Shan S Rd (Zhongshan S Rd), Zhongzheng District, Taipei City, Taiwan
| | - Yen-Pin Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No 7, Chung Shan S Rd (Zhongshan S Rd), Zhongzheng District, Taipei City, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No 7, Chung Shan S Rd (Zhongshan S Rd), Zhongzheng District, Taipei City, Taiwan.
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14
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Su X, Yang Y, Ren Y, Li J, Wang Q. Mental Distress and Professional Commitment among Chinese Medical Postgraduate Students: A Moderated Mediation of Psychological Capital and the Supervisor-Postgraduate Relationship. PSYCHOL HEALTH MED 2023; 28:2579-2595. [PMID: 37332157 DOI: 10.1080/13548506.2023.2224581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
This study determined the relationship between mental distress and professional commitment among medical postgraduate students, and the roles of psychological capital as a mediator and the supervisor-postgraduate relationship as a moderator. This cross-sectional study recruited 836 medical postgraduate students from eight medical universities and the medical college of comprehensive universities in Guangdong Province, China. Participants were assessed through questionnaires, which covered demographic items, the supervisor-postgraduate relationship scale, the psychological capital questionnaire, the symptom checklist - 90 (SCL -90), and the professional commitment scale. We used descriptive statistics to describe demographics and mental distress and professional commitment scores. Pearson's analysis was used to identify correlations between the variables and the SPSS PROCESS macro was performed to confirm mediating and moderating effects of psychological capital and the supervisor-postgraduate relationship. Mental distress was negatively related with professional commitment (r = -0.262, p < 0.01) and psychological capital (r = -0.442, p < 0.01). Psychological capital was positively associated with professional commitment (r = 0.486, p < 0.01). The confidence interval (CI) suggested that psychological capital mediated the relationship between mental distress and professional commitment (95% CI, -0.198 to - 0.143), and the supervisor-postgraduate relationship had a moderate role between psychological capital and professional commitment (95% CI, 0.069 to -0.212). Hence, educators may refer to these findings to improve professional commitment level among medical postgraduate students.
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Affiliation(s)
- Xi Su
- School of Nursing, Guangzhou Medical University, Guangdong, China
| | - Yao Yang
- School of Nursing, Guangzhou Medical University, Guangdong, China
| | - Yulan Ren
- School of Nursing, Guangzhou Medical University, Guangdong, China
| | - Jiamei Li
- School of Nursing, Guangzhou Medical University, Guangdong, China
| | - Qiao Wang
- Department of Gastrointestinal Surgery, TCM-Integrated Hospital of Southern Medical University, Guangdong, China
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15
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Glucina TT, Krägeloh CU, Spencer K, Holt K. Defining chiropractic professional identity: A concept analysis. J Bodyw Mov Ther 2023; 35:75-83. [PMID: 37330807 DOI: 10.1016/j.jbmt.2023.04.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/12/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The concept of professional identity within chiropractic is often discussed and debated, however in the field to date, there is no formal definition of chiropractic professional identity (CPI). This article aims to create a coherent definition of CPI and to formalise the conceptual domains that may encompass it. METHODS Using the Walker and Avant (2005) process, a concept analysis methodology was employed to clarify the diffuse concept of CPI. This method initially involved selecting the concept (CPI), determining the aims and purpose of the analysis, identifying concept uses, and defining attributes. This was achieved from a critical literature review of professional identity across health disciplines. Chiropractic-related model, borderline and contrary cases were used to exemplify characteristics of CPI. The antecedents required to inform CPI, consequences of having, and ways to measure the concept of CPI were evaluated. RESULTS From the concept analysis data, CPI was found to encompass six broad attributes or domains: knowledge and understanding of professional ethics and standards of practice, chiropractic history, practice philosophy and motivations, the roles and expertise of a chiropractor, professional pride and attitude, and professional engagement and interaction behaviours. These domains were not mutually exclusive and may overlap. CONCLUSION A conceptual definition of CPI may bring together members and groups within the profession and promote intra-professional understanding across other disciplines. The CPI definition derived from this concept analysis is: 'A chiropractor's self-perception and ownership of their practice philosophies, roles and functions, and their pride, engagement, and knowledge of their profession'.
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Affiliation(s)
- Tanja T Glucina
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand.
| | - Christian U Krägeloh
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Kirsten Spencer
- School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Kelly Holt
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
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Allen K, Najjar M, Ostermeier A, Washington N, Genies MC, Hazle M, Hardy C, Lewis K, McDaniel L, McFarlane DJ, Macias C, Molloy MJ, Perry MF, Piper L, Sevov C, Titus L, Toth H, Unaka NI, Weisgerber MC, Kasick R. The Autonomy Toolbox: A Multicenter Collaborative to Promote Resident Autonomy. Hosp Pediatr 2023; 13:490-503. [PMID: 37153964 DOI: 10.1542/hpeds.2022-006827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Autonomy is necessary for resident professional development and well-being. A recent focus on patient safety has increased supervision and decreased trainee autonomy. Few validated interventions exist to improve resident autonomy. We aimed to use quality improvement methods to increase our autonomy metric, the Resident Autonomy Score (RAS), by 25% within 1 year and sustain for 6 months. METHODS We developed a bundled-intervention approach to improve senior resident (SR) perception of autonomy on Pediatric Hospital Medicine (PHM) services at 5 academic children's hospitals. We surveyed SR and PHM faculty perceptions of autonomy and targeted interventions toward areas with the highest discordance. Interventions included SR and faculty development, expectation-setting huddles, and SR independent rounding. We developed a Resident Autonomy Score (RAS) index to track SR perceptions over time. RESULTS Forty-six percent of SRs and 59% of PHM faculty completed the needs assessment survey querying how often SRs were afforded opportunities to provide autonomous medical care. Faculty and SR ratings were discordant in these domains: SR input in medical decisions, SR autonomous decision-making in straightforward cases, follow-through on SR plans, faculty feedback, SR as team leader, and level of attending oversight. The RAS increased by 19% (3.67 to 4.36) 1 month after SR and faculty professional development and before expectation-setting and independent rounding. This increase was sustained throughout the 18-month study period. CONCLUSIONS SRs and faculty perceive discordant levels of SR autonomy. We created an adaptable autonomy toolbox that led to sustained improvement in perception of SR autonomy.
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Affiliation(s)
- Karen Allen
- Division of Hospital Medicine, Department of Pediatrics
| | | | - Austen Ostermeier
- Division of Hospital Medicine, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Nicole Washington
- Section of Hospital Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Marquita C Genies
- Division of Hospital Medicine, Department of Pediatrics, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Hazle
- Division of Hospital Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | | - Kristen Lewis
- Division of Hospital Medicine, Department of Pediatrics
- Division of Hospital Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lauren McDaniel
- Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Daniel J McFarlane
- Division of Hospital Medicine, Department of Pediatrics
- Division of Hospital Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Charlie Macias
- Planning and Business Development, Nationwide Children's Hospital, Columbus, Ohio
| | - Matthew J Molloy
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Laura Piper
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Claire Sevov
- Division of Hospital Medicine, Department of Pediatrics
- Division of Hospital Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lauren Titus
- Division of Hospital Medicine, Children's Wisconsin, Milwaukee, Wisconsin
- Departments of Pediatrics
| | - Heather Toth
- Division of Hospital Medicine, Children's Wisconsin, Milwaukee, Wisconsin
- Departments of Pediatrics
- Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ndidi I Unaka
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael C Weisgerber
- Division of Hospital Medicine, Children's Wisconsin, Milwaukee, Wisconsin
- Departments of Pediatrics
| | - Rena Kasick
- Division of Hospital Medicine, Department of Pediatrics
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17
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Herzog TL, Sawatsky AP, Kelm DJ, Nelson DR, Park JG, Niven AS. The Resident Learning Journey in the Medical Intensive Care Unit. ATS Sch 2023; 4:177-190. [PMID: 37533538 PMCID: PMC10391714 DOI: 10.34197/ats-scholar.2022-0103oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/27/2023] [Indexed: 08/04/2023] Open
Abstract
Background The medical intensive care unit (MICU) offers rich resident learning opportunities, but traditional teaching strategies can be difficult to employ in this fast-paced, high-acuity environment. Resident perspectives of learning within this environment may improve our understanding of the common challenges residents face and inform novel approaches to transform the MICU educational experience. Objective We conducted a qualitative study of internal medicine residents to better understand their approach to learning the critical care activities that they are entrusted to perform in the MICU. Methods Using a thematic analysis approach, we conducted six focus group interviews with 15 internal medicine residents, separated by postgraduate year. A trained investigator led each interview, which was audio-recorded and transcribed verbatim for analysis. Our diverse research team, representing different career stages across the continuum of learning to minimize interpretive bias, identified codes and subsequent themes inductively. We refined these themes through group discussion and sensitizing social learning theory concepts using Wenger's community of practice and organized them to create learner archetypes and a conceptual framework of resident learning in the MICU. Results We identified three thematic resident learning categories: learning goals and motivation, clinical engagement, and interprofessional collaboration. We distinguished three learner archetypes, the novice, experiential learner, and practicing member, to describe progressive resident development within the interprofessional MICU team, the challenges they frequently encounter, and potential teaching strategies to facilitate learning. Conclusion We developed a conceptual framework that describes the resident's journey to becoming a trusted, collaborating member of the interprofessional MICU team. We identified common developmental challenges residents face and offer educational strategies that may support their progress. These findings should inform future efforts to develop novel teaching strategies to promote resident learning in the MICU.
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Affiliation(s)
| | - Adam P. Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Diana J. Kelm
- Division of Pulmonary and Critical Care Medicine and
| | | | - John G. Park
- Division of Pulmonary and Critical Care Medicine and
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18
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Chang YC, Khwepeya M, Nkambule NS, Chuang RS, Chaou CH. Emergency residents' self-perceived readiness for practice: the association of milestones, entrustable professional activities, and professional identities-a multi-institutional survey. Front Med (Lausanne) 2023; 10:1032516. [PMID: 37250629 PMCID: PMC10213224 DOI: 10.3389/fmed.2023.1032516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
Background As a successful innovation, competency-based medical education and its assessment tools continue to be a key strategy in training future doctors and tracking their performance trajectories. Linked to professional identity, evidence suggests that clinical competence is related to thinking, acting and feeling like a physician. Thus, incorporating the values and attitudes of healthcare professions as part of their professional identity in the clinical workplace improves professional performance. Methods Through a cross-sectional study, we examined the association of milestone, entrustable professional activities (EPA) and professional identity using self-reported tools among emergency medicine residents from 12 teaching hospitals across Taiwan. Milestone, EPA and professional identity were assessed using the Emergency Medicine Milestone Scale, Entrustable Professional Activity Scale and Emergency Physician Professional Identity and Value Scale, respectively. Results The results of a Pearson correlation indicated a significant positive correlation between milestone-based core competencies and EPAs (r = 0.40 ~ 0.74, p < 0.01). The professional identity domain of skills acquisition, capabilities and practical wisdom was positively correlated with milestone-based core competencies of patient care, medical knowledge, practice-based learning and improvement, and system-based practice (r = 0.18 ~ 0.21, p ≤ 0.05), and six items of EPA (r = 0.16 ~ 0.22, p < 0.05). Additionally, the professional identity domain of professional recognition and self-esteem was positively correlated with practice-based learning and improvement, and system-based practice milestone competencies (r = 0.16 ~ 0.19, p < 0.05). Conclusion This study demonstrates milestone and EPA assessment tools are highly linked and therefore, can be synergistically used by supervisors and clinical educators to evaluate clinical performance during residency training. Emergency physicians' professional identity is partly influenced by the advancement of skills and a resident's ability to learn, effectively perform tasks and make appropriate medical decisions at the system level in their clinical practice. Further research is warranted to understand the importance of residents' competency in relation to their professional identity development trajectory during clinical training.
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Affiliation(s)
- Yu-Che Chang
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Madalitso Khwepeya
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Nothando S. Nkambule
- International Graduate Program of Education and Human Development (IGPEHD), National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Renee S. Chuang
- Health Policy and Leadership Program, School of Public Health, Loma Linda University, Loma Linda, CA, United States
| | - Chung-Hsien Chaou
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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19
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Cornett M, Palermo C, Ash S. Professional identity research in the health professions-a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:589-642. [PMID: 36350489 PMCID: PMC10169899 DOI: 10.1007/s10459-022-10171-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
Professional identity impacts the workforce at personal, interpersonal and profession levels however there is a lack of reviews of professional identity research across practising health professionals. To summarise professional identity research in the health professions literature and explore how professional identity is described a scoping review was conducted by searching Medline, Psycinfo, Embase, Scopus, CINAHL, and Business Source Complete using "professional identity" and related terms for 32 health professions. Empirical studies of professional identity in post-registration health professionals were examined with health profession, career stage, background to research, theoretical underpinnings and constructs of professional identity being extracted, charted and analysed using content analysis where relevant. From 9941 studies, 160 studies across 17 health professions were identified, with nursing and medicine most common. Twenty studies focussed on professional identity in the five years post-entry to the workforce and 56 studies did not state career stage. The most common background for the research was the impact of political, social and healthcare reforms and advances. Thirty five percent of studies (n = 57) stated the use of a theory or framework of identity, the most common being classified as social theories. Individual constructs of professional identity across the research were categorised into five themes-The Lived Experience of Professional Identity; The World Around Me; Belonging; Me; and Learning and Qualifications. Descriptions of professional identity are broad, varied, rich and multi-layered however the literature is under theorised with current theories potentially inadequate to capture its complexity and make meaningful contributions to the allied health professions.
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Affiliation(s)
- Marian Cornett
- Monash Centre for Scholarship in Health Education, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia.
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
| | - Susan Ash
- Monash Centre for Scholarship in Health Education, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
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20
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Barnhoorn PC, Nierkens V, Numans ME, Steinert Y, van Mook WNKA. "What kind of doctor do you want to become?": Clinical supervisors' perceptions of their roles in the professional identity formation of General Practice residents. MEDICAL TEACHER 2023; 45:485-491. [PMID: 36288745 DOI: 10.1080/0142159x.2022.2137395] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Supporting the development of a professional identity is a primary objective in postgraduate education. Few empirical studies have explored professional identity formation (PIF) in residency, and little is known about supervisors' perceptions of their roles in residents' PIF. In this study, we sought to understand how supervisors perceive their roles in the PIF of General Practice (GP) residents. MATERIALS AND METHODS Guided by principles of qualitative description, we conducted eight focus groups with 55 supervisors at four General Practice training institutes across the Netherlands. Informed by a conceptual framework of PIF, we performed a thematic analysis of focus group transcripts. RESULTS Three themes related to how GP supervisors described their roles in supporting residents' PIF: supervising with the desired goal of GP training in mind; role modeling and mentoring as key strategies to achieve that goal; and the value of developing bonds of trust to support the process. CONCLUSIONS To our knowledge, this study is the first to explore PIF in GP training from the perspective of clinical supervisors. The identified themes mirror the components of the therapeutic alliance between doctors and patients from a supervisor's perspective and highlight the pivotal roles of the supervisor in a resident's PIF.
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Affiliation(s)
- Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne Steinert
- Department of Family Medicine and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, and Maastricht UMC + Academy, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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21
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Vaa Stelling BE, Andersen CA, Suarez DA, Nordhues HC, Hafferty FW, Beckman TJ, Sawatsky AP. Fitting In While Standing Out: Professional Identity Formation, Imposter Syndrome, and Burnout in Early-Career Faculty Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:514-520. [PMID: 36512808 DOI: 10.1097/acm.0000000000005049] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Professional identity formation (PIF) is a dynamic process by which an individual internalizes the core values and beliefs of a specific profession. Within medical education, PIF begins in medical school and continues throughout training and practice. Transitions affect PIF, with a critical transition occurring between medical training and unsupervised practice. This study aims to characterize PIF during the transition from resident to early-career faculty physician and explores the relationship between PIF and burnout during this transition. METHOD The authors conducted a qualitative study using constructivist grounded theory. They conducted semistructured interviews with early-career faculty physicians (defined as practicing for ≤ 5 years) from the Department of Medicine, Mayo Clinic. Deidentified interview transcripts were processed through open and axial coding. The authors organized themes and identified relationships between themes that were refined through discussion and constant comparison with newly collected data. During data analysis, the authors identified self-determination theory, with the concepts of autonomy, competence, and relatedness, as a framework to support the organization and analysis of the data. RESULTS Eleven early-career faculty physicians participated in the interviews. Their PIF was characterized by the dual desires to fit in and stand out. Striving for these desires was characterized by imposter syndrome, driving physicians to question their decision making and overall competence. Participants associated imposter syndrome and academic pressures with burnout. Autonomy support by the institution to pursue opportunities important for career development helped mitigate burnout and support PIF. CONCLUSIONS Early-career faculty physicians face identity challenges when transitioning from training to unsupervised practice, including striving to fit in and stand out. They link this tension to imposter syndrome, which they associated with burnout. Institutional awareness and support, including addressing structural and cultural contributors to imposter syndrome, are paramount as new faculty explore their identities and navigate new challenges.
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Affiliation(s)
- Brianna E Vaa Stelling
- B.E. Vaa Stelling is assistant professor of medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carl A Andersen
- C.A. Andersen is assistant professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Diego A Suarez
- D.A. Suarez is instructor of medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hannah C Nordhues
- H.C. Nordhues is assistant professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-5610-0663
| | - Frederic W Hafferty
- F.W. Hafferty is professor of medical education, Division of General Internal Medicine, Program in Professionalism and Values, and College of Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-5604-7268
| | - Thomas J Beckman
- T.J. Beckman is professor of medicine and medical education, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Adam P Sawatsky
- A.P. Sawatsky is associate professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-4050-7984
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22
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Koh EYH, Koh KK, Renganathan Y, Krishna L. Role modelling in professional identity formation: a systematic scoping review. BMC MEDICAL EDUCATION 2023; 23:194. [PMID: 36991373 PMCID: PMC10052869 DOI: 10.1186/s12909-023-04144-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 03/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Role modelling's pivotal part in the nurturing of a physician's professional identity remains poorly understood. To overcome these gaps, this review posits that as part of the mentoring spectrum, role modelling should be considered in tandem with mentoring, supervision, coaching, tutoring and advising. This provides a clinically relevant notion of role modelling whilst its effects upon a physician's thinking, practice and conduct may be visualised using the Ring Theory of Personhood (RToP). METHODS A Systematic Evidence Based Approach guided systematic scoping review was conducted on articles published between 1 January 2000 to 31 December 2021 in the PubMed, Scopus, Cochrane, and ERIC databases. This review focused on the experiences of medical students and physicians in training (learners) given their similar exposure to training environments and practices. RESULTS 12,201 articles were identified, 271 articles were evaluated, and 145 articles were included. Concurrent independent thematic and content analysis revealed five domains: existing theories, definitions, indications, characteristics, and the impact of role modelling upon the four rings of the RToP. This highlights dissonance between the introduced and regnant beliefs and spotlights the influence of the learner's narratives, cognitive base, clinical insight, contextual considerations and belief system on their ability to detect, address and adapt to role modelling experiences. CONCLUSION Role modelling's ability to introduce and integrate beliefs, values and principles into a physician's belief system underscores its effects upon professional identity formation. Yet, these effects depend on contextual, structural, cultural and organisational influences as well as tutor and learner characteristics and the nature of their learner-tutor relationship. The RToP allows appreciation of these variations on the efficacy of role modelling and may help direct personalised and longitudinal support for learners.
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Affiliation(s)
- Eugene Yong Hian Koh
- Singapore Armed Forces, 303 Gombak Drive, Singapore, 669645, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Kai Kee Koh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Yaazhini Renganathan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK.
- Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Duke-NUS Medical School, National University of Singapore, College Rd, Singapore, 169857, Singapore.
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore.
- The Palliative Care Centre for Excellence in Research and Education, PalC, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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23
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Xia Y, Guo Q, Chen Q, Zeng L, Yi Q, Liu H, Huang H. Pathways from the clinical learning environment and ego identity to professional identity: A cross-sectional study. J Prof Nurs 2023; 45:29-34. [PMID: 36889891 DOI: 10.1016/j.profnurs.2023.01.006] [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: 07/25/2022] [Revised: 01/07/2023] [Accepted: 01/13/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The clinical learning environment and ego identity are positively related to professional identity. However, the pathways from these factors to professional identity are unknown. Aim This study explores the pathways from the clinical learning environment and ego identity to professional identity. METHODS The study used a convenience sampling method in a comprehensive hospital in Hunan Province, China to enrol 222 nursing interns between April and May 2021. General information questionnaires and scales with good psychometric properties (e.g., Environment Evaluation Scale for Clinical Nursing Internship, Ego Identity Scale, and Professional Identification Scale) were used to collect data. A structural equation model was used to explore the relationships between the clinical learning environment, ego identity, and professional identity among nursing interns. RESULTS The professional identity of nursing interns was positively correlated with the clinical learning environment and ego identity. The clinical learning environment had a direct effect (Effect = -0.052, P < 0.05) and an indirect effect through ego identity (Effect = -0.042, P < 0.05) on nursing interns' professional identity. CONCLUSION The clinical learning environment and ego identity are important influencing factors of professional identity among nursing interns. Therefore, clinical teaching hospitals and teachers should pay attention to the improvement in the clinical learning environment and the cultivation of nursing interns' ego identity.
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Affiliation(s)
- Yuting Xia
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Qinqin Guo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Qirong Chen
- Xiangya School of Nursing, Central South University, Changsha, China.
| | - Lihong Zeng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Qifeng Yi
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Huan Liu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hui Huang
- The Third Xiangya Hospital, Central South University, Changsha, China.
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24
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Scholz E, Trede F. Veterinary professional identity: Conceptual analysis and location in a practice theory framework. Front Vet Sci 2023; 10:1041475. [PMID: 36846257 PMCID: PMC9947248 DOI: 10.3389/fvets.2023.1041475] [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: 09/11/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Professional, social, and cultural issues and phenomena of veterinary practice are now established areas of commentary and interest in research, education, professional publications and even in the mainstream media. Despite the availability of theoretically informed literature in diverse relevant domains and disciplines including professional practice, workplace learning, and medical sociology and anthropology, commentary and research on veterinary practice issues and phenomena remains dominated by clinician-educators and clinician-policymakers. Reflecting the clinical disciplinary traditions, there is a resulting over-representation of individualistic, positivist perspectives and under-theorized research studies. In this paper we provide an interdisciplinary theoretical framework for veterinary practice and veterinary professional identity grounded in a practice theory perspective. We begin by arguing for the need for such a framework by scoping veterinary practice in its contemporary social context. We go on to provide a sociocultural framing of veterinary practice, underlining the mutual constitution of individuals and the social world through participation in practices and taking into consideration important concepts including knowledge, institutions, ethics, and embodiment. We assert the importance of professional identity as a core phenomenon of veterinary practice, constituted by making meaning of professional practice experiences, especially through narrative and dialogue. This practice theory framework for veterinary practice and veterinary professional identity development provides rich opportunities for understanding, researching, and enacting diverse activities and phenomena, especially learning, development and change within and beyond formal educational settings.
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Affiliation(s)
- Emma Scholz
- School of Animal, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia,*Correspondence: Emma Scholz ✉
| | - Franziska Trede
- Institute for Interactive Media and Learning, University of Technology Sydney, Sydney, NSW, Australia
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25
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Yiu S, Yeung M, Cheung WJ, Frank JR. Stress and conflict from tacit culture forges professional identity in newly graduated independent physicians. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:10.1007/s10459-022-10173-z. [PMID: 36477578 DOI: 10.1007/s10459-022-10173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/04/2022] [Indexed: 06/17/2023]
Abstract
To transition successfully into independent practice, newly graduated independent physicians (new "attendings") undergo a process of professional identity formation (PIF) as a clinician within a new community of practice (CoP). PIF is crafted by socialization within a CoP including transfer of tacit knowledge. While certain tacit knowledge is critical for professional identity, we understand little how it shapes PIF. We set out to describe the tacit knowledge acquired by new attendings within a CoP and how it contributes to PIF. Informed by constructivist grounded theory, we interviewed 23 new attendings about the tacit knowledge they acquired in early practice. Data collection and analysis occurred iteratively. We identified themes using constant comparative analysis and generated a theory that underwent member checking and feedback. Implicit standards from group culture imparted high expectations on new attendings and led to internal stress. New attendings also encountered a tacit code of conduct as behavioral elements of group culture. These elements created external conflict between new attendings and group members such as departmental colleagues, consulting physicians, and other health professionals. Depending on the support they received, new attendings responded to the stress and conflict in three ways: they doubted, adjusted, or avoided. These strategies molded their professional identity, and moved them towards or away from the CoP as they navigated their transition and PIF. We describe a novel theory of how tacit group culture shaped new attending physicians' professional identity in a new community of practice. Internal stress and external conflict occurred due to high expectations and tacit culture elements. New attendings' doubt, adjust, or avoid responses, shaped by support they received, in turn crafted their professional identity. Education leaders should prepare graduating trainees to navigate aspects of transition to independent practice successfully.
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Affiliation(s)
- Stella Yiu
- Department of Emergency Medicine, The Ottawa Hospital, 1053 Carling Avenue, K1Y 4E9, Ottawa, ON, Canada.
| | - Marianne Yeung
- Department of Emergency Medicine, The Ottawa Hospital, 1053 Carling Avenue, K1Y 4E9, Ottawa, ON, Canada
| | - Warren J Cheung
- Department of Emergency Medicine, The Ottawa Hospital, 1053 Carling Avenue, K1Y 4E9, Ottawa, ON, Canada
- Royal College of Surgeons and Physicians of Canada, Ottawa, Canada
| | - Jason R Frank
- Department of Emergency Medicine, The Ottawa Hospital, 1053 Carling Avenue, K1Y 4E9, Ottawa, ON, Canada
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26
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Rockman CB. Mirror, mirror, on the wall. J Vasc Surg 2022; 76:1111-1122. [DOI: 10.1016/j.jvs.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/25/2022] [Accepted: 05/08/2022] [Indexed: 10/31/2022]
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27
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Braam A, Buljac-Samardzic M, Hilders CGJM, van Wijngaarden JDH. Collaboration Between Physicians from Different Medical Specialties in Hospital Settings: A Systematic Review. J Multidiscip Healthc 2022; 15:2277-2300. [PMID: 36237842 PMCID: PMC9552793 DOI: 10.2147/jmdh.s376927] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/02/2022] [Indexed: 11/06/2022] Open
Abstract
Health care today is characterized by an increasing number of patients with comorbidities for whom interphysician collaboration seems very important. We reviewed the literature to understand what factors affect interphysician collaboration, determine how interphysician collaboration is measured, and determine its effects. We systematically searched six major databases. Based on 63 articles, we identified five categories that influence interphysician collaboration: personal factors, professional factors, preconditions and tools, organizational elements, and contextual characteristics. We identified a diverse set of mostly unvalidated tools for measuring interphysician collaboration that focus on information being transferred and understood, frequency of interaction and tone of the relationship, and value judgements about quality or satisfaction. We found that interphysician collaboration increased clinical outcomes as well as patient and staff satisfaction, while error rates and length of stay were reduced. The results should, however, be interpreted with caution, as most of the studies provide a low level of evidence.
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Affiliation(s)
- Anoek Braam
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands,Correspondence: Anoek Braam, Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle Building, P.O. Box 1738, Rotterdam, DR 3000, the Netherlands, Email
| | - Martina Buljac-Samardzic
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Carina G J M Hilders
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jeroen D H van Wijngaarden
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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28
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Schrewe B, Martimianakis MA. Re-thinking "I"dentity in medical education: genealogy and the possibilities of being and becoming. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:847-861. [PMID: 35122588 DOI: 10.1007/s10459-022-10095-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
Professional identity formation has emerged as a key topic for medical education research, with contributions from perspectives of psychological development and socialization opening up needed conversations in the field. Yet mainstream training practices may have the unintended effects of educating for a physician typology that may be too narrow to account for the complexity of learners' personal identities. Alternative approaches, such as Foucauldian genealogy, offer ways to empirically investigate how the legitimate contours of being and becoming have come to be as they are, how they shape professional identities, and to which degree their borders may be made more inclusive. Drawing upon an example of the contemporary practice of competency-based medical education in the Canadian context, this paper considers how genealogy's methodological tools of critical distancing, the dispositif, and problematization may help reveal how educational practices shape the identities of physicians-in-training in ways both intended and unintended. From this perspective it becomes apparent that any attempt to explore professional identity is incomplete without also considering that a trainee's evolving sense of self is inexorably bound up with forces of knowledge, power, and ethics that shape them into becoming certain kinds of physician subjects rather than others. In mapping this terrain, a genealogical approach determines how we reached the now in which we find ourselves and how we might transform it, such that we may shift the possibilities afforded to health professionals to establish professional identities aligned with their personal identities in ways that maximize inclusivity and minimize marginalization.
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Affiliation(s)
- Brett Schrewe
- Department of Pediatrics, The University of British Columbia, Victoria, BC, Canada.
- Centre for Health Education Scholarship, P. A. Woodward Instructional Resources Centre (IRC), 429-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
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29
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Leep Hunderfund AN, West CP, Rackley SJ, Dozois EJ, Moeschler SM, Vaa Stelling BE, Winters RC, Satele DV, Dyrbye LN. Social Support, Social Isolation, and Burnout: Cross-Sectional Study of U.S. Residents Exploring Associations With Individual, Interpersonal, Program, and Work-Related Factors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1184-1194. [PMID: 35442910 DOI: 10.1097/acm.0000000000004709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To examine associations of social support and social isolation with burnout, program satisfaction, and organization satisfaction among a large population of U.S. residents and fellows and to identify correlates of social support and social isolation. METHOD All residents and fellows enrolled in graduate medical education programs at Mayo Clinic sites were surveyed in February 2019. Survey items measured social support (emotional and tangible), social isolation, burnout, program satisfaction, and organization satisfaction. Factors of potential relevance to social support were collected (via the survey, institutional administrative records, and interviews with program coordinators and/or program directors) and categorized as individual, interpersonal, program, or work-related factors (duty hours, call burden, elective time, vacation days used before survey administration, required away rotations, etc.). Multivariable regression analyses were conducted to examine relationships between variables. RESULTS Of 1,146 residents surveyed, 762 (66%) from 58 programs responded. In adjusted models, higher emotional and tangible support were associated with lower odds of burnout and higher odds of program and organization satisfaction, while higher social isolation scores were associated with higher odds of burnout and lower odds of program satisfaction and organization satisfaction. Independent predictors of social support and/or social isolation included age, gender, relationship status, parental status, postgraduate year, site, ratings of the program leadership team, ratings of faculty relationships and faculty professional behaviors, satisfaction with autonomy, and vacation days used before survey administration. CONCLUSIONS This study demonstrates that social support and social isolation are strongly related to burnout and satisfaction among residents and fellows. Personal and professional relationships, satisfaction with autonomy, and vacation days are independently associated with social support and/or social isolation, whereas most program and work-related factors are not. Additional studies are needed to determine if social support interventions targeting these factors can improve well-being and enhance satisfaction with training.
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Affiliation(s)
- Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is associate professor of neurology, Mayo Clinic, and associate director of clinical learning environment optimization, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Colin P West
- C.P. West is professor of medicine, medical education, and biostatistics, Divisions of General Internal Medicine and Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1628-5023
| | - Sandra J Rackley
- S.J. Rackley is assistant professor of psychiatry, Mayo Clinic, and assistant dean for trainee well-being, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Eric J Dozois
- E.J. Dozois is professor of surgery, Mayo Clinic, Rochester, Minnesota
| | - Susan M Moeschler
- S.M. Moeschler is associate professor of anesthesiology, Mayo Clinic, Rochester, Minnesota
| | | | - Richard C Winters
- R.C. Winters is assistant professor of emergency medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel V Satele
- D.V. Satele is statistician, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Liselotte N Dyrbye
- L.N. Dyrbye is professor of medicine and medical education and co-director of the physician well-being program, Mayo Clinic, Rochester, Minnesota
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30
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Barnhoorn PC, Nierkens V, Numans ME, Steinert Y, Kramer AWM, van Mook WNKA. General practice residents’ perspectives on their professional identity formation: a qualitative study. BMJ Open 2022. [PMCID: PMC9301807 DOI: 10.1136/bmjopen-2021-059691] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To move beyond professionalism as a measurable competency, medical educators have highlighted the importance of forming a professional identity, in which learners come to ‘think, act, and feel like physicians’. This socialisation process is known as professional identity formation (PIF). Few empirical studies on PIF in residency have been undertaken. None of these studies focused on PIF during the full length of GP training as well as the interplay of concurrent socialising factors. Understanding the socialisation process involved in the development of a resident’s professional identity and the roles of influencing factors and their change over time could add to a more purposeful approach to PIF. Therefore, we aimed to investigate the process of PIF during the full length of General Practice (GP) training and which factors residents perceive as influential. Design A qualitative descriptive study employing focus group interviews. Setting Four GP training institutes across the Netherlands. Participants Ninety-two GP residents in their final training year participated in 12 focus group interviews. Results Study findings indicated that identity formation occurs primarily in the workplace, as residents move from doing to becoming and negotiate perceived norms. A tapestry of interrelated influencing factors—most prominently clinical experiences, clinical supervisors and self-assessments—changed over time and were felt to exert their influence predominantly in the workplace. Conclusions This study provides deeper empirical insights into PIF during GP residency. Doing the work of a GP exerted a pivotal influence on residents’ shift from doing as a GP to thinking, acting and feeling like a GP, that is, becoming a GP. Clinical supervisors are of utmost importance as role models and coaches in creating an environment that supports residents’ PIF. Implications for practice include faculty development initiatives to help supervisors be aware of how they can perform their various roles across different PIF stages.
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Affiliation(s)
- Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne Steinert
- Department of Family Medicine and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Anneke WM Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Walther NKA van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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31
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Kshetrapal A, Teunissen PW, Eppich WJ. Overextending: A Qualitative Study of Trainees Learning at the Edge of Evolving Expertise. J Grad Med Educ 2022; 14:295-303. [PMID: 35754652 PMCID: PMC9200247 DOI: 10.4300/jgme-d-21-01080.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The challenge of graduate medical education is to prepare physicians for unsupervised practice while ensuring patient safety. Current approaches may inadequately prepare physicians due to limited opportunities for autonomy. Recent work on how trainees gain autonomy shows that they actively influence their supervisors' entrustment decisions. If program directors more clearly understand how trainees experience increasing independence, they may better sensitize trainees to the deliberations they will face during patient care. OBJECTIVE The authors sought to explore how trainees experience lessening supervision as their clinical training advances. METHODS Using constructivist grounded theory, the authors recruited trainees from various specialties and training levels via email and conducted 17 semi-structured interviews from 2019 to 2020 to solicit clinical experiences during which their perceived autonomy changed. Through constant comparison and iterative analysis, key themes and conceptual relationships were identified. RESULTS Seventeen trainees from 4 specialties described novel clinical situations that required "overextending," or going beyond their perceived edge of evolving expertise. This move represented a spectrum based on perceived locus of control, from deliberate overextending driven by trainees, to forced overextending driven by external factors. Trainee judgments about whether or not to overextend were distilled into key questions: (1) Can I do it? (2) Must I do it? (3) Do I want to do it? and (4) Is it safe to do it? More advanced trainees posed a fifth question: (5) Am I missing something? CONCLUSIONS Decisions to move into the realm of uncertainty about capabilities carried weight for trainees. In making deliberative judgments about overextending, they attempted to balance training needs, capability, urgency, and patient safety.
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Affiliation(s)
- Anisha Kshetrapal
- Anisha Kshetrapal, MD, MSEd, is an Instructor in Pediatric Emergency Medicine, and Simulation Fellow, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Pim W. Teunissen
- Pim W. Teunissen, MD, PhD, is an Obstetrician-Gynecologist and Professor of Medical Education, The School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Walter J. Eppich
- Walter J. Eppich, MD, PhD, is a Pediatric Emergency Physician, Professor, and Chair of Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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32
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Nowland MH, Haidet P, Whitcomb TL. Connection and conflict: influence of the hidden curriculum on veterinary residents' professional identities within the specialty of laboratory animal medicine. J Am Vet Med Assoc 2022; 260:1-10. [PMID: 35417414 DOI: 10.2460/javma.21.04.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the role of the hidden curriculum in residents' development of professional identity during postgraduate training in laboratory animal medicine. SAMPLE 24 residents enrolled in 1 of 7 laboratory animal medicine training programs in the eastern US. PROCEDURE 24 qualitative, semistructured interviews were conducted and recorded. Deidentified transcriptions were analyzed by each author using open and axial coding. Constant comparative methodology was used to develop themes and subthemes. Member checks were performed to verify trustability of the conclusions drawn. RESULTS 3 themes and their related subthemes emerged from the qualitative analysis: 1) building relationships through competent communication (building rapport, practicing clinical empathy, overcoming language barriers, communicating in the "authorized" way, and navigating email limitations), 2) tension within the process of identity formation (acting as the middleman among stakeholders, overcoming the stigma of the policing role, experiencing a lack of power to impact change, and managing a culture of conditional value of veterinary knowledge), and 3) outlets for tension in identity formation (reliance on residency mates, limitations of venting). EDUCATIONAL RELEVANCE Our findings suggest that residents are navigating professional identity formation under challenging circumstances that include conflicting stakeholder needs, conditional value of veterinary knowledge, and lack of power to influence change. Residents have limited outlets for relieving the discord between their ideal professional role and their lived experiences. These results provide an important background for refining curricula and creating effective support systems for residents.
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Affiliation(s)
- Megan H Nowland
- 1Unit for Laboratory Animal Medicine, Office of Research, Medical School, University of Michigan, Ann Arbor, MI
| | - Paul Haidet
- 2Woodward Center for Excellence in Health Sciences Education and Departments of Medicine, Humanities, and Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, PA
| | - Tiffany L Whitcomb
- 3Department of Comparative Medicine, College of Medicine, Pennsylvania State University, Hershey, PA
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Santivasi WL, Nordhues HC, Hafferty FW, Vaa Stelling BE, Ratelle JT, Beckman TJ, Sawatsky AP. Reframing professional identity through navigating tensions during residency: A qualitative study. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:93-100. [PMID: 35301685 PMCID: PMC8941044 DOI: 10.1007/s40037-022-00709-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Professional identity formation (PIF) is the internalization of characteristics, values, and norms of the medical profession. An individual's identity formation has both psychological and sociological influences. Social psychology may be useful to explore the interactions between the psychological and sociological aspects of PIF. In this study, we explored how resident physicians navigated tensions between professional ideals and the reality of medical practice to characterize PIF during residency training. METHODS Using constructivist grounded theory, the authors conducted 23 semi-structured interviews with internal medicine residents. Interview transcripts were processed through open coding and analytic memo writing. During data gathering and analysis, the authors utilized Social Cognitive Theory, specifically the bidirectional influence between person, behavior, and context, to analyze relationships among themes. Theoretical insights were refined through group discussion and constant comparison with newly collected data. RESULTS Residents described tensions experienced during residency between pre-existing ideals of "a good doctor" and the realities of medical practice, often challenging residents to reframe their ideals. The authors provide evidence for the presence of dynamic, bidirectional influences between identity (person), behavior, and environment (context), and demonstrate how PIF is informed by a complex interplay between these elements. The authors present two examples to demonstrate how residents reframed their ideals during residency training. DISCUSSION The complex bidirectional influences between person, behavior, and context, informed by SCT, helps illuminate the process of PIF in residency training. This study highlights the effects of the context of residency training on the development of residents' professional identities.
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Affiliation(s)
- Wil L Santivasi
- Center for Palliative Care, Duke University School of Medicine, Durham, NC, USA
| | - Hannah C Nordhues
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - John T Ratelle
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas J Beckman
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Adam P Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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Prentice S. Empowering or validity threat? Trainee control over workplace-based assessments. MEDICAL EDUCATION 2022; 56:247-249. [PMID: 34841555 DOI: 10.1111/medu.14702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Shaun Prentice
- GPEx Ltd., Unley, South Australia, Australia
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Thammasitboon S, Brand PLP. The physiology of learning: strategies clinical teachers can adopt to facilitate learning. Eur J Pediatr 2022; 181:429-433. [PMID: 33782760 PMCID: PMC8821380 DOI: 10.1007/s00431-021-04054-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/16/2021] [Accepted: 03/21/2021] [Indexed: 11/23/2022]
Abstract
Almost all pediatricians working in a hospital or office environment have teaching responsibilities to learners such as medical students and residents. Although teaching and supporting learning in a busy work environment imposes challenges to clinical teachers, these clinical settings provide an ideal setup for experiential learning, learning from daily experiences with patients. Advances in the science of learning derived from various fields have informed us how adults learn best. Many techniques and strategies based on this "physiology of learning" have shown their educational values in everyday pediatric practice. This article outlines how clinical teachers can create the conditions to optimize experiential learning for individual or a group of learners. We highlight practical implications of educational theories and evidence-based educational practices for clinical teachers seeking to enhance their teaching effectiveness. These include promoting active learning and engaging learners in deliberate practice; retrieval of knowledge and prior experiences to enhance motivation; supporting a psychologically safe learning environment; helping learners to set goals; fostering collaborative learning; structuring teaching to link it to authentic roles and tasks; and customizing content to individual learners.Conclusion: Applying adult learning principles in everyday teaching activities will support busy pediatricians to be successful in their tasks as clinical teachers, and contribute to work satisfaction. What is Known: • Most pediatricians provide clinical teaching to medical students and residents, but few have had formal training in educational techniques. • Learning from clinical experiences (experiential learning) is of key importance to becoming and maintaining a competent pediatrician. What is New: • This review presents an up-to-date overview of the physiology of learning, i.e., how people learn. • Knowledge of the principles of how people learn helps pediatricians shape their clinical teaching effectively and contribute to their work satisfaction.
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Affiliation(s)
- Satid Thammasitboon
- grid.39382.330000 0001 2160 926XIntensive Care Medicine Section and Center for Research, Innovation and Scholarship in Medical Education (CRIS), Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Paul L. P. Brand
- grid.452600.50000 0001 0547 5927Isala Academy, Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands ,grid.4494.d0000 0000 9558 4598Lifelong Learning Education and Assessment Research Network (LEARN), University of Groningen and University Medical Center, Groningen, The Netherlands
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Sawatsky AP, O'Brien BC, Hafferty FW. Autonomy and developing physicians: Reimagining supervision using self-determination theory. MEDICAL EDUCATION 2022; 56:56-63. [PMID: 34091940 DOI: 10.1111/medu.14580] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
In this article, we address the question, 'What is the role of autonomy in physician development?' Medical education is a developmental process, and autonomy plays a motivational role in physician development. Calls for increased supervision of residents have raised concerns that the resulting decreased autonomy might interfere with resident development, leading the authors to explore the relationship between supervision and autonomy. The medical education literature posits a simple inverse relationship between supervision and autonomy. Within competency frameworks, autonomy is operationalised as independence and viewed as the end goal of training. Alternatively, there is emerging empirical literature describing autonomy and supervision as dynamic and developmental constructs and point towards more complex relationship between supervision and autonomy. Self-determination theory (SDT) presents a framework for understanding this dynamic relationship and the role of autonomy in physician development. Within SDT, autonomy is a fundamental psychological need, associated with motivation for learning, self-regulation and an internal locus of control. Supporting learner autonomy can afford learners the opportunity to internalise the values and norms of the profession, leading to an integrated regulation of their behaviours and actions. Conceptualising autonomy through the lens of SDT provides an avenue for education interventions and future research on supervision and autonomy. Educators can integrate supervision and autonomy support in the clinical setting, seeking to motivate learner development by balancing optimal challenge and support and integrating autonomy support with 'hands-on' approaches to supervision. SDT also provides a theoretical framework relevant to current discussions regarding feedback conversations and coaching in medical education. Lastly, conceptualising autonomy using SDT opens new avenues for investigation, exploring the complex relationship between supervision and autonomy and developing efforts to integrate autonomy support with clinical supervision.
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Affiliation(s)
- Adam P Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bridget C O'Brien
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
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Barnhoorn PC, Nierkens V, Mak-van der Vossen MC, Numans ME, van Mook WNKA, Kramer AWM. Unprofessional behaviour of GP residents and its remediation: a qualitative study among supervisors and faculty. BMC FAMILY PRACTICE 2021; 22:249. [PMID: 34930146 PMCID: PMC8686537 DOI: 10.1186/s12875-021-01609-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied. METHODS We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts. RESULTS Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined. CONCLUSIONS The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation.
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Affiliation(s)
- Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine and Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, the Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Gkiousias V. Scalpel Please! A Scoping Review Dissecting the Factors and Influences on Professional Identity Development of Trainees Within Surgical Programs. Cureus 2021; 13:e20105. [PMID: 35003955 PMCID: PMC8723698 DOI: 10.7759/cureus.20105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/05/2022] Open
Abstract
Professional identity development is a multifaceted process that has recently sparked interest in medical education. Literature in professional identity development has focused predominantly on medical students and postgraduate medical training and much less on surgery, despite the unique challenges faced by surgical trainees while trying to emulate the identity of a self-actualized surgeon. A scoping review was performed to explore the factors and influences on professional identity development of surgeons in training. MEDLINE, PubMed, and OpenGrey databases were initially screened for relevant existing literature of professional identity development in surgical trainees, including quantitative, qualitative, and gray literature, followed by a hand search of references that appeared to be of pertinence. Seven hundred and five records were initially identified. Following the removal of duplicates and application of study selection criteria, 11 studies were included in the review. Professional identity development in surgical trainees was found to be influenced by a variety of intricately interrelating factors. Gaps in the literature were identified, highlighting possible areas of future research to better elucidate the overall process of identity development in budding surgeons and help guide interventions and programs to facilitate the transition of trainees to qualified and independently practicing surgeons.
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Gin BC, Tsoi S, Sheu L, Hauer KE. How supervisor trust affects early residents' learning and patient care: A qualitative study. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:327-333. [PMID: 34297348 PMCID: PMC8633204 DOI: 10.1007/s40037-021-00674-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Trust between supervisors and trainees mediates trainee participation and learning. A resident (postgraduate) trainee's understanding of their supervisor's trust can affect their perceptions of their patient care responsibilities, opportunities for learning, and overall growth as physicians. While the supervisor perspective of trust has been well studied, less is known about how resident trainees recognize supervisor trust and how it affects them. METHODS In this qualitative study, 21 pediatric residents were interviewed at a single institution. Questions addressed their experiences during their first post-graduate year (PGY-1) on inpatient wards. Each interviewee was asked to describe three different patient care scenarios in which they perceived optimal, under-, and over-trust from their resident supervisor. Data were analyzed using thematic analysis. RESULTS Residents recognized and interpreted their supervisor's trust through four factors: supervisor, task, relationship, and context. Optimal trust was associated with supervision balancing supervisor availability and resident independence, tasks affording participation in decision-making, trusting relationships with supervisors, and a workplace fostering appropriate autonomy and team inclusivity. The effects of supervisor trust on residents fell into three themes: learning experiences, attitudes and self-confidence, and identities and roles. Optimal trust supported learning via tailored guidance, confidence and lessened vulnerability, and a sense of patient ownership and team belonging. DISCUSSION Understanding how trainees recognize supervisor trust can enhance interventions for improving the dialogue of trust between supervisors and trainees. It is important for supervisors to be cognizant of their trainees' interpretations of trust because it affects how trainees understand their patient care roles, perceive autonomy, and approach learning.
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Affiliation(s)
- Brian C Gin
- Department of Pediatrics, University of California-San Francisco, San Francisco, CA, USA.
| | - Stephanie Tsoi
- Department of Pediatrics, University of California-San Francisco, San Francisco, CA, USA
| | - Leslie Sheu
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Karen E Hauer
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
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What do they think and why it matters? Views of administrators and faculty on the use of Massively Multiplayer Online Games for Learning. COMPUTERS AND EDUCATION OPEN 2021. [DOI: 10.1016/j.caeo.2021.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Schweiss SK, Hager KD, Moon JY, Lounsbery JL, Pestka DL. Evaluating the evolution of philosophy of practice over postgraduate year 1 residency training. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Keri D. Hager
- University of Minnesota, College of Pharmacy Duluth Minnesota USA
| | - Jean Y. Moon
- University of Minnesota, College of Pharmacy Minneapolis Minnesota USA
| | - Jody L. Lounsbery
- University of Minnesota, College of Pharmacy Minneapolis Minnesota USA
| | - Deborah L. Pestka
- University of Minnesota, College of Pharmacy Minneapolis Minnesota USA
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Jansen I, Stalmeijer RE, Silkens MEWM, Lombarts KMJMH. An act of performance: Exploring residents' decision-making processes to seek help. MEDICAL EDUCATION 2021; 55:758-767. [PMID: 33539615 PMCID: PMC8247982 DOI: 10.1111/medu.14465] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 05/16/2023]
Abstract
CONTEXT Residents are expected to ask for help when feeling insufficiently confident or competent to act in patients' best interests. While previous studies focused on the perspective of supervisor-resident relationships in residents' help-seeking decisions, attention for how the workplace environment and, more specifically, other health care team members influence these decisions is limited. Using a sociocultural lens, this study aimed to explore how residents' decision-making processes to seek help are shaped by their workplace environment. METHODS Through a constructivist grounded theory methodology, we purposively and theoretically sampled 18 residents: 9 juniors (postgraduate year 1/2) and 9 seniors (postgraduate year 5/6) at Amsterdam University Medical Centers. Using semi-structured interviews, participating residents' decision-making processes to seek help during patient care delivery were explored. Data collection and analysis were iterative; themes were identified using constant comparative analysis. RESULTS Residents described their help-seeking decision-making processes as an 'act of performance': they considered how asking for help could potentially impact their assessments. They described this act of performance as the product of an internal 'balancing act' with at its core the non-negotiable priority for providing safe and high-quality patient care. With this in mind, residents weighed up demonstrating the ability to work independently, maintaining credibility and becoming an accepted member of the health care team when deciding to seek help. This 'balancing act' was influenced by sociocultural characteristics of the learning environment, residents' relationships with supervisors and the perceived approachability of other health care team members. CONCLUSIONS This study suggests that sociocultural forces influence residents to experience help-seeking as an act of performance. Especially, a safe learning environment resulting from constructive relationships with supervisors and the approachability of other health care team members lowered the barriers to seek help. Supervisors could address these barriers by having regular conversations with residents about when to seek help.
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Affiliation(s)
- Iris Jansen
- Professional Performance and Compassionate Care Research GroupDepartment of Medical PsychologyAmsterdam UMC/University of AmsterdamAmsterdamThe Netherlands
| | - Renée E. Stalmeijer
- School of Health Professions EducationFaculty of Health, Medicine, and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Milou E. W. M. Silkens
- Research Department of Medical EducationUCL Medical SchoolUniversity College LondonLondonUK
| | - Kiki M. J. M. H. Lombarts
- Professional Performance and Compassionate Care Research GroupDepartment of Medical PsychologyAmsterdam UMC/University of AmsterdamAmsterdamThe Netherlands
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Sorrell S, Ibrahim H. First year medical students' perceptions of the impact of wearing scrubs on professional identity: a narrative analysis in the United Arab Emirates. BMJ Open 2020; 10:e039357. [PMID: 33148751 PMCID: PMC7640520 DOI: 10.1136/bmjopen-2020-039357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Medical school serves as a critical developmental period for future physicians, during which students begin to form a professional identity. Just as personal appearance, particularly clothing, is an important external expression of one's personal identity, 'uniforms' in healthcare, including white coats and scrubs, symbolise status and a group identity. There are, however, limited studies on the impact of physician attire on medical students' formation of professional identity. Accordingly, through qualitative analysis of written narratives, we sought to analyse medical students' experiences of wearing professional physician attire, namely scrubs, and how the uniform impacted their confidence level, performance and behaviours, as well as their identity as future physicians. DESIGN Qualitative analysis of medical student's written narratives. SETTING Khalifa University College of Medicine and Health Sciences (KU CMHS) is a new medical school in the United Arab Emirates, with an inaugural class of 30 students admitted in August 2019. It is the only medical school in the city of Abu Dhabi, and the only school in the country that follows a postgraduate medical curriculum. PARTICIPANTS All first year medical students at KU CMHS were purposively sampled. METHODS Students completed a voluntary online anonymous questionnaire. We employed a social identity approach to data analysis. Thematic content analysis was conducted on their narratives to identify themes. RESULTS We identified three major themes, namely (1) emotions, (2) logistics and (3) interpersonal relationships. CONCLUSIONS Medical students form early perceptions regarding physician attire and its impact on their professional identity. Engaging in conversations regarding professional attire with educators or mentors could provide an important opportunity for students to discuss and explore professional identity early in training.
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Affiliation(s)
- Sara Sorrell
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Halah Ibrahim
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Bochatay N, van Schaik S, O'Brien B. Medical trainees as job crafters: Looking at identity formation through another lens. MEDICAL EDUCATION 2020; 54:972-974. [PMID: 32772425 DOI: 10.1111/medu.14342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Naike Bochatay
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Sandrijn van Schaik
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Bridget O'Brien
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Brenna CT, Das S. Divides of identity in medicine and surgery: A review of duty-hour policy preference. Ann Med Surg (Lond) 2020; 57:1-4. [PMID: 32685142 PMCID: PMC7358620 DOI: 10.1016/j.amsu.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/06/2020] [Indexed: 11/05/2022] Open
Abstract
Surgery and Medicine are broadly considered as the two fundamental paths that a physician's career can follow. But their convergence under the singular umbrella of doctoring is relatively recent in the context of medical history. Their co-existence within the structure of medical education and the healthcare system suggest that they bear great similarity to each other, when in reality several differences are intuitively recognizable between them. Here, we discuss recent evidence suggesting a discrepancy between these two streams in the work-hour policy preference of trainees. We argue that these differences betray a more radical divide between them, and one which illuminates an essential difference in the self-identification of surgical and non-surgical medical trainees. Additionally, these findings support a novel claim about the importance of uninterrupted relationships on the formation of professional identity among healthcare professionals. We suggest that the principal separation of surgical and non-surgical practice is significant enough to reconsider their dogmatic unification as well as warrant the adoption of unique rules and policies to govern each stream.
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Affiliation(s)
| | - Sunit Das
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
- Centre for Ethics, University of Toronto, Toronto, ON, Canada
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Yoshimura M, Saiki T, Imafuku R, Fujisaki K, Suzuki Y. Experiential learning of overnight home care by medical trainees for professional development: an exploratory study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:146-154. [PMID: 32712596 PMCID: PMC7870453 DOI: 10.5116/ijme.5f01.c78f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES In an ageing society, community-based medical education in a home care setting needs to be developed. Drawing on Kolb's experiential learning theory, this study aimed to explore the learning processes in overnight home care by medical trainees in terms of their understanding of terminally ill patients and their conceptualization of themselves as future physicians. METHODS An overnight home care program in which a trainee had to take care of terminally ill patients on his/her own under the supervision of a healthcare team was conducted. Nineteen trainees, including eight medical students and 11 residents, participated in this study. Text data of reflective reports written after the overnight care were collected and thematically analyzed. RESULTS The trainees' learning experiences in the program were categorized into four stages: predeparture, concrete experience, reflective observation and abstract conceptualization. Although they had mixed feelings, including anxiety, fear and expectations, at the predeparture stage, they could be actively involved in providing medical care and daily life support and in taking care of dying patients at the patients' homes overnight. By reflecting on their experiences, they gained a sense of achievement and identified the aspects upon which they should improve as future physicians. Subsequently, based on their reflective observation, they conceptualized their approaches to home care and the roles/responsibilities of physicians as healers, which led to professional identity formation. CONCLUSIONS Overnight home care by medical trainees has the potential as an educational strategy to promote their realistic understanding of home care and facilitate professional identity formation.
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Affiliation(s)
- Manabu Yoshimura
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Takuya Saiki
- Medical Education Development Center, Gifu University, Gifu, Japan
| | - Rintaro Imafuku
- Medical Education Development Center, Gifu University, Gifu, Japan
| | | | - Yasuyuki Suzuki
- Medical Education Development Center, Gifu University, Gifu, Japan
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Li H, Novack DH, Duke P, Gracely E, Cestone C, Davis T. Predictors of medical students' ethical decision-making: A pilot study using the Theory of Interpersonal Behavior. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30292-5. [PMID: 32540095 DOI: 10.1016/j.pec.2020.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To understand medical students' (MS) ethical decision-making using the Theory of Interpersonal Behavior (TIB). METHODS We conducted two rounds of focus groups to develop a TIB-based questionnaire by eliciting students' perspectives on an ethical dilemma they will encounter in a standardized patient (SP) station, in which an SP "surgeon" asked them to intubate a sedated patient whom the student knew had requested no student involvement. We administrated questionnaires to 241 third-year MS following this SP station, asking for their decisions in the SP station and if a surgeon made the same request in their clerkship. Confirmatory factor analysis (CFA) was used to test whether observed data fit the proposed TIB-based model. RESULTS The CFA provided an acceptable fit to the a priori proposed model. Fifty-five percent of students indicated they would intubate in an actual situation versus 18% in the SP station (p < 0.05). Using logistic regression, TIB domains affect and facilitating factors reported significant association with students' decisions in both the SP and hypothesized actual situations. CONCLUSIONS The TIB appears to be an effective theoretical framework for explaining students' ethical decision-making. PRACTICE IMPLICATIONS The TIB may guide design and assessment of educational programs for professional formation.
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Affiliation(s)
- Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China; Cambridge Health Alliance, Harvard Medical School, Cambridge, USA.
| | - Dennis H Novack
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
| | - Pamela Duke
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
| | - Edward Gracely
- Family Community and Preventive Medicine, Drexel University College of Medicine, Philadelphia, USA
| | - Christina Cestone
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
| | - Tiffany Davis
- Office of Educational Affairs, Drexel University College of Medicine, Philadelphia, USA
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