Klingler Corinna, Ismail Fatiha, Marckmann Georg, Kuehlmeyer Katja
Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.
PLoS One. 2018 Feb 15;13(2):e0193010. doi: 10.1371/journal.pone.0193010. eCollection 2018.
Hospitals in Germany employ increasing numbers of foreign-born and foreign-trained (FB&FT) physicians. Studies have investigated how FB&FT physicians experience their professional integration into the German healthcare system, however, the perspectives of stakeholders working with and shaping the work experiences of FB&FT physicians in German hospitals have so far been neglected. This study explores relevant stakeholders' opinions and attitudes towards FB&FT physicians-which likely influence how these physicians settle in-and how these opinions were formed. We conducted a qualitative interview study with 25 stakeholders working in hospitals or in health policy development. The interviews were analyzed within a constructivist research paradigm using methods derived from Grounded Theory (situational analysis as well as open, axial and selective coding). We found that stakeholders tended to focus on problems in FB&FT physicians' work performance. Participants criticized FB&FT physicians' work for deviating from presumably shared professional standards (skill or knowledge and behavioral standards). The professional standards invoked to justify problem-focused statements comprised the definition of an ideal behavior, attitude or ability and a tolerance range that was adapted in a dynamic process. Behavior falling outside the tolerance range was criticized as unacceptable, requiring action to prevent similar deviations in the future. Furthermore, we derived three strategies (minimization, homogenization and quality management) proposed by participants to manage deviations from assumed professional standards by FB&FT physicians. We critically reflect on the social processes of evaluation and problematization and question the legitimacy of professional standards invoked. We also discuss discriminatory tendencies visible in evaluative statements of some participants as well as in some of the strategies proposed. We suggest it will be key to develop and implement better support strategies for FB&FT physicians while also addressing problematic attitudes within the receiving system to further professional integration.
德国医院雇佣的外国出生和外国培训（FB&FT）医生数量日益增加。已有研究调查了FB&FT医生如何体验他们融入德国医疗体系的职业过程，然而，德国医院中与FB&FT医生共事并塑造其工作体验的利益相关者的观点，迄今一直被忽视。本研究探讨了相关利益者对FB&FT医生的意见和态度——这可能影响这些医生的融入情况——以及这些意见是如何形成的。我们对25名在医院或从事卫生政策制定工作的利益相关者进行了定性访谈研究。访谈在建构主义研究范式内进行分析，采用扎根理论衍生的方法（情境分析以及开放、轴心和选择性编码）。我们发现，利益相关者倾向于关注FB&FT医生工作表现中的问题。参与者批评FB&FT医生的工作偏离了大概共同认可的专业标准（技能或知识以及行为标准）。用于证明以问题为导向陈述的专业标准包括理想行为、态度或能力的定义以及在动态过程中调整的容忍范围。超出容忍范围的行为被批评为不可接受，需要采取行动以防止未来出现类似偏差。此外，我们得出了参与者提出的三种策略（最小化、同质化和质量管理），以管理FB&FT医生偏离假定专业标准的情况。我们批判性地反思了评估和问题化的社会过程，并质疑所援引专业标准的合法性。我们还讨论了一些参与者的评价陈述以及所提出的一些策略中明显存在的歧视倾向。我们建议，为FB&FT医生制定和实施更好的支持策略，同时解决接纳体系中的问题态度，对于促进进一步的职业融入将至关重要。
