Counternarratives that illuminate faculty agency: A five-year longitudinal qualitative study of physician educators in academic medicine.

PURPOSE: Physician educators are often expected to direct educational programs and assume roles that conform to field norms for career advancement but that may not afford meaningful work for educators. The purpose of this study was to describe and analyse the perspectives and actions taken by physician educators in response to tension between feeling compelled to direct an educational program and doing educationally meaningful work. METHODS AND MATERIALS: We used data from a longitudinal study and focused on three participants who, over the course of the five-year study, offered significant insights into how physician educators act in ways that run counter to expectations for career advancement. Our narrative analysis entailed organizing data from interview transcripts into time-ordered displays, weaving data into counternarratives that were edited by participants, and using the theory of faculty agency (and its key constructs, strategic perspectives and strategic action) to thread the stories together. RESULTS: In each counternarrative, the participant deliberated their sense of being a physician educator (strategic perspectives) and when expectations became untenable, they did what they needed to do to engage in meaningful work (strategic action) rather than comply with expectations for career advancement in academic medicine. For one participant, faculty agency meant leaving academic medicine; for another, it meant reducing clinical time so that unpaid time could be devoted to education; and for another, it meant opting not do direct a reputable education program. CONCLUSIONS: Faculty agency is a useful theoretical lens for conceptualizing how physician educators navigate their careers in academic medicine. Counternarratives that illuminate faculty agency offer stories that describe alternate career paths and portend a different future for physician educators.

Using the Skill of Noticing to Support Empathy for Third-Year Medical Students in Family Medicine.

BACKGROUND AND OBJECTIVES: Previous research has described a waning interest among third-year students to employ empathetic practice along with decreased opportunity to develop empathic communication skills. In this study we sought to address this decline using the skill of noticing (ie, the capacity to attune to specific aspects of practice and interactions) as an intervention for third-year medical students. METHODS: We designed a qualitative study to address the following research question: How can a focused noticing tool encourage empathetic moments during the patient interview for third-year medical students? Eight third-year medical students used the Social Emotional Noticing Tool (SENT) during their 4-week family medicine rotation, then joined a focus group to share their experiences with SENT and articulate barriers and opportunities toward practicing empathy during clerkship. RESULTS: Student participants (a) described using the tool, including barriers and opportunities; (b) made connections between the practice of noticing using SENT and enacting empathy; and (c) emphasized how enacting empathy in their third year is largely influenced by interactions with clinical faculty. CONCLUSIONS: The use of SENT helped students notice empathy or lack thereof. However, making connections between individual capacity for empathic interactions and the impact of positive or negative role models is necessary. Based on our findings, we encourage the need for shared responsibility among students, faculty and preceptors, and organizations.

"The faculty was really hearing what I had to say and really validating who I was": Learning from validation theory to support students of colour in undergraduate medical education.

BACKGROUND: Medical students of colour face numerous challenges during their undergraduate training period, reflecting the harmful norms and cultures in the learning context of medical school. Despite negative experiences for students of colour in medicine, there are episodes of support and encouragement that come from faculty or staff. This asset-based qualitative study uses Rendón's Validation Theory to illuminate specific ways faculty at a community-based medical college support medical students of colour, thereby challenging structural injustices in medical school. METHODS: This study is grounded in a humanising and asset-based perspective, where participants are viewed as legitimate knowers from whom researchers can learn. Twenty-four medical students of colour and 14 faculty identified by students as supportive participated in five focus groups where participants shared how they felt validated and supported during their undergraduate medical school experiences. Inductive open-coding followed by deductive thematic coding using Validation Theory-a theory that describes how external validation is a necessary component of fostering students' personal and academic drive-and literature about the context of medical school informed the three findings. FINDINGS: Three major themes provide examples of ways faculty validated students. First, participants indicated the importance of acknowledging identities and experiences to understand the socio, historical and cultural context of learning. Second, participants implored the value of giving praise and offering encouragement to work against professional expectations. Finally, participants shared the intimacy of fostering personal relationships to reduce hierarchies. CONCLUSION: This study offers concrete guidance on teaching practices faculty can use to support students of colour. As medical schools may seek to move toward a more student-centred approach, promoting feelings of validation for students of colour can be a key practice in teaching and learning to ensure support for medical students throughout their medical school journey.

Envisioning future roles: How women medical students navigate the figured world of medical school.

BACKGROUND: Women medical students experience tensions as they learn to become doctors. These tensions reflect the cultural world of medical school and clinical medicine, spaces that are highly gendered, racist and exclusionary. This study describes how women medical students are envisioning themselves as future doctors during their first 2 years of medical school while experiencing these tensions. METHODS: Using Figured Worlds theory, this qualitative study focused on four participants from a larger longitudinal study. Each participant was interviewed four times over a 2-year period using narrative methodology and provided multiple written reflections during their first year of medical school. Analysis was performed using deductive methods reflecting Figured Worlds theory. RESULTS: Participants offered storied experiences about how they understood their place in the figured world, ways they enacted agency and how they responded to contradictions they encountered in medical school as they learned to become doctors. These three findings reflect concepts of Figured Worlds theory: positionality and discourse, power and agency, and improvisation. These findings also illuminate ways women medical students are navigating gendered and hierarchical structures of medical school to reimagine their roles in medicine. CONCLUSION: Participants' stories illuminate that woman medical students' lived experiences shaped their decision to enter medical school and continue to shape how they navigate their educational experience. These interactions have implications for their future roles as physicians and how medical schools respond to cultures of teaching and learning that may not recognise these students' positionality and potential agency in medical school and clinical medicine.

Past resources, future envisioning, and present positioning: how women who are medical students at one institution draw upon temporal agency for resistance.

While women entering medical school are faced with a patriarchal system, they also enter into a community with other women and the potential for resistance. The purpose of this study is to use the theory of temporal agency to explore how first-year medical students who identify as women draw upon past, future, and present agency to resist the patriarchal system of medicine.The data for this study were drawn from the first year (October 2020-April 2021) of a longitudinal project using narrative inquiry to understand the socialization of women students in undergraduate medical education. Fifteen participants performed two interviews and a series of written reflection prompts about their childhood and medical school experiences, each lasting approximately 45 min.Participants' resistance drew on past resources, recognizing themselves as Other, which contributed to categorically locating themselves as part of a broader resisting community, even outside their institution. They also hypothesized future possibilities as part of resistance, either an ideal future where they would exercise power, or an unchanged one and the hypothetical resolutions they would use to manage it. Finally, they contextualized past and future in the present, identifying problems to make strategic decisions and execute actions.Our creative interweaving of the constructs of temporal agency, communal agency, and resistance allows us to paint a nuanced picture of how these women conceive of themselves as part of a larger group of women amidst the hierarchical, patriarchal structures of medical school while, at times, internalizing these hierarchies.

Redressing injustices: how women students enact agency in undergraduate medical education.

This study presents descriptions of epistemic injustice in the experiences of women medical students and provides accounts about how these students worked to redress these injustices. Epistemic injustice is both the immediate discrediting of an individual's knowledge based on their social identity and the act of persistently ignoring possibilities for other ways of knowing. Using critical narrative interviews and personal reflections over an eight-month period, 22 women students during their first year of medical school described instances when their knowledge and experience was discredited and ignored, then the ways they enacted agency to redress these injustices. Participants described three distinct ways they worked to redress injustices: reclaiming why they belong in medicine, speaking up and calling out the curriculum, and uplifting one another. This study has implications for recognizing medical students as whole individuals with lived histories and experiences and advocates for recognizing medical students' perspectives as valuable sources of knowledge.

"I might not fit that doctor image": Ideal worker norms and women medical students.

Despite the increasing numbers of women students in medical schools, focused attention on their perceptions about medical school and the medical profession remain underexamined. These perceptions are important to understand, particularly since women students are likely burdened with a host of gender norms related to work, family, and their future roles as physicians. Early experiences in medical school offer important insights into the larger student experience and are tied to academic outcomes and feelings of belonging. To examine early experiences of women medical students, this qualitative study used sensemaking theory to describe the current context and "story" of ideal worker norms. Critical qualitative interviews of 38 women students were performed during their first 2 months of medical school and explored both how the students perceived and experienced ideal worker norms, and how they made sense of the "story" of ideal worker norms. The participants described ways they encountered gendering and ideal worker norms through displays of nurturing behaviour, expectations to balance a future family, and whether they looked or acted the part of a doctor. This article highlights the challenges women medical students are already aware they will face, the opportunities they look forward to, and the strengths they anticipate leaning on to navigate their profession. Results from this study have implications for women medical students' learning experiences and transitions into medical school and for faculty, staff, and scholars concerned with challenging gendering norms that shape medical education.