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Lorelei Lingard

Publications and source records attributed to Lorelei Lingard.

25 records · Page 2Linked to original sources
PubMed2003

To be and not to be: the paradox of the emerging professional stance.

PURPOSE: Understanding how students resolve professional conflict is essential to teaching and evaluating professionalism. The purpose of this study was to refine an existing coding structure of rationalizations of student behaviour, and to further our understanding of students' reasoning strategies in the face of perceived professional lapses. METHODS: Anonymous essays were collected from final year medical students at two universities. Each essay included a description of a specific professional lapse, and a consideration of how the lapse was dealt with. Essays were analysed using grounded theory. The resulting coding structure was applied using NVivo software. RESULTS: Twenty essays, containing 147 instances of articulated reasoning, were included. Three major categories (and several subcategories) of reasoning strategies emerged: Narrative Attitude (deflection or reflection), Dissociation (condescension or identity mobility), and Engagement (with associated action or no action). This data set revealed a wider range of Narrative Attitude than in the original study, confirmed the dominance of Dissociation as a reasoning strategy, and, perhaps paradoxically, also revealed significant evidence of action on the part of the students (predominantly directed towards dealing with the consequences of a lapse or confronting the lapser). Most of these actions were perceived to be ineffective. CONCLUSIONS: Encountering a professional lapse can be a paradoxical and profoundly disordering experience for students. When students report these experiences, they invoke reasoning strategies that enable them to re-story the lapse. Their methods of re-storying provide insight into the double-binds that students experience, their efforts to transcend these double-binds, and, through these, their emerging professional stance.

Attitude of Health Personnel↗
PubMed2003

Technical skills in paediatrics: a qualitative study of acquisition, attitudes and assumptions in the neonatal intensive care unit.

PURPOSE: While the effective acquisition of technical skills is essential for excellent paediatric care, little is known about how technical skills are learned in the paediatric setting. This study sought to describe and theorise the variables influencing technical skills acquisition in a tertiary care neonatal intensive care unit (NICU) inpatient setting. METHODOLOGY: Using non-participant field methodology, paediatric residents and their teachers (nurses, respiratory therapists, neonatal staff and fellows) were observed at various times in the NICU for 8 weeks. Thirteen semistructured interviews with these teachers and learners and 1 focus group of additional learners were conducted and used to triangulate observational findings. Using a constant comparative process, field notes, interview and focus group transcripts were analysed by 2 researchers for emergent themes in the grounded theory tradition. RESULTS: Data sourced from over 90 hours of observation and 21 observed technical procedures, and both individual and group interviews are presented thematically. Dominant themes include: the nature, timing and purpose of feedback about technical procedures; opportunities to learn technical skills; multiple demands that intersect with technical procedure attempts; competing priorities, and teachers' and learners' differing perceptions. These themes interact to affect the learning environment. CONCLUSION: The NICU learning environment represents a complex interplay between competing priorities, learning opportunities and attributions about learners. This interplay must be understood if improvements to technical skills training in this domain are to be developed.

Attitude of Health Personnel↗
PubMed2003

The disavowed curriculum: understanding student's reasoning in professionally challenging situations.

CONTEXT: Understanding students' perceptions of and responses to lapses in professionalism is important to shaping students' professional development. OBJECTIVE: Utilize realistic, standardized professional dilemmas to obtain insight into students' reasoning and motivations in "real time." DESIGN: Qualitative study using 5 videotaped scenarios (each depicting a student placed in a situation which requires action in response to a professional dilemma) and individual interviews, in which students were questioned about what they would do next and why. SETTING: University of Toronto. PARTICIPANTS: Eighteen fourth-year medical students; participation voluntary and anonymous. MAIN OUTCOME MEASURE: A model to explain students' reasoning in the face of professional dilemmas. RESULTS: Grounded theory analysis of interview transcripts revealed that students were motivated to consider specific actions by referencing a Principle (an abstract or idealized concept), an Affect (a feeling or emotion), or an Implication (a potential consequence of suggested actions). Principles were classified as "avowed" as ideals of our profession (e.g., honesty or disclosure), or "unavowed" (unacknowledged or undeclared, e.g., obedience or allegiance). Implications could also be avowed (e.g., concerning patients) or unavowed (e.g., concerning others); but students were predominantly motivated by considering "disavowed" implications: those pertaining to themselves (e.g., concern for grades, evaluations, or reputation), which are actively denied by the profession and discouraged as being inconsistent with altruism. CONCLUSIONS: This "disavowed curriculum" has implications for education, feedback, and evaluation. Instead of denying their existence, we should teach students how to negotiate and balance these unavowed and disavowed implications and principles, in order to help them develop their own professional stance.

Clinical Competence↗
PubMed2002

Team communications in the operating room: talk patterns, sites of tension, and implications for novices.

PURPOSE: Although the communication that occurs within health care teams is important to both team function and the socialization of novices, the nature of team communication and its educational influence are not well documented. This study explored the nature of communications among operating room (OR) team members from surgery, nursing, and anesthesia to identify common communicative patterns, sites of tension, and their impact on novices. METHOD: Paired researchers observed 128 hours of OR interactions during 35 procedures from four surgical divisions at one teaching hospital. Brief, unstructured interviews were conducted following each observation. Field notes were independently read by each researcher and coded for emergent themes in the grounded theory tradition. Coding consensus was achieved via regular discussion. Findings were returned to insider "experts" for their assessment of authenticity and adequacy. RESULTS: Patterns of communication were complex and socially motivated. Dominant themes were time, safety and sterility, resources, roles, and situation. Communicative tension arose regularly in relation to these themes. Each procedure had one to four "higher-tension" events, which often had a ripple effect, spreading tension to other participants and contexts. Surgical trainees responded to tension by withdrawing from the communication or mimicking the senior staff surgeon. Both responses had negative implications for their own team relations. CONCLUSIONS: Team communications in the OR follow observable patterns and are influenced by recurrent themes that suggest sites of team tension. Tension in team communication affects novices, who respond with behaviors that may intensify rather than resolve interprofessional conflict.

Communication↗
PubMed2002

The anatomy of the professional lapse: bridging the gap between traditional frameworks and students' perceptions.

PURPOSE: To support students' developing professionalism, it is necessary to understand the professional challenges and dilemmas they perceive in the clinical setting. This study systematically documented and catalogued students' reports of professional lapses. METHOD: Six focus groups were conducted with senior medical students (n = 29) at three universities. Using a grounded-theory approach, three researchers analyzed the students' reports of specific lapses in professionalism for recurrent themes. The resulting coding structure was applied using NVivo qualitative data analysis software. RESULTS: A total of 120 pages of text yielded 48 specific incidents of professional lapses, which were analyzed by three researchers using grounded theory. Most incidents were witnessed (n = 34) or known about (n = 4), as opposed to self-reported (n = 10). Six critical "issues" emerged: communicative violations (to or about patients or other health care professionals); role resistance (individuals chafing against constraints or expectations of their perceived roles); objectification of patients (ignoring patients or treating patients as vehicles for learning); accountability (to colleagues or patients, including avoiding patients, failing to disclose information, or failing to treat appropriately); physical harm (to patients or others); and crossfire (being put in the middle of a struggle between superiors). CONCLUSIONS: This study explored how students experienced and operationalized professionalism in clinical settings at a variety of universities. Interestingly, the critical issues they reported as salient did not map easily onto standard, abstract definitions of professionalism. This incongruence suggested that the development of effective curricula in this domain must bridge the gap between traditional taxonomies and students' perceptions of professionalism.

Canada↗