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Medical students' experiences with goals of care discussions and their impact on professional identity formation.
Wang, Xuyi Mimi; Swinton, Marilyn; You, John J.
Afiliação
  • Wang XM; Division of Geriatric Medicine Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Swinton M; Centre for Healthy Aging, St Peter's Hospital, Hamilton, Ontario, Canada.
  • You JJ; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Med Educ ; 53(12): 1230-1242, 2019 12.
Article em En | MEDLINE | ID: mdl-31750573
CONTEXT: Goals of care (GoC) discussions occur amongst patients, family members and clinicians in order to establish plans of care and are invaluable aspects of end-of-life care. In previous research, medical learners have reported insufficient training and emotional distress about end-of-life decision making, but most studies have focused on postgraduate trainees and have been quantitative or have evaluated specific educational interventions. None have qualitatively explored medical students' experiences with GoC discussions, their perceptions of associated hidden curricula, and the impacts of these on professional identity formation (PIF), the individualised developmental processes by which laypersons evolve to think, act and feel like, and ultimately become, medical professionals. METHODS: Using purposive sampling at one Canadian medical school, individual semi-structured interviews were conducted with 18 medical students to explore their experiences with GoC discussions during their core internal medicine clerkship. Interviews were audiorecorded, transcribed and anonymised. Concurrently with data collection, transcripts were analysed iteratively and inductively using interpretative phenomenological analysis, a qualitative research approach that allows the rich exploration of subjective experiences. RESULTS: Participants reported minimal support and supervision in conducting GoC discussions, which were experienced as ethically challenging, emotionally powerful encounters exemplifying tensions between formal and hidden curricula. Role modelling and institutional culture were key mechanisms through which hidden curricula were transmitted, subverting formal curricula in doing so and contributing to participants' emotional distress. Participants' coping responses were generally negative and included symptoms of burnout, the pursuit of standardisation, rationalisation, compartmentalisation and the adaptation of previously held, more idealised professional identities. CONCLUSIONS: GoC discussions in this study were often led by inexperienced medical students and impacted negatively on their PIF. Through complex emotional processes, they struggled to reconcile earlier concepts of physician identities with newly developing ones and often reluctantly adopted suboptimal professional behaviours and attitudes. Improved education about GoC discussions is necessary for patient care and may represent concrete and specific opportunities to influence students' PIF positively.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Planejamento de Assistência ao Paciente / Estudantes de Medicina / Assistência Terminal / Profissionalismo Tipo de estudo: Prognostic_studies / Qualitative_research Limite: Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Med Educ Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Canadá

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Planejamento de Assistência ao Paciente / Estudantes de Medicina / Assistência Terminal / Profissionalismo Tipo de estudo: Prognostic_studies / Qualitative_research Limite: Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Med Educ Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Canadá