Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
Med Humanit. 2023 Dec 19;49(4):613-622. doi: 10.1136/medhum-2022-012520.
What constitutes a 'good doctor' varies widely across groups and contexts. While patients prioritise communication and empathy, physicians emphasise medical expertise, and medical students describe a combination of the two as professional ideals. We explored the conceptions of the 'good doctor' held by medical learners with chronic illnesses or disabilities who self-identify as patients to understand how their learning as both patients and future physicians aligns with existing medical school curricula. We conducted 10 semistructured interviews with medical students with self-reported chronic illness or disability and who self-identified as patients. We used critical discourse analysis to code for dimensions of the 'good doctor'. In turn, using concepts of Bakhtinian intersubjectivity and the hidden curriculum we explored how these discourses related to student experiences with formal and informal curricular content.According to participants, dimensions of the 'good doctor' included empathy, communication, attention to illness impact and boundary-setting to separate self from patients. Students reported that formal teaching on empathy and illness impact were present in the formal curriculum, however ultimately devalued through day-to-day interactions with faculty and peers. Importantly, teaching on boundary-setting was absent from the formal curriculum, however participants independently developed reflective practices to cultivate these skills. Moreover, we identified two operating discourses of the 'good doctor': an institutionalised discourse of the 'able doctor' and a counterdiscourse of the 'doctor with lived experience' which created a space for reframing experiences with illness and disability as a source of expertise rather than a source of stigma. Perspectives on the 'good doctor' carry important implications for how we define professional roles, and hold profound consequences for medical school admissions, curricular teaching and licensure. Medical students with lived experiences of illness and disability offer critical insights about curricular messages of the 'good doctor' based on their experiences as patients, providing important considerations for curriculum and faculty development.
什么样的医生才是“好医生”，不同群体和文化背景的人有不同的看法。患者通常看重医生的沟通能力和同理心，而医生则强调医学专业知识，医学生则将两者结合起来，认为这是专业理想。我们探讨了有慢性病或残疾且自认为是患者的医学学习者对“好医生”的概念，以了解他们作为患者和未来医生的学习与现有的医学院课程之间的一致性。我们对 10 名自报患有慢性病或残疾且自认为是患者的医学生进行了半结构化访谈。我们使用批判性话语分析对“好医生”的维度进行了编码。反过来，我们使用巴赫金的主体间性和隐性课程的概念，探讨了这些话语与学生对正式和非正式课程内容的体验之间的关系。
根据参与者的说法，“好医生”的维度包括同理心、沟通、关注疾病的影响以及设定边界以将自己与患者分开。学生们报告说，同理心和疾病影响的正式教学在正式课程中存在，但通过与教师和同学的日常互动，这些教学最终被贬低了。重要的是，边界设定的教学在正式课程中是缺失的，但参与者独立地发展了反思实践来培养这些技能。此外，我们确定了“好医生”的两种运作话语：一种是“有能力的医生”的制度化话语，另一种是“有亲身经历的医生”的反话语，这为重新定义疾病和残疾经历作为专业知识的来源而不是耻辱的来源创造了空间。对“好医生”的看法对我们如何定义专业角色具有重要意义，并对医学院招生、课程教学和执照颁发产生深远影响。有疾病和残疾亲身经历的医学生提供了有关“好医生”课程信息的重要见解，这些见解基于他们作为患者的经历，为课程和教师发展提供了重要的考虑因素。
