透过受污染的镜头:医学学习者对患者 "理应 "获得健康倡导的思考的定性研究

Ian Scott, M. Hubinette, T. van der Goes, Renate Kahlke
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引用次数: 0

摘要

导言:虽然健康倡导是许多能力框架的关键组成部分,但越来越多的证据表明,学习者并不认为这是他们学习和未来实践的核心。当学习者确实为病人进行宣传时,他们将这项工作描述为为少数病人 "做得更多"。当他们以这种方式考虑宣传时,学习者会选择哪些人值得他们付出努力。要想让教育者和决策者支持学习者深思熟虑、合乎道德地做出这些决定,我们必须首先了解他们目前是如何思考患者是否值得的。方法:我们对多个地点和学科的 29 名本科生和研究生医学学习者进行了定性访谈,讨论他们在健康倡导方面的经验和决策。然后,我们进行了主题分析,以了解学习者如何决定何时以及为谁倡导。在初步归纳编码的基础上,我们根据现有的 "应得 "概念化理论,制定了一个演绎编码框架。结果如果学习者认为他们的病人:对自己的病情没有责任、比其他人更需要支持、态度积极、正在努力改善自己的健康状况、与学习者有相似之处,那么他们就认为病人值得宣传。学习者注意到了他们自己对病人是否值得维权的想法所固有的紧张和不安。讨论:学习者关于是否应该进行辩护的决定植根于他们对病人的先入之见。需要对倡导决定进行明确的课程设置和对话,以支持学习者公平地做出倡导决定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Through a Tainted Lens: A Qualitatve Study of Medical Learners’ Thinking About Patient ‘Deservingness’ of Health Advocacy
Introduction: While health advocacy is a key component of many competency frameworks, mounting evidence suggests that learners do not see it as core to their learning and future practice. When learners do advocate for their patients, they characterize this work as ‘going above and beyond’ for a select few patients. When they think about advocacy in this way, learners choose who deserves their efforts. For educators and policymakers to support learners in making these decisions thoughtfully and ethically, we must first understand how they are currently thinking about patient deservingness. Methods: We conducted qualitative interviews with 29 undergraduate and postgraduate medical learners, across multiple sites and disciplines, to discuss their experiences of and decision-making about health advocacy. We then carried out a thematic analysis to understand how learners decided when and for whom to advocate. Stemming from initial inductive coding, we then developed a deductive coding framework, based in existing theory conceptualizing ‘deservingness.’ Results: Learners saw their patients as deserving of advocacy if they believed that the patient: was not responsible for their condition, was more in need of support than others, had a positive attitude, was working to improve their health, and shared similarities to the learner. Learners noted the tensions inherent in, and discomfort with, their own thinking about patient deservingness. Discussion: Learners’ decisions about advocacy deservingness are rooted in their preconceptions about the patient. Explicit curriculum and conversations about advocacy decisions are needed to support learners in making advocacy decisions equitably.
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