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Educator, judge, public defender: Conflicting roles for remediators of practising physicians.
Med Educ. 2020 Jun 27 [Online ahead of print]ME

Abstract

CONTEXT

Practising physicians who remediate their peers face unique challenges. Recent research suggests that leaders of regulatory and educational institutions (ie, those who might be seen as responsible for overseeing remediation programmes for practising physicians) view remediation as a duality: education and regulation. Research has yet to study the perspectives of remediators; therefore, to address that gap we asked: What is the nature of remediation as experienced by remediators?

METHODS

We used a theory-informing inductive data analysis study design with positioning theory as a sensitising concept. We interviewed nine remediators from five Canadian provinces, asking them to narrate particularly memorable remediation experiences, then exploring the stories in more depth by asking probing questions around topics related to the research question. We used a hermeneutic analytic approach to explore the meanings that participants gave to their remediation work by iteratively reading their stories, examining the sense making that participants achieved through these narratives, and identifying the positions and responsibilities they described.

RESULTS

In their remediation narratives, participants variably position themselves in three different ways: (a) educator; (b) judge, and (c) public defender. For each position, remediators in turn framed the remediatee in a particular way. Participants shifted between educator, judge and public defender in response to evolving experiences with the remediatee, but they expressed preference for the educator position. However, they sometimes encountered serious obstacles to enacting that educator position. Those obstacles were imposed both by regulators and by remediatees.

CONCLUSIONS

This study suggests that the duality of remediation as both education and regulation may be contributing to the challenges faced by those working one to one with remediatees. Understanding the dual nature of remediation and equipping remediators with the tools to manage this duality might contribute to improving the experience for both remediators and remediatees, and ultimately to a greater number of successful remediation outcomes.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.Department of Surgery, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands.Graduate Programs in Health Professions Education, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32594541

Citation

Bourgeois-Law, Gisèle, et al. "Educator, Judge, Public Defender: Conflicting Roles for Remediators of Practising Physicians." Medical Education, 2020.
Bourgeois-Law G, Regehr G, Teunissen PW, et al. Educator, judge, public defender: Conflicting roles for remediators of practising physicians. Med Educ. 2020.
Bourgeois-Law, G., Regehr, G., Teunissen, P. W., & Varpio, L. (2020). Educator, judge, public defender: Conflicting roles for remediators of practising physicians. Medical Education. https://doi.org/10.1111/medu.14285
Bourgeois-Law G, et al. Educator, Judge, Public Defender: Conflicting Roles for Remediators of Practising Physicians. Med Educ. 2020 Jun 27; PubMed PMID: 32594541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Educator, judge, public defender: Conflicting roles for remediators of practising physicians. AU - Bourgeois-Law,Gisèle, AU - Regehr,Glenn, AU - Teunissen,Pim W, AU - Varpio,Lara, Y1 - 2020/06/27/ PY - 2020/02/13/received PY - 2020/05/24/revised PY - 2020/06/18/accepted PY - 2020/7/1/pubmed PY - 2020/7/1/medline PY - 2020/6/29/entrez JF - Medical education JO - Med Educ N2 - CONTEXT: Practising physicians who remediate their peers face unique challenges. Recent research suggests that leaders of regulatory and educational institutions (ie, those who might be seen as responsible for overseeing remediation programmes for practising physicians) view remediation as a duality: education and regulation. Research has yet to study the perspectives of remediators; therefore, to address that gap we asked: What is the nature of remediation as experienced by remediators? METHODS: We used a theory-informing inductive data analysis study design with positioning theory as a sensitising concept. We interviewed nine remediators from five Canadian provinces, asking them to narrate particularly memorable remediation experiences, then exploring the stories in more depth by asking probing questions around topics related to the research question. We used a hermeneutic analytic approach to explore the meanings that participants gave to their remediation work by iteratively reading their stories, examining the sense making that participants achieved through these narratives, and identifying the positions and responsibilities they described. RESULTS: In their remediation narratives, participants variably position themselves in three different ways: (a) educator; (b) judge, and (c) public defender. For each position, remediators in turn framed the remediatee in a particular way. Participants shifted between educator, judge and public defender in response to evolving experiences with the remediatee, but they expressed preference for the educator position. However, they sometimes encountered serious obstacles to enacting that educator position. Those obstacles were imposed both by regulators and by remediatees. CONCLUSIONS: This study suggests that the duality of remediation as both education and regulation may be contributing to the challenges faced by those working one to one with remediatees. Understanding the dual nature of remediation and equipping remediators with the tools to manage this duality might contribute to improving the experience for both remediators and remediatees, and ultimately to a greater number of successful remediation outcomes. SN - 1365-2923 UR - https://www.unboundmedicine.com/medline/citation/32594541/Educator,_Judge,_Public_Defender:_Conflicting_roles_for_remediators_of_practicing_physicians L2 - https://doi.org/10.1111/medu.14285 DB - PRIME DP - Unbound Medicine ER -
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