Stability and Change in the Journeys of Medical Trainees: A 9-Year, Longitudinal Qualitative Study
Stability and Change in the Journeys of Medical Trainees: A 9-Year, Longitudinal Qualitative Study
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DOI：
10.1097/acm.0000000000003708
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发表时间：
2021-06-01
影响因子：
7.4
通讯作者：
Richards, Boyd F.
中科院分区：
文献类型：
--
作者：
Balmer, Dorene F.;Teunissen, Pim W.;Richards, Boyd F.
目的学员成为医生需要很多年的时间——时间太长，以至于他们的医学院学习和住院实习的个人经历很少被系统地研究，因此也没有被很好地理解。缺乏理解阻碍了对未来医生在传统的有时限的医学教育阶段的发展的有效支持。作者发起了一项纵向定性研究，追踪了来自同一所医学院和 6 个不同住院医师的 6 名实习生队列。他们问道，随着时间的推移，稳定性和变化如何表征受训者的生活经历？方法从 2010 年到 2019 年，作者每 6 到 12 个月对 6 名受训者进行一次深度访谈，使用关于形成性事件和之前访谈的反思性提示。数据以迭代方式进行归纳编码和分析。通过按时间顺序显示代码来仔细检查数据，作者确定了 3 种稳定性和变化模式，特别是与构建医学职业相关的模式。这项研究起源于纽约州的一所私立医学院。结果稳定与变化之间的平衡模式是由受训者的职业兴趣决定的。受稳定的临床兴趣激励的学员将他们的旅程视为“一系列垫脚石”。受到不断变化的临床兴趣的激励，学员描述了颠覆性的变化或“不安”；然而，他们仍然接受医学教育。相比之下，受稳定的非临床（即社会科学）兴趣驱动的受训者认为他们的住院医师之旅是一场“斗争”，因为该阶段的临床训练性质很重。结论根据这项对少数受训者进行的为期 9 年的描述性研究，医学教育似乎适合那些受临床兴趣驱动的受训者，即使这些临床兴趣随着时间的推移而发生变化。医学教育可以考虑有时间限制的参考框架的替代方案，并重点关注受训者将临床和社会科学融入医学培训的正确时间。
PurposeIt takes many years for trainees to become physicians-so long that their individual journeys through medical school and residency are seldom systematically studied and thus not well understood. Lack of understanding hinders effective support of future physicians' development across traditional time-bound phases of medical education. The authors initiated a longitudinal qualitative study, tracing a cohort of 6 trainees through the same medical school and 6 different residencies. They asked, how do stability and change characterize the lived experience of trainees through time?MethodFrom 2010 to 2019, the authors conducted in-depth interviews every 6 to 12 months with 6 trainees, using reflective prompts about formative events and prior interviews. Data were inductively coded and analyzed in an iterative fashion. By scrutinizing data via time-ordered displays of codes, the authors identified 3 patterns of stability and change, particularly related to constructing careers in medicine. The study originated at a private medical school in New York, New York.ResultsPatterns in the balance between stability and change were shaped by trainees' career interests. Trainees motivated by stable clinical interests perceived their journey as a "series of stepping-stones." Trainees motivated by evolving clinical interests described disruptive change or "upsets"; however, they were still accommodated by medical education. In contrast, trainees motivated by stable nonclinical (i.e., social science) interests perceived their journey as a "struggle" in residency because of the clinically heavy nature of that phase of training.ConclusionsBased on this descriptive, 9-year study of a small number of trainees, medical education seems to accommodate trainees whose journeys are motivated by clinical interests, even if those clinical interests change through time. Medical education could consider alternatives to time-bound frames of reference and focus on the right time for trainees to integrate clinical and social sciences in medical training.