The social construction of teacher and learner identities in medicine and surgery

Abstract

Introduction There are growing concerns about the quality and consistency of postgraduate clinical education. In response, faculty development for clinical teachers has improved formal aspects such as the assessment of performance, but informal work‐based teaching and learning have proved intractable. This problem has exposed a lack of research into how clinical teaching and learning are shaped by their cultural contexts. This paper explores the relationship between teacher–learner identity, educational practice and the workplace educational cultures of two major specialties: internal medicine and surgery. Methods This was a secondary analysis of a large dataset, comprising field notes, participant interviews, images and video‐recordings gathered in an ethnographic study. The lead author embedded himself in four clinical teams (two surgical and two medical) in two different hospitals. The authors undertook a critical reanalysis of the observational dataset, using Dialogism and Figured Worlds theory to identify how teachers and postgraduate learners figured and authored their professional identities in the specialty‐specific cultural worlds of surgery and internal medicine. Results Surgery and internal medicine privileged different ways of being, knowing and talking in formal and informal settings, where trainees authored themselves as capable practitioners. The discourse of surgical education constructed proximal coaching relationships in which trainees placed themselves at reputational risk in a closely observed, embodied practice. Internal medicine constructed more distal educational relationships, in which trainees negotiated abstract representations of patients' presentations, which aligned to a greater or lesser degree with supervisors' representations. Conclusions Our research suggests that clinical education and the identity positions available to teachers and learners were strongly influenced by the cultural worlds of individual specialties. Attempts to change work‐based learning should be founded on situated knowledge of specialty‐specific clinical workplace cultures and should be done in collaboration with the people who work there, the clinicians.

The figured world of medical education senior leaders: Making meaning and enacting agency

“…the field of medical education) as the phenomenon of study. Although other researchers in our field have used FW to study individuals in a social space 30,[32][33][34]36,38,39,[41][42][43][44] (e.g. focusing on medical educators in our field, not on the field itself), we focus our inquiry on medical education as an FW 28 wherein individuals navigate their lives by harnessing available affordances.…”

“…For that, we rely on FW theory. 28 FW theory has informed a growing body of health professions education (HPE) research [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] and focuses on the identities and the social interconnectedness of individuals who interact in complex settings and behave in intentional ways. Dorothy Holland and her co-authors label this setting an FW, i.e.…”

Meaning making about performance: A comparison of two specialty feedback cultures

“…[6][7][8] One reason for this conundrum may be that medical education tends to treat all types of practice equally; feedback conversations are often assumed to serve all situations and specialties. However, Cantillon et al 9 outline significant differences between specialties in ways of knowing and being. These unique 'cultural worlds' 9 provide direct challenge to a decontextualised approach to feedback.…”

On identity, agency and (sub)culture

“…Two papers in this issue begin to remedy this blind spot, adding depth to our understanding of medicine as an assortment of distinct and sometimes dissonant cultural worlds. Schrepel et al's study 3 of the influence of specialty identity on conflict between emergency medicine specialists and internists during admissions, and Cantillon et al's exploration 4 of the figured worlds of medicine and surgery begin to elaborate the strength and influence of medicine's disciplinary subcultures. In so doing, they mark important progress toward a more nuanced understanding of how medicine's subcultures impact teaching, learning and practice.…”

“…Education, too, may suffer. As Cantillon et al 4 point out, when trainees are situated in rigid, specialty‐specific cultural worlds, their opportunities to develop flexible identities may be suffocated by the weight of cultural expectations. Professional subcultures make room for a limited range of possible identities for members and tend to reinforce historical values, beliefs and behaviours.…”