Lynn Monrouxe | Chang Gung Memeorial Hospital (original) (raw)
Papers by Lynn Monrouxe
CONTEXT Feedback associated with teaching activities is often synonymous with reflection on actio... more CONTEXT Feedback associated with teaching
activities is often synonymous with reflection
on action, which comprises the evaluative
assessment of performance out of its original
context. Feedback in action (as correction
during clinical encounters) is an underexplored,
complementary resource facilitating
students’ understanding and learning.
OBJECTIVES The purpose of this study was to
explore the interactional patterns and correction
modalities utilised in feedback sequences between
doctors and students within general practicebased
bedside teaching encounters (BTEs).
METHODS A qualitative video ethnographic
approach was used. Participants were recorded in
their natural settings to allow interactional practices
to be contextually explored. We examined
12 BTEs recorded across four general practices
and involving 12 patients, four general practitioners
and fourmedical students (209 minutes
and 20 seconds of data) taken from a larger corpus.
Data analysis was facilitated by Transana
video analysis software and informed by previous
conversation analysis research in ordinary conversation,
classrooms and health care settings.
RESULTS A range of correction strategies
across a spectrum of underlying explicitness
were identified. Correction strategies classified
at extreme poles of this scale (high or low
explicitness) were believed to be less interactionally
effective. For example, those using
abrupt closing of topics (high explicitness) or
interactional ambiguity (low explicitness) were
thought to be less effective than embedded
correction strategies that enabled the student
to reach the correct answer with support.
CONCLUSIONS We believe that educators
who are explicitly taught linguistic strategies for
how to manage feedback in BTEs might manage
learning more effectively. For example, clinicians
might maximise learning moments during
BTEs by avoiding abrupt or ambiguous feedback
practices. Embedded correction strategies
can enhance student participation by guiding
students towards the correct answer. Clinician
corrections can sensitively manage student facesaving
by minimising the exposure of student
error to patients. Furthermore, we believe that
the effective practices highlighted by our analysis
might facilitate successful transformation of feedback in action into feedback for action
CONTEXT Feedback associated with teaching activities is often synonymous with reflection on actio... more CONTEXT Feedback associated with teaching
activities is often synonymous with reflection
on action, which comprises the evaluative
assessment of performance out of its original
context. Feedback in action (as correction
during clinical encounters) is an underexplored,
complementary resource facilitating
students’ understanding and learning.
OBJECTIVES The purpose of this study was to
explore the interactional patterns and correction
modalities utilised in feedback sequences between
doctors and students within general practicebased
bedside teaching encounters (BTEs).
METHODS A qualitative video ethnographic
approach was used. Participants were recorded in
their natural settings to allow interactional practices
to be contextually explored. We examined
12 BTEs recorded across four general practices
and involving 12 patients, four general practitioners
and fourmedical students (209 minutes
and 20 seconds of data) taken from a larger corpus.
Data analysis was facilitated by Transana
video analysis software and informed by previous
conversation analysis research in ordinary conversation,
classrooms and health care settings.
RESULTS A range of correction strategies
across a spectrum of underlying explicitness
were identified. Correction strategies classified
at extreme poles of this scale (high or low
explicitness) were believed to be less interactionally
effective. For example, those using
abrupt closing of topics (high explicitness) or
interactional ambiguity (low explicitness) were
thought to be less effective than embedded
correction strategies that enabled the student
to reach the correct answer with support.
CONCLUSIONS We believe that educators
who are explicitly taught linguistic strategies for
how to manage feedback in BTEs might manage
learning more effectively. For example, clinicians
might maximise learning moments during
BTEs by avoiding abrupt or ambiguous feedback
practices. Embedded correction strategies
can enhance student participation by guiding
students towards the correct answer. Clinician
corrections can sensitively manage student facesaving
by minimising the exposure of student
error to patients. Furthermore, we believe that
the effective practices highlighted by our analysis
might facilitate successful transformation of
feedback in action into feedback for action.
The aim of this chapter is to explore a broad and liberal conception of trust within doctor-patie... more The aim of this chapter is to explore a broad and liberal conception of trust within doctor-patient-student triadic bedside teaching encounters (BTEs) during which medical students learn with, from and about patients. Specifically building on past work examining audio-recordings of BTEs, we see trust as being achieved in and through interaction. Using a symbolic interactionist framework to examine interaction (including pronoun use and laughter), Monrouxe and her colleagues analysed the roles and identities that doctors, patients and students construct within these encounters: thus patients’ roles ranged from those of passive props or objects (primarily to be used by doctors and medical students for teaching and learning purposes) to being actively involved in consultations (as directors of physical examinations) (Monrouxe et al., 2009, Rees and Monrouxe, 2008, 2010). These different social roles result in patient inclusion or exclusion from the interaction in which their health was under discussion. Within this chapter we use video-recorded BTEs to explore how trust between doctor and patient is reconstituted, adjusted and reconfigured by the presence of medical students during medical encounters.
Bedside teaching encounters involve doctor-patient-student interactions, providing opportunities ... more Bedside teaching encounters involve doctor-patient-student interactions, providing opportunities for students to learn with, from and about patients. How the differing concerns of patient care and student education are balanced in situ remains largely unknown and undefined. This video ethnographic study explores patient involvement during a largely student-centric activity: ‘feedback sequences’ where students learn clinical and practical skills. Drawing on a data subset from a multi-site study, we used Conversation Analysis to investigate verbal and non-verbal interactional practices to examine patients’ inclusion and exclusion from teaching activities across 25 BTEs in General Practice and General Surgery and Medicine with 50 participants. Through analysis, we identified two representations of the patient: the patient embodied (where patients are actively involved) and the patient as-a-body (when they are used primarily as a prop for learning). Overall, patients were excluded more during physical examination than talk-based activities. Exclusion occurred through physical positioning of doctor-patient-student, and through doctors and students talking about, rather than to, patients using medical jargon and online commentaries. Patients’ exclusion was visibly noticeable through eye gaze: patients' middle-distance gaze coincided with medical terminology or complex wording. Inclusory activities maintained the patient embodied during teaching activities through doctors’ skilful embedding of teaching within their care: including vocalising clinical reasoning processes through students, providing patients with a ‘warrant to listen’, allocating turns-at-talk for them and eye-contact. This study uniquely demonstrates the visible nature patient exclusion, providing firm evidence of how this affects patient empowerment and engagement within educational activities for tomorrow’s doctors.
The present article reports upon the analytic progress of a video ethnographic study of bedside t... more The present article reports upon the analytic progress of a video ethnographic study of bedside teaching encounters (BTEs). Of particular interest is the exploration of how doctor-patient interactions are fundamentally transformed by the presence of medical students. Analysis of a large corpus of video recordings has explored how the concepts of patient-centredness and trust are displayed and learned during real-time BTEs through interaction. A short exemplar from the video corpus is provided to illustrate how these concepts can be 'found' in actual medical encounters; for example, by providing spaces for patient questions during consultations.
BMJ open, 2014
To explore Foundation trainees' and trainers' understandings and experiences of supervise... more To explore Foundation trainees' and trainers' understandings and experiences of supervised learning events (SLEs), compared with workplace-based assessments (WPBAs), and their suggestions for developing SLEs. A narrative interview study based on 55 individual and 19 group interviews. UK-wide study across three sites in England, Scotland and Wales. Using maximum-variation sampling, 70 Foundation trainees and 40 trainers were recruited, shared their understandings and experiences of SLEs/WPBAs and made recommendations for future practice. Data were analysed using thematic and discourse analysis and narrative analysis of one exemplar personal incident narrative. While participants volunteered understandings of SLEs as learning and assessment, they typically volunteered understandings of WPBAs as assessment. Trainers seemed more likely to describe SLEs as assessment and a 'safety net' to protect patients than trainees. We identified 333 personal incident narratives in ou...
BMJ (Clinical research ed.), 2015
This programme of research aimed to understand the extent to which current UK medical graduates a... more This programme of research aimed to understand the extent to which current UK medical graduates are prepared for practice. Commissioned by the General Medical Council, we conducted: (1) A Rapid Review of the literature between 2009 and 2013; (2) narrative interviews with a range of stakeholders; and (3) longitudinal audio-diaries with Foundation Year 1 doctors. The Rapid Review (RR) resulted in data from 81 manuscripts being extracted and mapped against a coding framework (including outcomes from Tomorrow's Doctors (2009) (TD09)). A narrative synthesis of the data was undertaken. Narrative interviews were conducted with 185 participants from 8 stakeholder groups: F1 trainees, newly registered trainee doctors, clinical educators, undergraduate and postgraduate deans and foundation programme directors, other healthcare professionals, employers, policy and government and patient and public representatives. Longitudinal audio-diaries were recorded by 26 F1 trainees over 4 months. Th...
BMJ open, 2014
To explore Foundation trainees' and trainers' understandings and experiences of supervise... more To explore Foundation trainees' and trainers' understandings and experiences of supervised learning events (SLEs), compared with workplace-based assessments (WPBAs), and their suggestions for developing SLEs. A narrative interview study based on 55 individual and 19 group interviews. UK-wide study across three sites in England, Scotland and Wales. Using maximum-variation sampling, 70 Foundation trainees and 40 trainers were recruited, shared their understandings and experiences of SLEs/WPBAs and made recommendations for future practice. Data were analysed using thematic and discourse analysis and narrative analysis of one exemplar personal incident narrative. While participants volunteered understandings of SLEs as learning and assessment, they typically volunteered understandings of WPBAs as assessment. Trainers seemed more likely to describe SLEs as assessment and a 'safety net' to protect patients than trainees. We identified 333 personal incident narratives in ou...
BMJ open, 2015
To understand the prevalence of healthcare students' witnessing or participating in something... more To understand the prevalence of healthcare students' witnessing or participating in something that they think unethical (professionalism dilemmas) during workplace learning and examine whether differences exist in moral distress intensity resulting from these experiences according to gender and the frequency of occurrence. Two cross-sectional online questionnaires of UK medical (study 1) and nursing, dentistry, physiotherapy and pharmacy students (study 2) concerning professionalism dilemmas and subsequent distress for (1) Patient dignity and safety breaches; (2) Valid consent for students' learning on patients; and (3) Negative workplace behaviours (eg, student abuse). 2397 medical (67.4% female) and 1399 other healthcare students (81.1% female) responded. The most commonly encountered professionalism dilemmas were: student abuse and patient dignity and safety dilemmas. Multinomial and logistic regression identified significant effects for gender and frequency of occurrence...
Trust and Discourse, 2014
Eur J Dent Educ, 2014
Previous healthcare student abuse research typically employs quantitative surveys that fail to ex... more Previous healthcare student abuse research typically employs quantitative surveys that fail to explore contributory factors for abuse and students' action in the face of abuse. Following a recent qualitative study of medical students' abuse narratives, the current study explores dental, nursing, pharmacy and physiotherapy students' abuse narratives to better understand healthcare workplace abuse. We conducted three individual and 11 group interviews with 69 healthcare students in three Universities to elicit professionalism dilemma narratives. Of 226 professionalism dilemmas elicited, 79 were coded as student abuse. Secondary-level thematic analysis of the abuse narratives addressed the following questions: What types of abuse experiences do healthcare students narrate? What factors do they cite as contributing to abuse and their responses to abuse? Healthcare students reported mostly covert abuse in their narratives. Although narrators described individual, relational, work and organisational factors contributing to abuse, they mostly cited factors relating to perpetrators. Most participants stated that they acted in the face of their abuse, and they mostly cited factors relating to themselves for acting. Students who did nothing in the face of abuse typically cited the perpetrator-recipient relationship as the main contributory factor. There are many similarities across the narratives of the five healthcare student groups, suggesting that complex interactional/organisational factors are all-important when considering how abuse is perpetuated within the healthcare workplace. Although some organisational factors may be difficult to change, we recommend that educational initiatives are a key starting point to tackle healthcare workplace abuse.
Education in Medicine Journal, 2014
Journal business models are basically classified based on the source of income to cover publicati... more Journal business models are basically classified based on the source of income to cover publication costs and in general there are two main journal business models which are the toll-access and open-access. These leading to a question that still remains around the ethics of publishing academic work across the different journal business models in terms of (a) editorial decision-making and (b) the dissemination of research that has not been appropriately peer-reviewed for quality and rigor. This paper discussed about these two areas based on the literature and the authors' observations.
Medical Education, 2014
Medical students encounter situations during workplace learning in which they witness or particip... more Medical students encounter situations during workplace learning in which they witness or participate in something unprofessional (so-called professionalism dilemmas), sometimes having a negative emotional impact on them. Less is known about other health care students' experiences of professionalism dilemmas and the resulting emotional impact. To examine dental, nursing, pharmacy and physiotherapy students' narratives of professionalism dilemmas: the types of events they encounter ('whats') and the ways in which they narrate those events ('hows'). A qualitative cross-sectional study. Sixty-nine health care students (29 dentistry, 13 nursing, 12 pharmacy, 15 physiotherapy) participated in group/individual narrative interviews. Data were analysed using framework analysis (examining the 'whats'), linguistic inquiry and word count software (examining the 'hows' by dilemma type and student group) and narrative analysis (bringing together 'whats' and 'hows'). In total, 226 personal incident narratives (104 dental, 34 nursing, 39 pharmacy and 49 physiotherapy) were coded. Framework analysis identified nine themes, including 'Theme 2: professionalism dilemmas', comprising five sub-themes: 'student abuse', 'patient safety and dignity breaches by health care professionals', 'patient safety and dignity breaches by students', 'whistleblowing and challenging' and 'consent'. Using Linguistic Inquiry and Word Count (liwc) software, significant differences in negative emotion talk were found across student groups and dilemma types (e.g. more anger talk when narrating patient safety and dignity breaches by health care professionals than similar breaches by students). The narrative analysis illustrates how events are constructed and the emotional implications of assigning blame (an ethical dimension) resulting in emotional residue. Professionalism dilemmas experienced by health care students, including issues concerning whistleblowing and challenging, have implications for interprofessional learning. By focusing on common professionalism issues at a conceptual level, health care students can share experiences through narratives. The role-playing of idealised actions (how students wish they had acted) can facilitate synergy between personal moral values and moral action enabling students to commit and re-commit to professionalism values together.
Medical Education, 2013
Bedside teaching is essential for helping students develop skills, reasoning and professionalism,... more Bedside teaching is essential for helping students develop skills, reasoning and professionalism, and involves the learning triad of student, patient and clinical teacher. Although current rhetoric espouses the sharing of power, the medical workplace is imbued with power asymmetries. Power is context-specific and although previous research has explored some elements of the enactment and resistance of power within bedside teaching, this exploration has been conducted within hospital rather than general practice settings. Furthermore, previous research has employed audio-recorded rather than video-recorded observation and has therefore focused on language and para-language at the expense of non-verbal communication and human-material interaction. A qualitative design was adopted employing video- and audio-recorded observations of seven bedside teaching encounters (BTEs), followed by short individual interviews with students, patients and clinical teachers. Thematic and discourse analyses of BTEs were conducted. Power is constructed by students, patients and clinical teachers throughout different BTE activities through the use of linguistic, para-linguistic and non-verbal communication. In terms of language, participants construct power through the use of questions, orders, advice, pronouns and medical/health belief talk. With reference to para-language, participants construct power through the use of interruption and laughter. In terms of non-verbal communication, participants construct power through physical positioning and the possession or control of medical materials such as the stethoscope. Using this paper as a trigger for discussion, we encourage students and clinical teachers to reflect critically on how their verbal and non-verbal communication constructs power in bedside teaching. Students and clinical teachers need to develop their awareness of what power is, how it can be constructed and shared, and what it means for the student-patient-doctor relationship within bedside teaching.
CONTEXT Feedback associated with teaching activities is often synonymous with reflection on actio... more CONTEXT Feedback associated with teaching
activities is often synonymous with reflection
on action, which comprises the evaluative
assessment of performance out of its original
context. Feedback in action (as correction
during clinical encounters) is an underexplored,
complementary resource facilitating
students’ understanding and learning.
OBJECTIVES The purpose of this study was to
explore the interactional patterns and correction
modalities utilised in feedback sequences between
doctors and students within general practicebased
bedside teaching encounters (BTEs).
METHODS A qualitative video ethnographic
approach was used. Participants were recorded in
their natural settings to allow interactional practices
to be contextually explored. We examined
12 BTEs recorded across four general practices
and involving 12 patients, four general practitioners
and fourmedical students (209 minutes
and 20 seconds of data) taken from a larger corpus.
Data analysis was facilitated by Transana
video analysis software and informed by previous
conversation analysis research in ordinary conversation,
classrooms and health care settings.
RESULTS A range of correction strategies
across a spectrum of underlying explicitness
were identified. Correction strategies classified
at extreme poles of this scale (high or low
explicitness) were believed to be less interactionally
effective. For example, those using
abrupt closing of topics (high explicitness) or
interactional ambiguity (low explicitness) were
thought to be less effective than embedded
correction strategies that enabled the student
to reach the correct answer with support.
CONCLUSIONS We believe that educators
who are explicitly taught linguistic strategies for
how to manage feedback in BTEs might manage
learning more effectively. For example, clinicians
might maximise learning moments during
BTEs by avoiding abrupt or ambiguous feedback
practices. Embedded correction strategies
can enhance student participation by guiding
students towards the correct answer. Clinician
corrections can sensitively manage student facesaving
by minimising the exposure of student
error to patients. Furthermore, we believe that
the effective practices highlighted by our analysis
might facilitate successful transformation of feedback in action into feedback for action
CONTEXT Feedback associated with teaching activities is often synonymous with reflection on actio... more CONTEXT Feedback associated with teaching
activities is often synonymous with reflection
on action, which comprises the evaluative
assessment of performance out of its original
context. Feedback in action (as correction
during clinical encounters) is an underexplored,
complementary resource facilitating
students’ understanding and learning.
OBJECTIVES The purpose of this study was to
explore the interactional patterns and correction
modalities utilised in feedback sequences between
doctors and students within general practicebased
bedside teaching encounters (BTEs).
METHODS A qualitative video ethnographic
approach was used. Participants were recorded in
their natural settings to allow interactional practices
to be contextually explored. We examined
12 BTEs recorded across four general practices
and involving 12 patients, four general practitioners
and fourmedical students (209 minutes
and 20 seconds of data) taken from a larger corpus.
Data analysis was facilitated by Transana
video analysis software and informed by previous
conversation analysis research in ordinary conversation,
classrooms and health care settings.
RESULTS A range of correction strategies
across a spectrum of underlying explicitness
were identified. Correction strategies classified
at extreme poles of this scale (high or low
explicitness) were believed to be less interactionally
effective. For example, those using
abrupt closing of topics (high explicitness) or
interactional ambiguity (low explicitness) were
thought to be less effective than embedded
correction strategies that enabled the student
to reach the correct answer with support.
CONCLUSIONS We believe that educators
who are explicitly taught linguistic strategies for
how to manage feedback in BTEs might manage
learning more effectively. For example, clinicians
might maximise learning moments during
BTEs by avoiding abrupt or ambiguous feedback
practices. Embedded correction strategies
can enhance student participation by guiding
students towards the correct answer. Clinician
corrections can sensitively manage student facesaving
by minimising the exposure of student
error to patients. Furthermore, we believe that
the effective practices highlighted by our analysis
might facilitate successful transformation of
feedback in action into feedback for action.
The aim of this chapter is to explore a broad and liberal conception of trust within doctor-patie... more The aim of this chapter is to explore a broad and liberal conception of trust within doctor-patient-student triadic bedside teaching encounters (BTEs) during which medical students learn with, from and about patients. Specifically building on past work examining audio-recordings of BTEs, we see trust as being achieved in and through interaction. Using a symbolic interactionist framework to examine interaction (including pronoun use and laughter), Monrouxe and her colleagues analysed the roles and identities that doctors, patients and students construct within these encounters: thus patients’ roles ranged from those of passive props or objects (primarily to be used by doctors and medical students for teaching and learning purposes) to being actively involved in consultations (as directors of physical examinations) (Monrouxe et al., 2009, Rees and Monrouxe, 2008, 2010). These different social roles result in patient inclusion or exclusion from the interaction in which their health was under discussion. Within this chapter we use video-recorded BTEs to explore how trust between doctor and patient is reconstituted, adjusted and reconfigured by the presence of medical students during medical encounters.
Bedside teaching encounters involve doctor-patient-student interactions, providing opportunities ... more Bedside teaching encounters involve doctor-patient-student interactions, providing opportunities for students to learn with, from and about patients. How the differing concerns of patient care and student education are balanced in situ remains largely unknown and undefined. This video ethnographic study explores patient involvement during a largely student-centric activity: ‘feedback sequences’ where students learn clinical and practical skills. Drawing on a data subset from a multi-site study, we used Conversation Analysis to investigate verbal and non-verbal interactional practices to examine patients’ inclusion and exclusion from teaching activities across 25 BTEs in General Practice and General Surgery and Medicine with 50 participants. Through analysis, we identified two representations of the patient: the patient embodied (where patients are actively involved) and the patient as-a-body (when they are used primarily as a prop for learning). Overall, patients were excluded more during physical examination than talk-based activities. Exclusion occurred through physical positioning of doctor-patient-student, and through doctors and students talking about, rather than to, patients using medical jargon and online commentaries. Patients’ exclusion was visibly noticeable through eye gaze: patients' middle-distance gaze coincided with medical terminology or complex wording. Inclusory activities maintained the patient embodied during teaching activities through doctors’ skilful embedding of teaching within their care: including vocalising clinical reasoning processes through students, providing patients with a ‘warrant to listen’, allocating turns-at-talk for them and eye-contact. This study uniquely demonstrates the visible nature patient exclusion, providing firm evidence of how this affects patient empowerment and engagement within educational activities for tomorrow’s doctors.
The present article reports upon the analytic progress of a video ethnographic study of bedside t... more The present article reports upon the analytic progress of a video ethnographic study of bedside teaching encounters (BTEs). Of particular interest is the exploration of how doctor-patient interactions are fundamentally transformed by the presence of medical students. Analysis of a large corpus of video recordings has explored how the concepts of patient-centredness and trust are displayed and learned during real-time BTEs through interaction. A short exemplar from the video corpus is provided to illustrate how these concepts can be 'found' in actual medical encounters; for example, by providing spaces for patient questions during consultations.
BMJ open, 2014
To explore Foundation trainees' and trainers' understandings and experiences of supervise... more To explore Foundation trainees' and trainers' understandings and experiences of supervised learning events (SLEs), compared with workplace-based assessments (WPBAs), and their suggestions for developing SLEs. A narrative interview study based on 55 individual and 19 group interviews. UK-wide study across three sites in England, Scotland and Wales. Using maximum-variation sampling, 70 Foundation trainees and 40 trainers were recruited, shared their understandings and experiences of SLEs/WPBAs and made recommendations for future practice. Data were analysed using thematic and discourse analysis and narrative analysis of one exemplar personal incident narrative. While participants volunteered understandings of SLEs as learning and assessment, they typically volunteered understandings of WPBAs as assessment. Trainers seemed more likely to describe SLEs as assessment and a 'safety net' to protect patients than trainees. We identified 333 personal incident narratives in ou...
BMJ (Clinical research ed.), 2015
This programme of research aimed to understand the extent to which current UK medical graduates a... more This programme of research aimed to understand the extent to which current UK medical graduates are prepared for practice. Commissioned by the General Medical Council, we conducted: (1) A Rapid Review of the literature between 2009 and 2013; (2) narrative interviews with a range of stakeholders; and (3) longitudinal audio-diaries with Foundation Year 1 doctors. The Rapid Review (RR) resulted in data from 81 manuscripts being extracted and mapped against a coding framework (including outcomes from Tomorrow's Doctors (2009) (TD09)). A narrative synthesis of the data was undertaken. Narrative interviews were conducted with 185 participants from 8 stakeholder groups: F1 trainees, newly registered trainee doctors, clinical educators, undergraduate and postgraduate deans and foundation programme directors, other healthcare professionals, employers, policy and government and patient and public representatives. Longitudinal audio-diaries were recorded by 26 F1 trainees over 4 months. Th...
BMJ open, 2014
To explore Foundation trainees' and trainers' understandings and experiences of supervise... more To explore Foundation trainees' and trainers' understandings and experiences of supervised learning events (SLEs), compared with workplace-based assessments (WPBAs), and their suggestions for developing SLEs. A narrative interview study based on 55 individual and 19 group interviews. UK-wide study across three sites in England, Scotland and Wales. Using maximum-variation sampling, 70 Foundation trainees and 40 trainers were recruited, shared their understandings and experiences of SLEs/WPBAs and made recommendations for future practice. Data were analysed using thematic and discourse analysis and narrative analysis of one exemplar personal incident narrative. While participants volunteered understandings of SLEs as learning and assessment, they typically volunteered understandings of WPBAs as assessment. Trainers seemed more likely to describe SLEs as assessment and a 'safety net' to protect patients than trainees. We identified 333 personal incident narratives in ou...
BMJ open, 2015
To understand the prevalence of healthcare students' witnessing or participating in something... more To understand the prevalence of healthcare students' witnessing or participating in something that they think unethical (professionalism dilemmas) during workplace learning and examine whether differences exist in moral distress intensity resulting from these experiences according to gender and the frequency of occurrence. Two cross-sectional online questionnaires of UK medical (study 1) and nursing, dentistry, physiotherapy and pharmacy students (study 2) concerning professionalism dilemmas and subsequent distress for (1) Patient dignity and safety breaches; (2) Valid consent for students' learning on patients; and (3) Negative workplace behaviours (eg, student abuse). 2397 medical (67.4% female) and 1399 other healthcare students (81.1% female) responded. The most commonly encountered professionalism dilemmas were: student abuse and patient dignity and safety dilemmas. Multinomial and logistic regression identified significant effects for gender and frequency of occurrence...
Trust and Discourse, 2014
Eur J Dent Educ, 2014
Previous healthcare student abuse research typically employs quantitative surveys that fail to ex... more Previous healthcare student abuse research typically employs quantitative surveys that fail to explore contributory factors for abuse and students' action in the face of abuse. Following a recent qualitative study of medical students' abuse narratives, the current study explores dental, nursing, pharmacy and physiotherapy students' abuse narratives to better understand healthcare workplace abuse. We conducted three individual and 11 group interviews with 69 healthcare students in three Universities to elicit professionalism dilemma narratives. Of 226 professionalism dilemmas elicited, 79 were coded as student abuse. Secondary-level thematic analysis of the abuse narratives addressed the following questions: What types of abuse experiences do healthcare students narrate? What factors do they cite as contributing to abuse and their responses to abuse? Healthcare students reported mostly covert abuse in their narratives. Although narrators described individual, relational, work and organisational factors contributing to abuse, they mostly cited factors relating to perpetrators. Most participants stated that they acted in the face of their abuse, and they mostly cited factors relating to themselves for acting. Students who did nothing in the face of abuse typically cited the perpetrator-recipient relationship as the main contributory factor. There are many similarities across the narratives of the five healthcare student groups, suggesting that complex interactional/organisational factors are all-important when considering how abuse is perpetuated within the healthcare workplace. Although some organisational factors may be difficult to change, we recommend that educational initiatives are a key starting point to tackle healthcare workplace abuse.
Education in Medicine Journal, 2014
Journal business models are basically classified based on the source of income to cover publicati... more Journal business models are basically classified based on the source of income to cover publication costs and in general there are two main journal business models which are the toll-access and open-access. These leading to a question that still remains around the ethics of publishing academic work across the different journal business models in terms of (a) editorial decision-making and (b) the dissemination of research that has not been appropriately peer-reviewed for quality and rigor. This paper discussed about these two areas based on the literature and the authors' observations.
Medical Education, 2014
Medical students encounter situations during workplace learning in which they witness or particip... more Medical students encounter situations during workplace learning in which they witness or participate in something unprofessional (so-called professionalism dilemmas), sometimes having a negative emotional impact on them. Less is known about other health care students' experiences of professionalism dilemmas and the resulting emotional impact. To examine dental, nursing, pharmacy and physiotherapy students' narratives of professionalism dilemmas: the types of events they encounter ('whats') and the ways in which they narrate those events ('hows'). A qualitative cross-sectional study. Sixty-nine health care students (29 dentistry, 13 nursing, 12 pharmacy, 15 physiotherapy) participated in group/individual narrative interviews. Data were analysed using framework analysis (examining the 'whats'), linguistic inquiry and word count software (examining the 'hows' by dilemma type and student group) and narrative analysis (bringing together 'whats' and 'hows'). In total, 226 personal incident narratives (104 dental, 34 nursing, 39 pharmacy and 49 physiotherapy) were coded. Framework analysis identified nine themes, including 'Theme 2: professionalism dilemmas', comprising five sub-themes: 'student abuse', 'patient safety and dignity breaches by health care professionals', 'patient safety and dignity breaches by students', 'whistleblowing and challenging' and 'consent'. Using Linguistic Inquiry and Word Count (liwc) software, significant differences in negative emotion talk were found across student groups and dilemma types (e.g. more anger talk when narrating patient safety and dignity breaches by health care professionals than similar breaches by students). The narrative analysis illustrates how events are constructed and the emotional implications of assigning blame (an ethical dimension) resulting in emotional residue. Professionalism dilemmas experienced by health care students, including issues concerning whistleblowing and challenging, have implications for interprofessional learning. By focusing on common professionalism issues at a conceptual level, health care students can share experiences through narratives. The role-playing of idealised actions (how students wish they had acted) can facilitate synergy between personal moral values and moral action enabling students to commit and re-commit to professionalism values together.
Medical Education, 2013
Bedside teaching is essential for helping students develop skills, reasoning and professionalism,... more Bedside teaching is essential for helping students develop skills, reasoning and professionalism, and involves the learning triad of student, patient and clinical teacher. Although current rhetoric espouses the sharing of power, the medical workplace is imbued with power asymmetries. Power is context-specific and although previous research has explored some elements of the enactment and resistance of power within bedside teaching, this exploration has been conducted within hospital rather than general practice settings. Furthermore, previous research has employed audio-recorded rather than video-recorded observation and has therefore focused on language and para-language at the expense of non-verbal communication and human-material interaction. A qualitative design was adopted employing video- and audio-recorded observations of seven bedside teaching encounters (BTEs), followed by short individual interviews with students, patients and clinical teachers. Thematic and discourse analyses of BTEs were conducted. Power is constructed by students, patients and clinical teachers throughout different BTE activities through the use of linguistic, para-linguistic and non-verbal communication. In terms of language, participants construct power through the use of questions, orders, advice, pronouns and medical/health belief talk. With reference to para-language, participants construct power through the use of interruption and laughter. In terms of non-verbal communication, participants construct power through physical positioning and the possession or control of medical materials such as the stethoscope. Using this paper as a trigger for discussion, we encourage students and clinical teachers to reflect critically on how their verbal and non-verbal communication constructs power in bedside teaching. Students and clinical teachers need to develop their awareness of what power is, how it can be constructed and shared, and what it means for the student-patient-doctor relationship within bedside teaching.
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).