Stories of Becoming an Emergency Medicine Physician Aman Hussain, BA, MA A thesis submitted ...

281 Pages·2017·1.87 MB·English

Stories of Becoming an Emergency Medicine Physician
Aman Hussain, B.A., M.A.

A thesis submitted for the degree of Doctor of Philosophy at
The University of Queensland in 2017
School of Human Movement Studies
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Abstract

There exists a large output of empirical research and numerous calls for reform in medical
education (Cooke et al., 2010; Frenk et al., 2010). Relatively little of this research, however,
to the best of our knowledge, focuses on the professional learning practices within medical
education, particularly within the context of post-graduate medical education or PGME (Van
de Wiel, et al., 2011; Van der Zwet et al., 2011). To this end, it is important that medical
educators, administrators, and practicing Attending physicians are provided with a clear
understanding of the professional learning environment of current medical Residents, the
teaching methods used by Attending physicians and ultimately, the unique milestones,
instances of critical learning, and the transitions within the learning process of specializing
within a particular medical residency. The rationale, therefore, for this study was to attempt
to fulfil some of the calls for further investigation into PGME in a gainful attempt to
investigate the learning processes of medical Residents and practicing Attending physicians
in the context of emergency medicine. Specifically, there was interest examining the lived
experience of becoming a practicing emergency medicine physician. With this in mind,
research questions were developed to determine 1) What is the nature of learning in the
residency workplace, 2) How are learning experiences structured, 3) What are the residents
perceptions of the learning experiences provided by the medical residency educational
curriculum, 4) What is the significance of mentor relationships in medical residency, 5) What
are the critical instances of learning in residency education, and 6) What unintended learning
takes place?
Using a hermeneutic phenomenological theoretical framework informed by Heidegger
(1962), semi-structured interviews were conducted with eighteen emergency medicine
residents (n=18) and fifteen (n=15) practicing emergency medicine Attending physicians. In
addition to the interviews, five (n=5) observations were conducted of the participants in the
emergency department to get a better understanding of the combined learning environment
and workplace. These observations helped develop vignettes to illustrate several of the
findings and contextualize the lived experience of the participants.
This thesis provides novel insight into how ‘learning to become’ occurs within PGME
and specifically, within the context of emergency medicine. Due to the large volume of data
gathered during the interview and observation process, the findings of this study were divided
by focusing one chapter on the Residents (chapter 4) and the subsequent chapter focused on
the Attending physicians (chapter 5). For the Residents, the nature of their learning was
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characterized by a struggle for autonomy while establishing an identity as a physician.
Findings from the Residents also focused on how they managed themselves within the
residency process by handling multiple relationships, learning from mistakes and debriefing,
engaged in informal teaching, utilized technology, and were involved with transitions as
impactful learning experiences during residency.
Findings from the Attending physicians suggest that the residency process was an
opportunity to specialize within a chosen field of practice while being able to consolidate
knowledge and work in a clinical environment. The findings from the Attending physicians,
moreover, suggest that impactful learning is often facilitated by ‘important others’ who are
often involved with teaching and mentoring. Perspectives are also shared on the use of media
and technology in practice. Lastly, the Attending physicians describe transitions as impactful
learning experiences, particularly as they exited residency and practiced as fully qualified
practitioners.
Revisiting the research questions, the lived experience of the participants can be
summarized into four major discussion points; 1) learning in emergency medicine involves
dynamic changes in identity, 2) learning experiences are highly structured, but are informal in
practice, 3) mentorship is critical in medical residency, and 4) instances of critical learning
are varied and personal. The implications of the participants lived experience ‘learning to
become’ practicing emergency physicians, led to both pedagogical and methodological
recommendations for PGME and emergency medicine, specifically.
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Declaration by author

This thesis is composed of my original work, and contains no material previously published
or written by another person except where due reference has been made in the text. I have
clearly stated the contribution by others to jointly-authored works that I have included in my
thesis.

I have clearly stated the contribution of others to my thesis as a whole, including statistical
assistance, survey design, data analysis, significant technical procedures, professional
editorial advice, and any other original research work used or reported in my thesis. The
content of my thesis is the result of work I have carried out since the commencement of my
research higher degree candidature and does not include a substantial part of work that has
been submitted to qualify for the award of any other degree or diploma in any university or
other tertiary institution. I have clearly stated which parts of my thesis, if any, have been
submitted to qualify for another award.

I acknowledge that an electronic copy of my thesis must be lodged with the University
Library and, subject to the policy and procedures of The University of Queensland, the thesis
be made available for research and study in accordance with the Copyright Act 1968 unless a
period of embargo has been approved by the Dean of the Graduate School.

I acknowledge that copyright of all material contained in my thesis resides with the copyright
holder(s) of that material. Where appropriate I have obtained copyright permission from the
copyright holder to reproduce material in this thesis.
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Publications during candidature

Hussain, A., & Bekkering, H. (2017, February). Sustainable performance in critical care
nursing. Oral presentation at the Winnipeg Regional Health Authority, Critical Care
Nursing Education Program, Winnipeg, Manitoba, Canada.
Sytnik, P., Hussain, A., Brooks, J., & Pham, C. (2016, October). The impact of high
performance physician training on resident wellness and clinical performance. Oral
presentation at the International Conference on Residency Education, Niagara Falls,
ON, Canada.
Sytnik, P., Brooks, J., Hussain, A., & Pham, C. (2016). The impact of high performance
physician training (HPP) on resident wellness and clinical performance. Paper
presentation at the Canadian Association of Emergency Physicians Annual Conference.
Quebec City, Quebec, Canada.
Hussain, A., & Brooks, J., & Bekkering, H. (2016, November). Sustainable performance in
critical care nursing. Oral presentation at the Winnipeg Regional Health Authority,
Critical Care Nursing Education Program, Winnipeg, Manitoba, Canada.
Hussain, A. (2016, December). Stories of becoming an emergency medicine physician. Oral
presentation at the KINECT Research Day, University of Winnipeg, Manitoba, Canada.
Hussain, A. (2016, November). Time management: Towards time optimization. Oral
presentation at the Department of Emergency Medicine Administration Rotation,
University of Manitoba, Winnipeg, Manitoba, Canada.
Brooks, J., & Hussain, A. (2016, September). Sustainable high performance in residency.
Oral presentation at the Combined Cardiac Sciences Lecture Series. College of
Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Brooks, J., & Hussain, A. (2016, March). Transitioning into clerkship. Oral presentation at
the Health & Wellness Symposium, College of Medicine, University of Manitoba,
Winnipeg, Manitoba, Canada.
Hussain, A. (2015, November). Time management for emergency medicine physicians –
Moving towards time optimization. Oral presentation at the Department of Emergency
Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba.
Winnipeg, Manitoba, Canada.
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Pham, C., Sytnik, J., Hussain, A., & Brooks, J. (2015, October). The high performance
physician program (HPP): Performance psychology and physician health. Oral
presentation at the Canadian Conference on Physician Health. Winnipeg, Manitoba,
Canada.
Hussain, A. (2015, September). Sustainable high performance in residency. Oral presentation
at the Combined Cardiac Sciences Lecture Series. College of Medicine, University of
Manitoba, Winnipeg, Manitoba, Canada.
Brooks, J., & Hussain, A. (2015, February). Transitioning into clerkship. Oral presentation at
the Health & Wellness Symposium, College of Medicine, University of Manitoba,
Winnipeg, Manitoba, Canada.
Botterill, C., Brooks., J., Hussain, A., Botterill, J., & Bednarczyk, J. (2014, October).
Developing sustainable high performance. Oral presentation at the Academic Health
Sciences Leadership Program. Winnipeg, Manitoba, Canada.
Hussain, A., Brooks, J., & Rossi, T. (2011). Application of performance psychology to
emergency medicine resident physicians. Paper presentation at the Canadian Society for
Psychomotor Learning and Sport Psychology, Winnipeg, Manitoba, Canada.

Publications included in thesis

No publications included.
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Contributions by others to the thesis

In terms of non-routine technical work, an outside professional agency was used for
transcription of research interviews. Member checking through informal discussion, in
several instances, was conducted with some of the participants to present my interpretations
of the findings. I further discussed my interpretations with my doctoral adviser throughout the
research process. All of these activities have been outlined in my thesis and were presented at
the time of the colloquium. Moreover, they are consistent with the particular theoretical
framework and methodology adopted for the study (i.e. hermeneutic-phenomenology).

Statement of parts of the thesis submitted to qualify for the award of another degree

None
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Acknowledgements

This thesis would not have been possible without the unwavering support and encouragement
of Dr. Tony Rossi. Thank you for your advice, guidance, perspective and friendship. Though
late in the process, the guidance and advice from Dr. Steven Rynne has been invaluable. I
must also acknowledge the friendship and support from Dr. Jason Brooks and Dr. Cal
Botterill. Solving the world’s problems, while staying hydrated has been more impactful than
you can possibly know. Thanks!

I also want to acknowledge the amazing support from UQ support staff and advisors (in
particular, Deb Noon, Sally Goodwin, and Dr. Jill Thistlethwaite). Being an International off-
shore student is tough. Thank you for making this process easier.

Words don’t adequately describe the contributions my family have made towards helping me
finish this thesis. Mom, Sufu, Chad, Wesley and Nicolas: thank you, for your encouraging
words and for helping me maintain perspective. I love you all. I want to dedicate this thesis to
my Dad. I recall that in a period of absolute lucidity while you were sick, you made me
promise to finish. I have fulfilled that promise. Love you and miss you.

Lastly, it was a true privilege to engage in this work. It would not have been possible without
the absolutely wonderful participants who made themselves so available and welcomed me
into their lives and their professional community. These are their stories.
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Keywords

medical education, post-graduate medical education, residency, workplace learning,
phenomenology, ontology, qualitative research

Australian and New Zealand Standard Research Classifications (ANZSRC)

ANZSRC code: 930199, Learner and learning not elsewhere classified, 60%
ANZSRC code: 939999, Education and training not elsewhere classified, 40%

Fields of Research (FoR) Classification

FoR code: 1303, Specialist Studies in Education, 60%
FoR code: 1302, Curriculum and Pedagogy, 20%
FoR code: 1399, Other Education 20%
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TABLE OF CONTENTS
ABSTRACT .....................................................................................................................ii
DECLARATION BY AUTHOR .....................................................................................iv
PUBLICATIONS DURING CANDIDATURE ..............................................................v
ACKNOWLEDGEMENTS .............................................................................................viii
TABLE OF CONTENTS .................................................................................................x
LIST OF TABLES AND FIGURES ...............................................................................xiv
LIST OF VIGNETTES ....................................................................................................xv

CHAPTER 1 – INTRODUCTION 1
1.0 Introduction ....................................................................................................1
1.1 The Medical Context ......................................................................................2
1.2 The pressures of medical residency ...................................................3
1.3 Towards a Personal Understanding of Medical Residency in Canada ..........5
1.4 The Issue ........................................................................................................7
1.5 Rationale & Purpose ......................................................................................8

CHAPTER 2 – REVIEW OF LITERATURE 10
2.0 Introduction ....................................................................................................10
2.1 Policies Related to Becoming a Doctor: An Agenda of Reform ...................10
2.1.1 CanMEDS: An Example of National Policy Reform .....................13
2.2 Knowing & Reasoning in Medical Education ...............................................15
2.3 Dual Role of Service Provider & Learner ......................................................17
2.4 Approaches to Teaching in Residency ...........................................................19
2.5 Interprofessional Education & Collaborative Practice ..................................21
2.6 A Commentary Regarding Mentorship ..........................................................22
2.6.1 Mentorship in Nursing ....................................................................22
2.6.2 Mentorship in Education .................................................................23
2.6.3 Mentorship in Business ...................................................................24
2.6.4 Mentorship in Sport Coaching ........................................................26
2.6.5 Mentorship in Post-Graduate Medical Education ...........................26
2.7 A Commentary on Workplace Learning ........................................................27
2.7.1 Workplace Learning in Post-Graduate Medical Education ............30
2.8 A Summary of Review of Literature .............................................................32