Doctoral Identity Research Articles

The experiences of general practitioner partners living with distress: An interpretative phenomenological analysis.

Doctors, including general practitioners, experience higher levels of mental illness than the general population. General practitioners who are partners in their practices may face heightened stress. In total, 10 general practitioner partners living with work-related distress were interviewed, and transcripts were analysed using interpretative phenomenological analysis. Three major themes arose: (1) extreme distress, (2) conflicted doctor identity and (3) toxic versus supportive workplace relationships. Participants detailed symptoms of depression, anxiety and burnout; reported conflicted identities; and discussed the impact of bullying partnerships. We recommend that organisational interventions tackling issues such as bullying be implemented and opportunities to debrief be offered as protected time activities to general practitioner partners.

Pain perception in professional identity of young doctors

Pain perception in professional identity of young doctors

Process Evaluation of Rural Integrated Care Delivery Model (RICDM) in China: How Providers Affects the Policy Implementation

Background: Most of the integration-related policies are facing implementation problems. During 2012/07-2014/12, we implemented an trial-based intervention in Qianjing, a rural district in southwestern China, to test the effects of an innovative integrated care delivery model targeted for rural patients (RICDM ) with hypertension. Using the difference-in-differences analysis, we found that the blood pressure did decrease in treatment group compared to the control group however the health-related quality of life did not, which violated our assumptions. To explore whether the provider performance interfered with the outcomes, we did a process evaluation mainly to compare their behaviors during trial implementation. Methods: All the doctors’ behaviors were bimonthly-recorded using diaries, and their attitudes were evaluated using questionnaires adapted from D’Amour’s inter-professional collaboration model. We firstly observed the referral amounts and provider communication frequency on four inter-professional cooperation types (village to town, town to county, county to town, and town to village – the former indicated the initiated party). Then we conducted interviews with the doctors, investigating the following aspects that potentially affected the collaboration: willing to cooperate, actual motivation, mutual trust, personal relations and ability to cooperate. All variables were compared between groups before and after intervention. After then we did a regression analysis examining the relations between the cooperation level and the identities of doctors. The implementation degree was also estimated by multiplying the percentage of reach scope for each step of trial process. Results: 120 doctors were included. There were no significant differences between treatment group and control group either on the referral amounts or the communication frequency (all P >0.05). Most of the cooperation aspects showed a low- and middle-level performance (>90%). The collaboration ability in treatment group was significantly higher than control group (P 0.05). And the doctors from county hospitals showed a lower performance in each of the aspect compared to doctors from town hospitals and village clinics. Associated with the professional identity, the medical staff showed relatively low interests in collaboration compared to primary care professionals. By observing and analyzing the processes of exposure, enrollment, reach and follow-ups, we had found out the implementation degree to be only 61%. For each part, the patient were reached out by 100%, the supplier 72%, and the hospitals 85%. Lessons Learned: The RICDM improved patient health, but did not fully achieve desired effects. We inferred that one possible reason might lied in the providers’ reluctance to cooperate. By furtherly investigating into the provider behaviors and implementing process, we had proved our guess and the actual model effect might therefore be underestimated. However the study did not successfully connect the health-related outcomes with the provider behaviors through statistical analysis, so we could not reach a direct conclusion that the incomplete implementation was the exact reason for imperfect model effects. Further studies need to be proposed and also potential bias from provider side should be properly dealt with in the stage of study design.

Inspiring desire: A new materialist bent to doctoral education in Arts and Humanities

Doctoral learning entails transition from experienced student to stance-defending researcher, exposed to international critique: a disorientation and reorientation into a new identity. Arts and Humanities candidates typically navigate these moves without much of a map, choosing their own topics, avoiding the more externally defined approach available to STEM students, and mapping out their own research routes. They are often driven by desire and passion for their topic. Much of each candidate’s core identity will be inflected by this transition of emergence, a transition that involves their embodiment, emotion and social persona. With intense and sometimes uncomfortable transition in mind, and desire as driver, new materialism, namely nomadic feminism and queer theory, can inform doctoral pedagogy in Arts and Humanities. The destabilization of normativity opens the potentials and challenges of inhabited and performed identity. Queer theory’s longstanding negotiation of social and personal tensions gives a heuristic model for understanding doctoral identity transition.

Teaching Psychology in Medicine: The Context, Methodologies and Doctor's Professional Identity.

Teaching Psychology in medical curriculum has been the subject of numerous dissertations that focus on the relevance of this knowledge for doctors, at a general level. A non-systematic review of the relevant literature, particularly from the last decade, as well as national and international recommendations addressing the need for integration of behavioural and social sciences in medical training, was performed. The literature supports the existence of preconceptions and negative attitudes towards the role of psychology in medical education, demonstrated by research in various european and american universities. The socio-cultural context, the different methodologies and barriers experienced by teachers in medical education are listed and provide the matrix for a more comprehensive discussion of the development of the doctor's identity. Revisiting the experience of many years of teaching Medical Psychology, it is considered that the process of integration of this curricular area should occur horizontally and vertically throughout the course, stressing the need for the pedagogical training of teachers. Concepts that arise from personal reflection, adjusted to the reality of our education and the basic principles that guide it, are elaborated in order to integrate the teaching of Psychology in Medicine, emphasizing its importance and utility in the competencies and abilities of future doctors.

Possibility and agency in Figured Worlds: becoming a 'good doctor'.

Figured Worlds is a socio-cultural theory drawing on Vygotskian and Bakhtinian traditions, which has been applied in research into the development of identities of both learners and teachers in the wider education literature. It is now being adopted in medical education. The objective of this paper is to show what Figured Worlds can offer in medical education. Having explained some of its central tenets, we apply it to an important tension in our field. The assumption that there is a uniform 'good doctor' identity, which must be inculcated into medical students, underlies much of what medical educators do, and what our regulators enforce. Although diversity is encouraged when students are selected for medical school, pressure to professionalise students creates a drive towards a standardised professional identity by graduation. Using excerpts from reflective pieces written by two junior medical students, we review the basic concepts of Figured Worlds and demonstrate how it can shed light on the implications of this tension. Taking a Bakhtinian approach to discourse, we show how Adam and Sarah develop their professional identities as they negotiate the multiple overlapping and competing ways of being a doctor that they encounter in the world of medical practice. Each demonstrates agency by 'authoring' a unique identity in the cultural world of medicine, as they appropriate and re-voice the words of others. Finally, we consider some important areas in medical education where Figured Worlds might prove to be a useful lens: the negotiation of discourses of gender, sexuality and social class, career choice as identification within specialty-specific cultural worlds, and the influence of hidden and informal curricula on doctor identity.

‘Black sheep in the herd’? The role, status and identity of generalist doctors in secondary care

Changing patient demographics raise important challenges for healthcare providers around the world. Medical generalists can help to bridge gaps in existing healthcare provision. Various approaches to medical generalism can be identified, for example, hospitalists in the US and the restructuring of care away from medical disciplines in the Netherlands, which have different implications for training and service provision. Drawing on international debates around the definition and role of generalism, this article explores one manifestation of generalism in the UK to understand how abstract ideas work in practice and some of the benefits and challenges. Broad-based training is a two-year postgraduate training programme for doctors recently piloted in England. The programme provided 6-month placements in four specialties (general practice, core medicine, psychiatry and paediatrics) and aimed to develop broad-based practitioners adept at managing complex and specialty integration. Our longitudinal, mixed methods evaluation of the programme demonstrates that although trainees value becoming more holistic in their medical practice, they also raise concerns about being perceived differently by co-workers, and report feeling isolated. Using identity theory to explore the interplay between generalism and existing boundaries of professionalism in healthcare provision, we argue that professional identity, based on disciplinary structure and maintained by boundary work, troubles identity formation for generalist trainees who transcend normative disciplinary boundaries. We conclude that it is important to address these challenges if generalism in secondary care settings is to realise its potential contribution to meeting increasing health service demands.

The Heroic and the Villainous: a qualitative study characterising the role models that shaped senior doctors' professional identity.

BackgroundThe successful development and sustaining of professional identity is critical to being a successful doctor. This study explores the enduring impact of significant early role models on the professional identity formation of senior doctors.MethodsPersonal Interview Narratives were derived from the stories told by twelve senior doctors as they recalled accounts of people and events from the past that shaped their notions of being a doctor. Narrative inquiry methodology was used to explore and analyse video recording and transcript data from interviews.ResultsRole models were frequently characterised as heroic, or villainous depending on whether they were perceived as good or bad influences respectively. The degree of sophistication in participants’ characterisations appeared to correspond with the stage of life of the participant at the time of the encounter. Heroes were characterised as attractive, altruistic, caring and clever, often in exaggerated terms. Conversely, villains were typically characterised as direct or covert bullies. Everyday events were surprisingly powerful, emotionally charged and persisted in participants’ memories much longer than expected. In particular, unresolved emotions dating from encounters where bullying behaviour had been witnessed or experienced were still apparent decades after the event.ConclusionThe characterisation of role models is an important part of the professional identity and socialisation of senior doctors. The enduring impact of what role models say and do means that all doctors, need to consistently reflect on how their own behaviour impacts the development of appropriate professional behaviours in both students and training doctors. This is especially important where problematic behaviours occur as, if not dealt with, they have the potential for long-lasting undesirable effects. The importance of small acts of caring in building a nurturing and supportive learning atmosphere at all stages of medical education cannot be underestimated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0731-0) contains supplementary material, which is available to authorized users.

Legal study on the development predicament and outlet of rural doctors

The paper analyzed legally the following predicaments of legitimization of rural doctors in China: no legitimacy protection for their practice, vague criteria for practicing medicine, conflicts between legal regulations for medical practice and rural realities, and lack of a liability insurance system.The authors, based on an exploration of the legislative framework for rural doctors, made four corresponding legislative proposals as follows: to clearly define the legal scope and identity of rural doctors, to establish a qualification and employment system for rural doctors, to develop practicing norms applicable for rural doctors, and to set standards for their income. Key words: Rural doctors; Predicaments; Legitimization; Legislation

Strengthening doctoral supervision in a Doctor of Psychology (DPsych) Specialisation in Child and Adolescent Psychology

Supervision differs in PhD and DPsych contexts. PhD supervision focuses on students' pursuit of a career in academia, with the emphasis on research. In a DPsych framework, the focus of supervision is to assist students, who are experienced practitioners in a professional field, to complete a structured course and a research component. The aim of the article is to reflect on the application of supervision principles, models, metaphors and supervisory styles within a DPsych context. This article presents a case illustration of supervision in a DPsych programme (with specialisation in child and adolescence, or DPsych Child) presented at the University of the Free State in South Africa. Supervision focuses on developing the DPsych students' doctoral identity so that they, as scientist-practitioners, could contribute ultimately to the professional context of child psychology and apply theoretical knowledge to complex challenges. The article proposes that research on supervision processes and practices within a DPsych Child context could complement explorations into the value of the implementation of the scientist-practitioner model and thus augment quality assurance of the DPsych programme.

Risking the Sustainability of the Public Health System: Ethical Conundrums and Ideologically Embedded Reform

The purpose of this paper is to examine the outcomes arising from ideologically driven health reforms, which confronted an enduring socialized model of public health care in New Zealand. The primary focus is on the narratives arising from the unprecedented strike action of junior doctors, symbolic of industrial unrest in the public health sector. Analysis revealed the way in which moral obligations ingrained in the professional identities of junior doctors can be both enacted and persistently challenged by ongoing and extensive ideologically embedded reform. A socialized public healthcare system privileges cooperation and relies on a public service ethos, espousing commitment and goodwill of health professionals. The inverse tenets of a pursuit of efficiency through New Public Management validate an ideology of market principles which legitimate competitive and self-interested behavior. The value-based disconnect that occurred not only affected the goodwill and trust of junior doctors, but also destabilized their commitment to their work in a way that threatened the ongoing sustainability of the public health service. This paper suggests four areas in which research might help solve the ethical conundrums currently undermining a public health service. The suggested direction moves the emphasis on systems and activities toward the cognitive and emotional needs of healthcare professionals.

On Bian Que and the culture of witch doctor of Eastern Yi Ethnic Group as viewed from the Picture of Bian Que's Needling in the stone-carved figure of Han Dynasty

The culture of witch doctor of the Eastern Ethnic Yi Group exerted profound influence on early acupuncture art and medicine. There is a score of Bian Que's Needling Picture in the stone-carved figure unearthed in Shandong Province, demonstrating the origin of acupuncture in the region of Eastern Yi Ethnic Group. Bian Que, with the identity of witch doctor, and"doctor stone needling witch"with the legend of a professional acupuncturing indicates the important influence of witch doctor on the origin of acupuncture art.The archeological discovery of tortoise shell, divination carved on bones, and conical needles all buried together in the Da-wen-kou culture indicates that the earliest therapy witch doctor applied was related to needling. As a representative of the Eastern Yi Ethnic Group, Bian Que,"the Father of Medical Prescription"was the embryonic form of early acupuncture art, promoted the formation and development of early medical theory, the theory of pulse feeling, being the important part of the early stage of origin of needling-pulse feeling theory.

Tıp Fakültesi’ndeki Araştırma Görevlilerinde Depresyon Düzeyinin İş Doyumu ile İlişkisinin İncelenmesi

Aim: The purpose of this study was to examine the relationships between job satisfaction level and depression degree, personal and environmental factors among assistants of Duzce University Medical Faculty. Methods: 117 physicians including 70 males (%60) and 47 females (%40), participated in this descriptive and cross-sectional survey. A questionnaire was applied by face-to-face interview, which consisted of open-ended questions and questions with two or multiple-choices. Questions were asked about demographic attributes, usage of anti-depressant medications, having chronic illnesses, working conditions, habits, and spare time activities. Beck Depression Scale and Minnesota Job Satisfaction Scale were added to the semi-structured questionnaire form. Results: Most of the assistant doctors joined this research (n=74; 63.2%) implied that if they had a chance, they would prefer another faculty because of difficulty of doctorate education, heavy job responsibilities threatening human physiology, high intensity of working tempo, decreasing respect on doctor identity, and of course low salary. Inadequacy of physical conditions in working area, scarcity of supportive staff, high numbers of night duties, inadequacy of night duty assistant doctors and the most important factor that is deprivation from allowance after night duty cause reduction of internal and external work satisfaction. Conclusion: It was pointed out that many assistants have the idea to prefer another department that has less labor and less risk factor if they had the opportunity. There was no significant diversity between internal, external and general job satisfaction scores of doctors from different specialties

Being and becoming an intercultural doctoral student: reflective autobiographical narratives

This paper underscores the dynamic and complex dimensions of ‘becoming’ an intercultural doctoral student. It employs autobiography as a research method to portray the reshaping of ourselves as doctoral students to help us engage in self-reflexivity on our mediation of academic, personal and cultural identities in international doctoral education. Our self-narratives on how the plurality of our doctoral identities has emerged and how we have mediated these multiple identities show that becoming an intercultural research student is intimately linked to the process of self-empowerment and re-construction of oneself as a flexible and reflexive intercultural learner and human being. The paper concludes by discussing the notion of ‘reciprocal intercultural supervision’ in doctoral education. It highlights the increased need for (Western) supervisors to develop reciprocal interculturality and the capacity for greater agency in their international doctoral students so that both groups can understand each other better.

Changing the Ties That Bind? The Emerging Roles and Identities of General Practitioners and Managers in the New Clinical Commissioning Groups in the English NHS

1. Julia Segar[1][1] 2. Kath Checkland[1][1] 3. Anna Coleman[1][1] 4. Imelda McDermott[1][1] 5. Stephen Harrison[1][1] 6. Stephen Peckham[2][2] 1. 1University of Manchester, UK 2. 2University of Kent, Canterbury, UK 1. Julia Segar, Centre for Primary Care, University of Manchester, 5th Floor, Williamson Building, Oxford Road, Manchester M13 9PL, UK. Email: julia.segar{at}manchester.ac.uk The English National Health Service (NHS) is undergoing significant reorganization following the 2012 Health and Social Care Act. Key to these changes is the shift of responsibility for commissioning services from Primary Care Trusts (PCTs) to general practitioners (GPs) working together in Clinical Commissioning Groups (CCGs). This article is based on an empirical study that examined the development of emerging CCGs in eight case studies across England between September 2011 and June 2012. The findings are based on interviews with GPs and managers, observations of meetings, and reading of related documents. Scott’s notion that institutions are constituted by three pillars—the regulative, normative, and cognitive–cultural—is explored here. This approach helps to understand the changing roles and identities of doctors and managers implicated by the present reforms. This article notes the far reaching changes in the regulative pillar and questions how these changes will affect the normative and cultural–cognitive pillars. [1]: #aff-1 [2]: #aff-2

Writing realities: An exploration of drawbacks and benefits of publishing while enrolled in a doctoral program

This paper dives into the complicated work of publishing while working on a doctoral dissertation. Although the author recognizes the dissertation as being a capstone synthesis of a multi‐year endeavor, there can be some educational and social benefits to engaging with a publication process. A few key benefits include, but are not limited to, scholarly feedback on ideas, a strengthened writing portfolio and skills, a better position to receive awards, and an expansion of networking opportunities. The author reaffirms existing literature that points out that through publishing work, the doctoral identity shifts from that of being a student to becoming a scholar.

Doctoral identity change towards researcher autonomy during research journeys across disciplines

With some understanding of doctoral identity comes a focus on the ways in which candidates both shape and are shaped by research milieus and contexts. Doctoral identity is thus both a continuous conscious and unconscious process influenced by interacting elements such as biological characteristics, own unique psychological needs, interests and defences as well as and the cultural milieu or context in which doctoral candidates operate. This brings forth the idea of doctoral identity formation as a doctoral ‘journey’ towards researcher autonomy. Employing a researcher development framework, this article elaborates on research conducted on how doctoral education seems to have mattered for seven doctoral graduates across five disciplinary areas in terms of identity change as demonstrated in becoming more autonomous as researchers. Findings indicate identity changes in six dimensions, namely curiosity, determination, criticality, organisation, creativity and persuasion. The research finding indicate that doctoral graduates seem to differ in moving towards researcher autonomy within their distinctive doctoral journeys and therefore may also differ in the nature and tempo of identity formation as independent or autonomous researchers. A conceptual framework is suggested which may assist doctoral supervisors in gaining a better understanding of the processes and dynamics involved in doctoral identity formation towards researcher autonomy at research-led universities.

“Rather a manager and networker than a researcher”: converging technologies in the clinic

Technological developments brought about new approaches to and new insight into the functioning of the brain and neurological disorders. More specifically, advancement in the areas of neuroimaging, genomic technologies and molecular biology is conceived as a pathway to more differentiated diagnosis and appropriate treatment. In this regard, the convergence of technologies in the area of health care and medical research has significantly increased during the past two decades. The aim of this article is to better understand how the convergence of technologies in the field of neuroscience takes place at the micro-level of knowledge production, namely the clinic. It is based on the results of an ethnographic study conducted at an Epilepsy Monitoring Unit in Vienna. I start from the assumption that the convergence of technologies in the diagnosis and treatment of epilepsy anticipates a specific means of knowledge production that impacts on the understanding and definition of neurological conditions and the identity of patients and medical doctors simultaneously. One important result concerns the scientization of the way that people with epilepsy perceive, explain and understand epilepsy and the brain. On the one hand respective narratives seem to support the scientific definition of epilepsy; on the other, the failure of seizure control tends to induce a specific understanding of the brain as having unpredictable and uncontrollable mastery over body, memory and soul.

Identidade profissional e as humanidades na Famed/UFU

This essay investigates identity in education, particularly the professional identity of the physician and how it relates to the undergraduate medicine course at the Federal University of Uberlândia (UFU). Identity is a set of representations such as name, education, nationality, marital status and occupation that individuals bear and allow to be recognized. Individuals are inserted into the world of culture, standards of conduct, values and duties by their social role. This is also what enables individuals to be recognized and accepted by their group. Historically speaking, the current model of medical education has influenced the professional identity of doctors. Questions concerning sensory, reflective and educational activities at UFU Medicine School (FAMED/UFU) are addressed in the paper. In conclusion, there are many more questions to be answered and probably many more questions to be asked. The best professional identity is sure to be consistent with the best training.

Social Questions, Medical Answers: Contesting British Abortion Law

The 1967 Abortion Act, rather than granting women a 'right' to abortion, further entrenched medical power over women's reproductive capacities. Critiques of the Act have assumed that this process was uncomplicated for state actors, who had no qualms about this dispersal of power, and for the medical profession, which stepped in to fill this new regulatory role without question. This article argues that the medicalization of abortion was a fraught and incomplete process involving fundamental tensions over doctors' responsibilities. It links medicalization to a process of governmentalization which requires constant renegotiation of the identities of doctors, women, and fetuses.