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Price T, Reynolds E, O'Brien T, Gale T, Quick O, Bryce M. Role of remediation in cases of serious misconduct before UK healthcare regulators: a qualitative study. BMJ Qual Saf 2024:bmjqs-2024-017187. [PMID: 39107109 DOI: 10.1136/bmjqs-2024-017187] [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: 01/30/2024] [Accepted: 07/16/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND The raison d'etre of healthcare profession regulators across the globe is to protect patients and the public from the risk of harm. In cases of serious misconduct, remediation is deemed to be an important factor when considering the risk of harm from a practitioner under investigation. Yet, we know very little about how regulators account for remediation in their decision-making, and whether it is consistent with the aim of risk reduction. This paper explores the role of remediation in decision-making in cases of serious misconduct before UK healthcare regulators. METHODS We conducted interviews with 21 participants from across eight of the nine UK healthcare profession regulators, covering a range of roles in the decision-making process in misconduct cases. Interviews were conducted remotely by video call and digitally transcribed. Data were analysed using the framework analysis method. The initial framework was developed from existing literature and guidance documents from the regulators, and was subsequently refined through the various rounds of coding. RESULTS Remediation influenced decision-making in three ways: (1) Some types of misconduct were deemed more inherently remediable than others. In cases involving dishonesty or sexual misconduct, remediation was less likely to serve as a mitigating factor. (2) Decision-makers often view remediation as a proxy indicator of practitioner insight. (3) Whether a practitioner had demonstrated their commitment to change through undergoing remediation was more likely to feed into decision-making at the point where current impairment was under consideration. CONCLUSIONS Remediation plays a key role in decision-makers' judgements in cases of misconduct, particularly when these cases relate to clinical misconduct. In such cases, remediation informs judgements on the levels of practitioner insight and the risk of such misconduct being repeated. Our results suggest a need to develop remediation interventions that are explicitly geared towards the regulatory function of developing practitioner insight. Regulators should also consider the structure of their fitness to practise processes and whether there are appropriate opportunities for judgements on remediation to feed into decisions and to facilitate balanced and proportionate outcomes.
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Affiliation(s)
- Tristan Price
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Ellie Reynolds
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | | | - Thomas Gale
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Oliver Quick
- University of Bristol Law School, University of Bristol, Bristol, UK
| | - Marie Bryce
- Peninsula Medical School, University of Plymouth, Plymouth, UK
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Marais DL. It's very difficult to set the boundaries, it's human nature to want to respond: exploring health professions educators' responses to student mental health difficulties through a positioning theory lens. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:67-88. [PMID: 37296198 PMCID: PMC10252173 DOI: 10.1007/s10459-023-10254-7] [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: 11/14/2022] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
By virtue of their teaching role and contact with students, health professions (HP) educators are often the first point of connection for students who are experiencing mental health difficulties. Educators are increasingly expected to include some form of pastoral care in their role. Mental health-related interactions with students may have a negative emotional impact on educators, particularly when roles and expectations are not clearly defined and where boundaries are not managed effectively. Using positioning theory as a lens, this study explored how educators experienced such interactions and how this manifested in positions, storylines, and speech acts. Interviews were conducted with 27 HP educators at a faculty of medicine and health sciences. Reflexive thematic analysis using inductive coding identified themes corresponding to the nearing, weighted, ambivalent, and distancing positions participants adopted in relation to students with mental health difficulties. There was fluidity in and between positions, and more than one position could be occupied simultaneously; participants each moved through different positions in response to different relational situations. Multiple storylines informed these positions, representing how moral- and care-informed responsibility intersected with responsiveness to make certain actions possible or impossible. Normative and personal value narratives were evident in storylines, in many cases underscored by care or justice ethics. The value of positioning theory in facilitating reflective faculty development initiatives for educators engaged in these interactions is discussed.
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Affiliation(s)
- Debra L Marais
- Research and Internationalisation Development and Support, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Jamieson J, Gibson S, Hay M, Palermo C. Teacher, Gatekeeper, or Team Member: supervisor positioning in programmatic assessment. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:10.1007/s10459-022-10193-9. [PMID: 36469231 DOI: 10.1007/s10459-022-10193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Competency-based assessment is undergoing an evolution with the popularisation of programmatic assessment. Fundamental to programmatic assessment are the attributes and buy-in of the people participating in the system. Our previous research revealed unspoken, yet influential, cultural and relationship dynamics that interact with programmatic assessment to influence success. Pulling at this thread, we conducted secondary analysis of focus groups and interviews (n = 44 supervisors) using the critical lens of Positioning Theory to explore how workplace supervisors experienced and perceived their positioning within programmatic assessment. We found that supervisors positioned themselves in two of three ways. First, supervisors universally positioned themselves as a Teacher, describing an inherent duty to educate students. Enactment of this position was dichotomous, with some supervisors ascribing a passive and disempowered position onto students while others empowered students by cultivating an egalitarian teaching relationship. Second, two mutually exclusive positions were described-either Gatekeeper or Team Member. Supervisors positioning themselves as Gatekeepers had a duty to protect the community and were vigilant to the detection of inadequate student performance. Programmatic assessment challenged this positioning by reorientating supervisor rights and duties which diminished their perceived authority and led to frustration and resistance. In contrast, Team Members enacted a right to make a valuable contribution to programmatic assessment and felt liberated from the burden of assessment, enabling them to assent power shifts towards students and the university. Identifying supervisor positions revealed how programmatic assessment challenged traditional structures and ideologies, impeding success, and provides insights into supporting supervisors in programmatic assessment.
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Affiliation(s)
- Janica Jamieson
- Monash University, Melbourne, Australia.
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
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Bourgeois-Law G, Regehr G, Teunissen PW, Varpio L. Strangers in a strange land: The experience of physicians undergoing remediation. MEDICAL EDUCATION 2022; 56:670-679. [PMID: 35080035 DOI: 10.1111/medu.14736] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The experience of remediation in practising physicians has not been widely studied. Remediatees frequently present negative emotions, but observers can only infer the underlying reasons behind these. Understanding remediatees' perspectives may help those mandating and organising remediation to structure the process in ways that improve the experience for all concerned parties and maximise chances of a successful outcome for remediatees. METHODS Seventeen physicians who had undergone remediation for clinical competence concerns were interviewed via telephone. Participant data were first iteratively analysed thematically and then reanalysed using a narrative mode of analysis for each participant in order to understand the stories as wholes. Figured worlds (FW) theory was used as a lens for analysing the data for this constructivist research study. RESULTS Participants entering the FW of remediation perceived that their position as a 'good doctor' was threatened. Lacking experience with this world and with little available support to help them navigate it, participants used their agency to draw on various discursive threads within the FW to construct a narrative account of their remediation. In their narratives, participants tended to position themselves either as victims of regulatory bodies or as resilient individuals who could make the best of a difficult situation. In both cases, the chosen discursive threads enabled them to maintain their self-identity as 'good doctor'. CONCLUSION Remediation poses a threat to a physician's professional and personal identity. Focusing mainly on the educational aspect of remediation-that is, the improvement in knowledge and skills-risks missing its impact on physician identity. We need to ensure not only that we support physicians in dealing with this identity threat but that our assessment and remediation processes do not inadvertently encourage remediatees to draw on discursive threads that lead them to see themselves as victims.
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Affiliation(s)
- Gisèle Bourgeois-Law
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Glenn Regehr
- Department of Surgery, University of British Columbia, Vancouver, Canada
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Pim W Teunissen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lara Varpio
- Graduate Programs in Health Professions Education, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Clement T, Ingham G, Willems J. Using organisational role theory and job analysis to identify and define the roles of an effective Australian general practice supervisor. EDUCATION FOR PRIMARY CARE 2022; 33:207-213. [PMID: 35416132 DOI: 10.1080/14739879.2022.2045228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
General practice (GP) supervisors - the key resource for training the future GP workforce - are often described as 'occupying a role' or enacting a series of roles. However, as much of the discourse uses a lay understanding of role, or merely hints at theory, a significant body of theoretical literature is underutilised. We reasoned that a more rigorous application of role theory might provide a conceptually clearer account of the GP-supervisor's job. To this end, we describe the use of organisational role theory and job analysis to identify and define the roles of the Australian GP-supervisor. Our search of the academic literature identified 64 role titles, which we condensed to an initial iteration of core roles, using inclusion and exclusion criteria. We analysed GP training organisations' documents to map embedded supervisory tasks against our list of roles to verify their presence, review our role titles and definitions, and look for additional roles that we may have missed. We used subject matter experts iteratively, to authenticate a final list of ten roles and their accompanying definitions, which can be used to support Australian GP-supervisors to perform effectively. We encourage those who support GP-supervisors in other countries and those who educate other health professionals in primary care settings to review the roles to judge whether they are transferable to their contexts.
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Affiliation(s)
- Tim Clement
- Eastern Victoria General Practice Training, Hawthorn, Victoria Australia.,Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
| | - Gerard Ingham
- Eastern Victoria General Practice Training, Hawthorn, Victoria Australia
| | - Julie Willems
- Eastern Victoria General Practice Training, Hawthorn, Victoria Australia
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Bourgeois-Law G, Varpio L, Teunissen P, Regehr G. Remediation in Practice: A Polarity to be Managed. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:130-134. [PMID: 34974506 DOI: 10.1097/ceh.0000000000000413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Originally developed in the business literature, a polarity is a concept where 2 distinctive and opposing characteristics (poles), each presenting advantages and disadvantages or opportunities and pitfalls, must both be taken into account to ensure effective management of a challenging problem. Managing a polarity is a thorny endeavor because it entails striving to maximize the benefits of both poles while simultaneously minimizing or controlling the downsides of each. Previous investigations into stakeholder conceptualizations of remediation led us to suggest that remediation is framed in stakeholders' minds simultaneously as an educational endeavor (ie, the remediatee needs educational support to regain full competence) and a regulatory act (ie, the revocation of the individual's professional right to self-regulate their practice and learning). In this article, we argue that viewing remediation for practicing physicians as a polarity to be managed offers a framework that can further the conversation about how to address some of remediation's challenges.
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Affiliation(s)
- Gisèle Bourgeois-Law
- Dr. Bourgeois-Law: Clinical Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada. Dr. Varpio: Professor, Department of Medicine, and Associate Director of Research, Graduate Programs in Health Professions Education, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. Regehr: Professor, Department of Surgery and Associate Director (Research), Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, Canada. Dr. Teunissen: Scientific and Research Director of the School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands, and Specialist Obstetrician Gynecologist, Maastricht University Medical Centre, Maastricht, the Netherlandsnp
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