Nurturing anaesthetic expertise
On narrative, affect and professional inclusivity
This article seeks to establish the educational and social significance of narrative and affect in anaesthetic training. Data were obtained from focus group discussions involving three groups of eight (total 24) young anaesthetists from around Australia held at an Australian and New Zealand College of Anaesthetists (ANZCA) residential conference. Analysis applied to transcripts of the discussions revealed the prominence of narratives used among trainees and supervisors as a medium for explaining and nurturing anaesthetic expertise. Nurturing expertise was accomplished by sharing narratives about extreme circumstances that highlighted a need for constant vigilance directed towards not just clinical circumstances but also colleagues. The article suggests that the narrative emphasis on remaining vigilant and maintaining personal resourcefulness may explain graduands' tendency towards social exclusivity (avoidance of non-colleague others), and contribute to a better understanding of medicine's professional inclusivity (strong in-group bonding).
Bloor, G. (1999) Organisational culture, organisational learning and total quality management: A literature review and synthesis. Australian Health Review 22 (3): 162-179.
Boreham, N. (2004) A theory of collective competence: Challenging the neo-liberal individualisation of performance at work. British Journal of Educational Studies 52 (2): 5-17.
Boreham, N. C., Shea, C. E. and Mackway-Jones, K. (2000) Clinical risk and collective competence in the hospital emergency department in the UK. Social Science & Medicine 51 (1): 83-91.
Bosk, C. (2003) Forgive and Remember: Managing Medical Failure (2nd edition). Chicago: University of Chicago Press. https://doi.org/10.7208/chicago/9780226924687.001.0001
Branch, W. T. and Frankel, R. (2016) Not all stories of professional identity formation are equal: An analysis of formation narratives of highly humanistic physicians. Patient Education & Counseling 99 (8): 1394-1399. https://doi.org/10.1016/j.pec.2016.03.018
Charon, R. (2001) Narrative medicine: A model for empathy, reflection, profession, and trust. Journal of the American Medical Association 286 (15): 1897-1902. https://doi.org/10.1001/jama.286.15.1897
Clandinin, J., Cave, M. T. and Berendonk, C. (2017) Narrative inquiry: A relational research methodology for medical education. Medical Education 51 (1): 89-96. doi:10.1111/medu.13136
De Vries-Erich, J. M., Dornan, T., Boerboom, T., Jaarsma, D. C. and Helmich, E. (2016) Dealing with emotions: Medical undergraduates’ preferences in sharing their experiences. Medical Education 50 (8): 817-828. https://doi.org/10.1111/medu.13004
Degeling, P., Hill, M. and Kennedy, J. (2001) Mediating the cultural boundaries between medicine, nursing and management - The central challenge in hospital reform. Health Services Management Research 14 (1): 36-48. https://doi.org/10.1258/0951484011912519
DelVecchio Good, M., Gadmer, N. M., Ruopp, P., Lakoma, M., Sullivan, A. M., Redinbaugh, E., Arnold, R.M. and Block, S.D. (2004) Narrative nuances on good and bad deaths: Internists’ tales from high technology work places. Social Science & Medicine 58 (5): 939-953.
Dobie, S. (2007) Reflections on a well-traveled path: Self-awareness, mindful practice, and relationship centered care as foundations for medical education. Academic Medicine 82 (4): 422-427. https://doi.org/10.1097/01.ACM.0000259374.52323.62
Eisenberg, E. M., Murphy, A. G., Sutcliffe, K., Wears, R., Schenkel, S., Perry, S. and Vanderhoef, M. (2005) Communication in emergency medicine: Implications for patient safety. Communication Monographs 72 (4): 390-413. https://doi.org/10.1080/03637750500322602
Erickson, F. (1999) Appropriation of voice and presentation of self as a fellow physician: aspects of a discourse of apprenticeship in medicine. In S. Sarangi and C. Roberts (eds) Talk, Work and the Institutional Order: Discourse in Medical, Mediation and Management Settings, 109-144. Berlin: Mouton de Gruyter. https://doi.org/10.1515/9783110208375.2.109
Fletcher, G., Flin, R., McGeorge, P., Glavin, R., Maran, N. and Patey, R. (2003) The anaesthetists’ non-technical skills system (ANTS): Evaluation of a behavioural marker system. British Journal Anaesthesia 90 (5): 580-588. https://doi.org/10.1093/bja/aeg112
Greenhalgh, T., Russell, J. and Swinglehurst, D. (2005) Narrative methods in quality improvement research. BMJ Quality and Safety Health Care 14 (6): 443-449. https://doi.org/10.1136/qshc.2005.014712
Iedema, R. (2007) Essai: The materiality, contingency and multi-modality of organizational discourse. Organization Studies 28 (6): 931-946. https://doi.org/10.1177/0170840607075264
Iedema, R., Jorm, C. and Lum, M. (2009) Affect is central to patient safety: The horror stories of young anaesthetists. Social Science & Medicine 69 (12): 1750-1756.
Iedema, R., Carroll, K., Hor, S., Collier, A., Mesman, J. and Wyer, M. (2019) Video-Reflexive Ethnography in Healthcare Research and Healthcare Improvement. London: Taylor & Francis.
Karnieli-Miller, O., Vu, T. R., Frankel, R. M., Holtman, M. C., Clyman, S. G., Hui, S. L. and Inui, T. S. (2011) Which experiences in the hidden curriculum teach students about professionalism? Academic Medicine 86 (3): 369-377. https://doi.org/10.1097/ACM.0b013e3182087d15
Lave, J. (1993) The Practice of learning. In S. Chaiklin and J. Lave (eds) Understanding Practice: Perspectives on Activity and Context, 3-32. Cambridge: Cambridge University Press.
Martin, J. R. (1992) English Text: System and Structure. Amsterdam: John Benjamins. https://doi.org/10.1075/z.59
Massumi, B. (2002) Parables for the Virtual: Movement, Affect, Sensation. Durham, NC: Duke University Press. https://doi.org/10.1215/9780822383574
McKechnie, C. C. (2014) Anxieties of communication: The limits of narrative in the medical humanities. BMJ Journal of Medical Ethics & Medical Humanities 40 (2): 119-124.
McDonald, R., Waring, J. and Harrison, S. (2005) ‘Balancing risk, that is my life’: The politics of risk in a hospital operating theatre department. Health, Risk & Society 7 (4): 397-411.
McDonald, R., Waring, J. and Harrison, S. (2006) Rules, safety and the narrativisation of identity: A hospital operating theatre case study. Sociology of Health and Illness 28 (2): 178-202.
Rees, C., Monrouxe, L. V. and McDonald, L. A. (2013) Narrative, emotion and action: Analysing ‘most memorable’ professionalism dilemmas. Medical Education 47 (1): 80-96.
Rittel, H. and Webber, M. (1973) Dilemmas in a general theory of planning. Policy Sciences 4 (2): 155-169. https://doi.org/10.1007/BF01405730
Schleifer, R. and Vannatta, J. B. (2013) The Chief Concern of Medicine: The Integration of the Medical Humanities and Narrative Knowledge into Medical Practices. Ann Arbor: University of Michigan Press. https://doi.org/10.3998/mpub.3157169
Schulman, P. R. (2004) General attributes of safe organisations. Quality and Safety in Health Care 13 (supp ii): ii39-ii44. https://doi.org/10.1136/qshc.2003.009613
Smith, A., Goodwin, D., Mort, M. and Pope, C. (2003).Expertise in practice: An ethnographic study exploring acquisition and use of knowledge in anaesthesia. British Journal of Anaesthesia 91 (3): 319-328. https://doi.org/10.1093/bja/aeg180
Smith, A. C. and Kleinman, S. (1989) Managing emotions in medical school: Students’ contacts with the living and the dead. Social Psychology Quarterly 52 (1): 56-69. https://doi.org/10.2307/2786904
Strawson, G. (2004). Against narrativity. Ratio 17 (4): 428-452. https://doi.org/10.1111/j.1467-9329.2004.00264.x
Weaver, R., Peters, K., Koch, J. and Wilson, I. (2011) ‘Part of the team’: Professional identity and social exclusivity in medical students. Medical Education 45 (12): 1220-1229. https://doi.org/10.1111/j.1365-2923.2011.04046.x
Weick, K. and Roberts, K. H. (1993) Collective mind in organizations: Heedful interrelating on flight decks. Administrative Science Quarterly 38 (3): 357-381. https://doi.org/10.2307/2393372
Woods, A. (2011) The limits of narrative: Provocations for the medical humanities. Journal of Medical Ethics & Medical Humanities 37 (2): 73-78. https://doi.org/10.1136/medhum-2011-010045
copyright Equinox Publishing Ltd.