Finding Themselves, Their Place, Their Way: Uncertainties Identified by Medical Students

Phenomenon: Navigating uncertainty is a core skill when practicing medicine. Increasingly, the need to better prepare medical students for uncertainty has been recognized. Our current understanding of medical students' perspectives on uncertainty is primarily based on quantitative studies with limited qualitative research having been performed to date. We need to know from where and how sources of uncertainty can arise so that educators can better support medical students learning to respond to uncertainty. This research's aim was to describe the sources of uncertainty that medical students identify in their education. Approach: Informed by our previously published framework of clinical uncertainty, we designed and distributed a survey to second, fourth-, and sixth-year medical students at the University of Otago, Aotearoa New Zealand. Between February and May 2019, 716 medical students were invited to identify sources of uncertainty encountered in their education to date. We used reflexive thematic analysis to analyze responses. Findings: Four-hundred-sixty-five participants completed the survey (65% response rate). We identified three major sources of uncertainty: insecurities, role confusion, and navigating learning environments. Insecurities related to students' doubts about knowledge and capabilities, which were magnified by comparing themselves to peers. Role confusion impacted upon students' ability to learn, meet the expectations of others, and contribute to patient care. Navigating the educational, social, and cultural features of clinical and non-clinical learning environments resulted in uncertainty as students faced new environments, hierarchies, and identified challenges with speaking up. Insights: This study provides an in-depth understanding of the wide range of sources of medical students' uncertainties, encompassing how they see themselves, their roles, and their interactions with their learning environments. These results enhance our theoretical understanding of the complexity of uncertainty in medical education. Insights from this research can be applied by educators to better support students develop the skills to respond to a core element of medical practice.

Knowing me, knowing you: a qualitative study of the effects on patients of doctors’ self-illness disclosures

ABSTRACT INTRODUCTIONVery little is known how patients react to learning about their own doctors’ illnesses. Doctors can be uncertain if and when such disclosures can be helpful, and in what way, to patients. This paper attempts to bridge this gap by providing an in-depth analysis of one group of patients’ experiences with this type of disclosure. AIMTo understand from patients’ perspectives, the effects on them of doctors disclosing their own illnesses, to provide guidance concerning the uses of this disclosure for general practitioners. METHODSThis qualitative study was an exploration of 13 patients’ reactions to receiving such information, using semi-structured interviews and thematic analysis. RESULTSThe major themes were the emotional dimensions of illness and patienthood, the doctor–patient relationship and patients’ concerns about disclosures. Disclosures can have profound effects on patients with both negative and positive consequences. CONCLUSIONWe present suggestions about how to use such disclosures in primary care to minimise potential harms and emphasise potential benefits, based on these patients’ perspectives and the current literature.

Sexualization of the doctor-patient relationship: is it ever ethically permissible?

Whilst having sexual relationships with current patients is clearly unethical, the ethics of such a relationship between a doctor and former patient is more debatable. In this review of the current evidence, based on major articles listed in Medline and Bioethicsline in the past 15 years, the argument is made here that such relationships are almost always unethical due to the persistence of transference, the unequal power distribution in the original doctor-patient relationship and the ethical implications that arise from both these factors especially with respect to the patient's autonomy and ability to consent, even when a former patient. Only in very particular circumstances could such relationships be ethically permissible.