Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Surgery, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Med Educ. 2020 Dec;54(12):1171-1179. doi: 10.1111/medu.14285. Epub 2020 Aug 5.
Practising physicians who remediate their peers face unique challenges. Recent research suggests that leaders of regulatory and educational institutions (ie, those who might be seen as responsible for overseeing remediation programmes for practising physicians) view remediation as a duality: education and regulation. Research has yet to study the perspectives of remediators; therefore, to address that gap we asked: What is the nature of remediation as experienced by remediators?
We used a theory-informing inductive data analysis study design with positioning theory as a sensitising concept. We interviewed nine remediators from five Canadian provinces, asking them to narrate particularly memorable remediation experiences, then exploring the stories in more depth by asking probing questions around topics related to the research question. We used a hermeneutic analytic approach to explore the meanings that participants gave to their remediation work by iteratively reading their stories, examining the sense making that participants achieved through these narratives, and identifying the positions and responsibilities they described.
In their remediation narratives, participants variably position themselves in three different ways: (a) educator; (b) judge, and (c) public defender. For each position, remediators in turn framed the remediatee in a particular way. Participants shifted between educator, judge and public defender in response to evolving experiences with the remediatee, but they expressed preference for the educator position. However, they sometimes encountered serious obstacles to enacting that educator position. Those obstacles were imposed both by regulators and by remediatees.
This study suggests that the duality of remediation as both education and regulation may be contributing to the challenges faced by those working one to one with remediatees. Understanding the dual nature of remediation and equipping remediators with the tools to manage this duality might contribute to improving the experience for both remediators and remediatees, and ultimately to a greater number of successful remediation outcomes.
对同行进行补救的执业医师面临着独特的挑战。最近的研究表明，监管和教育机构的领导者（即那些可能被视为负责监督执业医师补救计划的人）将补救视为教育和监管的双重性。研究尚未研究补救者的观点；因此，为了弥补这一差距，我们提出了以下问题：补救者所经历的补救的本质是什么？
我们使用了一种理论指导的归纳数据分析研究设计，并将定位理论作为一个敏感概念。我们采访了来自加拿大五个省份的九名补救者，要求他们讲述特别难忘的补救经历，然后通过围绕与研究问题相关的主题提出探究性问题，更深入地探讨这些故事。我们使用解释学分析方法，通过迭代阅读参与者的故事，检查参与者通过这些叙述实现的意义建构，并确定他们描述的立场和责任，来探索参与者赋予其补救工作的意义。
在他们的补救叙述中，参与者以三种不同的方式定位自己：（a）教育者；（b）法官；（c）公设辩护人。对于每个职位，补救者依次以特定的方式构建补救对象。参与者根据与补救对象的不断变化的经验在教育者、法官和公设辩护人之间转换，但他们表示更喜欢教育者的立场。然而，他们有时会遇到实施该教育者立场的严重障碍。这些障碍既来自监管者，也来自补救者。
本研究表明，补救既是教育又是监管的双重性可能是那些与补救对象一对一合作的人面临的挑战的原因。了解补救的双重性质，并为补救者提供管理这种双重性的工具，可能有助于改善补救者和补救对象的体验，并最终提高更多成功的补救结果。
