The Big D(eal): professional identity through discursive constructions of 'patient'.

Autor: Schrewe B; Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Bates J; Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Pratt D; Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada., Ruitenberg CW; Department of Educational Studies, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada., McKellin WH; Department of Anthropology, University of British Columbia, Vancouver, British Columbia, Canada.
Jazyk: angličtina
Zdroj: Medical education [Med Educ] 2017 Jun; Vol. 51 (6), pp. 656-668.
DOI: 10.1111/medu.13299
Abstrakt: 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.
(© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje