This innovative volume provides fresh perspectives on how medical students and patients construct identities in relation to each other, using stories of their clinical encounters. It explores how paying attention to medical students’ and patients’ stories in clinical teaching encounters can encourage empathy and the formation of professional identities that embody desirable values such as integrity and respect.
Written by an experienced clinician and based on original, rigorous research combining ethnography and dialogic narrative analysis, Storytelling Encounters as Medical Education: Crafting Relational Identity includes patient stories alongside those of students and clinical teachers.
This is an important contribution for all those interested in medical education, narrative medicine, person-centred care and identity formation in healthcare. It will also be of value to scholars in a range of other disciplines, who are using a dialogic approach.
Author(s): Sally G. Warmington
Series: Routledge Advances in the Medical Humanities
Publisher: Routledge
Year: 2019
Language: English
Pages: 170
City: London
Cover
Half Title
Series Page
Title Page
Copyright Page
Dedication
Table of Contents
List of Figures
Acknowledgements
Chapter: 1 Storytelling matters
Background
Narrative, storytelling and identity
Aims
Outline of theory and methods
Crafting relational identity
Daniel’s story
Social and cultural research on identity
A dynamic and relational phenomenon
Social identity complexity
Modes of identification with social groups
Identity research in medical education
Socialisation, professionalism and identity construction
Drama at the bedside
Narrative-based activities in medical education
Relational perspectives
Identity dissonance
Clinical case presentation genre
References
Chapter 2: Dialogues from the field
Theoretical framework
Dialogue and the dynamic subject
Ethnographic fieldwork
The fieldwork begins
Finding my place
Presence and impact
Strange but familiar
Ethical considerations
Recruiting the storytellers
Medical students
Clinical teachers
Patients
Gathering the stories
Field observations: making contact
Handbooks: espoused values and expected practices
Interviews: fertile ground for storytelling
Dialogic narrative analysis
Preliminary steps
Narrative contexts
Narrative production
Narrative performance
Narrative work
Stories in dialogue
References
Chapter 3: Real patients are different
Learning about clinical communication
Storytelling metaphors
The precession of simulacra
Struggle for an integrated identity
I don’t know how to cut them off!
A multi-vocal narrative
Interactional positioning
Identity work at the bedside
There’s no-one else like me!
Stories within stories
Analysis and interpretation
Heteroglossia, answerability and intertextuality
Parallel narratives of disease, illness and identity
Identity and academic learning
References
Chapter 4: Imagining the students’ world
Engaging with patients’ stories
Responding to students with empathy
The students approach
The intravenous line
An empathic response
Shifting power relations
Resisting identity disruption
Doing that ‘one-upmanship’
Disrupting identity work
Identity construction in the research interview
Relating dialogically
References
Chapter 5: Object or active participant?
Patient participation in clinical teaching
Looking for courage and connection
Objectivity and objectification
Demonstrating the signs
Power, identity and customary practice
Dehumanisation and dissonance
Dehumanisation in everyday practice
Towards active participation
References
Chapter 6: Allies and adversaries
Obligation or option
Revealing everyday consent practices
Talking about sensitive examinations
Consent and the physical examination
Consent and performing procedures
Consent and ward rounds
Negotiating identity in practice
Negotiation, accommodation and resistance
Fear, desire and ‘disavowed’ motivations
Constructing the patient as adversary
Note
References
Chapter 7: Complexity, contest and confusion
Perspectives on a bedside teaching encounter
Researcher’s story: narrative silencing
The neurological examination
Narrative silencing and the eloquent body
Relationships and status
Student’s story: complexity and confusion
Complexity generates confusion
Dual ‘voices’ and an evolving identity
Patient’s story: a boring operation
Identity shifts
Responding creatively to disruption
Different stories, common threads
Power dynamics and identity
Primacy of the student-doctor relationship
References
Chapter 8: Towards a dialogic medical education
Contexts of relational identity construction
Constructing identity in research interviews
Constructing identity in clinical teaching encounters
Illuminating patient experiences
Imagining the students’ world
Object or active participant
The patient as adversary
Humanising clinical teaching
Engaging dialogically
Opportunities for dialogic transformation
Clinical teaching encounters
Curriculum design and delivery
Institutional and professional cultures
References
Index
