Lynn Monrouxe | Chang Gung Memeorial Hospital (original) (raw)
Papers by Lynn Monrouxe
Frontiers in Medicine, Jan 15, 2024
Introduction: Although dignity in workplace learning in healthcare is gathering interest, we know... more Introduction: Although dignity in workplace learning in healthcare is gathering interest, we know little about stakeholders' conceptualizations in this area across professional groups. Dignity breaches in workplace learning are common, often with serious and long-lasting consequences for the affected. Conceptualizations shape behaviours and experiences. To prevent dignity violations in students' learning, it is thus important to understand stakeholders' understandings of the topic. This study therefore explores the dignity conceptualizations around workplace learning that students, placement educators and university staff hold across seven allied health professional groups. Methods: Using a social constructionist perspective, we conducted individual and group narrative interviews (n = 51) with students, placement educators and university workplace learning staff from seven allied health professional groups. We used the 5-step Framework Analysis to explore and develop themes, identifying differences and similarities across stakeholder groups. Results: We identified eight distinct, yet interrelated, dimensions of dignity from participants' narratives: dignity as respect, dignity as self-x (the various relationships we have with ourselves), dignity as feeling safe, dignity as understanding otherness, dignity as supporting others, dignity as equality, dignity as professionalism, and dignity as belonging. Dignity as respect was identified across all participants, although mutual respect and a culture of respect were only present in academic participants' talk. The remaining seven dimensions all present important factors extending our understanding of the construct of dignity. Discussion: In line with existing research, our study identifies the absence of an unambiguous, positive conceptualization of dignity in workplace learning among stakeholders. It adds novelty in two ways: by identifying dignity dimensions that require informed action beyond respecting others, and by revealing a tension between dignity as professionalism and dignity as equality. We suggest revising existing dignity concepts in workplace learning to address this tension and to reinforce that active care, team integration and skilled support are all non-negotiable elements of dignified behaviour within workplace learning.
Drawing on theory, research, and practice, the contributors to this interdisciplinary volume syst... more Drawing on theory, research, and practice, the contributors to this interdisciplinary volume systematically analyze these ethical dilemmas and offer practical suggestions that are sure to interest students, academics, and professionals
Medical Education, May 14, 2023
Social Science & Medicine, May 1, 2023
BMJ Open, 2018
► With a plethora of research on medical students and doctors' opinions, our study uniquely gives... more ► With a plethora of research on medical students and doctors' opinions, our study uniquely gives voice to patients and carers about their views of medical training in the UK. ► This is a multisite study with patients representing three UK countries. ► Participants focused on issues of respect, communication and the need for doctors to be trained for a diverse patient cohort. ► Participants were mainly part of support groups and charities and thus might be more politicised than the general public. ► The majority of participants were female and/or mature so the views of male and younger patient groups are not as well represented.
Cambridge University Press eBooks, Mar 29, 2016
Medical Education, Mar 26, 2023
IntroductionOur professional identity refers to our sense of who we are and how we should behave ... more IntroductionOur professional identity refers to our sense of who we are and how we should behave as professionals. Professional identities are developed through socialisation processes: Established ways of knowing and doing are acquired and reproduced. The professional identities of health care professionals have implications for the realisation of health care reforms that require new ways of being and doing from clinicians. Tension and frustration can arise when professional identities are incongruent with reform directions. More knowledge is required about the professional identities of mental health care professionals—including clinical psychologists—so that they can be supported to develop professional identities that align with health care system reforms.MethodWe undertook a scoping review of existing literature aiming to (i) identify the relevant literature; (ii) review the literature quality; (iii) thematically summarise the literature findings; (iv) consult with clinical psychologists; and (v) identify recommendations for research, training and practice.ResultsA systematic database search (PsycINFO, CINAHL, Scopus and Web of Science) identified 24 relevant published articles and dissertations. Quantitative studies were excluded due to their markedly different research focus. Included studies were independently reviewed and findings summarised. Findings were organised around three themes: ‘integration of personal and professional identities’, ‘intersectionality’ and ‘changes in professional identity over time’. Research quality issues were identified. The trustworthiness of the findings was corroborated in consultation with clinical psychologists.DiscussionClinical psychologists recognise their professional identities as being interrelated with their personal identities and changing over time. They recognised professional identity as important yet inadequately considered in the profession. The research area is emerging yet remains undertheorised and requires improved research methodologies. Future theoretically informed research is required to build up a credible research base to better understand the development of clinical psychologists' professional identities so that this process can be facilitated to enable the realisation of health care reforms.
Oxford University Press eBooks, Sep 16, 2013
Medical Education, Feb 16, 2023
BMC Medical Education, Jun 2, 2023
Background Physicians' values about what constitute their professional identities are integral in... more Background Physicians' values about what constitute their professional identities are integral in understanding how they ascribe meaning to their practice. However, there is no general consensus on the conceptualization and measurement of physicians' professional identities. This study developed and validated a values-based scale for measuring physicians' professional identities. Methods A hybrid research method was used to gather both qualitative and quantitative data. We employed literature review, semi-structured interview, Q-sorting exercise to examine the conceptualization of emergency physicians' professional identities and to initially develop a 40-item scale. A panel of five experts assessed the scale's content validity. Using 150 emergency physicians as our sample, we conducted Confirmatory Factor Analyses (CFA) to test the fit of our hypothesised four-factor model based on our preliminary findings. Results Initial CFA suggested revisions to the model. Following theoretical assumptions and modification indices, the model was revised and adjusted to a four-factor 20 item Emergency Physicians Professional Identities Value Scale (EPPIVS) with acceptable fit statistics χ2 = 389.38, df = 164, Normed χ2 = 2.374, GFI = 0.788, CFI = 0.862, RMSEA = 0.096. The Cronbach's alpha, McDonald's Omega reliability and composite reliability of the subscales ranged from α: 0.748 to 0.868, Omega: 0.759 to 0.868 and CR: 0.748 to 0.851, respectively. Conclusion The results indicate that the EPPIVS is a valid and reliable scale for measuring physicians' professional identities. Further research on the sensitivity of this instrument to important changes over career progression in emergency medicine is warranted.
Frontiers in Medicine, Jan 25, 2022
Objectives: Objective structured clinical examinations (OSCEs) are common for formative assessmen... more Objectives: Objective structured clinical examinations (OSCEs) are common for formative assessment. We developed an Online Smart Communicative Education System and aimed to explore the factors that affect the perceptions of both teachers and students for teaching and learning. Methods and Analysis: A two-year cross-sectional cohort study was undertaken. The program includes three parts. Part I Pre-OSCE: an online flipped class in preparation for task-related knowledge and skills. Part II OSCE-day: 10 tasks in one track formative OSCE. Part III Post-OSCE: extended online feedback for participants with further questions after the exam and raters with more feedback after reviewing their performance online. Principal component analysis with varimax rotation was performed to analyze the perceptions of students and teachers to the Online System by means of questionnaires. Results: Seventy-six pharmacy students (male 32.9%) took the exam and 24 raters (male, 25%) participated in the scoring during the OSCEs. The mean G coefficient was 0.88. Seventy-six questionnaires from the students were obtained for the analysis. Results explained the cumulative variance of 73.9% for component (1) "Effects of extended online feedback": 40% and (2) "Facilitation of learning": 33.9%. Thirty-nine questionnaires from the raters who experienced the Online System were obtained for the analysis (male 23.1%). Results explained a cumulative variance of 77.3% for component (1) "Effects of extended online feedback": 36.6%, (2) "Facilitation of scoring and feedback": 24.5%, and (3) "Feasibility of online platform": 16.2%, respectively. Conclusion: We demonstrated good reliability for digitizing the scoring system with educational support to facilitate teaching. "Effects of extended online feedback" was the major aspect in explaining the variance from the perceptions of students and raters by factor analysis. In comparison with traditional formative OSCEs, extended online feedback is a novel approach, which extends the process of learning and teaching among the learners and raters and overcomes the barriers of time limitation and distance.
Frontiers research topics, 2022
BMJ Open, 2021
IntroductionThe assistant in medicine is a new and paid role for final-year medical students that... more IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and...
BMJ open, Mar 22, 2018
Compliance to hygiene behaviours has long been recognised as important in the prevention and cont... more Compliance to hygiene behaviours has long been recognised as important in the prevention and control of healthcare associated infections, but medical doctors still display some of the lowest rates of compliance of all healthcare workers. We aim to understand compliance to hygiene behaviours by analysing medical students', junior doctors' and medical educators' narratives of these behaviours to identify their respective attitudes and beliefs around compliance and how these are learnt during training. Such an understanding can inform future interventions to improve compliance targeted to areas of greatest need. A qualitative study, using narrative interviews (nine focus groups and one individual interview). Data were analysed thematically using inductive framework analysis. Teaching hospitals in the UK. Convenience sample of 25 participants: third-year medical students in their first clinical year (n=13), junior doctors (n=6) and medical educators (n=6). We identified four...
Advances in health sciences education : theory and practice, Jan 29, 2017
Emotion characterises learners' feedback experiences. While the failure-to-fail literature su... more Emotion characterises learners' feedback experiences. While the failure-to-fail literature suggests that emotion may be important, little is known about the role of emotion for educators. Secondary analyses were therefore conducted on data exploring 110 trainers' and trainees' feedback experiences. Group and individual narrative interviews were conducted across three UK sites. We analysed 333 narratives for emotional talk using textual analysis: Linguistic Inquiry and Word Count. Furthermore, thematic framework analysis was conducted on the trainer narratives to explore aspects of feedback processes that are emotional. An additional in-depth little 'd' discourse analysis was conducted on selected trainer narratives to enable us to explore the complex relationship between the whats (reported events) and the hows (emotional talk). Trainer narratives did not differ significantly in positive or negative emotional talk from trainee narratives. By exploring the interpl...
Frontiers in Medicine, Jan 15, 2024
Introduction: Although dignity in workplace learning in healthcare is gathering interest, we know... more Introduction: Although dignity in workplace learning in healthcare is gathering interest, we know little about stakeholders' conceptualizations in this area across professional groups. Dignity breaches in workplace learning are common, often with serious and long-lasting consequences for the affected. Conceptualizations shape behaviours and experiences. To prevent dignity violations in students' learning, it is thus important to understand stakeholders' understandings of the topic. This study therefore explores the dignity conceptualizations around workplace learning that students, placement educators and university staff hold across seven allied health professional groups. Methods: Using a social constructionist perspective, we conducted individual and group narrative interviews (n = 51) with students, placement educators and university workplace learning staff from seven allied health professional groups. We used the 5-step Framework Analysis to explore and develop themes, identifying differences and similarities across stakeholder groups. Results: We identified eight distinct, yet interrelated, dimensions of dignity from participants' narratives: dignity as respect, dignity as self-x (the various relationships we have with ourselves), dignity as feeling safe, dignity as understanding otherness, dignity as supporting others, dignity as equality, dignity as professionalism, and dignity as belonging. Dignity as respect was identified across all participants, although mutual respect and a culture of respect were only present in academic participants' talk. The remaining seven dimensions all present important factors extending our understanding of the construct of dignity. Discussion: In line with existing research, our study identifies the absence of an unambiguous, positive conceptualization of dignity in workplace learning among stakeholders. It adds novelty in two ways: by identifying dignity dimensions that require informed action beyond respecting others, and by revealing a tension between dignity as professionalism and dignity as equality. We suggest revising existing dignity concepts in workplace learning to address this tension and to reinforce that active care, team integration and skilled support are all non-negotiable elements of dignified behaviour within workplace learning.
Drawing on theory, research, and practice, the contributors to this interdisciplinary volume syst... more Drawing on theory, research, and practice, the contributors to this interdisciplinary volume systematically analyze these ethical dilemmas and offer practical suggestions that are sure to interest students, academics, and professionals
Medical Education, May 14, 2023
Social Science & Medicine, May 1, 2023
BMJ Open, 2018
► With a plethora of research on medical students and doctors' opinions, our study uniquely gives... more ► With a plethora of research on medical students and doctors' opinions, our study uniquely gives voice to patients and carers about their views of medical training in the UK. ► This is a multisite study with patients representing three UK countries. ► Participants focused on issues of respect, communication and the need for doctors to be trained for a diverse patient cohort. ► Participants were mainly part of support groups and charities and thus might be more politicised than the general public. ► The majority of participants were female and/or mature so the views of male and younger patient groups are not as well represented.
Cambridge University Press eBooks, Mar 29, 2016
Medical Education, Mar 26, 2023
IntroductionOur professional identity refers to our sense of who we are and how we should behave ... more IntroductionOur professional identity refers to our sense of who we are and how we should behave as professionals. Professional identities are developed through socialisation processes: Established ways of knowing and doing are acquired and reproduced. The professional identities of health care professionals have implications for the realisation of health care reforms that require new ways of being and doing from clinicians. Tension and frustration can arise when professional identities are incongruent with reform directions. More knowledge is required about the professional identities of mental health care professionals—including clinical psychologists—so that they can be supported to develop professional identities that align with health care system reforms.MethodWe undertook a scoping review of existing literature aiming to (i) identify the relevant literature; (ii) review the literature quality; (iii) thematically summarise the literature findings; (iv) consult with clinical psychologists; and (v) identify recommendations for research, training and practice.ResultsA systematic database search (PsycINFO, CINAHL, Scopus and Web of Science) identified 24 relevant published articles and dissertations. Quantitative studies were excluded due to their markedly different research focus. Included studies were independently reviewed and findings summarised. Findings were organised around three themes: ‘integration of personal and professional identities’, ‘intersectionality’ and ‘changes in professional identity over time’. Research quality issues were identified. The trustworthiness of the findings was corroborated in consultation with clinical psychologists.DiscussionClinical psychologists recognise their professional identities as being interrelated with their personal identities and changing over time. They recognised professional identity as important yet inadequately considered in the profession. The research area is emerging yet remains undertheorised and requires improved research methodologies. Future theoretically informed research is required to build up a credible research base to better understand the development of clinical psychologists' professional identities so that this process can be facilitated to enable the realisation of health care reforms.
Oxford University Press eBooks, Sep 16, 2013
Medical Education, Feb 16, 2023
BMC Medical Education, Jun 2, 2023
Background Physicians' values about what constitute their professional identities are integral in... more Background Physicians' values about what constitute their professional identities are integral in understanding how they ascribe meaning to their practice. However, there is no general consensus on the conceptualization and measurement of physicians' professional identities. This study developed and validated a values-based scale for measuring physicians' professional identities. Methods A hybrid research method was used to gather both qualitative and quantitative data. We employed literature review, semi-structured interview, Q-sorting exercise to examine the conceptualization of emergency physicians' professional identities and to initially develop a 40-item scale. A panel of five experts assessed the scale's content validity. Using 150 emergency physicians as our sample, we conducted Confirmatory Factor Analyses (CFA) to test the fit of our hypothesised four-factor model based on our preliminary findings. Results Initial CFA suggested revisions to the model. Following theoretical assumptions and modification indices, the model was revised and adjusted to a four-factor 20 item Emergency Physicians Professional Identities Value Scale (EPPIVS) with acceptable fit statistics χ2 = 389.38, df = 164, Normed χ2 = 2.374, GFI = 0.788, CFI = 0.862, RMSEA = 0.096. The Cronbach's alpha, McDonald's Omega reliability and composite reliability of the subscales ranged from α: 0.748 to 0.868, Omega: 0.759 to 0.868 and CR: 0.748 to 0.851, respectively. Conclusion The results indicate that the EPPIVS is a valid and reliable scale for measuring physicians' professional identities. Further research on the sensitivity of this instrument to important changes over career progression in emergency medicine is warranted.
Frontiers in Medicine, Jan 25, 2022
Objectives: Objective structured clinical examinations (OSCEs) are common for formative assessmen... more Objectives: Objective structured clinical examinations (OSCEs) are common for formative assessment. We developed an Online Smart Communicative Education System and aimed to explore the factors that affect the perceptions of both teachers and students for teaching and learning. Methods and Analysis: A two-year cross-sectional cohort study was undertaken. The program includes three parts. Part I Pre-OSCE: an online flipped class in preparation for task-related knowledge and skills. Part II OSCE-day: 10 tasks in one track formative OSCE. Part III Post-OSCE: extended online feedback for participants with further questions after the exam and raters with more feedback after reviewing their performance online. Principal component analysis with varimax rotation was performed to analyze the perceptions of students and teachers to the Online System by means of questionnaires. Results: Seventy-six pharmacy students (male 32.9%) took the exam and 24 raters (male, 25%) participated in the scoring during the OSCEs. The mean G coefficient was 0.88. Seventy-six questionnaires from the students were obtained for the analysis. Results explained the cumulative variance of 73.9% for component (1) "Effects of extended online feedback": 40% and (2) "Facilitation of learning": 33.9%. Thirty-nine questionnaires from the raters who experienced the Online System were obtained for the analysis (male 23.1%). Results explained a cumulative variance of 77.3% for component (1) "Effects of extended online feedback": 36.6%, (2) "Facilitation of scoring and feedback": 24.5%, and (3) "Feasibility of online platform": 16.2%, respectively. Conclusion: We demonstrated good reliability for digitizing the scoring system with educational support to facilitate teaching. "Effects of extended online feedback" was the major aspect in explaining the variance from the perceptions of students and raters by factor analysis. In comparison with traditional formative OSCEs, extended online feedback is a novel approach, which extends the process of learning and teaching among the learners and raters and overcomes the barriers of time limitation and distance.
Frontiers research topics, 2022
BMJ Open, 2021
IntroductionThe assistant in medicine is a new and paid role for final-year medical students that... more IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and...
BMJ open, Mar 22, 2018
Compliance to hygiene behaviours has long been recognised as important in the prevention and cont... more Compliance to hygiene behaviours has long been recognised as important in the prevention and control of healthcare associated infections, but medical doctors still display some of the lowest rates of compliance of all healthcare workers. We aim to understand compliance to hygiene behaviours by analysing medical students', junior doctors' and medical educators' narratives of these behaviours to identify their respective attitudes and beliefs around compliance and how these are learnt during training. Such an understanding can inform future interventions to improve compliance targeted to areas of greatest need. A qualitative study, using narrative interviews (nine focus groups and one individual interview). Data were analysed thematically using inductive framework analysis. Teaching hospitals in the UK. Convenience sample of 25 participants: third-year medical students in their first clinical year (n=13), junior doctors (n=6) and medical educators (n=6). We identified four...
Advances in health sciences education : theory and practice, Jan 29, 2017
Emotion characterises learners' feedback experiences. While the failure-to-fail literature su... more Emotion characterises learners' feedback experiences. While the failure-to-fail literature suggests that emotion may be important, little is known about the role of emotion for educators. Secondary analyses were therefore conducted on data exploring 110 trainers' and trainees' feedback experiences. Group and individual narrative interviews were conducted across three UK sites. We analysed 333 narratives for emotional talk using textual analysis: Linguistic Inquiry and Word Count. Furthermore, thematic framework analysis was conducted on the trainer narratives to explore aspects of feedback processes that are emotional. An additional in-depth little 'd' discourse analysis was conducted on selected trainer narratives to enable us to explore the complex relationship between the whats (reported events) and the hows (emotional talk). Trainer narratives did not differ significantly in positive or negative emotional talk from trainee narratives. By exploring the interpl...
available information about their health and access to their bodies (see analysis of historytakin... more available information about their health and access to their bodies (see analysis of historytaking phase).