Search

Professional identity formation has emerged as a key topic for medical education research, with contributions from perspectives of psychological development and socialization opening up needed conversations in the field. Yet mainstream training practices may have the unintended effects of educating for a physician typology that may be too narrow to account for the complexity of learners' personal identities. Alternative approaches, such as Foucauldian genealogy, offer ways to empirically investigate how the legitimate contours of being and becoming have come to be as they are, how they shape professional identities, and to which degree their borders may be made more inclusive. Drawing upon an example of the contemporary practice of competency-based medical education in the Canadian context, this paper considers how genealogy's methodological tools of critical distancing, the "dispositif," and problematization may help reveal how educational practices shape the identities of physicians-in-training in ways both intended and unintended. From this perspective it becomes apparent that any attempt to explore professional identity is incomplete without also considering that a trainee's evolving sense of self is inexorably bound up with forces of knowledge, power, and ethics that shape them into becoming certain kinds of physician subjects rather than others. In mapping this terrain, a genealogical approach determines how we reached the now in which we find ourselves and how we might transform it, such that we may shift the possibilities afforded to health professionals to establish professional identities aligned with their personal identities in ways that maximize inclusivity and minimize marginalization.

One of the most exciting yet stressful times in a physician's life is transitioning from supervised training into independent practice. The majority of literature devoted to this topic has focused upon a perceived gap between clinical and non-clinical skills and interventions taken to address it. Building upon recent streams of scholarship in identity formation and adaptation to new contexts, this work uses a Heideggerian perspective to frame an autoethnographical exploration of the author's transition into independent paediatric practice. An archive of reflective journal entries and personal communications was assembled from the author's first 3 years of practice in four different contexts and analyzed using Heidegger's linked existentials of understanding, attunement and discourse. Insights from his journey suggest this period is a time of anxiety and vulnerability when one questions one's competence and very identity as a medical professional. At the same time, it illustrates the inseparable link between practitioners and the network of relationships in which they are bound, how these relationships contextually vary and how recognizing and tuning to these differences may allow for a more seamless transition. While this work is the experience of one person, its insights support the ideas that change is a constant in professional practice and competence is contextual. As a result, developing educational content that inculcates contextual flexibility and an increased comfort level with uncertainty may prepare our trainees not just to navigate the unavoidable novelty of transition, but lay the groundwork for professional identities attuned to engage more broadly with change itself.

In contemporary and popular discourse, imposter syndrome is frequently outlined as an individual problem that can be overcome. Rather than the locus of responsibility being placed on the individual, we posit that neoliberal academic institutions contribute to imposter syndrome by (de)legitimising certain forms of knowledge. [ABSTRACT FROM AUTHOR]

Emergent discourses of social responsibility and accountability have in part fuelled the expansion of distributed medical education (DME). In addition to its potential for redressing physician maldistribution, DME has conferred multiple unexpected educational benefits. In several countries, its recent rise has occurred around the boundaries of traditional medical education practices. Canada has been no exception, with DME proliferating against a backdrop of its longstanding central node, the clinical teaching unit (CTU). The CTU first appeared just over 50 years ago with its position in Canadian health care largely taken-for-granted. Given the increasing prominence of DME, however, it is timely to reconsider what the place of tertiary centre-based practices such as the CTU might be in shifting medical education systems. From a genealogical perspective, it becomes clear that the CTU did not just "happen". Rather, its creation was made possible by multiple interrelated cultural, social, and political changes in Canadian society that, while subtle, are powerfully influential. Making them visible offers a better opportunity to harmonize the benefits of longstanding entities such as the CTU with novel practices such as DME. In so doing, the medical education field may sidestep the pitfalls of investing significant resources that may only produce superficial changes while unwittingly obstructing deeper transformations and improvements. Although this work is refracted through a Canadian prism, reconceptualizing the overall design of medical education systems to take advantage of both tradition and innovation is a persistent challenge across the international spectrum, resistant to tests of time and constraints of context.

More than 100 years following its publication, the Flexner Report endures as a principal text in contemporary medical education. While recent scholarship has questioned popular conceptions of the report and attends to marginalized passages, explanations as to why the Flexner story endures as myth in medical education remain absent in the literature. From a Bourdieusian perspective applied to an archive of both primary and secondary texts related to the history, production, and reception of the Flexner Report, this work examines the events that led to the production of a mythological "Flexner" and what significance this has for repeated yet insufficient efforts towards improving medical education. Specifically, this work links the values, beliefs, and assumptions embedded in the Flexner mythology to the unintentional obstruction of wholesale curricular reform and suggests it is in productively struggling with the legacy of this myth that we may be better positioned to reconcile ourselves to the Flexner legacy and its implication for future training.

The article discusses the author's experience as a pediatric resident presenting research on the use of language in healthcare encounters. The author reflects on the negative response they received from a judge and the doubts it raised about the value of their research. The author explores the tension between their roles as a pediatrician and an education scholar, recognizing the power of words in both realms. They embrace the ambiguity of living in these two professional worlds and the potential for bridging them to improve healthcare education and practice. [Extracted from the article]

Introduction: Medical education continues to diversify its settings. For postgraduate trainees, moving across diverse settings, especially community‐based rotations, can be challenging personally and professionally. Competent performance is embedded in context; as a result, trainees who move to new contexts are challenged to use their knowledge, skills and experience to adjust. What trainees need to adapt to and what that requires of them are poorly understood. This research takes a capability approach to understand how trainees entering a new setting develop awareness of specific contextual changes that they need to navigate and learn from. Methods: We used constructivist grounded theory with in‐depth interviews. A total of 29 trainees and recent graduates from three internal medicine training programmes in Canada participated. All participants had completed at least one community‐based rotation geographically far from their home training site. Interviews were recorded, transcribed and anonymised. The interview framework was adjusted several times following initial data analysis. Results: Contextual competence results from trainees' ability to attend to five key stages. Participants had first to meet their physiological and practical needs, followed by developing a sense of belonging and legitimacy, which paved the way for a re‐constitution of competence and appropriate autonomy. Trainee's attention to these stages of adaptation was facilitated by a process of continuously moving between using their knowledge and skill foundation and recognising where and when contextual differences required new learning and adaptations. Discussion: An ability to recognise contextual change and adapt accordingly is part of Nussbaum and Sen's concept of capability development. We argue this key skill has not received the attention it deserves in current training models and in the support postgraduate trainees receive in practice. Recommendations include supporting residents in their capability development by debriefing their experiences of moving between settings and supporting clinical teachers as they actively coach residents through this process. The authors illustrate what contextual competence entails in the context of training in remote community contexts. They argue this key skill has not received the attention it deserves in current training models. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: The onset of acute illness may be accompanied by a profound sense of disorientation for patients. Addressing this vulnerability is a key part of a physician's purview, yet well‐intended efforts to do so may be impeded by myriad competing tasks in clinical practice. Resolving this dilemma goes beyond appealing to altruism, as its limitless demands may lead to physician burnout, disillusionment, and a narrowed focus on the biomedical aspects of care in the interest of self‐preservation. The authors propose an ethic of hospitality that may better guide physicians in attending to the comprehensive needs of patients that have entered "the kingdom of the sick." Methods: Using philosophical methods, the authors explore what compels people to present to emergent medical attention and why altruism may not offer physicians a sustainable way to address the vulnerabilities that occur in such situations. They then present the concept of hospitality from a Derridean perspective and use it to interpret a narrative case of an on‐call paediatrician caring for an infant with bronchiolitis to demonstrate how this approach may be practically implemented in the acute care hospital context. Results: Hospitality allows physicians to acknowledge that clinical presentations that are routine in their world may be disorienting and frightening to patients experiencing them acutely. Further, it recognizes that the vulnerability that accompanies acute illness may be compounded by the unfamiliarity of the hospital environment in which patients have sought support. Conclusion(s): While it is unlikely that anything physicians do will make the hospital a place where patients and caregivers will desire to be, hospitality may focus their efforts upon making it less unwelcoming. Specifically, it offers an orientation that supports patients in navigating the disorienting and unfamiliar terrains of acute illness, the hospital setting in which help is sought, and engagement with the health care system writ large. [ABSTRACT FROM AUTHOR]

Objectives Completing training is a rite of passage common to all physicians, yet our knowledge of the components in postgraduate paediatric education that equip learners for successful transition to practice is limited. In order to optimally design training programs, it is critical to develop a better sense of what early career paediatricians (ECPs) experience as they navigate this time of transition. Methods We created and distributed a 23-question survey via e-mail to 481 Canadian ECPs in September 2017, specifically to those who received Royal College certification in 2011 or later. Survey responses were obtained confidentially through an online platform (Survey Monkey). Descriptive statistics and thematic analysis were used to analyze responses to closed-ended and free text questions, respectively. Results Response rate was 42% with nearly 70% of the respondents self-identifying as general paediatricians. Factors facilitating transition to practice included: dedicated mentorship; supportive new colleagues and workplace environment; and ease of finding work. Identified challenges included: billing, finances, and practice management; adjusting to a different scope of practice and learning local resources; managing comfort level; and achieving work–life balance. Nearly half of the respondents expressed interest in mentoring new ECP colleagues. Conclusions Our findings suggest that ECPs find clear value in mentorship, but desire further support to adapt to new practice contexts and activities. As a result, we must consider strategies in both individual programs and nationally that effectively prepare learners prior to transition and align with needs in the first years of independent practice. [ABSTRACT FROM AUTHOR]

The article focuses on COVID-19 pandemic has powerfully paediatric practice in certain responses have been predictable, such as reconfiguring hospitals to address anticipated patient surges. Topics include the technology has made high-quality care accessible when its reliable delivery in-person had been seriously threatened, and the virtual solutions offer creative possibilities to facilitate health care and primary and secondary education.

The article offers information on COVID-19 pandemic has shifted the realities of clinical practice for many physicians and forced a significant re-calibration of their lives in response. Topics include the need to maintain knowledge of the latest diagnostic and therapeutic strategies, to judiciously use personal protective equipment, and the work collaboratively to ensure sufficient coverage during patient surges and colleague absences due to illness or self-isolation.

The article discusses providing clinical care to children from Indigenous backgrounds has a privilege afforded to paediatricians for the country. Topics include how Indigenous communities face an implicit violence of omission in national discourse; and the magnitude of injustice has evident in the number of lives traumatized and lost in residential schools.

Context: The tensions that emerge between the universal and the local in a global world require continuous negotiation. However, in medical education, standardization and contextual diversity tend to operate as separate philosophies, with little attention to the interplay between them. Methods: The authors synthesise the literature related to the intersections and resulting tensions between standardization and contextual diversity in medical education. In doing so, the authors analyze the interplay between these competing concepts in two domains of medical education (admissions and competency‐based medical education), and provide concrete examples drawn from the literature. Results: Standardization offers many rewards: its common articulations and assumptions promote patient safety, foster continuous quality improvement, and enable the spread of best practices. Standardization may also contribute to greater fairness, equity, reliability and validity in high stakes processes, and can provide stakeholders, including the public, with tangible reassurance and a sense of the stable and timeless. At the same time, contextual variation in medical education can afford myriad learning opportunities, and it can improve alignment between training and local workforce needs. The inevitable diversity of contexts for learning and practice renders any absolute standardization of programs, experiences, or outcomes an impossibility. Conclusions: The authors propose a number of ways to examine the interplay of contextual diversity and standardization and suggest three ways to move beyond an either/or stance. In reconciling the laudable goals of standardization and the realities of the innumerable contexts in which we train and deliver care, we are better positioned to design and deliver a medical education system that is globally responsible and locally engaged. The authors propose three key strategies for advancing productively in the face of tensions arising from the interplay between increasing standardization and increasing contextual diversity. [ABSTRACT FROM AUTHOR]

Context Professional identity formation has become a key focus for medical education. Who one becomes as a physician is contingent upon learning to conceptualise who the other is as a patient, yet, at a time when influential ideologies such as patient-centred care have become espoused values, there has been little empirical investigation into assumptions of 'patient' that trainees take up as they progress through their training. Methods Our team employed a critical discourse analysis approach to transcripts originally produced from a micro-ethnography of medical student learning on an acute care in-patient paediatric ward. The dataset included 20 case presentations and 14 sign-over rounds taken from a 3-week observation period. We paid specific attention to how trainees used language to talk about, refer to and categorise patients. Results Identified discourses included patient-as-disease-category, patient-as-educational-commodity and patient-as-marginalised-actor. These discourses conceptualise 'patient' as an entity that is principally biomedical, useful for clinical learning and spoken for and about. Medical student participation in these discourses contributes to an identity that allows them to move further into the professional medical world they are joining. Conclusions We contend that as learners participate in these discourses, they are also performatively produced by them. By making these discourses visible, we can consider how to minimise unintended effects such discourses may cause. Our findings, although limited, offer a glimpse of the effects that those assumptions may have as we look to align better the formation of professional medical identity with the ideals of patient-centred care and socially responsible health care systems. [ABSTRACT FROM AUTHOR]

3q27.2-qter deletion syndromes feature an overlapping set of terminal and interstitial deletions with variable congenital malformations. Diamond-Blackfan anemia (DBA) is etiologically heterogeneous disorder in which one cause is dominant mutations of the RPL35A gene on 3q29. We report a child with a 3q27.2-qter deletion that contains the RPL35A gene. She had clinical and laboratory features consistent with DBA and as well, an unexplained immunodeficiency disorder. Given these unusual findings, we reviewed other patients in the literature with overlapping genomic deletions. In addition, we evaluated our patient for the immunodeficiency disorder, RIDDLE syndrome, due to recessive mutations in the RNF168 gene on 3q29. A PubMed search for case reports of 3q27.2-qter overlapping deletions was performed. To determine if RPL35A was in the deletion region, the chromosomal regions reported were mapped to genomic regions using the UCSC Genome Browser. We identified 85 overlapping deletions, of which six included the RPL35A gene and all should be had DBA. Interestingly, none of the reported cases had immunodeficiency. To evaluate RIDDLE syndrome (radiosensitivity, immunodeficiency, dysmorphic features, and learning difficulties), we sequenced the remaining RNF168 gene and examined her fibroblast culture for a DNA double strand break repair deficiency. These results were normal, indicating that the immunodeficiency is unlikely to result from a RNF168 deficiency. We show that RPL35A haploinsufficiency is a cause of DBA and we report a novel case with 3q27.2-qter deletion and immunodeficiency. The etiology for the immunodeficiency remains unsolved and could be caused by an unknown gene effect or consequent to the DBA phenotype. [ABSTRACT FROM AUTHOR]

The interrelationship of pedagogical skills, educational ends, and underlying values and assumptions constitute a teacher's 'pedagogical validity' – who they are as a teacher and why they teach the way they do. If reflection, judgment, and improvement are to be helpful, they must have regard for a more complete understanding of what frames a teacher's pedagogical validity. This article briefly describes four kinds of pedagogical validity that teachers draw upon when explaining or justifying their notion of 'good' teaching. Teachers generally have some part of each, but most of us draw upon one or two more than all four as we define ourselves as teachers and make sense of our teaching. [ABSTRACT FROM AUTHOR]

Whether it is rock playing in the background during a surgery, cool jazz that wafts from our office computer speakers as we write up our clinical notes, or the soaring of a symphony on the radio that inspires that perfect flourish to an article, music is woven throughout much of our clinical and academic lives. For the five of us, however, music alternates between the background and foreground in our lives as health professions educators. Music balances the working day, illuminates our research, and reconciles the utility of our training with the originality of our practice. We invite you to discover the interplays, dissonances and harmonies inspired by and reflected in this leitmotif. Pull up a chair, sit back, put on one of your own favourite pieces and explore these ideas as we riff and rhapsodise on variations on this theme. [ABSTRACT FROM AUTHOR]

The article discusses the coronavirus pandemic has threatened the lives of the vulnerable, ravaged global economic systems. Topics include the information technology infrastructure and maintain the enormous demands upon render results and patient care data available on a continuous basis; and a sufficient number of ventilators have available to care for needing advanced respiratory support demands not sufficient production.

Mom and Dad were hit by a semi while on vacation". I had taken the recognition in those eyes for granted every day of my life, yet over the last 48 hours it felt like a gift, as the original prognosis had included phrases like "we're not sure he'll ever wake up" and "it's very possible that if he does, he isn't going to be your dad anymore." Now I belong on the other side, learning a new form of patience, getting a crash course in what it is like to be a family member thrown into the anxieties, vulnerabilities and exile of devastating illness and injury, not knowing whether there will be a way back. [Extracted from the article]

A personal narrative is presented which explores the author's experiences from his profession of a physician.

The article offers information on an intergenerational narrative medicine workshop designed to help medical professionals combat burnout. Topics covered include the problems that were addressed by the program, the activities during each session, such as discussions of selected readings of poetry or short prose, and the lessons that can be learned from implementing the workshop.

The article discusses the significance of integrating theory to support and enrich qualitative medical education scholarship and research.

After an uncomplicated term delivery, a newborn infant experienced a life-threatening even a few minutes after being born. Few such events have been described before, they may be due to suffocation; minor changes in surveillance can probably prevent these potentially devastating events. [ABSTRACT FROM AUTHOR]