Castanelli Damian J, Molloy Elizabeth, Bearman Margaret
School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
Department of Anaesthesia & Perioperative Medicine, Monash Health, Clayton, VIC, Australia.
Adv Health Sci Educ Theory Pract. 2025 Jun;30(3):815-830. doi: 10.1007/s10459-024-10382-8. Epub 2024 Oct 16.
The stigma of underperformance is widely acknowledged but seldom explored. 'Failure to fail' is a perennial problem in health professions education, and learner remediation continues to tax supervisors. In this study, we draw on Goffman's seminal work on stigma to explore supervisors' accounts of judging performance and managing remediation in specialty anesthesia training in Australia and New Zealand. In doing so, we focus on what Goffman calls a "stigma theory" to explain the supervisors' reported practices. We performed a secondary analysis of nineteen interviews originally gathered using purposive sampling to explore how assessment decisions were made. We conducted a theory-informed thematic analysis of the supervisors' accounts to identify signifiers of stigma and underlying structures and beliefs. From both deductive and inductive analysis, we developed themes that demonstrate how the stigma of underperformance influences and is induced by supervisors' reticence to discuss underperformance, their desire to conceal remediation, and their differential treatment of trainees. We also found that accounts of trainees 'lacking insight' resembled stigma-induced stereotyping. We argue from our data that our cultural expectations of perfectionism propagate a stigma that undermines our efforts to remediate underperformance and that our remediation practices inadvertently induce stigma. We suggest that a multifaceted approach using both individual and collective action is necessary to change both culture and practice and encourage the normalisation of remediation.
表现不佳的污名化现象虽广为人知，但很少有人深入探究。“无法失败”是卫生专业教育中长期存在的问题，对学习者的补救工作也一直让督导人员倍感压力。在本研究中，我们借鉴戈夫曼关于污名的开创性著作，探讨澳大利亚和新西兰专科麻醉培训中督导人员对评判表现和管理补救措施的描述。在此过程中，我们聚焦于戈夫曼所称的“污名理论”，以解释督导人员报告的做法。我们对最初采用目的抽样法收集的19次访谈进行了二次分析，以探究评估决策是如何做出的。我们对督导人员的描述进行了基于理论的主题分析，以识别污名的标志以及潜在的结构和信念。通过演绎分析和归纳分析，我们得出了一些主题，这些主题展示了表现不佳的污名是如何影响督导人员不愿讨论表现不佳的情况、他们隐瞒补救措施的愿望以及他们对学员的区别对待，并由此产生的。我们还发现，关于学员“缺乏洞察力”的描述类似于污名导致的刻板印象。我们从数据中推断，我们对完美主义的文化期望传播了一种污名，这种污名破坏了我们补救表现不佳情况的努力，而且我们的补救措施无意中引发了污名。我们建议，需要采取一种包括个人和集体行动的多方面方法来改变文化和实践，并鼓励补救措施的常态化。
