Medical educators’ social acts of explaining passing underperformance in students: a qualitative study

Abstract

Passing underperformance in students is ubiquitous across health and social care educators and is intimately related to the subsequent welfare of patients: underperforming students may become underperforming practitioners. This paper aims to examine how medical educators construct passing underperformance through an analysis of their social act of explaining such behaviours in peer-group settings. Ten focus groups were conducted with 70 medical educators across two UK schools with different curricular/assessment styles (England, Scotland). A qualitative content analysis of how educators explained their behaviours of passing underperformance was undertaken using the psychological concepts of proximality and distalness according to: (1) Malle's F.Ex. coding framework for behavioural explanations, and (2) participants' use of pronouns. 149 explanations of passing underperformance were identified: 72 for participants' own behaviour, 77 for others' behaviour. When explaining their own behaviour, participants used the proximal pronoun I 37% (n = 27) of the time and the distancing pronouns we/you 51% (n = 37) of the time. More Causal History of Reasons (38%; n = 27) and Enabling Factors (29%; n = 21) than Reasons (33%; n = 24) were cited. A similar pattern was found for explaining others' behaviour. Thus, medical educators used linguistic form, explanation mode and informational content within peer-group discussions to distance themselves from intentionality for their action of passing underperformance and highlighted desirable characteristics of themselves and medical educators in general. Faculty development programmes should develop assessors' awareness of how implicit factors within their talk can legitimise a culture of passing underperformance and explore the steps for cultural change.

Medical students learning intimate examinations without valid consent: a multicentre study

“…Compared with naturalistic talk around socially acceptable behaviours, 7 our students employed substantially more non‐Reason explanations (CHRs and EFs), desire and unmarked Reasons when explaining their compliance in order to portray themselves in a more positive light, as has been found in previous research in which students and medical educators have described their negative actions 9,17 . What is striking about our findings is the high proportion of EF explanations for compliance and refusal behaviours.…”

“…Compared with naturalistic talk around socially acceptable behaviours, 7 our students employed substantially more non-Reason explanations (CHRs and EFs), desire and unmarked Reasons when explaining their compliance in order to portray themselves in a more positive light, as has been found in previous research in which students and medical educators have described their negative actions. 9,17 What is striking about our findings is the high proportion of EF explanations for compliance and refusal behaviours. Other research has found that EFs occur seven to eight times more frequently in explanations of difficult rather than easy behaviours 7 and this is likely to account for our findings: both compliance and refusal behaviours are difficult, as illustrated in the emotional talk employed by students when narrating their intimate examination dilemmas.…”

“…This important aspect of the social act of explaining behaviours can shed light on how both positive and negative behaviours can be legitimised within certain communities. 9 Thus, by focusing on the hows, the theory differentiates one mode for explaining unintentional behaviours (Causal Explanation) and three modes for explaining intentional behaviours (Reason, Causal History of Reason [CHR] and Enabling Factor [EF] explanations). Table 1 shows a description of explanation types.…”

“…In terms of hows , it focuses on how behavioural explanations are articulated for, amongst other things, impression management purposes. This important aspect of the social act of explaining behaviours can shed light on how both positive and negative behaviours can be legitimised within certain communities 9 …”

Failing to fail: clinicians’ experience of assessing underperforming dental students

“…Distancing indicates the influence of social desirability (25), that is, the drive for approval from others, which was also apparent at interview in the attitude of some clinicians who were self-deprecatory, apologetic and not wishing to appear critical of senior staff. According to Monrouxe et al '… when we explain our behaviour to others we are motivated to provide a convincing story portraying us in a positive light' (9). Social desirability could account for the paradoxical remarks of one respondent who said she rarely marked down clinical performance, but later said she would not hesitate to fail a student who performed poorly because of her duty of care to the patient.…”