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.
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References
Bleakley, A. (2005). Stories as data, data as stories: Making sense of narrative inquiry in clinical education. Medical Education, 39, 534–540.
Bleakley, A., & Bligh, J. (2008). Students learning from patients: Let’s get real in medical education. Advances in Health Sciences Education, 13, 89–107.
Bleakley, A., Bligh, J., & Browne, J. (2011). Medical education for the future: Identity, power and location. New York, NY: Springer.
Branch, W. T., Jr. (2000). The ethics of caring and medical education. Academic Medicine, 75(2), 127–132.
Brody, H. (2003). Stories of sickness (2nd ed.). Oxford: Oxford University Press.
Bunniss, S., & Kelly, D. R. (2010). Research paradigms in medical education research. Medical Education, 44(4), 358–366.
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.
Clandinin, D. J., & Cave, M. T. (2008). Creating pedagogical spaces for developing doctor professional identity. Medical Education, 42(8), 765–770.
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.
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.
Erikson, E. H. (1958). Young man Luther. New York, NY: Norton.
Erikson, E. H. (1963). Childhood and society. New York, NY: Norton.
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.
Gilligan, C. (1982). In a different voice. Cambridge, MA: Harvard University Press.
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.
Held, V. (2006a). The ethics of care: Personal, political, and global. Oxford: Oxford University Press.
Held, V. (2006b). The ethics of care. In D. Copp (Ed.), The Oxford handbook of ethical theory (pp. 537–566). Oxford: Oxford University Press.
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.
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.
Kennedy, T. J. T., & Lindgard, L. A. (2006). Making sense of grounded theory in medical education. Medical Education, 40, 101–108.
Koro-Ljungberg, M., Yendol-Hoppey, D., Smith, J. J., & Hayes, S. B. (2009). Educational Researcher, 38, 687687.
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.
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/.
Monrouxe, L. (2010). Identity, identification and medical education: Why should we care? Medical Education, 44, 40–49.
Montgomery, K. (2006). How doctors think: Clinical judgement and the practice of medicine. Oxford: Oxford University Press.
Noddings, N. (1988). An ethic of caring and its implications for instructional arrangements. American Journal of Education, 96(2), 215–230.
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.
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.
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.
Rennie, D. (2000). Grounded theory methodology as methodical hermeneutics. Reconciling realism and relativism. Theory Psychol, 10(4), 481–502.
Stake, Robert. E. (2004). Standards-based and responsive evaluation. Thousand Oaks: Sage.
Tronto, J. C. (1994). Moral boundaries: A political argument for an ethic of care. New York, NY: Routledge.
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.
van Manen, M. (1997). Researching lived experience: Human science for an action sensitive pedagogy (2nd ed.). London, Ontario: The University of Western Ontario.
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.
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.
Ybema, S., Keenoy, T., Oswick, C., Beverungen, A., Ellis, N., & Sabelis, I. (2009). Articulating identities. Human Relations, 62, 299–319.
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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.
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Konkin, J., Suddards, C. Creating stories to live by: caring and professional identity formation in a longitudinal integrated clerkship. Adv in Health Sci Educ 17, 585–596 (2012). https://doi.org/10.1007/s10459-011-9335-y
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DOI: https://doi.org/10.1007/s10459-011-9335-y