Flashcards in Culture, habitus & discourses of Professional Identity Deck (31):
What is professionalism (with regards to doctors)?
The moral contract that exists between a professional and the public; an implicit agreement enabling patients to place their trust in medical professionals during times of often extreme vulnerability, fear and anxiety.
Royal Colleges of Physicians - what is involved? (4)
Define the attitudes, values and behaviours required of the modern doctor and identify how those can be taught, nurtured and learned.
Evaluate the role and evolution of professional regulation and standards.
Examine the changing forces of society and their impact on professionalism.
Develop practical recommendations to highlight the importance of professionalism and embed it's practice within the context of modern medicine.
Professionalism - 'doing it right'. (3)
Internalisation of values and behaviours
Membership of an organisation
Why is professionalism important?
In February 2011, a report into the NHS care of older people revealed ‘‘an attitude which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism’’. We need to change this.
What are the barriers to changing practice? (5)
Issues of identity and the social language in which it is embedded
Power and control
Political processes involving the contestation of ideas and values
Dynamic instability of practices that are new
Structure of medical education experience
The case for change was premised on what three main ideas?
Flexner, ethical erosion, science of learning.
What did Flexner suggest?
Continuity of teachers and the “closeness” of students as they follow their patients, that students should be “close” to reality. Now, patients and students rotate through placements too quickly to be close to anything.
What does ethical erosion mean?
There is a decline in students’ professionalism / humanism as a consequence of current approaches to medical education. Students decline in patient-centredness seems to occur as a consequence of their clinical years and exposure to teachers. Their empathy declined significantly in medical school.
What does science of learning mean in relation to changing practice?
There is no learning theory to suggest that random, dissociated clinical placements, where students are directed by junior clinicians with no pedagogical training, is a good learning environment for students. There is very little evidence that supports the current model of medical education.
What are the professional issues in medical identity formation?
Doctor as diagnostician, symptomatologist & connoisseur - they perceive the limits of patients’ accounts. They have to present certainty on the exterior in order to manage impressions that people might have of them, even if they are uncertain on the interior.
What is the sociocultural view of professional learning?
Learning – practice (learning as doing), community (learning as belonging), identity (learning as becoming), meaning (learning as experience). I.e. developing a sense of professional identity involves working with others in the professional community.
What makes up identification?
Who we think we are (internal) and who we think other people think we are (external)
When does identity development begin?
Early childhood, with the recognition of separate self and separate others. In childhood it is dominated by external factors (who we think other people think we are), with weak internal responses.
What may affect early identity development? (2)
What is habitus?
AN EMBODIED SOCIALISED TENDENCY TO THINK, ACT OR FEEL IN A CERTAIN WAY.
Non-conscious bulk of identity. Unconscious assumptions about the way the world works – usually understood in moral terms. Experience shapes the body & how it is used; gestures, body language, expressions. Means that conscious change is difficult to achieve.
What conflicts are there with professional identity?
May want to embrace professional role and internalise that as an identity, but habitus may make this process challenging. Conflict between chosen professional role and non-conscious identities.
Give three identity metaphors.
Naïve image of self-hood (cake metaphor)
Integrate multiple identities (elephant metaphor)
Least simplistic (room full of furniture)
Explain the cake metaphor.
All one’s identities (roles) are smoothly incorporated into a seamless whole.
Explain the elephant metaphor.
Different people will see us differently although we are unified and coherent entities. Disjunction is in the eye of the beholder.
Explain the room full of furniture metaphor.
Disjunctures between a person’s various identities are not illusions in the eyes of beholder but intrinsic to selfhood in complex societies. Mismatch between religious identity, professional identity, ethnic identity, family identity...
What is meant by identity consonance?
Experience of acquiring a new identity when it blends smoothly with other internalised personal identities.
What is meant by dissonance?
When one’s personal identities are dissonant with the professional role. This may cause students to feel uncertain about values, ambitions, abilities and self-worth.
What is culture?
All that in society which is socially rather than biologically transmitted. Symbolic and learned aspects of society.
At what three levels does analysis of cultural anthropology take place?
-Learned patterns of behaviour
-Aspects of culture that are below conscious levels – speech, gestures
-Patterns of thought and behaviour
What is 'cultural capital'?
Symbols, ideas, tastes, preferences that can be strategically used as resources in social action.
What is the medical role/identity?
Medical skills & knowledge
Curing people & helping them
Do not make mistakes
Discernment about appropriate treatment
Respect = skill
Commitment to finish, succeed
What are the three basic types of uncertainty in medical students on first clinical year?
-Acknowledging the limitations in current medical school
-Students’ incomplete or imperfect mastery of available knowledge
-Difficulty in distinguishing between personal ignorance or ineptitude and the limitations of present medical knowledge
How does tolerance for uncertainty develop?
Facing the inexactness of medicine
Coping with responsibility
Tolerating oneself as incomplete
Accepting oneself as a good-enough doctor-to-be
What is the social accountability framework for health workforce training? (4)
Section 1 – what needs are we addressing?
Section 2 – How do we work?
Section 3 – What do we do?
Section 4 – What difference do we make?
Name some confounders for attempts to narrow health inequalities.
• increased burden of ill health
• poorer access
• less time available for patients to discuss their problems
• higher GP stress
• lower patient enablement