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‘Of Course They’re Bloody Scared!’ Managing Medical Student Fear to Better Cultivate Thinking

Abstract

Background

One aim of medical education is to cultivate student thinking, and specific methods have been developed, implemented, and evaluated for doing this. However, doing so is not as straightforward as simply employing these methods.

Methods

In a wider year-long participatory action research study about developing student thinking, we interviewed, observed, and video-recorded six medical teacher-participants. Participants also filled out reflective journals and regularly discussed practices as a group.

Results

We found that teaching methods customarily used to develop student thinking (e.g. reflective thinking, clinical reasoning) sometimes failed. This failure was because students experienced fear as a result of such methods, such as fear of looking stupid in a discussion. Our teacher-participants went on to develop very specific methods for identifying and mitigating fears and better cultivating students’ thinking. They (1) got to know students and understand what they were afraid of, (2) mitigated student fear by talking regularly and ‘normalising’ fear in learning for them, (3) modified teaching methods to make students feel less scared and (4) demonstrated ‘care’ for their students, a value which could increase students’ confidence and help them mitigate fears for themselves.

Recommendations and Summary

We suggest teachers to (1) create opportunities to learn about their students, (2) regularly discuss with their students how fear can be normal in learning, (3) adjust teaching methods to mitigate fear and (4) care and show their care for their students. We also suggest that medical teachers could benefit from staff development about the phenomenon of potential student fear and recommend the pursuit of a better understanding of how ‘caring’ might be identified, nurtured in teachers and usefully expressed in practice.

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References

  1. Paterson R. The good doctor: what patients want. Auckland: Auckland University Press; 2013.

    Google Scholar 

  2. Cooke M, Irby D, O’Brien B. Educating physicians: a call for reform of medical school and residency. San Francisco: Jossey Bass; 2010.

    Google Scholar 

  3. Wilson H, Cunningham W. Being a doctor: understanding medical practice. Dunedin: Otago University Press; 2013.

    Google Scholar 

  4. Loftus S. Rethinking clinical reasoning: time for a dialogical turn. Med Ed. 2012;46(12):1174–8. https://doi.org/10.1111/j.1365-2923.2012.04353.x.

    Article  Google Scholar 

  5. Schön D. The reflective practitioner: how professionals think in action. London: Basic Books; 1983.

    Google Scholar 

  6. Monteiro S, Norman G. Diagnostic reasoning: where we’ve been, where we’re going. Teach Learn Med. 2013;25(sup1):S26–32. https://doi.org/10.1080/10401334.2013.842911.

    Article  Google Scholar 

  7. Biggs J, Tang C. Teaching for quality learning at university. Maidenhead: McGraw-Hill & Open University Press; 2011.

    Google Scholar 

  8. Brookfield S, Preskill S. Discussion as a way of teaching. Buckingham: SRHE & OUP; 1999.

    Google Scholar 

  9. Browne M, Freeman K. Distinguishing features of critical thinking classrooms. Teach High Educ. 2000;5(3):302–9.

    Article  Google Scholar 

  10. McCarthy C, McEvoy J. Pimping in medical education: lacking evidence and under threat. JAMA. 2015;314(22):2347–8. https://doi.org/10.1001/jama.2015.13570.

    Article  Google Scholar 

  11. Howe A, Smajdor A, Stockl A. Towards an understanding of resilience and its relevance to medical training. Med Educ. 2012;46(4):349–56. https://doi.org/10.1111/j.1365-2923.2011.04188.x.

    Article  Google Scholar 

  12. Kaufman D, Mensink D, Day V. Stressors in medical school: relation to curriculum format and year of study. Teach Learn Med. 1998;10(3):138–44. https://doi.org/10.1207/S15328015TLM1003_3.

    Article  Google Scholar 

  13. Niemi P, Vainiomäki P. Medical students’ academic distress, coping, and achievement strategies during the preclinical years. Teach Learn Med. 1999;11(3):125–34. https://doi.org/10.1207/S15328015TL110302.

    Article  Google Scholar 

  14. Saravanan C, Wilks R. Medical students’ experience of and reaction to stress: the role of depression and anxiety. Sci World J. 2014;2014:1–9. https://doi.org/10.1155/2014/737382.

    Article  Google Scholar 

  15. Radcliffe C, Lester H. Perceived stress during undergraduate medical training: a qualitative study. Med Educ. 2003;37(1):32–8. https://doi.org/10.1046/j.1365-2923.2003.01405.x.

    Article  Google Scholar 

  16. Herr K, Anderson G. The action research dissertation: a guide for students and faculty. California: Sage; 2005. https://doi.org/10.4135/9781452226644.

    Book  Google Scholar 

  17. Kagan N, Schauble P, Resnikoff A, Danish S, Krathwohl D. Interpersonal process recall. J Nerv Ment Dis. 1969;148(4):365–74. https://doi.org/10.1097/00005053-196904000-00004.

    Article  Google Scholar 

  18. Thomas D. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27(2):237–46. https://doi.org/10.1177/1098214005283748.

    Article  Google Scholar 

  19. Conrad C. Grounded theory: an alternative approach to research in higher education. Rev High Educ. 1982;5(4):239–49. https://doi.org/10.1353/rhe.1982.0010.

    Article  Google Scholar 

  20. Carter S, Little M. Justifying knowledge, justifying method, taking action: epistemologies, methodologies and methods in qualitative research. Qual Health Res. 2007;17(10):1316–28. https://doi.org/10.1177/1049732307306927.

    Article  Google Scholar 

  21. Kost A, Chen F. Socrates was not a pimp: changing the paradigm of questioning in medical education. Acad Med. 2015;90(1):20–4. https://doi.org/10.1097/ACM.0000000000000446.

    Article  Google Scholar 

  22. Hafferty F. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73(4):403–7. https://doi.org/10.1097/00001888-199804000-00013.

    Article  Google Scholar 

  23. Moridi G, Khaledi S, Valiee S. Clinical training stress-inducing factors from the students' viewpoint: a questionnaire-based study. Nurse Ed Pract. 2014;14(2):160–3. https://doi.org/10.1016/j.nepr.2013.08.001.

    Article  Google Scholar 

  24. Lazaras R, Folkman S. Stress, appraisal and coping. New York: Springer; 1984.

    Google Scholar 

  25. Seaward B. Managing stress: principles and strategies for health and wellbeing. Jones and Barlett: Boston; 2004.

    Google Scholar 

  26. Martin A, Marsh H. Academic buoyancy: towards an understanding of students' everyday academic resilience. J Sch Psychol. 2008;46(1):53–83. https://doi.org/10.1016/j.jsp.2007.01.002.

    Article  Google Scholar 

  27. Berryman E. Bullying culture: valuing the teacher-student relationship. New Zealand. Med J. 2015;128(1424):13–7.

    Google Scholar 

  28. Crampton P, Wilkinson T, Anderson L, Walthert S, Wilson H. Bullying in health care settings: time for a whole-of-system response. New Zealand. Med J. 2015;28(1424):10–2.

    Google Scholar 

  29. Tiberius R. Small group teaching: a trouble-shooting guide. London: Routledge; 2013.

    Google Scholar 

  30. Ritchhart R, Perkins D. Learning to think: the challenges of teaching thinking. The Cambridge handbook of thinking and reasoning. 2005; 775–802.

  31. Palmer P. The courage to teach: exploring the inner landscape of a teacher’s life. Hoboken: John Wiley & Sons; 2010.

    Google Scholar 

  32. Burbules N. Tacit teaching. Educ Philos Theory. 2008;40(5):666–77. https://doi.org/10.1111/j.1469-5812.2008.00453.x.

    Article  Google Scholar 

  33. Taylor E, Tisdell E, Gusic M. Teaching beliefs of medical educators: perspectives on clinical teaching in pediatrics. Med Teach. 2007;29(4):371–6. https://doi.org/10.1080/01421590701510553.

    Article  Google Scholar 

  34. Golding C. Educating for critical thinking: thought encouraging questions in a community of inquiry. High Ed Res Dev. 2011;30(3):357–79.

    Article  Google Scholar 

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Correspondence to Althea Gamble Blakey.

Ethics declarations

This research, in its entirety, was granted approval by the University of Otago (Dunedin, New Zealand) Human Ethics Committee

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Gamble Blakey, A., Golding, C. ‘Of Course They’re Bloody Scared!’ Managing Medical Student Fear to Better Cultivate Thinking. Med.Sci.Educ. 28, 165–173 (2018). https://doi.org/10.1007/s40670-017-0524-z

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Keywords

  • Small group teaching
  • Undergraduate medical teaching
  • Group process
  • Fear
  • Anxiety
  • Medical teaching
  • Student engagement
  • Values
  • Caring
  • Staff development
  • Medical teacher recruitment and selection