Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Med Educ. 2019 Aug;53(8):808-823. doi: 10.1111/medu.13886. Epub 2019 May 15.
Although the literature on professional identity formation in medical education is increasing, it is scant by comparison on student and clinician identities within interprofessional contexts. We therefore adopt a novel discursive approach to identities to explore how soon-to-become graduates and workplace-based clinicians construct their own and others' identities in interprofessional student-clinician (IPSC) interaction narratives.
We conducted a qualitative narrative interview study with 38 students and 23 clinicians representing the fields of medicine, midwifery, nursing, occupational therapy, paramedicine and physiotherapy. Through framework analysis, we identified the breadth of student and clinician identity constructions across 208 IPSC interaction narratives, and explored how common constructions differed by narrative and narrator. Through in-depth positioning analysis, we explored how student and clinician identities are discursively positioned within two selected IPSC interaction narratives.
We identified 11 common constructions of student identities and eight common constructions of clinician identities across all 208 narratives. We found differences in identity constructions across positively versus negatively evaluated narratives, and student versus clinician narrators, highlighting the rhetorical nature of narratives. Our in-depth positioning analysis of two narratives illustrates how one student and one clinician discursively positioned theirs and others' identities during interprofessional interactions, and how identities vary depending on narrators' evaluations of their stories. Although both positioning analyses illustrate how the narrators' language serves to reproduce the common societal discourse of interprofessional conflict, the clinician narrative also draws on the competing discourse of interprofessional collaboration.
Although some of the identities support previous uniprofessional research, our findings illustrate greater breadth and depth in terms of student and clinician identities within interprofessional contexts. We encourage educators to embed identities curricula into existing workplace learning for students and clinicians to help them make sense of their developing professional and interprofessional identities. Workplace educators should facilitate meaningful IPSC interactions to promote interprofessional learning and collaboration.
尽管医学教育专业身份形成的文献越来越多，但与跨专业背景下的学生和临床医生身份相比，这方面的文献仍然很少。因此，我们采用一种新颖的话语方法来探索即将毕业的学生和在职临床医生如何在跨专业学生-临床医生（IPSC）互动叙述中构建自己和他人的身份。
我们对 38 名学生和 23 名代表医学、助产、护理、职业治疗、护理人员和物理治疗领域的临床医生进行了定性叙事访谈研究。通过框架分析，我们在 208 个 IPSC 互动叙述中确定了学生和临床医生身份构建的广度，并探讨了常见的叙述和叙述者的构建有何不同。通过深入的定位分析，我们探讨了学生和临床医生的身份如何在两个选定的 IPSC 互动叙述中被话语定位。
我们在所有 208 个叙述中确定了 11 种常见的学生身份构建和 8 种常见的临床医生身份构建。我们发现，在积极评价和消极评价的叙述中，以及在学生和临床医生叙述者中，身份构建存在差异，突出了叙述的修辞性质。我们对两个叙述的深入定位分析说明了一个学生和一个临床医生在跨专业互动中如何话语定位自己和他人的身份，以及身份如何因叙述者对其故事的评价而有所不同。尽管两个定位分析都说明了叙述者的语言如何再现专业冲突的共同社会话语，但临床医生的叙述也借鉴了专业合作的竞争话语。
尽管一些身份支持以前的单专业研究，但我们的研究结果表明，在跨专业背景下，学生和临床医生的身份更加广泛和深入。我们鼓励教育工作者将身份课程纳入学生和临床医生现有的工作场所学习中，以帮助他们理解自己正在发展的专业和跨专业身份。工作场所教育者应促进有意义的 IPSC 互动，以促进跨专业学习和合作。
