Warmington Sally, McColl Geoffrey
Faculty of Medicine, Dentistry and Health Sciences, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia.
Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Parkville, VIC, 3010, Australia.
Adv Health Sci Educ Theory Pract. 2017 Mar;22(1):147-163. doi: 10.1007/s10459-016-9689-2. Epub 2016 May 27.
Professional identity formation is acknowledged as one of the fundamental tasks of contemporary medical education. Identity is a social phenomenon, constructed through participation in everyday activities and an integral part of every learning interaction. In this paper we report from an Australian ethnographic study into how medical students and patients use narrative to construct their identities. The dialogic narrative analysis employed focused on the production of meaning through the use of language devices in a given context, and the juxtaposition of multiple perspectives. Two stories told by students about their participation in patient care-related activities reveal how identities are constructed in this context through depictions of the relationships between medical students, patients and clinical teachers. These students use the rhetorical functions of stories to characterise doctors and patients in certain ways, and position themselves in relation to them. They defend common practices that circumvent valid consent processes, justified by the imperative to maximise students' participation in patient care-related activities. In doing so, they identify patients as their adversaries, and doctors as allies. Both students are influenced by others' expectations but one reveals the active nature of identity work, describing subtle acts of resistance. These stories illustrate how practices for securing students' access to patients can influence students' emerging identities, with implications for their future disclosure and consent practices. We argue that more collaborative ways of involving medical students in patient care-related activities will be facilitated if students and clinical teachers develop insight into the relational nature of identity work.
专业身份形成被公认为当代医学教育的基本任务之一。身份是一种社会现象，通过参与日常活动构建而成，并且是每次学习互动的一个组成部分。在本文中，我们报告了一项澳大利亚人种学研究，该研究探讨了医学生和患者如何运用叙事来构建他们的身份。所采用的对话式叙事分析聚焦于在特定情境中通过语言手段产生意义，以及多种视角的并置。学生讲述的两个关于他们参与患者护理相关活动的故事揭示了在这种情境中身份是如何通过描绘医学生、患者和临床教师之间的关系而构建的。这些学生利用故事的修辞功能以特定方式刻画医生和患者，并表明自己与他们的关系。他们为规避有效同意程序的常见做法辩护，理由是必须最大限度地让学生参与患者护理相关活动。在此过程中，他们将患者视为对手，将医生视为盟友。两名学生都受到他人期望的影响，但其中一名揭示了身份构建工作的主动性，描述了微妙的抵抗行为。这些故事说明了确保学生接触患者的做法如何能够影响学生正在形成的身份，这对他们未来的信息披露和同意做法具有启示意义。我们认为，如果学生和临床教师深入了解身份构建工作的关系本质，将有助于采用更具协作性的方式让医学生参与患者护理相关活动。
