Educational Innovation Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
Teach Learn Med. 2021 Apr-May;33(2):164-172. doi: 10.1080/10401334.2020.1813583. Epub 2020 Oct 8.
The link between ownership of patient care and professional identity formation (PIF) has not been formally established, yet PIF researchers frequently cite clinical experiences as powerful contributions to PIF. Using clinical simulation, this study aimed to explore the relationship between patient care ownership and the cognitive processes involved in the creation of a professional identity. In 2018-2019, 189 third-year students participated in a simulation in which they were placed in the role of a physician treating a patient in respiratory distress. Data were collected from 12 focus groups ( = 84; 44% of the third-year class), each lasting 15-25 minute. Students were asked four questions designed to identify moments when they felt like a physician and experienced feelings of ownership. Each focus group was transcribed and analyzed for the presence of known elements that contribute to feelings of psychological ownership, and then inductively for how students related their feelings of ownership to their professional identity. When students were asked to take ownership of their patient's care, they underwent a three-step process: (1) experiencing disorientation, (2) reconceptualizing roles and responsibilities, and (3) reorientation to professional goals. Patient care ownership was disorienting because it marked a departure from the clinical roles the students had previously experienced. While disoriented, students engaged in a process of reflection during which they asked themselves who they were, who they were becoming, and who they needed to become to effectively serve in the role of a physician. This process prompted students to realize the limitations of their clinical reasoning abilities and that the role of a physician requires new ways of thinking. This study advances a conceptual model of PIF that identifies patient care ownership as a in developing a professional identity. Assuming responsibility for patients places students into an unfamiliar role, which opens a channel for students to access new perspectives in their development as physicians.
患者护理所有权与专业身份形成（PIF）之间的联系尚未得到正式确立，但 PIF 研究人员经常将临床经验作为对 PIF 的有力贡献。本研究使用临床模拟来探索患者护理所有权与创建专业身份所涉及的认知过程之间的关系。在 2018-2019 年，189 名三年级学生参加了一项模拟，在模拟中他们扮演一名治疗呼吸窘迫患者的医生。从 12 个焦点小组（ = 84；三年级班级的 44%）收集数据，每个小组持续 15-25 分钟。学生被问到四个问题，旨在确定他们觉得自己像医生并体验到所有权的时刻。每个焦点小组的转录内容都经过分析，以确定哪些元素有助于产生心理所有权，然后根据学生如何将他们的所有权感与其专业身份联系起来进行归纳。当学生被要求对自己患者的护理负责时，他们经历了一个三步骤过程：（1）感到迷失方向，（2）重新构想角色和责任，（3）重新定位到专业目标。患者护理所有权令人迷失方向，因为它标志着与学生之前经历的临床角色的背离。在迷失方向的同时，学生进行了反思过程，在此过程中他们问自己是谁，他们正在成为谁，以及他们需要成为谁才能有效地担任医生的角色。这个过程促使学生意识到自己临床推理能力的局限性，以及医生的角色需要新的思维方式。本研究提出了一个 PIF 的概念模型，该模型将患者护理所有权视为形成专业身份的一个转折点。对患者负责将学生置于一个不熟悉的角色中，这为学生在发展为医生的过程中提供了获取新视角的渠道。
