Harmony or dissonance? The affordances of palliative care learning for emerging professional identity
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Perspect Med Educ https://doi.org/10.1007/s40037-020-00608-x
Harmony or dissonance? The affordances of palliative care learning for emerging professional identity Frances Kilbertus
· Rola Ajjawi
· Douglas Archibald
© The Author(s) 2020
Abstract Introduction Patient demographics demand physicians who are competent in and embrace palliative care as part of their professional identity. Published literature describes ways that learners acquire knowledge, skills and attitudes for palliative care. These studies are, however, limited by their focus on the individual where learning is about acquisition. Viewing learning as a process of becoming through the interplay of individual, social relationships and cultures, offers a novel perspective from which to explore the affordances for professional identity development. Methods Qualitative narrative methods were used to explore 45 narratives of memorable learning (NMLs) for palliative care recounted by 14 graduating family medicine residents in one family medicine residency program. Thematic and narrative analyses identified the affordances that support and constrain the dynamic emergence of professional identity. Results Participants recounted affordances that supported and/or constrained their learning acting on personal (e.g. past experiences of death), interpersonal (e.g. professional support) and systemic (e.g. patient continuity) levels. Opportunities for developing professional identity were dynamic: factors acted in harmony, were misaligned, or colliding to support
F. Kilbertus () Division of Clinical Science, Northern Ontario School of Medicine, Mindemoya, Ontario, Canada [email protected] R. Ajjawi Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia D. Archibald Department of Family Medicine, University of Ottawa, Ottawa, Canada
or constrain an emerging professional identity for palliative care practice. Conclusion Findings highlight how individual factors interplay with interpersonal and structural conditions in the workplace in dynamic and emergent ways that may support or constrain the emergence of professional identity. Viewing learning as a process of becoming allows teachers, curriculum developers and administrators to appreciate the complexity and importance of the interplay between the individual and the workplace affordances to create environments that nurture professional identity for palliative care practice. Keywords Palliative care learning · Professional identity · Personal narrative
Introduction Learning in health professions happens within complex and dynamic clinical workplaces [1, 2]. While the workplace context is acknowledged as an important factor in supporting learning and practice, attention to this influence and to the interplay of an individual within the workplace environment is lacking, particularly when using traditional research methods for educational interventions [3–5]. In this paper, we seek to explore palliative care learning using the metaphor of learning as becoming: a continuo
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