Destabilising institutions to make healthcare more equitable: Clinicians, educators, and researchers co-producing change

Dornan, Tim; Kearney, Grainne; Pyörälä, Eeva

doi:10.1080/0142159x.2020.1795102

Cited by 5 publications

(7 citation statements)

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“…15 It is well suited to use-inspired research because its reach extends from individual action to social structure in a seamless whole, and it is used increasingly within medical education research. [16][17][18][19] SCT is also well suited to researching processes within large, multifaceted and complex organisations, such as hospitals. By identifying constraints and affordances to exercising agency, SCT can help to convert stultifying institutional norms 20 into energy for expansive learning.…”

Section: Introductionmentioning

confidence: 99%

“…Sociocultural theory (SCT) is a complex learning theory that locates subjectivity between rather than inside people 15 . It is well suited to use‐inspired research because its reach extends from individual action to social structure in a seamless whole, and it is used increasingly within medical education research 16–19 . SCT is also well suited to researching processes within large, multifaceted and complex organisations, such as hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Constraints and affordances for UK doctors‐in‐training to exercise agency: A dialogical analysis

et al. 2023

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IntroductionThe goal of medical education is to develop clinicians who have sufficient agency (capacity to act) to practise effectively in clinical workplaces and to learn from work throughout their careers. Little research has focused on experiences of organisational structures and the role of these in constraining or affording agency. The aim of this study was to identify priorities for organisational change, by identifying and analysing key moments of agency described by doctors‐in‐training.MethodsThis was a secondary qualitative analysis of data from a large national mixed methods research programme, which examined the work and wellbeing of UK doctors‐in‐training. Using a dialogical approach, we identified 56 key moments of agency within the transcripts of 22 semi‐structured interviews with doctors based across the UK in their first year after graduation. By analysing action within the key moments from a sociocultural theoretical perspective, we identified tangible changes that healthcare organisations can make to afford agency.ResultsWhen talking about team working, participants gave specific descriptions of agency (or lack thereof) and used adversarial metaphors, but when talking about the wider healthcare system, their dialogue was disengaged and they appeared resigned to having no agency to shape the agenda. Organisational changes that could afford greater agency to doctors‐in‐training were improving induction, smoothing peaks and troughs of responsibility and providing a means of timely feedback on patient care.ConclusionsOur findings identified some organisational changes needed for doctors‐in‐training to practise effectively and learn from work. The findings also highlight a need to improve workplace‐based team dynamics and empower trainees to influence policy. By targeting change, healthcare organisations can better support doctors‐in‐training, which will ultimately benefit patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Constraints and affordances for UK doctors‐in‐training to exercise agency: A dialogical analysis

et al. 2023

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“…If learners also perceive agency primarily as the ability to influence their personal trajectory, learners may therefore perceive the shift from individual to systems issues as a lack of agency. Agency may be better interpreted as directed at activities spanning clinical care, research and learning, bridging the gap between the individual and the system 8 …”

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confidence: 99%

“…Within this view, learners are not ‘mere and hapless hostages’ within the wider healthcare system 2,5 . Learners are active participants in their local system and can create agency through the clinical care, research and learning activities that fall within their role 8 . Learners are already uniquely situated to act as ‘change agents’ through holding both a near‐outsider perspective and an insider position within the system.…”

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confidence: 99%