Professionalism, professionalization, expertise and compassion: a qualitative study of medical residents

Abstract

BackgroundFormal and informal medical curricula convey expectations about professionalization, that is, the development of physician identity, and also about professionalism. This study examined whether, in general, junior residents experienced any dissonance between these roles and focused particularly on how they negotiated conflicts between compassion, self-care, duty and medical expertise.MethodsIn 2015, purposive sampling was used to select 21 first-year residents at a Canadian medical school. Participants listened to a 5-min audio-recording narrated in either male or female voice. Facing compassion fatigue after three obstetrical disasters over less than 2 days the resident narrator asks to go home. Participants reacted in writing to questions about this request and relevant teaching/modelling. Responses were analyzed using a qualitative, exploratory, thematic research design.ResultsFour themes were identified: i) empathy, self-doubt and fear of weakness, ii) the need for support from and communication with physicians and others, iii) education received, and iv) professionalization outranks professionalism. Participants agreed that under the circumstances the narrator’s care, compassion and request were appropriate. Never the less, many grappled with feeling that asking to be relieved of work demonstrated weakness and a shirking of responsibility. Respondents had received no formal teaching about balancing compassion for patients or self with professional duty. Preceptors’ informal teaching and modeling valorized scientific disengagement above all else. What emerged was participants’ drive to become detached clinicians who set aside emotional responses and interactions that could impede and be incompatible with professionalization. However, participants also recognized and lamented what was lost in such a transformation.ConclusionIn the transition from student to practitioner, trainees’ views and the modeling they receive shift emotion and compassion, whether for self or patients, from assets to liabilities as they aim to be invincible medical experts.

‘Waiting in the wings’; Lived experience at the threshold of clinical practice

“…Participants were determined to comply with all the potential demands of the job, including long hours and high work intensity. Even prior to commencing work, participants appeared to prioritise the implicit message of ‘unwavering duty’ and to ‘soldier on’ above self‐care and compassion …”

Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?

“…There is some variation in the conceptualisation of professionalism of HCPs among scholars, with differences centred around whether professionalism is connected to HCPs' inner morality or to observable behaviours or to integration into a community of practice [22]. Two core attributes can be identified across conceptualisations, which we term competence and care [22][23][24][25][26]. Competence encompasses both the technical knowledge and clinical skills to provide high-quality care, and the ability to collaborate with relevant HCPs and policymakers to ensure that the health system works optimally.…”

Who are you and who do you want to be? Key considerations in developing professional identities in medicine

“…Some individuals struggle to make sense of competing values in medical education; for example, the value of diversity versus the standardisation of medical graduates 11 . Others experience identity dissonance through fractures between personal (eg, being empathic, compassionate humans) and professional (eg, being objective, detached experts) identities 12 . And some become disenchanted when experiencing professionalism dilemmas (eg, witnessing or participating in workplace professionalism lapses), leading them to experience dissonance between their sometimes morally dubious actions and their moral identities 2 .…”

“…11 Others experience identity dissonance through fractures between personal (eg, being empathic, compassionate humans) and professional (eg, being objective, detached experts) identities. 12 And some become disenchanted when experiencing professionalism dilemmas (eg, witnessing or participating in workplace professionalism lapses), leading them to experience dissonance between their sometimes morally dubious actions and their moral identities. 2 Finally, even if appropriate professional identities are formed, they might be threatened under certain circumstances, including changing doctorepatient relationships (eg, threatening doctors' authority), patient complaint situations, poor media reports, the use of negative stereotypical labels, changing roles and responsibilities (eg, blurring professional boundaries), the removal of dress codes (eg, white coats), regulatory processes (eg, revalidation), and working hours restrictions (threatening traditional rites of passage).…”