Résumés
Abstract
Background: Preclinical medical students commonly perceive shadowing as beneficial for career exploration. However, research is sparse on the broader impact of shadowing as a learning strategy. We explored students’ perceptions and lived experiences of shadowing to understand its role and impact on their personal and professional lives.
Methods: Between 2020-2021, individual semi-structured video interviews were conducted with 15 Canadian medical students in this qualitative descriptive study. Inductive analysis proceeded concurrently with data collection until no new dominant concepts were identified. Data were iteratively coded and grouped into themes.
Results: Participants described internal and external factors that moulded shadowing experiences, arising tensions between intended and perceived experiences, and how these lived experiences impacted their wellness. Internal factors associated with shadowing behaviour included: 1) aspiring to be the best and shadowing to demonstrate excellence, 2) shadowing for career exploration, 3) shadowing as learning opportunities for early clinical exposure and career preparedness, and 4) reaffirming and redefining professional identity through shadowing. External factors were: 1) unclear residency match processes which position shadowing as competitive leverage, 2) faculty messaging that perpetuates student confusion around the intended value of shadowing, and 3) social comparison in peer discourse, fuelling a competitive shadowing culture.
Conclusions: The tension between balancing wellness with career ambitions and the unintended consequences of unclear messaging regarding shadowing in a competitive medical culture highlights issues inherent in shadowing culture.
Résumé
Contexte : De manière générale, les étudiants en médecine préclinique considèrent que l’observation présente une occasion intéressante d’explorer les possibilités de carrière. Cependant, peu de recherches ont été menées sur l’impact plus large de l’observation comme stratégie d’apprentissage. Nous avons exploré les perceptions et les expériences vécues des étudiants en matière d’observation afin de comprendre son rôle et ses répercussions sur leur vie personnelle et professionnelle.
Méthodes : Dans le cadre de cette étude qualitative descriptive, entre 2020 et 2021, des entretiens vidéo individuels semi-structurés ont été menés avec 15 étudiants en médecine canadiens. L’analyse inductive s’est déroulée simultanément à la collecte des données jusqu’à ce qu’aucun concept dominant nouveau n’apparaisse. Les données ont été codées de manière itérative et regroupées en thèmes.
Résultats : Les participants ont décrit les facteurs internes et externes qui ont façonné leur expérience de l’observation et les tensions qui en ont découlé, ainsi que l’impact de ces expériences sur leur bien-être. Les facteurs internes associés au comportement d’observation sont les suivants : 1) vouloir être le meilleur et faire de l’observation pour montrer son excellence, 2) faire de l’observation dans le but d’explorer les débouchés de carrière, 3) faire de l’observation pour apprendre par l’exposition clinique précoce et pour se préparer à la carrière, et 4) réaffirmer et redéfinir l’identité professionnelle par l’observation. Les facteurs externes sont 1) le manque de clarté dans les processus de jumelage des résidents pouvant donner l’impression que l’observation est un atout, 2) le discours enseignant qui entretient la confusion des étudiants quant à la valeur de l’observation, et 3) la comparaison sociale dans le discours des pairs, alimentant une culture de l’observation compétitive.
Conclusions : La difficulté de trouver un équilibre entre le bien-être et les ambitions professionnelles, et les conséquences involontaires d’un discours peu clair concernant l’observation dans le contexte d’un climat compétitif mettent en évidence les problèmes inhérents à la culture de l’observation.
Parties annexes
Bibliography
- Graham P, Tso S, Wood E. Shadowing a foundation-year doctor: a third-year medical student’s perspective. Clin Teach. 2011 Sep;8(3):156–9. https://doi.org/10.1111/j.1743-498x.2011.00449.x
- Soo J, Brett-MacLean P, Cave M-T, Oswald A. At the precipice: a prospective exploration of medical students’ expectations of the pre-clerkship to clerkship transition. Adv Health Sci Educ Theory Pract. 2016 Mar;21(1):141–62. https://doi.org/10.1007/s10459-015-9620-2
- Kitsis E, Goldsammler M. Physician shadowing: A review of the literature and proposal for guidelines. Acad Med. 2013 Jan;88(1):102–10. https://doi.org/10.1097/ACM.0b013e318277d5b2
- Gruppen LD, Irby DM, Durning SJ, Maggio LA. Conceptualizing learning environments in the health professions. Acad Med J Assoc Am Med Coll. 2019 Jul;94(7):969–74. https://doi.org/10.1097/ACM.0000000000002702
- Bordage G, Harris I. Making a difference in curriculum reform and decision-making processes. Med Educ. 2011 Jan;45(1):87–94. https://doi.org/10.1111/j.1365-2923.2010.03727.x
- Jarvis-Selinger S, Hubinette M. The Matrix: moving from principles to pragmatics in medical school curriculum renewal. Acad Med J Assoc Am Med Coll. 2018 Oct;93(10):1464–71. https://doi.org/10.1097/acm.0000000000002306
- Ozolins I, Hall H, Peterson R. The student voice: recognising the hidden and informal curriculum in medicine. Med Teach. 2008;30(6):606–11. https://doi.org/10.1080/01421590801949933
- Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med J Assoc Am Med Coll. 2012 Sep;87(9):1185–90. https://doi.org/10.1097/acm.0b013e3182604968
- Skochelak SE, Stansfield RB, Dunham L, et al. Medical student perceptions of the learning environment at the end of the first year: a 28-medical school collaborative. Acad Med J Assoc Am Med Coll. 2016 Sep;91(9):1257–62. https://doi.org/10.1097/acm.0000000000001137
- Klamen DL, Williams R, Hingle S. Getting real: aligning the learning needs of clerkship students with the current clinical environment. Acad Med J Assoc Am Med Coll. 2019 Jan;94(1):53–8. https://doi.org/10.1097/acm.0000000000002434
- Dyrbye LN, Lipscomb W, Thibault G. Redesigning the learning environment to promote learner well-being and professional development. Acad Med J Assoc Am Med Coll. 2020 May;95(5):674–8. https://doi.org/10.1097/acm.0000000000003094
- Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016 Jan;50(1):132–49. https://doi.org/10.1111/medu.12927
- Dornan T, Ashcroft D, Heathfield H, et al. An in-depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education: EQUIP study. 2009; Available from: https://www.research.manchester.ac.uk/portal/en/publications/an-indepth-investigation-into-causes-of-prescribing-errors-by-foundation-trainees-in-relation-to-thier-medical-education-equip-study(dec5f06d-ac7b-4e0f-83f1-34806e280f8a)/export.html [Accessed on Dec 27, 2021].
- Raat ANJ, Kuks JBM, van Hell EA, Cohen-Schotanus J. Peer influence on students’ estimates of performance: social comparison in clinical rotations. Med Educ. 2013 Feb;47(2):190–7. https://doi.org/10.1111/medu.12066
- Siemens DR, Punnen S, Wong J, Kanji N. A survey on the attitudes towards research in medical school. BMC Med Educ. 2010 Jan 22;10(1):4. 1472-6920-10-4. https://doi.org/10.1186/
- Emmerich N. Chapter 2 sociological perspectives on medical education. in medical ethics education: an interdisciplinary and social theoretical perspective, Springer briefs in ethics. 2013; Pages 21-39. https://doi.org/10.1007/978-3-319-00485-3_2.
- Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006 Jan 1;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa
- Boyland JR. A social constructivist approach to the gathering of empirical data. Australian Counselling Research Journal. 2019;13(2) Available from: https://www.acrjournal.com.au/resources/assets/journals/Volume-13-Issue-2-2019/Manuscript5%20-%20A%20Social%20Constructivist%20Approach.pdf
- Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013 Sep;15(3):398–405. https://doi.org/10.1111/nhs.12048
- Patton M. 1990. Qualitative designs and data collection. In: Qualitative evaluation and research methods. Beverly Hills (CA): Sage; p. 169–186.
- Varpio L, Ajjawi R, Monrouxe LV, O'Brien BC, Rees CE. 2017. Shedding the cobra effect: problematising thematic emergence, triangulation, saturation, and member checking. Med Educ. Jan;51(1):40-50. https://doi.org/10.1111/medu.13124
- Buunk AP, Cohen-Schotanus J, van Nek RH. Why and how people engage in social comparison while learning social skills in groups. Group Dyn Theory Res Pract. 2007;11(3):140–52. https://doi.org/10.1037/1089-2699.11.3.14021.
- Janet Raat AN, Schönrock-Adema J, van Hell EA, Kuks JBM, Cohen-Schotanus J. Student distress in clinical workplace learning: differences in social comparison behaviours. Adv Health Sci Educ Theory Pract. 2015;20(1):101–11. https://doi.org/10.1007/s10459-014-9513-9
- Vaughan S, Sanders T, Crossley N, O’Neill P, Wass V. Bridging the gap: the roles of social capital and ethnicity in medical student achievement. Med Educ. 2015 Jan;49(1):114–23. https://doi.org/10.1111/medu.12597
- Dornan DT, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach. 2006 Jan 1;28(1):3–18. https://doi.org/10.1080/01421590500410971
- Block L, Wang K, Gao CC, Wu AW, Feldman LS. There’s a lot more to being a physician: insights from an intensive clinical shadowing experience in internal medicine. Teach Learn Med. 2018 Jul 3;30(3):266–73. https://doi.org/10.1080/10401334.2017.1415148
- Iwata K, Gill D. Learning through work: clinical shadowing of junior doctors by first year medical students. Med Teach. 2013 Aug 1 [cited 2020 Jun 2];35(8):633–8. https://doi.org/10.3109/0142159X.2013.801552
- Hee JM, Yap HW, Ong ZX, et al. Understanding the mentoring environment through thematic analysis of the learning environment in medical education: a systematic review. J Gen Intern Med. 2019 Oct;34(10):2190–9. https://doi.org/10.1007/s11606-019-05000-y
- Schindler BA, Novack DH, Cohen DG, et al. The impact of the changing health care environment on the health and well-being of faculty at four medical schools. Acad Med J Assoc Am Med Coll. 2006 Jan;81(1):27–34. https://doi.org/10.1097/00001888-200601000-00008.
- Pololi L, Conrad P, Knight S, Carr P. A study of the relational aspects of the culture of academic medicine. Acad Med J Assoc Am Med Coll. 2009 Jan;84(1):106–14. https://doi.org/10.1097/ACM.0b013e3181900efc
- Adler PS, Kwon S-W. The mutation of professionalism as a contested diffusion process: clinical guidelines as carriers of institutional change in medicine. J Manag Stud. 2013;50(5):930–62. https://doi.org/10.1111/joms.12003
- van Vendeloo SN, Godderis L, Brand PLP, Verheyen KCPM, Rowell SA, Hoekstra H. Resident burnout: evaluating the role of the learning environment. BMC Med Educ. 2018 Mar 27;18(1):54. https://doi.org/10.1186/s12909-018-1166-6
- Krupat E, Pololi L, Schnell ER, Kern DE. Changing the culture of academic medicine: the C-Change learning action network and its impact at participating medical schools. Acad Med. 2013 Sep 1;88(9):1252–8. https://doi.org/10.1097/ACM.0b013e31829e84e0
- Li M, Pieris D, Xu G, Law M. In the shadows: medical student clinical observerships and career exploration in the face of COVID-19. Can Med Educ J. 2021 Jun 30;12(3):179–81. https://doi.org/10.36834/cmej.71523