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可控燃烧:应对医学教育中放弃专业身份的“森林大火”

Controlled Burn: Managing the "Forest Fire" of Leaving a Professional Identity in Medical Education.

作者信息

McMains Kevin C, Durning Steven J, Meyer Holly S

机构信息

Dr. McMains: Professor, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.

Dr. Durning: Professor, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD; and.

出版信息

J Contin Educ Health Prof. 2025 Apr 1;45(2):78-84. doi: 10.1097/CEH.0000000000000576. Epub 2024 Sep 17.

Abstract

INTRODUCTION

Professional identity formation is central to physicians' identity over their full careers. There is little guidance within military service on how to leave careers as clinician educator faculty in graduate medical education programs. The objective of our study was to explore how leaving this community of practice (COP) affects a clinician educator's professional identity.

METHODS

We used reflexive thematic analysis with Communities of Practice as a sensitizing construct. Fifteen semi-structured interviews were conducted among active-duty clinician educators at the point of their retirement from the military. Interview questions focused participants' lived experiences as clinician educators and professional identity changes leading to and resulting from the decision to retire.

RESULTS

We found the clinician educators' journey through a time of professional transition led to three connected themes: Loss Precedes Growth, Fallow Season-Liminal Space, and New Growth.

DISCUSSION

The experiences of military clinician educators retiring from active duty demonstrate how leaving one COP emanates across a range of professional identities. In addition, the decision to leave a professional COP can lead to a sense of disloyalty to that community. Normalizing this transition in a way that honors the community's values offers the opportunity to enable the decision to retire. Understanding retirement as a process that first involves identity loss, followed by the discomfort of a liminal space before achieving new growth creates the opportunity to engage in rituals that celebrate the service of departing community members, releasing them to grow into new identities.

摘要

引言

职业身份的形成是医生整个职业生涯身份认同的核心。在军事服务中,对于如何从研究生医学教育项目中的临床教师岗位离职,几乎没有相关指导。我们研究的目的是探讨离开这个实践社区(COP)如何影响临床教师的职业身份。

方法

我们以实践社区为敏感概念,采用反思性主题分析。在现役临床教师从军队退休时,对他们进行了15次半结构化访谈。访谈问题聚焦于参与者作为临床教师的生活经历以及导致退休决定和退休决定所引发的职业身份变化。

结果

我们发现临床教师经历职业转型的过程产生了三个相互关联的主题:成长之前先有失落、休耕期——阈限空间、新的成长。

讨论

从现役退休的军事临床教师的经历表明,离开一个实践社区如何在一系列职业身份中产生影响。此外,离开一个专业实践社区的决定可能会导致对该社区的不忠感。以尊重社区价值观的方式使这种转型正常化,为做出退休决定提供了机会。将退休理解为一个首先涉及身份丧失,接着是阈限空间的不适,然后才实现新成长的过程,创造了参与仪式的机会,以颂扬即将离开的社区成员的服务,让他们能够成长为新的身份。

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