Medicine and Health Sciences Commons^™

The Disavowed Curriculum: Understanding Student's Reasoning In Professionally Challenging Situations, Shiphra Ginsburg, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

CONTEXT: Understanding students' perceptions of and responses to lapses in professionalism is important to shaping students' professional development. OBJECTIVE: Utilize realistic, standardized professional dilemmas to obtain insight into students' reasoning and motivations in "real time." DESIGN: Qualitative study using 5 videotaped scenarios (each depicting a student placed in a situation which requires action in response to a professional dilemma) and individual interviews, in which students were questioned about what they would do next and why. SETTING: University of Toronto. PARTICIPANTS: Eighteen fourth-year medical students; participation voluntary and anonymous. MAIN OUTCOME MEASURE: A model to explain students' reasoning in the face …

'Talking The Talk': School And Workplace Genre Tension In Clerkship Case Presentations, Lorelei Lingard, C. Schryer, K. Garwood, M. Spafford

Lorelei Lingard

BACKGROUND: Socialisation into a community involves learning sanctioned ways of talking. This study investigates the case presentation genre as a site of socialisation into the clinical community of practice. METHODS: Sixteen oral case presentations and the teaching exchanges surrounding them (involving 11 students and 10 faculty members) were observed by paired researchers during inpatient paediatric medicine rounds. A total of 21 in-depth interviews were conducted with 11 students and 10 faculty. Both data sets were audio-recorded, transcribed and analysed for emergent themes and rhetorical strategies. RESULTS: Students emphasised case presentation as a school genre and described the ideal presentation as …

Clinical Oversight: Conceptualizing The Relationship Between Supervision And Safety, Tara Kennedy, Lorelei Lingard, G. Baker, Lisa Kitchen, Glenn Regehr

Lorelei Lingard

BACKGROUND: Concern about the link between clinical supervision and safe, quality health care has led to widespread increases in the supervision of medical trainees. The effects of increased supervision on patient care and trainee education are not known, primarily because the current multifacted and poorly operationalized concept of clinical supervision limits the potential for evaluation.

OBJECTIVE: To develop a conceptual model of clinical supervision to inform and guide policy and research.

DESIGN, SETTING, AND PARTICIPANTS: Observational fieldwork and interviews were conducted in the Emergency Department and General Internal Medicine in-patient teaching wards of two academic health sciences centers associated with …

'You Learn Better Under The Gun': Intimidation And Harassment In Surgical Education, Laura Musselman, Helen Macrae, Richard Reznick, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Medical literature has documented a high prevalence of intimidation and harassment in the educational context. However, the research has failed to adequately delineate the nature of these phenomena as well as the different ways in which diverse actors perceive the behaviours in question.

METHODS: Based on qualitative methodology anchored in a social constructionism framework, how teachers (staff surgeons) and learners (surgical residents) define intimidation and harassment were documented and compared. In addition, teachers' and learners' perceptions of the impact of these behaviours on the learning environment, including their effects on the socialisation of surgeons in training, were examined.

FINDINGS: …

Before The White Coat: Perceptions Of Professional Lapses In The Pre-Clerkship, Shiphra Ginsburg, Natasha Kachan, Lorelei Lingard

Lorelei Lingard

BACKGROUND: It has been shown that the professional development of clinical clerks is influenced by their experiences of unprofessional behaviour, but the perceptions of pre-clerkship students have received relatively little attention. Our purpose was to develop a greater contextual understanding of the situations in which pre-clerkship students encounter professional challenges, and to investigate what pre-clerkship students consider to be professional lapses in these situations.

METHODS: We conducted 4 focus groups (n = 22 students); transcripts were analysed by 3 researchers using grounded theory.

RESULTS: Pre-clerkship students reported lapses in the areas of communicative violation, role resistance, objectification, accountability and harm, …

Preserving Professional Credibility: Grounded Theory Study Of Medical Trainees' Requests For Clinical Support, Tara Kennedy, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: To develop a conceptual framework of the influences on medical trainees' decisions regarding requests for clinical support from a supervisor.

DESIGN: Phase 1: members of teaching teams in internal and emergency medicine were observed during regular clinical activities (216 hours) and subsequently completed brief interviews. Phase 2: 36 in depth interviews were conducted using videotaped vignettes to probe tacit influences on decisions to request support. Data collection and analysis used grounded theory methods.

SETTING: Three teaching hospitals in an urban setting in Canada.

PARTICIPANTS: 124 members of teaching teams on general internal medicine wards and in the emergency department, …

Know When To Rock The Boat: How Faculty Rationalize Students' Behaviors, Shiphra Ginsburg, Lorelei Lingard, Glenn Regehr, Kathryn Underwood

Lorelei Lingard

BACKGROUND: When faculty evaluate medical students' professionalism, they make judgments based on the observation of behaviors. However, we lack an understanding of why they feel certain behaviors are appropriate (or not).

OBJECTIVE: To explore faculty's reasoning around potential student behaviors in professionally challenging situations.

DESIGN: Guided interviews with faculty who were asked to respond to 5 videotaped scenarios depicting students in professionally challenging situations.

SUBJECTS: Purposive sample of 30 attending Internists and surgeons.

APPROACH: Transcripts were analyzed using modified grounded theory to search for emerging themes and to attempt to validate a previous framework based on student responses.

RESULTS: Faculty's …