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Exploring the Meaning of Respect in Medical Student Education: an Analysis of Student Narratives

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ABSTRACT

BACKGROUND

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.

OBJECTIVE

To describe third-year medical students’ narratives of respect and disrespect [(dis)respect] during their internal medicine clerkship.

DESIGN

Qualitative thematic analysis of 152 third-year student narratives that ‘taught them something about professionalism,’ focusing on (dis)respect.

APPROACH

Immersion/crystallization narrative analysis.

RESULTS

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.

CONCLUSIONS

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.

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References

  1. Beach MC, Duggan PS, Cassel CK, Geller G. What does ‘respect’ mean? Exploring the moral obligation of health professionals to respect patients. J Gen Intern Med. 2007;22:692–5.

    Article  PubMed  Google Scholar 

  2. Wilkinson TJ, Wade WB, Knock LD. A blueprint to assess professionalism: Results of a systematic review. Acad Med. 2009;84:551–8.

    Article  PubMed  Google Scholar 

  3. Inui TS. A flag in the wind: educating for professionalism in medicine. Washington: Association of American Medical Colleges; 2003.

    Google Scholar 

  4. The Accreditation Council for Graduate Medical Education. Available at: http://www.acgme.org/ Accessed July 17, 2010.

  5. Swick HM. Toward a normative definition of medical professionalism. Acad Med. 2000;75:612–6.

    Article  CAS  PubMed  Google Scholar 

  6. Emirbayer M. Manifesto for a relational sociology. Amer J Soc. 1997;103:281–317.

    Article  Google Scholar 

  7. 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.

  8. 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.

  9. Branch WT. Teaching respect for patients. Acad Med. 2006;81:463–7.

    Article  PubMed  Google Scholar 

  10. Beach MC, Roter DL, Wang NY, Duggan PS, Cooper LA. Are physicians’ attitudes of respect accurately perceived by patients and associated with more positive communication behaviors? PEC. 2006;62:347–54.

    Google Scholar 

  11. Gillon R. Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”. J Med Ethics. 2003;29:307–12.

    Article  CAS  PubMed  Google Scholar 

  12. Ainslie DC. ‘Watching’ medicine: do bioethicists respect patients’ privacy? Theor Med Bioethics. 2000;21:537–52.

    Article  CAS  Google Scholar 

  13. 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.

  14. Baldwin DC Jr, Daugherty SR, Eckenfels EJ. Student perceptions of mistreatment and harassment during medical school—A survey of ten United States schools. West J Med. 1991;155:140–5.

    PubMed  Google Scholar 

  15. Langdon SW. Conceptualizations of respect: Qualitative and quantitative evidence of four (five) themes. The J Psy. 2007;141:469–84.

    Article  Google Scholar 

  16. Spagnoletti CL, Arnold RM. R-E-S-P-E-C-T: Even more difficult to teach than to define. J Gen Intern Med. 2007;22:707–9.

    Article  PubMed  Google Scholar 

  17. Sennet R. Respect: The formation of character in an age of inequality. London: Penguin; 2003.

    Google Scholar 

  18. Meitar D, Karnieli-Miller O, Eidelman S. Personal difficulties with breaking bad news and their influence on patterns of communication. Acad Med. 2009;84:1582–94.

    Article  PubMed  Google Scholar 

  19. Stern DM. Measuring Medical Professionalism. New York: Oxford Press; 2006.

    Google Scholar 

  20. Lieblich A, Tuval-Mashiach R, Zilber T. Between the whole and its parts, between content and structure. In: Kasan L, Kromer-Nevo M, eds. Analyzing qualitative data. Beer-Sheva: Ben Gurion University of the Negev press; 2010:21–43.

    Google Scholar 

  21. Crabtree BF, Miller WL. Doing Qualitative Research: Research methods for primary care. Thousand Oaks, CA: Sage Publications; 1999:179–94.

    Google Scholar 

  22. Shwalb DW, Shwalb BJ. Research and theory on respect and disrespect: Catching up with the public and practitioners. New Dir Child Adolesc Dev. 2006;114:1–8.

    Article  PubMed  Google Scholar 

  23. Wright EB, Holcombe C, Salmon P. Doctors' communication of trust, care, and respect in breast cancer: Qualitative study. BMJ. 2004;328:864.

    Article  PubMed  Google Scholar 

  24. Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion and respect: Attending physicians’ responses to problematic behaviors. J Gen Intern Med. 1999;14:49–55.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

None.

Funding

Dr Karnieli-Miller is supported by a grant from Indiana University School of Medicine for studying and writing about professionalism.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Community Mental Health, University of Haifa, Eshcol building, room 1111, Har HaCarmel, Haifa, 31905, Israel

    Orit Karnieli-Miller PhD

  2. Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA

    Orit Karnieli-Miller PhD, Ann H. Cottingham MAR, MA, Thomas S. Inui ScM, MD, T. Robert Vu MD & Richard M. Frankel PhD

  3. Indiana University-Purdue University, Indianapolis, IN, USA

    Amanda C. Taylor MS

  4. The Regenstrief Institute, Indiana University, Indianapolis, IN, USA

    Thomas S. Inui ScM, MD & Richard M. Frankel PhD

  5. Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA

    T. Robert Vu MD & Richard M. Frankel PhD

Authors
  1. Orit Karnieli-Miller PhD
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  2. Amanda C. Taylor MS
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  3. Ann H. Cottingham MAR, MA
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  4. Thomas S. Inui ScM, MD
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  6. Richard M. Frankel PhD
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Correspondence to Orit Karnieli-Miller PhD.

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Karnieli-Miller, O., Taylor, A.C., Cottingham, A.H. et al. Exploring the Meaning of Respect in Medical Student Education: an Analysis of Student Narratives. J GEN INTERN MED 25, 1309–1314 (2010). https://doi.org/10.1007/s11606-010-1471-1

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  • DOI: https://doi.org/10.1007/s11606-010-1471-1

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