Sibbald Matt, Sheth Urmi, Last Nicole, Keuhl Amy, McPherson Isla, Wojkowski Sarah, Bakker Dorothy, Rowland Paula
Michael G. Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Educational Services, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Med Educ. 2025 Apr;59(4):418-427. doi: 10.1111/medu.15540. Epub 2024 Oct 2.
Health professions training programmes face increasing reports of professionalism lapses, which can delay, or end, trainee progression. How programmes respond to professionalism lapses to facilitate professional identity development has not been clarified. The objective of this study is to identify factors that facilitate and impair transformations around professionalism lapses in health professions training programmes.
We conducted a qualitative study interviewing 5 faculty and 20 trainees with firsthand or secondhand experience with professionalism lapses from a range of health professions training programmes at McMaster University. Using reflexive thematic analysis, we coded verbatim transcripts informed by the lenses of social and transformative learning theories. We constructed themes through iterative and comparative analysis, seeking meaningful variation across professions and triangulating faculty and trainee perspectives.
Four themes were constructed. First, lapses are in the eye of the beholder with personal definitions intersecting with institutional and situation norms. Difficulties exist in recognising and convincing trainees to respond to lapses that are perceived to be minor or subject to interpretation. Second, responses to professionalism lapses occurred within power hierarchies, which impacted how trainees reacted to the remediation process, risked superficial trainee responses to concerns and led to concerns around inequitable treatment in how standards were applied. Third, fostering transformation involves building trainee confidence, agency, trust and engagement. Focused support and advocacy for trainees can empower and promote agency in tackling disorienting lapses. Fourth, perspective shifts involve deep engagement over time, including but not limited to self-reflection, structured discussion and seeking support.
Identifying and addressing professionalism lapses is complex and requires nuanced and contextual exploration of personal, institutional and situational dynamics at play. By fostering environments that promote genuine reflection and dialogue and focus on building trainee confidence, agency, trust and engagement, health professions training programmes can better support trainees in navigating these complex situations and contribute to the broader goal of socialising to a professional culture and practice.
卫生专业培训项目面临着越来越多关于专业精神缺失的报告，这可能会延迟或终止学员的进步。项目如何应对专业精神缺失以促进职业身份发展尚未明确。本研究的目的是确定在卫生专业培训项目中促进和阻碍围绕专业精神缺失进行转变的因素。
我们进行了一项定性研究，采访了5名教员和20名学员，他们来自麦克马斯特大学一系列卫生专业培训项目，有过与专业精神缺失相关的直接或间接经历。我们采用反思性主题分析方法，根据社会和变革性学习理论的视角对逐字记录进行编码。我们通过迭代和比较分析构建主题，寻求不同专业之间有意义的差异，并对教员和学员的观点进行三角验证。
构建了四个主题。首先，旁观者眼中的失误，个人定义与机构和情境规范相互交织。在识别和说服学员应对被认为是轻微或有多种解读的失误方面存在困难。其次，对专业精神缺失的回应发生在权力等级制度中，这影响了学员对补救过程的反应，使学员对相关问题的回应流于表面，并引发了对标准应用中不公平待遇的担忧。第三，促进转变包括建立学员的信心、能动性、信任和参与度。对学员的针对性支持和倡导可以增强其能力，并促进其在应对令人困惑的失误时发挥能动性。第四，视角转变需要长期深入参与，包括但不限于自我反思、结构化讨论和寻求支持。
识别和解决专业精神缺失问题很复杂，需要对个人、机构和情境动态进行细致入微的情境探索。通过营造促进真正反思和对话的环境，并专注于建立学员的信心、能动性、信任和参与度，卫生专业培训项目可以更好地支持学员应对这些复杂情况，并有助于实现融入专业文化和实践这一更广泛的社会化目标。
