How to play the game of medical education: Sociocultural analyses of educational difficulties among medical residents.

Mette K Christensen,Rune D Jensen,Johanne K Sørensen,Lotte D O'Neill,Lene S Mortensen,Karen Norberg,Signe G Brøndt,Peder Charles

doi:10.15694/mep.2020.000125.1

Mette K Christensen, Rune D Jensen + Show 6 more

Open Access

https://doi.org/10.15694/mep.2020.000125.1

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Abstract

This article was migrated. The article was marked as recommended. Medical residents in difficulty struggle to comply with educational requirements. They pose a liability to patient safety and they have problems to adapt to the professional role of a doctor. Consequently, being a resident in difficulty may cause identity crisis and have the potential to disrupt the resident's professional identity as a doctor. Only few studies explore the tipping point between becoming a resident in difficulty or not, and these studies rarely reflect the surrounding sociocultural aspects of the residents' difficulties such as organisational culture in the workplace. This article explores how medical residency training culture influence on residents' risk of ending in difficulty. Our study was based on six focus-group interviews with residents (n=28) and in-depth interviews with residents in difficulty (n=10). The interpretation of data employed sociologist Pierre Bourdieu's theoretical framework around dispositions. Across the data, we identified four themes: Conflicting games in the field of medical education, altruism, organisational hierarchy, and coping with stress. We found a (mis)match between legitimate rules in the field of medicine and the residents' dispositions to appreciate those rules. These results can inform clinical supervisors and consultants in their decisions for supporting residents in difficulty and increasing educational achievement among struggling residents.

Highlights

Residents in difficulty are resource demanding for healthcare institutions (Roberts et al, 2012; Williams, Roberts, Schwind, and Dunnington, 2009)
The aforementioned studies have contributed to knowledge of the number of residents in difficulty in different specialties, the behaviours of individual residents in difficulty, the management and remediation of residents in difficulty, and personality traits that may identify a resident at early stages of difficulty
It could be argued that these studies did not reflect the surrounding sociocultural aspects such as organisational culture in terms of learning climate, working hours, working climate, social structure, and hierarchy in the workplace

Summary

Introduction

Residents in difficulty are resource demanding for healthcare institutions (Roberts et al, 2012; Williams, Roberts, Schwind, and Dunnington, 2009). We introduce sociologist Pierre Bourdieu’s concepts doxa, habitus and illusio (Bourdieu, 1992; Bourdieu, 1998; Bourdieu and Wacquant, 1992) as a theoretical framework for understanding the organisational culture and educational difficulties in the field of medicine. These concepts provide a useful lens for investigating norms, practices and ‘drivers’ along with other sociocultural aspects of residents’ socialisation and learning processes

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