Main Article Content
Objective—This article provides a reflection on medical teaching opportunities for whole person care based on our experiences mentoring 2nd-year medical students through an Ethnography Practicum at a Canadian university.
Background—The Ethnography Practicum is a new addition to the Family Medicine Transition to Clinical Practice (TCP) curriculum introduced in the second year of medical school at McGill University. It involves 30 hours of instruction (6 hours in lectures with an instructor, and 24 hours in small-group tutorials with the authors), and 9 hours of fieldwork observations in various community health settings across Montreal, QC. The primary aims of the Practicum converge with those of the TCP generally in two important ways: to inculcate in students the concepts of patient centered care, and to promote family medicine as both an academic discipline and career option.
Results and Discussion— Our experiences illustrate two tensions that shape students’ expectations and experiences throughout their involvement in the Practicum and, in turn, highlight the implications for teaching whole-person care. First, ethnography as a combination of different methods has itself been the locus of tensions between positivist and critical traditions in the three last decades. Second, the Practicum is situated precisely at the crossroads of key moments on the professional identity formation continuum for our students. Such a crossroads is disruptive to the status quo of medical traineeship characteristic of the first two years in medical school, and thus reorients professional identity formation. The above tensions reveal how ethnography is not only a revered research tradition in the humanities, but can also be a conduit to whole person care-inspired clinical practice.
Conclusion—As instructors and mentors involved in this Ethnography Practicum, we are continually forging a new relevance for organizational ethnography in medical training, where medical students can reflect and act on competencies beyond clinical ones. The Practicum provides a space for students to wrestle with alternative epistemologies to understanding the social world in which medicine is embedded. We lastly provide pragmatic ways to better address these tensions in an effort to support students as they proceed through the (multifaceted) development of their professional identities as future physicians.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. Creative Comons 4.0 CC-BY
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
Forget CE. The case of the vanishing Québec physicians: how to improve access to care. Toronto: Howe Institute; 2014.
Gulli C, Lunau K. Adding fuel to the doctor crisis [Internet]. 2008 Jan 2 [cited 2015 Apr 3] Available from: http://www.macleans.ca/society/health/adding-fuel-to-the-doctor-crisis/.
Flannery MT. The 2014 United States National Residency Match Program data for primary care programs: A review. Eur J Int Med. 2015;26(1):6-8.
Denzin NK. Interpretive ethnography: ethnographic practices for the 21st century. Thousand Oaks, Calif.: Sage Publications; 1997.
Becker HS. Boys in white; student culture in medical school. Chicago: Univ. of Chicago Press; 1961.
Atkinson PA. The Clinical Experience. 2nd ed. Aldershot, UK: Ashgate; 1997.
Atkinson PA. Medical discourse, evidentiality and the construction of professional responsibility. In: Srikant S, Roberts C, eds. Talk, Work and Institutional Order: Discourse in Medical, Mediation and Management Settings. Berlin: Walter de Gruyter; 1999. p. 75-107.
Sathe V. Implications of corporate culture: A manager's guide to action. Org Dynamics. 1983;12(2):5-23.
Brown R, Kuzara J, Copeland W, Costello EJ, Angold A, Worthman C. Moving from ethnography to epidemiology: Lessons learned in Appalachia. Ann Hum Bio. 2009;36(3):248-60.
Hall P. Interprofessional teamwork: Professional cultures as barriers. J Interprof Care. 2005;19(Supplement):188-96.
Mahoney JS. An ethnographic approach to understanding the illness experiences of patients with congestive heart failure and their family members. Heart & Lung. 2001;30(6):429-36.
Reid A. Understanding our patients. An anthropological approach. Aus Fam Phys. 1998;27(Suppl 2):S99-102.
Hoffmaster B. Can ethnography save the life of medical ethics? Soc Sci Med. 1992;35(12):1421-31.
Dharamsi S, Charles G. Ethnography: traditional and criticalist conceptions of a qualitative research method. Can Fam Phys. 2011;57(3):378-9.
Bloor M. The ethnography of health and medicine. In: Atkinson P, Coffey A, Delamont S, Lofland J, eds. Handbook of ethnography. London: Sage Publications; 2001. p. 177-87.
Sufrin C. "Doctor, Why Didn't You Adopt My Baby?" Observant Participation, Care, and the Simultaneous Practice of Medicine and Anthropology. Cult Med Psychiatry. 2015 Feb 20. [Epub ahead of print]
Atkinson P. Training for certainty. Soc Sci Med. 1984;19(9):949-56.
Rodriguez C, Lopez-Roig S, Pawlikowska T, Schweyer FX, Belanger E, Pastor-Mira MA, et al. The influence of academic discourses on medical students’ identification with the discipline of family medicine. Acad Med. 2015;90(5):660-70.
Hanna M, Fins JJ. Viewpoint: power and communication: why simulation training ought to be complemented by experiential and humanist learning. Acad Med. 2006;81(3):265-70.
Branch WT. Teaching professional and humanistic values: suggestion for a practical and theoretical model. Patient Educ Couns. 2015;98(2):162-7.
Jensen DH, Jetten J. Bridging and bonding interactions in higher education: social capital and students' academic and professional identity formation. Frontiers in Psychology. 2015;6:126.
Hodges B. Medical education and the maintenance of incompetence. Med Teach. 2006;28(8):690-6.
Whitehead CR, Kuper A, Hodges B, Ellaway R. Conceptual and practical challenges in the assessment of physician competencies. Med Teach. 2015;37(3):245-51.
Goldie J. The formation of professional identity in medical students: considerations for educators. Med Teach. 2012;34(9):e641-8.
Radcliffe C, Lester H. Perceived stress during undergraduate medical training: a qualitative study. Med Educ. 2003;37(1):32-8.
Verdonk P, Rantzsch V, de Vries R, Houkes I. Show what you know and deal with stress yourself: a qualitative interview study of medical interns' perceptions of stress and gender. BMC Med Educ. 2014;14:96.
Prince KJAH, Boshuizen HPA, Van Der Vleuten CPM, Scherpbier AJJA. Students' opinions about their preparation for clinical practice. Med Educ. 2005;39(7):704-12.
Baarts C, Tulinius C, Reventlow S. Reflexivity--patient-centred approach in general practice. Fam Pract. 2000;17(5): 430-4.
Goffman E. The presentation of self in everyday life. Garden City, N.Y.: Doubleday; 1959.