Health Services Research Commons^™

Pulling Together And Pushing Apart: Tides Of Tension In The Icu Team, Laura Hawryluck, Sherry Espin, Kim Garwood, Cathy Evans, Lorelei Lingard

Lorelei Lingard

No abstract provided.

Error Or "Act Of God"? A Study Of Patients' And Operating Room Team Members' Perceptions Of Error Definition, Reporting, And Disclosure, Sherry Espin, Wendy Levinson, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Calls abound for a culture change in health care to improve patient safety. However, effective change cannot proceed without a clear understanding of perceptions and beliefs about error. In this study, we describe and compare operative team members' and patients' perceptions of error, reporting of error, and disclosure of error. METHODS: Thirty-nine interviews of team members (9 surgeons, 9 nurses, 10 anesthesiologists) and patients (11) were conducted at 2 teaching hospitals using 4 scenarios as prompts. Transcribed responses to open questions were analyzed by 2 researchers for recurrent themes using the grounded-theory method. Yes/no answers were compared across groups …

Context, Conflict, And Resolution: A New Conceptual Framework For Evaluating Professionalism, Shiphra Ginsburg, Glenn Regehr, Rose Hatala, Nancy Mcnaughton, Alice Frohna, Brian Hodges, Lorelei Lingard, David Stern

Lorelei Lingard

No abstract provided.

Exploring The Gap Between Knowledge And Behavior: A Qualitative Study Of Clinician Action Following An Educational Intervention, Tara Kennedy, Glenn Regehr, Jay Rosenfield, S. Roberts, Lorelei Lingard

Lorelei Lingard

PURPOSE: Many medical education interventions improve clinicians' knowledge but fail to change behavior. The authors exposed this knowledge-behavior gap through standardized clinical interactions, thus allowing in-depth exploration of the contributing factors. METHOD: A typical evidence-based educational intervention in one clinical domain (early signs of autism) was administered to family medicine residents at the University of Toronto in 2001-02, and change in knowledge was assessed through a multiple-choice test. Six to eight weeks later, participants' relevant knowledge was documented, and their clinical behavior was observed during four interactions with standardized patients. Factors producing a knowledge-behavior discrepancy were then explored using semistructured …

Childhood Immunization. How Knowledgeable Are We?, Helen Heurter, Karen Breen-Reid, Leya Aronson, Lorelei Lingard, David Manning, E. Ford-Jones

Lorelei Lingard

No abstract provided.

'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: …

Basing The Evaluation Of Professionalism On Observable Behaviors: A Cautionary Tale, Shiphra Ginsburg, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

PROBLEM STATEMENT AND BACKGROUND: The evaluation of professionalism often relies on the observation and interpretation of students' behaviors; however, little research is available regarding faculty's interpretations of these behaviors.

METHOD: Interviews were conducted with 30 faculty, who were asked to respond to five videotaped scenarios in which students are placed in professionally challenging situations. Behaviors were catalogued by person and by scenario.

RESULTS: There was little agreement between faculty about what students should and should not do in each scenario. Abstracted principles (e.g., honesty, altruism) were defined and applied inconsistently, both between and within individual faculty. There was no apparent …

Technical Skills In Paediatrics: A Qualitative Study Of Acquisition, Attitudes And Assumptions In The Neonatal Intensive Care Unit, Susan Bannister, Robert Hilliard, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

PURPOSE: While the effective acquisition of technical skills is essential for excellent paediatric care, little is known about how technical skills are learned in the paediatric setting. This study sought to describe and theorise the variables influencing technical skills acquisition in a tertiary care neonatal intensive care unit (NICU) inpatient setting. METHODOLOGY: Using non-participant field methodology, paediatric residents and their teachers (nurses, respiratory therapists, neonatal staff and fellows) were observed at various times in the NICU for 8 weeks. Thirteen semistructured interviews with these teachers and learners and 1 focus group of additional learners were conducted and used to triangulate …

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, …

To Be And Not To Be: The Paradox Of The Emerging Professional Stance, Shiphra Ginsburg, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

PURPOSE: Understanding how students resolve professional conflict is essential to teaching and evaluating professionalism. The purpose of this study was to refine an existing coding structure of rationalizations of student behaviour, and to further our understanding of students' reasoning strategies in the face of perceived professional lapses.

METHODS: Anonymous essays were collected from final year medical students at two universities. Each essay included a description of a specific professional lapse, and a consideration of how the lapse was dealt with. Essays were analysed using grounded theory. The resulting coding structure was applied using NVivo software.

RESULTS: Twenty essays, containing 147 …

Persistence Of Unsafe Practice In Everyday Work: An Exploration Of Organizational And Psychological Factors Constraining Safety In The Operating Room, S. Espin, Lorelei Lingard, G. Baker, G. Regehr

Lorelei Lingard

This paper explores the factors that influence the persistence of unsafe practice in an interprofessional team setting in health care, towards the development of a descriptive theoretical model for analyzing problematic practice routines. Using data collected during a mixed method interview study of 28 members of an operating room team, participants' approaches to unsafe practice were analyzed using the following three theoretical models from organizational and cognitive psychology: Reason's theory of "vulnerable system syndrome", Tucker and Edmondson's concept of first and second order problem solving, and Amalberti's model of practice migration. These three theoretical approaches provide a critical insight into …

'Is That Normal?' Pre-Clerkship Students' Approaches To Professional Dilemmas, Shiphra Ginsburg, Lorelei Lingard

Lorelei Lingard

OBJECTIVES: Context has been recognised as a key variable in studies of medical student professionalism, yet the effect of students' stage of training has not been well explored, despite growing recognition that medical students begin to form their professional ethos from their earliest medical school experiences. The purpose of this study, which builds on previous research involving clinical clerks, was to explore the decision-making processes of pre-clerkship medical students in the face of standardised professional dilemmas.

METHODS: Structured interviews were conducted with 30 pre-clerkship (Years 1 and 2) medical students at one institution. During the interviews, students were asked to …