A phenomenological investigation of patients’ experiences during direct observation in residency: busting the myth of the fly on the wall

Rietmeijer, Chris; Deves, Mark; Esch, Suzanne C. M. van; Horst, Henriëtte E. van der; Blankenstein, Annette H.; Veen, Mario; Scheele, Fedde; Teunissen, Pim W.

doi:10.1007/s10459-021-10044-z

Cited by 9 publications

(23 citation statements)

References 28 publications

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“…In the current research field, we see that researching reflective practice in situ to provide more dynamism to technicist abstractions is still underrepresented. Studies that examine reflection ‘as it occurs in practice,’ for instance with conversation analysis of reflection group sessions (van Braak et al, 2018 ; Veen & de la Croix, 2016 ), or phenomenological approaches (Rietmeijer et al, 2021 ) can provide additional dynamism.…”

Section: Discussionmentioning

confidence: 99%

Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research

Schaepkens

Veen

Croix

2021

Adv in Health Sci Educ

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Reflection is a complex concept in medical education research. No consensus exists on what reflection exactly entails; thus far, cross-comparing empirical findings has not resulted in definite evidence on how to foster reflection. The concept is as slippery as soap. This leaves the research field with the question, ‘how can research approach the conceptual indeterminacy of reflection to produce knowledge?’. The authors conducted a critical narrative umbrella review of research on reflection in medical education. Forty-seven review studies on reflection research from 2000 onwards were reviewed. The authors used the foundational literature on reflection from Dewey and Schön as an analytical lens to identify and critically juxtapose common approaches in reflection research that tackle the conceptual complexity. Research on reflection must deal with the paradox that every conceptualization of reflection is either too sharp or too broad because it is entrenched in practice. The key to conceptualizing reflection lies in its use and purpose, which can be provided by in situ research of reflective practices.

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Section: Discussionmentioning

confidence: 99%

Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research

Schaepkens

Veen

Croix

2021

Adv in Health Sci Educ

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“…21(p1) Phenomenology does not make any claim about whether these kinds of mechanisms exist or what they consist of, but only that they are not immediately available when we simply observe what occurs to us. Applying this principle of phenomenology to our interview study on how patients experience direct observation (DO) situations, 1 our goal was to study participants' immediate access to the phenomenon in an everyday life context, looking for recurring patterns in the relationship between the DO situation and the patient.…”

Section: Immediate Access To Phenomenamentioning

confidence: 99%

“…This simple, recurring structure was responsible for all kinds of thoughts and behaviors of patients toward the senior. 1 For instance, patients often looked for signs of approval from the senior of the treatment plan. This finding made us question the appropriateness of a fly-on-the-wall approach by supervisors during DO; supervisors, by being there, completely change the situation that they intend to observe.…”

Section: Magic At the End Of The Tunnelmentioning

confidence: 99%

“…A few years ago, my PhD supervisor suggested a phenomenological approach for a patient interview study. 1 We had finished two constructivist grounded theory focus group studies on the residents' and the supervisors' perspectives on direct observation (DO) in general practice training. 2,3 My supervisor argued that since we were interested in the patients' experiences with DO situations, a phenomenological approach seemed appropriate.…”

Section: Introduction Chrismentioning

confidence: 99%

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Phenomenological Research in Health Professions Education: Tunneling from Both Ends

Rietmeijer

Veen

2021

Teaching and Learning in Medicine

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Issue: The term "phenomenology" is increasingly being used in Health Professions Education research. Phenomenology refers to a philosophical tradition or discipline. For researchers in Health Professions Education without a philosophical or humanities background, there are two practical problems. The first is that it is not always clear how studies that call themselves "phenomenological" are distinct from studies that use other methods; phenomenology as a label seems to be used for any study that is interested in the experiences of participants. The second problem is that a more in-depth study of phenomenology in the literature yields either abstract definitions such as "examining the underlying structures of consciousness, " or contrasting translations of phenomenology to concrete research tools. What would phenomenology in medical education research look like that is both true to its philosophical roots and yields research findings that contribute to the quality of medical education? Evidence: Two medical education researchers, one with a medical background and the other with a philosophy background, engaged in a dialogue with the purpose of formulating an approach for phenomenology in medical education research. The first departed from the practical demands of his research project in which phenomenology was suggested as a methodology, but guidance was lacking. The other departed from the philosophical tradition of phenomenology with the purpose of exploring how phenomenological insights can be valuable for medical education research. The paper presents these journeys and the results of this dialogue where they formulate starting points for an approach to conducting HPE research that has scientific phenomenological integrity and yields practical results. Implications: Phenomenology has been one of the defining developments in philosophy and the humanities in the 20th century. A basic grasp of its insights is useful for medical education researchers since any research today takes place in the light of these insights. Within medical education, there are certain types of phenomena, research questions, and research goals that call for an explicitly phenomenological approach. Rather than prescribing specific methods or methodologies, phenomenology offers signposts for how to think about the relationship between our research object, methods, and data, and our own role as researchers. We suggest that researchers in HPE, when reporting a phenomenological study, instead of claiming to have followed a certain phenomenological method, explain how their research question, methods, and results fit the purposes and standards of phenomenology. We illustrate this with an example of how to use phenomenology in an interview study.

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“…Patient engagement across the educational spectrum can lead us towards true patient-centred medical education and increased social accountability, 15 and yet the patient voice remains conspicuously absent, and inconsequential, from assessment endeavours that inform decisions vis-à-vis competence. [16][17][18] Some recent evidence has positioned administrative challenges (e.g. time and human resource constraints, perceived lack of assessment tools and sociocultural and organisational hurdles) as a barrier to patient inclusion in assessment.…”

Section: Introductionmentioning

confidence: 99%

Patient involvement in assessment of postgraduate medical learners: A scoping review

et al. 2022

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Context Competency‐based assessment of learners may benefit from a more holistic, inclusive, approach for determining readiness for unsupervised practice. However, despite movements towards greater patient partnership in health care generally, inclusion of patients in postgraduate medical learners' assessment is largely absent. Methods We conducted a scoping review to map the nature, extent and range of literature examining the inclusion (or exclusion) of patients within the assessment of postgraduate medical learners. Guided by Arskey and O'Malley's framework and informed by Levac et al. and Thomas et al., we searched two databases (MEDLINE® and Embase®) from inception until February 2021 using subheadings related to assessment, patients and postgraduate learners. Data analysis examined characteristics regarding the nature and factor influencing patient involvement in assessment. Results We identified 41 papers spanning four decades. Some literature suggests patients are willing to be engaged in assessment, however choose not to engage when, for example, language barriers may exist. When stratified by specialty or clinical setting, the influence of factors such as gender, race, ethnicity or medical condition seems to remain consistent. Patients may participate in assessment as a stand‐alone group or part of a multi‐source feedback process. Patients generally provided high ratings but commented on the observed professional behaviours and communication skills in comparison with physicians who focused on medical expertise. Conclusion Factors that influence patient involvement in assessment are multifactorial including patients' willingness themselves, language and reading‐comprehension challenges and available resources for training programmes to facilitate the integration of patient assessments. These barriers however are not insurmountable. While understudied, research examining patient involvement in assessment is increasing; however, our review suggests that the extent which the unique insights will be taken up in postgraduate medical education may be dependent on assessment systems readiness and, in particular, physician readiness to partner with patients in this way.

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A phenomenological investigation of patients’ experiences during direct observation in residency: busting the myth of the fly on the wall

Cited by 9 publications

References 28 publications

Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research

Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research

Phenomenological Research in Health Professions Education: Tunneling from Both Ends

Patient involvement in assessment of postgraduate medical learners: A scoping review

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