Phronesis and the Medical Community

这项研究探索了在市场和用户选择的时代，医生在他们的职业生涯中如何利用道德资源来驾驭复杂的医疗保健世界。双重目标是首先了解医生通过医学教育和实践传播、解释和颁布实践经验的性质，其次是制定一种以艺术为基础的方法，在参与研究的机构中可靠地制定实践经验，并可用于其他专业(如教师和律师)的实践经验研究。到目前为止，很少有研究探索在一段时间内如何在一个专业社区内培养潜意识。缺乏与医疗专业人员的研究，以探索他们是如何在日常实践中积累和实施触诊的。很少有人问，专业人士如何在道德上(或其他方面)具备能力，在充斥着相互竞争的需求和关系的混乱实践世界中导航。到目前为止，医学领域的许多研究人员已经提出了在医学教育中重新定位为先天疗法的理由，但很少有人探索这可能是什么样子。现有的研究往往在一个快照中、在一个组织内或通过跟踪一个从业者来捕捉实践智慧。在这项研究中，将研究三个时期的医生群体：正式医学学习的开始；正式学习结束时的安置；以及具有5年以上合格经验的已建立的医疗专业人员。这一设计将提供一个机会，让我们看到精神是如何随着时间的推移而发展的，同时使人们能够就如何获得道德资源以及正规教育在让从业者适应混乱的实践现实方面所扮演的角色进行不同的讨论。通过探索处于职业生涯不同阶段的医生如何获得或利用道德资源，我们感兴趣的是，他们如何为手头的患者做出“好”的决定；平衡护理、同情心、质量、资源、能力、医疗结果和更广泛的社区福祉。参与者将参与创造性地塑造一系列原创的肥皂剧风格的视频剪辑，这些视频剪辑将连接到现有的由卫生和社会护理从业者、患者和公众组成的虚拟社区。其目的是让他们参与提供一种艺术解释，通过这种艺术解释，他们看到了他们实践舞台上的精神问题。这部肥皂剧及其与社区的联系方式将与广泛的学者、从业者、患者和政策制定者以及其他对该领域感兴趣的人进行辩论。通过这一过程，我们希望得到关于我们的方法、道德教育、公众参与和公众信任等方面的信息和挑战。该系列视频将通过AHRC网站以及DVD和YouTube等其他媒体提供。报告、期刊和会议论文将成为互联社区研究人员、医学教育从业者、更广泛的学术界以及卫生和社会护理社区使用的资源。这一系列视频将为许多基于文本的建议提供一个创新的、前卫的补充，这些建议来自丑闻调查报告和迄今基于社会科学的研究。医疗保健研究人员、教育工作者、从业者和政策制定者将对医疗保健研究人员、教育工作者、从业者和政策制定者感兴趣的新理解是，在许多丑闻的背景下，对医疗界的养成及其在重建公众信任方面的作用有新的理解。预计通过以艺术为基础的方法对AHRC Connected Community方案有具体的价值。该项目旨在通过影响医生作为一个社区的医疗和专业教育，在医学界和公众之间建立更紧密的联系，并重建公众对医疗专业的信心，从而实现AHRC的投资回报。

This study explores how doctors across their professional careers utilise moral resources to navigate the complex world of healthcare in an era of markets and user choice. The dual aims are first to understand the nature of phronesis (practical wisdom) transmission, interpretation and enactment by doctors through medical education and into practice and second to develop an arts based methodology to reliably frame phronesis in the institutions that participate in the study and that can be used in the study of phronesis in other professions (e.g. teachers and lawyers). To date little research has explored the ways in which phronesis is cultivated over a period of time within one professional community. There is an absence of research with medical professionals to explore how they have accumulated and enacted phronesis within their daily practice. Questions have rarely been asked as to how professionals are equipped morally (or otherwise) to navigate a chaotic world of practice rife with competing demands and relationships. To date, many researchers within medicine have made the case for a reorientation towards phronesis in medical education, but little has been undertaken to explore what that might look like.Existing studies have tended to capture practical wisdom within one snapshot, within one organisation or by following one practitioner. In this study three communities of doctors over three time periods will be studied: beginning of formal medical study; on placement at the end of formal study; and established medical professionals with 5 years plus qualified experience. This design will offer an opportunity to see how phronesis develops over time whilst enabling a varied discussion about how moral resources are accessed and what the role of formal education is in equipping practitioners for the messy realities of practice.By exploring how doctors at different points in their careers have access to or draw upon moral resources, we are interested to see how they make 'good' decisions for the patient at hand; balancing care, compassion, quality, resources, capacity, medical outcomes and the wider well-being of the community. The participants will be involved in creatively shaping an original 'soap opera' style series of video clips that will connect to an existing virtual community of health and social care practitioners, patients and the public. The purpose is to engage them in providing an artistic interpretation through which they see the issues of phronesis in their practice arena. The soap opera and the way it links to the community will be debated with a broad audience of academics, practitioners, patients and policy makers and others with an interest in the field. Through this process we expect to be informed and challenged e.g. about our approach, the teaching of ethics, public engagement and public trust. The video series will be available through the AHRC website and other mediums such as DVD and YouTube. A report, journal and conference papers will become a resource for Connected Communities researchers, medical education practitioners, wider academia and health and social care communities to utilise. The video series will offer an innovative, edgy complement to the many text based recommendations that have emanated from scandal enquiry reports and social science based studies to date. New understandings of the cultivation of phronesis in medical communities and its role in rebuilding public trust in the light of many scandals will be of interest to healthcare researchers, educators, practitioners and policymakers. Specific value to the AHRC Connected Community programme through the arts based methodology is expected. The project aims to deliver a return on the AHRC's investment by impacting on the medical and professional education of doctors as a community, building stronger links between the medical community and the public and rebuilding public confidence in the medical profession.