Saracoglu Merve, Inanici Sinem Yildiz, Gulpinar Mehmet Ali
Department of Medical Education, Marmara University Faculty of Medicine, Istanbul, Turkiye.
North Clin Istanb. 2025 Jun 20;12(3):359-371. doi: 10.14744/nci.2024.94210. eCollection 2025.
Understanding the health system and the clinical and learning experiences from the perspective of complexity theory requires a reflective and contextual approach. The context in which experience takes place consists of multidimensional elements that influence each other, such as sociocultural environment, work/educational climate, stakeholders, educational/healthcare system. In this framework, it is important to read and analyze the parties' experiential narratives within their contexts. The aim of this study is to analyze the narratives of the team working in a surgical clinic about their clinical education and healthcare experiences in terms of the "institutional, clinical and national system" as one of the contextual elements in which the experience is lived. In line with this purpose, the research problems were identified as follows: (1) what are the experiences and narratives of the team regarding the system in clinical education and healthcare processes, (2) how do the parties relate to the system, and (3) what are the outcomes of different ways of relating?
This narrative study was conducted in the surgical clinic of a university hospital. The voluntary participant group consisted of 31 participants, including clinical instructors (n=5), surgical residency students (n=5), medical students/interns (n=15) and nurses (n=6) working as a team in the clinic. The narratives obtained through in-depth interviews were analyzed using the "Three-Stage Contextual Theme Analysis" created for this study.
The themes that emerged from the analysis were grouped under three contextual categories: "clinical system: structure, functioning and workload", "clinical environment, climate and culture", "national, social environment and extra challenging situations". The themes related to the consequences of these contextual experiences were grouped under two categories: "ways of coping/not coping" and "consequences/effects".
The contextual dimension of the experience can cause parties to live experiences in their own way and to focus more on their context and not see enough of what others experience. This points to the importance of planning, conducting and evaluating clinical education, research and healthcare processes within their context, including the system.
从复杂性理论的角度理解卫生系统以及临床和学习经历，需要一种反思性的和基于情境的方法。经历发生的情境由相互影响的多维度要素组成，如社会文化环境、工作/教育氛围、利益相关者、教育/卫生保健系统。在此框架下，在其情境中阅读和分析各方的经验叙述非常重要。本研究的目的是从作为经历发生情境要素之一的“机构、临床和国家系统”角度，分析外科诊所团队关于其临床教育和医疗保健经历的叙述。基于此目的，研究问题确定如下：（1）团队在临床教育和医疗保健过程中关于系统的经历和叙述是什么，（2）各方与系统的关系如何，以及（3）不同关系方式的结果是什么？
本叙述性研究在一家大学医院的外科诊所进行。自愿参与组由31名参与者组成，包括临床教员（n = 5）、外科住院医师学生（n = 5）、医学生/实习生（n = 15）以及在诊所团队工作的护士（n = 6）。通过深入访谈获得的叙述采用为本研究创建的“三阶段情境主题分析”进行分析。
分析得出的主题分为三个情境类别：“临床系统：结构、功能和工作量”、“临床环境、氛围和文化”、“国家、社会环境和额外挑战情况”。与这些情境经历后果相关的主题分为两类：“应对/未应对方式”和“后果/影响”。
经历的情境维度可能导致各方以自己的方式体验经历，并更多地关注自身情境，而对他人的经历了解不足。这表明在包括系统在内的情境中规划、开展和评估临床教育、研究和医疗保健过程的重要性。
