Advances in Health Sciences Education

, Volume 17, Issue 4, pp 585–596 | Cite as

Creating stories to live by: caring and professional identity formation in a longitudinal integrated clerkship

Article

Abstract

Building on other models of longitudinal integrated clerkships (LIC), the University of Alberta developed its Integrated Community Clerkship with guiding principles of continuity of care, preceptor and learning environment. Professionalism is an important theme in medical education. Caring is important in professional identity formation and an ethic of caring is a moral framework for caring. This study explored the development of an ethic of caring in an LIC using empathy, compassion and taking responsibility as descriptors of caring. Through a hermeneutic phenomenological study, the authors focused on students’ accounts of being with patients. Following an iterative process of successive analyses and explorations of the relevant literature, sensitizing concepts related to physician identity, and an ethic of caring were used to make sense of these accounts following the principles of constructivist grounded theory methodology. Continuity afforded by the LIC results in a safe environment in which students can meaningfully engage with patients and take responsibility for their care under the supervision of a physician teacher. Together these attributes foster an emerging physician identity born at the site of patient-student interaction and grounded in an ethic of caring. A medical student’s evolving professional identity in the clerkship includes the emergence of an ethic of caring. Student accounts of being with patients demonstrate that the LIC at the University of Alberta affords opportunities for students be receptive to and responsible for their patients. This ethic of caring is part of an emerging physician identity for the study participants.

Keywords

Caring Clerkship Professionalism Undergraduate medical education Professional identity formation 

Notes

Acknowledgments

Thank you to Dr. Carol Hodgson, Gilbert Chair, Medical Education Research, Faculty of Medicine and Dentistry, University of Alberta and Marie Cave, Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta for reviewing the manuscript.

References

  1. Bleakley, A. (2005). Stories as data, data as stories: Making sense of narrative inquiry in clinical education. Medical Education, 39, 534–540.CrossRefGoogle Scholar
  2. Bleakley, A., & Bligh, J. (2008). Students learning from patients: Let’s get real in medical education. Advances in Health Sciences Education, 13, 89–107.CrossRefGoogle Scholar
  3. Bleakley, A., Bligh, J., & Browne, J. (2011). Medical education for the future: Identity, power and location. New York, NY: Springer.CrossRefGoogle Scholar
  4. Branch, W. T., Jr. (2000). The ethics of caring and medical education. Academic Medicine, 75(2), 127–132.CrossRefGoogle Scholar
  5. Brody, H. (2003). Stories of sickness (2nd ed.). Oxford: Oxford University Press.Google Scholar
  6. Bunniss, S., & Kelly, D. R. (2010). Research paradigms in medical education research. Medical Education, 44(4), 358–366.CrossRefGoogle Scholar
  7. Charmaz, K. (2000). Grounded theory: Objectivist and contructivist methods. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (2nd ed., pp. 509–536). Thousand Oaks, CA: Sage.Google Scholar
  8. Clandinin, D. J., & Cave, M. T. (2008). Creating pedagogical spaces for developing doctor professional identity. Medical Education, 42(8), 765–770.CrossRefGoogle Scholar
  9. Clouder, L. (2005). Caring as a ‘threshold concept’: Transforming students in higher education into health (care) professionals. Teaching in Higher Education, 10(4), 505–517.CrossRefGoogle Scholar
  10. Cooke, M., Irby, D. M., & O’Brien, B. C. (2010). Educating physicians: A call for reform of medical school and residency. San Francisco, CA: Jossey-Bass.Google Scholar
  11. Erikson, E. H. (1958). Young man Luther. New York, NY: Norton.Google Scholar
  12. Erikson, E. H. (1963). Childhood and society. New York, NY: Norton.Google Scholar
  13. Gee, J. P. (2000). Identity as an analytic lens for research in education. In Review of Educational Research v25 (2000–2001) (pp. 99–125). AERA. Last accessed on 26 January 2011 at: Accessed online at http://www.jstor.org/stable/1167322.
  14. Gilligan, C. (1982). In a different voice. Cambridge, MA: Harvard University Press.Google Scholar
  15. Health Canada. (2001). Social accountability: A vision for Canadian Medical Schools. Ottawa: Health Canada. Downloaded on 1 October 2011 at: www.afmc.ca/pdf/pdf_sa_vision_canadian_medical_schools_en.pdf.
  16. Held, V. (2006a). The ethics of care: Personal, political, and global. Oxford: Oxford University Press.Google Scholar
  17. Held, V. (2006b). The ethics of care. In D. Copp (Ed.), The Oxford handbook of ethical theory (pp. 537–566). Oxford: Oxford University Press.Google Scholar
  18. Hirsh, D. A., Ogur, B., Thibault, G. E., & Cox, M. (2007). “Continuity” as an organizing principle for clinical education reform. New England Journal of Medicine, 356, 858–866.CrossRefGoogle Scholar
  19. Jaye, C., Egan, T., Parker, S. (2006). ‘Do as I say, not as I do’: Medical education and Foucault’s normalizing technologies of self. Anthropology & Medicine, 13(2), 141–155.CrossRefGoogle Scholar
  20. Kennedy, T. J. T., & Lindgard, L. A. (2006). Making sense of grounded theory in medical education. Medical Education, 40, 101–108.CrossRefGoogle Scholar
  21. Koro-Ljungberg, M., Yendol-Hoppey, D., Smith, J. J., & Hayes, S. B. (2009). Educational Researcher, 38, 687687.Google Scholar
  22. Mattingly, C. (2000). Emergent narratives. In C. Mattingly & L. C. Garro (Eds.), Narrative and the cultural construction of illness and healing (pp. 181–211). Berkeley, CA: University of California Press.Google Scholar
  23. Monrouxe, L. (2009). Negotiating professional identities: Dominant and contesting narratives in medical students’ longitudinal audio diaries. Current Narratives, 1, 41–59. Last accessed on 10 October 2011 at: http://ro.uow.edu.au/currentnarratives/vol1/iss1/.
  24. Monrouxe, L. (2010). Identity, identification and medical education: Why should we care? Medical Education, 44, 40–49.CrossRefGoogle Scholar
  25. Montgomery, K. (2006). How doctors think: Clinical judgement and the practice of medicine. Oxford: Oxford University Press.Google Scholar
  26. Noddings, N. (1988). An ethic of caring and its implications for instructional arrangements. American Journal of Education, 96(2), 215–230.CrossRefGoogle Scholar
  27. Ogur, B., & Hirsh, D. (2009). Learning through longitudinal patient care—narratives from the Harvard Medical School-Cambridge Integrated Clerkship. Academic Medicine, 84(7), 844–850.CrossRefGoogle Scholar
  28. Ogur, B., Hirsh, D., Krupat, E., & Bor, D. (2007). The Harvard Medical School-Cambridge integrated clerkship: An innovative model of clinical education. Academic Medicine, 82(4), 397–404.CrossRefGoogle Scholar
  29. Poncelet, A., Bokser, S., Calton, B., Hauer, K. E., Kirsch, H., Jones, T., et al. (2011). Development of a longitudinal integrated clerkship at an academic medical center. Medical Education Online, 16, 5939. doi:10.3402/meo.v16i0.5939.CrossRefGoogle Scholar
  30. Rennie, D. (2000). Grounded theory methodology as methodical hermeneutics. Reconciling realism and relativism. Theory Psychol, 10(4), 481–502.CrossRefGoogle Scholar
  31. Stake, Robert. E. (2004). Standards-based and responsive evaluation. Thousand Oaks: Sage.Google Scholar
  32. Tronto, J. C. (1994). Moral boundaries: A political argument for an ethic of care. New York, NY: Routledge.Google Scholar
  33. Tronto, J. C. (2001). An ethic of care. In M. B. Holstein & P. B. Mitzen (Eds.), Ethics in community-based elder care. New York, NY: Springer.Google Scholar
  34. van Manen, M. (1997). Researching lived experience: Human science for an action sensitive pedagogy (2nd ed.). London, Ontario: The University of Western Ontario.Google Scholar
  35. Walters, L., Prideaux, D., Worley, P., Greenhill, J. (2011). Demonstrating the value of longitudinal integrated placements to general practice preceptors. Medical Education, 45, 455–463.CrossRefGoogle Scholar
  36. Worley, P., Esterman, A., & Prideaux, D. (2004). Cohort study of examination performance of undergraduate medical students learning in community settings. BMJ, 328(7433), 207–209.CrossRefGoogle Scholar
  37. Ybema, S., Keenoy, T., Oswick, C., Beverungen, A., Ellis, N., & Sabelis, I. (2009). Articulating identities. Human Relations, 62, 299–319.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Division of Community Engagement, Department of Family Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  2. 2.ICC Program Evaluation, Office of Rural and Regional Health, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada

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