"You're Not Trying to Save Somebody From Death": Learning as "Becoming" in Palliative Care

作者:Kilbertus Frances*; Ajjawi Rola; Archibald Douglas B
来源:Academic Medicine, 2018, 93(6): 929-936.
DOI:10.1097/ACM.0000000000001994

摘要

Purpose
Learning can be conceptualized as a process of becoming, considering individuals, workplace participation, and professional identity formation. How postgraduate trainees learn palliative care, encompassing technical competence, compassion, and empathy, is not well understood or explained by common conceptualizations of learning as acquisition and participation. Learning palliative care, a practice that has been described as a cultural shift in medicine challenging the traditional role of curing and healing, provided the context to explore learning as becoming.
Method
The authors undertook a qualitative narrative study, interviewing 14 residents from the University of Ottawa Family Medicine Residency Program eliciting narratives of memorable learning (NMLs) for palliative care. Forty-five NMLs were analyzed thematically. To illuminate the interplay among themes, an in-depth analysis of the NMLs was done that considered themes and linguistic and paralinguistic features of the narratives.
Results
Forty-five NMLs were analyzed. The context of NMLs was predominantly a variety of clinical workplaces during postgraduate training. Themes clustered around the concept of palliative care and how it contrasted with other clinical experiences, the emotional impact on narrators, and how learning happened in the workplace. Participants had expectations about their identities as doctors that were challenged within their NMLs for palliative care.
Conclusions
NMLs for palliative care were a complex entanglement of individual experience and social and workplace cultures highlighting the limitations of the acquisition and participation metaphors of learning. By conceptualizing learning as becoming, what occurs during memorable learning can be made accessible to those supporting learners and their professional identity formation.

  • 出版日期2018-6
  • 单位迪肯大学