Navigating landscapes of practice: A longitudinal qualitative study of physicians in medical education

Abstract

Introduction: Despite its widespread application in medical education, belonging to a single community of practice does not reflect the overall experience of physicianeducators. Knowing how physician-educators find their way among different communities of practice (ie their landscape of practice) has implications for professional development but the limited description in the literature. In this longitudinal qualitative research, we explored how physicians who pursue graduate degrees in medical education navigate their landscape of practice.Methods: 11/29 physicians in one cohort of a masters in medical education programme were interviewed annually from 2016 (programme start) to 2020 (2 years post-graduation). We iteratively collected and analysed data, creating inductive codes and categorising coded data by mode of identification (engagement, imagination, alignment) and time. We organised narratives into time-ordered data matrices so that final analysis wove together mode, time and participant.Results: All participants consistently spoke of navigating their landscape of practice, which included the community created in the graduate programme; but that single community 'doesn't define the journey itself'. They shifted engagement from teaching individual learners to translating what they learned in the graduate programme to develop educational projects and produce scholarship. They shifted the imagination from relying on internal and external assessments to experience-inspired versions of their future self. And they shifted alignment from belonging to the graduate programme's community of practice, then belonging to different communities in their landscape of practice and ultimately focussing on communities that mattered most to them. Discussion: Physicians in a graduate programme in medical education navigated their dynamic landscape of practice by shifting how they engaged in medical education, as well as what they imagined and who they aligned with as physician-educators. Our work offers novel insights into how knowledgeability emerges through time as overlapping modes of identification.

The Effects of Coaching Pediatric Residents on Faculty Coaches’ Relationships, Learning, and Professional Identity Formation

“…This finding reinforces the idea that identities are continually negotiated through socialization in communities of practice throughout faculty members' careers. 24,26,44,51 We further illustrate how moving through communities in a landscape of practice 32,33 supported coaches' multiple identities. Our findings highlight how rank mediated PIF, as junior faculty came to see themselves as legitimate educators through their coaching roles, while senior faculty deepened and expanded their identities through this work.…”

Counternarratives that Illuminate Faculty Agency: A Longitudinal Qualitative Study of Physician Educators in Academic Medicine

“…We derived data for this study from a larger LQR that traced the storied experiences of a cohort of eleven US physician educators who started the same graduate program in medical education in 2016 and completed the program in 2018. More information about the program, the cohort, and their experiences in and after the program can be found elsewhere (Balmer, Rosenblatt, & Boyer, 2021). Three participants from the original cohort offered signi cant insights into how physician educators acted in ways that run counter to eld norms for their career advancement.…”

Equipping brokers for medical landscapes of practice

“…Gingerich et al argue, in their article entitled Urban ideals and rural realities, that overlapping personal and professional worlds in the rural context can lead to 'private' information being gathered as a part of social connectedness, with consequent violations of urban practice ideals to do with the separation of practice and person. 1 Their point is, however, that this information is then judiciously used for the patients' best outcome. My agreement with their argument lies in the thesis that genuine expertise lies in the judicious and wise use of information for best patient outcomes, which stands in contrast to the ethics taught to urban medical students under the rubric of 'confidentiality'.…”

“…Balmer, Rosenblatt and Boyer call for those training medical educators to ‘recast belonging to multiple communities of practice as knowledgeability, not as tension or identity crisis’ 1 . Reinterpreting the experience of multi‐membership as a strength is welcome.…”

“…Balmer, Rosenblatt and Boyer call for those training medical educators to 'recast belonging to multiple communities of practice as knowledgeability, not as tension or identity crisis'. 1 Reinterpreting the experience of multi-membership as a strength is welcome. In this commentary, I suggest that graduate programmes may go further and aim to equip students to capitalize on this knowledgeability by calving out legitimate zones in the peripheries, by becoming brokers at boundaries, and by handling the conflicts that often emerge from claims to multiple competencies.…”