专业精神、专业化、专业技能与同情心：一项关于住院医师的定性研究
Professionalism, professionalization, expertise and compassion: a qualitative study of medical residents.
作者信息
Phillips Susan P, Dalgarno Nancy
机构信息
Department of Family Medicine, Queen's University, PO Bag 888, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada.
Department of Family Medicine - Centre for Studies in Primary Care/Office of Health Sciences Education, Queen's University, PO Bag 888, 220 Bagot Street, Kingston, ON, K7L 5E9, Canada.
出版信息
BMC Med Educ. 2017 Jan 23;17(1):21. doi: 10.1186/s12909-017-0864-9.
BACKGROUND
Formal and informal medical curricula convey expectations about professionalization, that is, the development of physician identity, and also about professionalism. This study examined whether, in general, junior residents experienced any dissonance between these roles and focused particularly on how they negotiated conflicts between compassion, self-care, duty and medical expertise.
METHODS
In 2015, purposive sampling was used to select 21 first-year residents at a Canadian medical school. Participants listened to a 5-min audio-recording narrated in either male or female voice. Facing compassion fatigue after three obstetrical disasters over less than 2 days the resident narrator asks to go home. Participants reacted in writing to questions about this request and relevant teaching/modelling. Responses were analyzed using a qualitative, exploratory, thematic research design.
RESULTS
Four themes were identified: i) empathy, self-doubt and fear of weakness, ii) the need for support from and communication with physicians and others, iii) education received, and iv) professionalization outranks professionalism. Participants agreed that under the circumstances the narrator's care, compassion and request were appropriate. Never the less, many grappled with feeling that asking to be relieved of work demonstrated weakness and a shirking of responsibility. Respondents had received no formal teaching about balancing compassion for patients or self with professional duty. Preceptors' informal teaching and modeling valorized scientific disengagement above all else. What emerged was participants' drive to become detached clinicians who set aside emotional responses and interactions that could impede and be incompatible with professionalization. However, participants also recognized and lamented what was lost in such a transformation.
CONCLUSION
In the transition from student to practitioner, trainees' views and the modeling they receive shift emotion and compassion, whether for self or patients, from assets to liabilities as they aim to be invincible medical experts.
背景
正式和非正式的医学课程传达了对职业化（即医生身份的形成）以及专业精神的期望。本研究调查了初级住院医生总体上是否在这些角色之间经历了任何不一致，并特别关注他们如何协调同情、自我关怀、职责和医学专业知识之间的冲突。
方法
2015年，采用目的抽样法从一所加拿大医学院选取了21名一年级住院医生。参与者收听了一段由男性或女性叙述的5分钟音频记录。在不到两天的时间里经历了三次产科灾难后，面对同情疲劳，住院医生叙述者请求回家。参与者以书面形式回答了关于这一请求及相关教学/示范的问题。使用定性、探索性、主题研究设计对回答进行分析。
结果
确定了四个主题：i）同理心、自我怀疑和对软弱的恐惧，ii）需要医生和其他人的支持以及与他们沟通，iii）接受的教育，iv）职业化高于专业精神。参与者一致认为，在这种情况下，叙述者的关心、同情和请求是恰当的。然而，许多人纠结于这样一种感觉，即请求解除工作显示出软弱和逃避责任。受访者没有接受过关于平衡对患者或自我的同情与职业职责的正式教学。带教老师的非正式教学和示范将科学超脱置于首位。结果是参与者渴望成为超脱的临床医生，抛开可能阻碍职业化且与之不相容的情感反应和互动。然而，参与者也认识到并 lamented 在这种转变中失去了什么。
结论
在从学生向从业者的转变过程中，受训者的观点以及他们所接受的示范将情感和同情，无论是对自己还是对患者，从资产转变为负债，因为他们的目标是成为无敌的医学专家。
注
“lamented”原词有误，应该是“lamented”，意为“哀叹；惋惜” 。完整准确译文如下：
背景
正式和非正式的医学课程传达了对职业化（即医生身份的形成）以及专业精神的期望。本研究调查了初级住院医生总体上是否在这些角色之间经历了任何不一致，并特别关注他们如何协调同情、自我关怀、职责和医学专业知识之间的冲突。
方法
2015年，采用目的抽样法从一所加拿大医学院选取了21名一年级住院医生。参与者收听了一段由男性或女性叙述的5分钟音频记录。在不到两天的时间里经历了三次产科灾难后，面对同情疲劳，住院医生叙述者请求回家。参与者以书面形式回答了关于这一请求及相关教学/示范的问题。使用定性、探索性、主题研究设计对回答进行分析。
结果
确定了四个主题：i）同理心、自我怀疑和对软弱的恐惧，ii）需要医生和其他人的支持以及与他们沟通，iii）接受的教育，iv）职业化高于专业精神。参与者一致认为，在这种情况下，叙述者的关心、同情和请求是恰当的。然而，许多人纠结于这样一种感觉，即请求解除工作显示出软弱和逃避责任。受访者没有接受过关于平衡对患者或自我的同情与职业职责的正式教学。带教老师的非正式教学和示范将科学超脱置于首位。结果是参与者渴望成为超脱的临床医生，抛开可能阻碍职业化且与之不相容的情感反应和互动。然而，参与者也认识到并惋惜在这种转变中失去了什么。
结论
在从学生向从业者的转变过程中，受训者的观点以及他们所接受的示范将情感和同情，无论是对自己还是对患者，从资产转变为负债，因为他们的目标是成为无敌的医学专家。
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