Exploring the Meaning of Respect in Medical Student Education: an Analysis of Student Narratives
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Respect for others is recognized in the medical literature and society as an essential attribute of the good medical professional. However, the specific meaning of respect varies widely and is underexplored as a lived experience of physicians-in-training.
To describe third-year medical students’ narratives of respect and disrespect [(dis)respect] during their internal medicine clerkship.
Qualitative thematic analysis of 152 third-year student narratives that ‘taught them something about professionalism,’ focusing on (dis)respect.
Immersion/crystallization narrative analysis.
We reviewed 595 professionalism narratives and found that one in four narratives involved (dis)respect. We then found that 2/3 of these narratives were negative (describing instances of disrespect rather than respect). In the other coded categories, the proportion of negative narratives was significantly lower. In order to better understand these results, we analyzed the content of the (dis)respect narratives and identified six primary themes: (1) content and manner of communication (including, appreciating or belittling, being sensitive or blunt and respecting privacy); (2) conduct: behaviors expressing (dis)respect; (3) patient centeredness: honoring others’ preferences, decisions and needs; (4) treating others as equals; (5) valuing the other and their experience and/or problem; and (6) nurturing students’ learning.
Focusing on the lived experience of (dis)respect on wards broadens the concept of respect beyond any one type of act, behavior or attitude. Students perceive respect as a way of being that applies in all settings (private and public), with all participants (patients, family members, nurses, colleagues and students) and under all circumstances (valuing others’ time, needs, preferences, choices, opinions and privacy). Respect seems to entail responding to a need, while disrespect involves ignoring the need or bluntly violating it.
- Beach, MC, Duggan, PS, Cassel, CK, Geller, G (2007) What does ‘respect’ mean? Exploring the moral obligation of health professionals to respect patients. J Gen Intern Med. 22: pp. 692-5 CrossRef
- Wilkinson, TJ, Wade, WB, Knock, LD (2009) A blueprint to assess professionalism: Results of a systematic review. Acad Med. 84: pp. 551-8 CrossRef
- Inui, TS (2003) A flag in the wind: educating for professionalism in medicine. Association of American Medical Colleges, Washington
- The Accreditation Council for Graduate Medical Education. Available at: http://www.acgme.org/ Accessed July 17, 2010.
- Swick, HM (2000) Toward a normative definition of medical professionalism. Acad Med. 75: pp. 612-6 CrossRef
- Emirbayer, M (1997) Manifesto for a relational sociology. Amer J Soc. 103: pp. 281-317 CrossRef
- Reich W, Schirmer W, editors. A theory of respect. Work in progress, a shortened version of this manuscript will be presented in the American Sociological Association conference; 2009 Aug; San Francisco. http://humiliationstudies.org/documents/SchirmerReichATheoryo%20Respect2009.pdf. Accessed July 17, 2010.
- American Medical Association. Declaration of Professional Responsibility: Medicine’s Social Contract with Humanity. 2001. Available at: http://www.ama-assn.org/ama/upload/mm/369/decofprofessional.pdf. Accessed July 17, 2010.
- Branch, WT (2006) Teaching respect for patients. Acad Med. 81: pp. 463-7 CrossRef
- Beach, MC, Roter, DL, Wang, NY, Duggan, PS, Cooper, LA (2006) Are physicians’ attitudes of respect accurately perceived by patients and associated with more positive communication behaviors?. PEC. 62: pp. 347-54
- Gillon, R (2003) Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”. J Med Ethics. 29: pp. 307-12 CrossRef
- Ainslie, DC (2000) ‘Watching’ medicine: do bioethicists respect patients’ privacy?. Theor Med Bioethics. 21: pp. 537-52 CrossRef
- Association of American Medical Colleges. Compact Between Teachers and Learners of Medicine. Available at: http://www.med.illinois.edu/depts_programs/ClinicalAffairs/Document/Compact%20Between%20teachers%20and%20Learners%20of%20Medicine.pdf Accessed July 17, 2010.
- Baldwin, DC, Daugherty, SR, Eckenfels, EJ (1991) Student perceptions of mistreatment and harassment during medical school—A survey of ten United States schools. West J Med. 155: pp. 140-5
- Langdon, SW (2007) Conceptualizations of respect: Qualitative and quantitative evidence of four (five) themes. The J Psy. 141: pp. 469-84 CrossRef
- Spagnoletti, CL, Arnold, RM (2007) R-E-S-P-E-C-T: Even more difficult to teach than to define. J Gen Intern Med. 22: pp. 707-9 CrossRef
- Sennet, R (2003) Respect: The formation of character in an age of inequality. Penguin, London
- Meitar, D, Karnieli-Miller, O, Eidelman, S (2009) Personal difficulties with breaking bad news and their influence on patterns of communication. Acad Med. 84: pp. 1582-94 CrossRef
- Stern, DM (2006) Measuring Medical Professionalism. Oxford Press, New York
- Lieblich, A, Tuval-Mashiach, R, Zilber, T Between the whole and its parts, between content and structure. In: Kasan, L, Kromer-Nevo, M eds. (2010) Analyzing qualitative data. Ben Gurion University of the Negev press, Beer-Sheva, pp. 21-43
- Crabtree, BF, Miller, WL (1999) Doing Qualitative Research: Research methods for primary care. Sage Publications, Thousand Oaks, CA
- Shwalb, DW, Shwalb, BJ (2006) Research and theory on respect and disrespect: Catching up with the public and practitioners. New Dir Child Adolesc Dev. 114: pp. 1-8 CrossRef
- Wright, EB, Holcombe, C, Salmon, P (2004) Doctors' communication of trust, care, and respect in breast cancer: Qualitative study. BMJ. 328: pp. 864 CrossRef
- Burack, JH, Irby, DM, Carline, JD, Root, RK, Larson, EB (1999) Teaching compassion and respect: Attending physicians’ responses to problematic behaviors. J Gen Intern Med. 14: pp. 49-55 CrossRef
- Exploring the Meaning of Respect in Medical Student Education: an Analysis of Student Narratives
Journal of General Internal Medicine
Volume 25, Issue 12 , pp 1309-1314
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- medical professional
- medical education
- Industry Sectors
- Author Affiliations
- 1. Department of Community Mental Health, University of Haifa, Eshcol building, room 1111, Har HaCarmel, Haifa, 31905, Israel
- 2. Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA
- 3. Indiana University-Purdue University, Indianapolis, IN, USA
- 4. The Regenstrief Institute, Indiana University, Indianapolis, IN, USA
- 5. Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA