Helmich Esther, Yeh Huei-Ming, Yeh Chi-Chuan, de Vries Joy, Fu-Chang Tsai Daniel, Dornan Tim
E. Helmich is senior researcher, Center for Education Development and Research in Health Professions, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.H.-M. Yeh is assistant professor, Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.C.-C. Yeh is attending physician, Department of Medical Education/Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.J. de Vries is a PhD student, Center for Evidence-Based Education, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands.D.F.-C. Tsai is professor, Research Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, and attending physician, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.T. Dornan is professor, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom.
Acad Med. 2017 Jun;92(6):853-859. doi: 10.1097/ACM.0000000000001658.
Current knowledge about the interplay between emotions and professional identity formation is limited and largely based on research in Western settings. This study aimed to broaden understandings of professional identity formation cross-culturally.
In fall 2014, the authors purposively sampled 22 clinical students from Taiwan and the Netherlands and asked them to keep audio diaries, narrating emotional experiences during clerkships using three prompts: What happened? What did you feel/think/do? How does this interplay with your development as a doctor? Dutch audio diaries were supplemented with follow-up interviews. The authors analyzed participants' narratives using a critical discourse analysis informed by Figured Worlds theory and Bakhtin's concept of dialogism, according to which people's spoken words create identities in imagined future worlds.
Participants talked vividly, but differently, about their experiences. Dutch participants' emotions related to individual achievement and competence. Taiwanese participants' rich, emotional language reflected on becoming both a good person and a good doctor. These discourses constructed doctors' and patients' autonomy in culturally specific ways. The Dutch construct centered on "hands-on" participation, which developed the identity of a technically skilled doctor, but did not address patients' self-determination. The Taiwanese construct located physicians' autonomy within moral values more than practical proficiency, and gave patients agency to influence doctor-patient relationships.
Participants' cultural constructs of physician and patient autonomy led them to construct different professional identities within different imagined worlds. The contrasting discourses show how medical students learn about different meanings of becoming doctors in culturally specific contexts.
目前关于情绪与职业身份形成之间相互作用的知识有限，且主要基于西方背景下的研究。本研究旨在拓宽对跨文化职业身份形成的理解。
2014年秋季，作者有目的地从台湾和荷兰抽取了22名临床学生，要求他们保留音频日记，使用三个提示叙述实习期间的情感经历：发生了什么？你有什么感受/想法/做了什么？这与你作为一名医生的成长有何相互作用？荷兰的音频日记辅以后续访谈。作者使用基于具身世界理论和巴赫金对话主义概念的批判性话语分析来分析参与者的叙述，根据该理论，人们的言语在想象的未来世界中塑造身份。
参与者生动地讲述了他们的经历，但方式有所不同。荷兰参与者的情绪与个人成就和能力有关。台湾参与者丰富的情感语言反映了既要成为一个好人又要成为一名好医生。这些话语以特定文化的方式构建了医生和患者的自主性。荷兰的构建以“实践”参与为中心，培养了技术熟练的医生身份，但没有涉及患者的自我决定权。台湾的构建将医生的自主性更多地定位在道德价值观而非实际能力上，并赋予患者影响医患关系的权力。
参与者对医生和患者自主性的文化构建使他们在不同的想象世界中构建了不同的职业身份。这些截然不同的话语展示了医学生如何在特定文化背景下了解成为医生的不同意义。
