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Learning palliative care: a process of ‘becoming’

Learning palliative care: a process of ‘becoming’. Frances Kilbertus MD, CCFP(PC), FCFP, MMEd Associate Professor, Northern Ontario School of Medicine. Dr. Rola Ajjawi PhD S enior R esearch Fellow, Centre for Research in Assessment and Digital Learning

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Learning palliative care: a process of ‘becoming’

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  1. Learning palliative care: a process of ‘becoming’ Frances Kilbertus MD, CCFP(PC), FCFP, MMEd Associate Professor, Northern Ontario School of Medicine

  2. Dr. RolaAjjawi PhD Senior Research Fellow, Centre for Research in Assessment and Digital Learning DeakinUniversity, Australia.

  3. Faculty/Presenter Disclosure Frances Kilbertus, RolaAjjawi: Relationships with commercial interests: NONE Potential for conflict(s) of interest: NONE

  4. Where did the research questions come from?

  5. Research questions: 1- What are family medicine residents' memorable learning experiences in palliative care? 2- How does this contribute to professional identity formation for palliative care?

  6. Methods and methodology Qualitative methods: answers WHAT and HOW questions Narrative methodology: focus on the story Thematic narrative analysis: common themes across many stories Structural narrative analysis: what is revealed in the telling

  7. Voluntary, consented participants • 14 family medicine residents in the last 6 months of training • One Canadian family medicine program, 3 urban sites • Semi-structured individual interviews that co-created stories of memorable learning (narratives of memorable learning = NMLs): NMLs: 2-5 NML per interview 45 NMLs for analysis

  8. Context of memorable learning

  9. Theme: the concept of palliative care as different “… you’re not trying to save somebody from death…” P13 P: participant

  10. Theme: emotion

  11. … the daughter’s looking … “No… doctor you have to understand we’re going shopping tomorrow …we have to keep her alive… we promised we’re going shopping tomorrow.” It was… it was a difficult conversation. P12

  12. Theme: workplace learning Workplace based learning: 41 of 45 NMLs • Learning by doing • Learning through clinical supervision • Learning from interprofessional colleagues • Learning from patients and families

  13. Structural narrative analysis What is revealed in the narrative by how the story is told?

  14. Four paradigms for describing the complex interplay between emotion, meaning-making, and identity in clinical encounters Feeling insecure: feelings of uncertainty, fear and being a burden Complying:being largely detached, sticking to rules, procedural, structural aspects Developing: active involvement in emotional exploration, personal development and reflection on uncertainty Participating: active contribution to care, willing to shape learning opportunities, enhance personal and professional development Helmich et al 2012

  15. Conclusions: learning as becoming

  16. By conceptualizing learning as “becoming,” what occurs during memorable learning can be made accessible to those supporting learners and their professional identity formation.

  17. Acknowledgements This study was undertaken with the support of a “Program in Innovation in Medical Education Grant “ (PIME) through the Department of Family Medicine and the Bruyere Research Institute at the University of Ottawa.

  18. Selected references • Bleakley, A., Bligh, J., & Browne, J. (2011). Medical Education for the Future. Identity, Power and Location (Vol. 1): Springer Netherlands. • Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical education to support professional identity formation. Acad Med. 2014;89:1446–51. • Dornan, T., Pearson, E., Carson, P., Helmich, E., & Bundy, C. (2015). Emotions and identity in the figured world of becoming a doctor. Medical Education, 49(2), 174-185. doi:10.1111/medu.12587 • Hager P, Hodkinson P. Becoming as an appropriate metaphor for understanding professional learning. In: Scanlon L, ed. “Becoming” a Professional: An Interdisciplinary Analysis of Professional Learning. Netherlands: Springer; 2011:33-56. • Helmich, E., Bolhuis, S., Dornan, T., Laan, R., & Koopmans, R. (2012). Entering medical practice for the very first time: emotional talk, meaning and identity development. Medical Education, 46(11), 1074-1086. doi:10.1111/medu.12019 • Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: Integrating identity formation into the medical education discourse. Acad Med. 2012;87:1185-1190. • Jenkins, R. (2014). Social Identity (Fourth ed.). London: Routledge. • Kilbertus F, Ajjawi R, Archibald D. “You’re not trying to save somebody from death”: Learning as ‘becoming’ in palliative care. (in press) Academic Medicine. 2017. • Mann, K. V. (2011). Theoretical perspectives in medical education: past experience and future possibilities. Medical Education, 45(1), 60-68. doi:10.1111/j.1365-2923.2010.03757.x • Monrouxe, L. (2009). Negotiating Professional Identities: dominant and contesting narratives in medical students longitudinal audiodiaries. Current Narratives, 1, 41-49. • Monrouxe, L. V. (2010). Identity, identification and medical education: why should we care? Medical Education, 44(1), 40-49. doi:10.1111/j.1365-2923.2009.03440.x • Riessman, C. K. (2008). Narrative Methods for the Human Sciences. Thousand Oaks, California: Sage Publications.

  19. Questions? fkilbertus@nosm.ca

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