Professionalism lapses and hierarchies: A qualitative analysis of medical students' narrated acts of resistance

Shaw, Malissa Kay; Rees, Charlotte E.; Andersen, Nina Bjerre; Black, Lori; Monrouxe, Lynn V.

doi:10.1016/j.socscimed.2018.10.009

Cited by 37 publications

(26 citation statements)

References 28 publications

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“…Interestingly, although students were able to analyse and make suggestions for change, none of them described engaging team members in conversations about change. Contrary to Shaw's findings (10) we encountered neither reports nor encouragements of acts of resistance, perhaps due to the junior status of the students involved. Their liminality, as uninitiated participants in the workplace culture, may have provided them with fresh eyes on old problems, but not the legitimacy to initiate change.…”

Section: Discussioncontrasting

confidence: 99%

Intra- and interprofessional practices through fresh eyes: a qualitative analysis of medical students’ early workplace experiences

Leedham‐Green

Knight

Iedema

2019

Preprint

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Background Professional identities are influenced by experiences in the clinical workplace including socialisation processes that may be hidden from academic faculty and potentially divergent from formal curricula. With the current educational emphasis on complexity, preparedness for practice, patient safety and team-working it is necessary to evaluate and respond to what students are learning about collaborative practices during their clinical placements. Methods 394 second year medical students at a London medical school were invited to submit a short formative essay as part of their coursework describing, evaluating and reflecting on their experiences of how healthcare professionals work together. Their experiences were derived from having spent two days each week for 25 weeks in clinical contexts across primary and secondary care. We consented 311 participants and used a Consensual Qualitative Research approach to analyse these essays, creating a ‘students-eye view’ of intra- and interprofessional practices in the workplace. Results We identified four overarching themes in students’ essays: - Theme 1: analyses of contextual factors driving team tensions including staff shortages, shifting teams, and infrastructural issues; - Theme 2: observations of hierarchical and paternalistic attitudes and behaviours; - Theme 3: respect for team members’ ability to manage and mitigate tensions and attitudes; and - Theme 4: take-forward learning including enthusiasm for quality improvement and system change. Conclusions Students are being socialised into a complex, hierarchical, pressurised clinical workplace and experience wide variations in professional behaviours and practices. They articulate a need to find constructive ways forward in the interests of staff wellbeing and patient care. We present educational recommendations including providing safe reflective spaces, using students’ lived experience as raw material for systems thinking and quality improvement, and closing the feedback loop with placement sites on behalf of students.

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Section: Discussioncontrasting

confidence: 99%

Intra- and interprofessional practices through fresh eyes: a qualitative analysis of medical students’ early workplace experiences

Leedham‐Green

Knight

Iedema

2019

Preprint

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“…Visualizations can stimulate reflection and creative problem solving between educators and residents about safely resisting hierarchies and transforming dominance in medical structures. 36 Although social network approaches are underutilized in medical education, 37 they hold great potential as a teaching or debriefing tool to reveal the function and outcome of power in collaborative practice.…”

Section: Using Social Network Theory In Ipementioning

confidence: 99%

Social Network Theory in Interprofessional Education: Revealing Hidden Power

Nimmon

Artino

Varpio

2019

Journal of Graduate Medical Education

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“…At the undergraduate level, we often see that approximately half of medical students faced with others’ professionalism lapses do nothing in the face of those lapses, thereby complying with (or going along with) them. 6 13 25 Doing the right thing, however, includes students, trainees and qualified healthcare professionals enacting resistance, either during or after safety and dignity violations 25 26. In terms of during events, students have been shown to enact one or more of the following: direct or indirect verbal resistance, verbal or bodily role modelling, verbally demonstrating concern, disruptive or discreet bodily acts and psychological acts such as emotional withdrawal 25.…”

Section: Introductionmentioning

confidence: 99%

“…6 13 25 Doing the right thing, however, includes students, trainees and qualified healthcare professionals enacting resistance, either during or after safety and dignity violations 25 26. In terms of during events, students have been shown to enact one or more of the following: direct or indirect verbal resistance, verbal or bodily role modelling, verbally demonstrating concern, disruptive or discreet bodily acts and psychological acts such as emotional withdrawal 25. With respect to after the events, students have been shown to enact one or more of the following: directly raising concerns, discreetly addressing concerns or apologising 25.…”

Section: Introductionmentioning

confidence: 99%

“…In terms of during events, students have been shown to enact one or more of the following: direct or indirect verbal resistance, verbal or bodily role modelling, verbally demonstrating concern, disruptive or discreet bodily acts and psychological acts such as emotional withdrawal 25. With respect to after the events, students have been shown to enact one or more of the following: directly raising concerns, discreetly addressing concerns or apologising 25. Despite such resistance, it has long been argued that both patient and staff safety dilemmas are under-reported 11 26 27.…”

Section: Introductionmentioning

confidence: 99%

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Understanding the healthcare workplace learning culture through safety and dignity narratives: a UK qualitative study of multiple stakeholders’ perspectives

et al. 2019

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ObjectivesWhile studies at the undergraduate level have begun to explore healthcare students’ safety and dignity dilemmas, none have explored such dilemmas with multiple stakeholders at the postgraduate level. The current study therefore explores the patient and staff safety and dignity narratives of multiple stakeholders to better understand the healthcare workplace learning culture.DesignA qualitative interview study using narrative interviewing.SettingTwo sites in the UK ranked near the top and bottom for raising concerns according to the 2013 General Medical Council National Training Survey.ParticipantsUsing maximum variation sampling, 39 participants were recruited representing four different groups (10 public representatives, 10 medical trainees, 8 medical trainers and 11 nurses and allied health professionals) across the two sites.MethodsWe conducted 1 group and 35 individual semistructured interviews. Data collection was completed in 2015. Framework analysis was conducted to identify themes. Theme similarities and differences across the two sites and four groups were established.ResultsWe identified five themes in relation to our three research questions (RQs): (1) understandings of safety and dignity (RQ1); (2) experiences of safety and dignity dilemmas (RQ2); (3) resistance and/or complicity regarding dilemmas encountered (RQ2); (4) factors facilitating safety and/or dignity (RQ3); and (5) factors inhibiting safety and/or dignity (RQ3). The themes were remarkably similar across the two sites and four stakeholder groups.ConclusionsWhile some of our findings are similar to previous research with undergraduate healthcare students, our findings also differ, for example, illustrating higher levels of reported resistance in the postgraduate context. We provide educational implications to uphold safety and dignity at the level of the individual (eg, stakeholder education), interaction (eg, stakeholder communication and teamwork) and organisation (eg, institutional policy).

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Professionalism lapses and hierarchies: A qualitative analysis of medical students' narrated acts of resistance

Cited by 37 publications

References 28 publications

Intra- and interprofessional practices through fresh eyes: a qualitative analysis of medical students’ early workplace experiences

Intra- and interprofessional practices through fresh eyes: a qualitative analysis of medical students’ early workplace experiences

Social Network Theory in Interprofessional Education: Revealing Hidden Power

Understanding the healthcare workplace learning culture through safety and dignity narratives: a UK qualitative study of multiple stakeholders’ perspectives

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