Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Female victims and female perpetrators: medical students' narratives of gender dynamics and professionalism dilemmas.(Springer Netherlands, 2020) Shaw, M.K.; Chandratilake, M.; Ho, M.J.; Rees, C.E.; Monrouxe, L.V.ABSTRACT: Medicine is a gendered discipline, in which women, both as patients and practitioners, have often held subordinate positions. The reproduction of dominant gender biases in the medical setting can negatively impact the professional development of medical students and the wellbeing of patients. In this analysis of medical students' narratives of professionalism dilemmas, we explore students' experiences of gender bias in hospital settings. Seventy-one students participated in 12 group interviews, where they discussed witnessing or participating in various activities that they thought were professionalism lapses. Within the dataset, 21 narratives had a distinctly gendered component broadly pertaining to patient dignity and safety dilemmas, informed consent issues, and female student abuse. Interestingly, perpetrators of such acts were commonly female healthcare professionals and educators. Although students recognized such acts as professionalism lapses and often expressed concern for patient wellbeing, students did not intervene or report such acts due to hierarchical cultural contexts, and at times even reproduced the discriminatory behavior they were criticizing. This raises concerns about medical students' professionalism development and the extent to which gender bias is ingrained within particular medical systems. The normalization of disrespectful and abusive treatment of female patients poses immediate and future consequences to the wellbeing and safety of women. Furthermore, the same socio-cultural values that sustain these acts may account for perpetrators often being women themselves as they strive to overcome their subordinate position within medicine.Item Professionalism in Medicine; the transition of a movable feast and its implications for clinical and educational practices(Postgraduate Institute of Medicine University of Colombo, 2016) Chandratilake, M.N.Item Taiwanese medical students' narratives of intercultural professionalism dilemmas: exploring tensions between Western medicine and Taiwanese culture(Springer Netherlands, 2017) Ho, M.J.; Gosselin, K.; Chandratilake, M.; Monrouxe, L.V.; Rees, C.E.In an era of globalization, cultural competence is necessary for the provision of quality healthcare. Although this topic has been well explored in non-Western cultures within Western contexts, the authors explore how Taiwanese medical students trained in Western medicine address intercultural professionalism dilemmas related to tensions between Western medicine and Taiwanese culture. A narrative interview method was employed with 64 Taiwanese medical students to collect narratives of professionalism dilemmas. Noting the prominence of culture in students' narratives, we explored this theme further using secondary analysis, identifying tensions between Western medicine and Taiwanese culture and categorizing students' intercultural professionalism dilemmas according to Friedman and Berthoin Antal's 'intercultural competence' framework: involving combinations of advocacy (i.e., championing one's own culture) and inquiry (i.e., exploring one's own and others' cultures). One or more intercultural dilemmas were identified in nearly half of students' professionalism dilemma narratives. Qualitative themes included: family relations, local policy, end-of-life care, traditional medicine, gender relations and Taiwanese language. Of the 62 narratives with sufficient detail for further analysis, the majority demonstrated the 'suboptimal' low advocacy/low inquiry approach (i.e., withdrawal or inaction), while very few demonstrated the 'ideal' high advocacy/high inquiry approach (i.e., generating mutual understanding, so 'intercultural competence'). Though nearly half of students' professionalism narratives concerned intercultural dilemmas, most narratives represented disengagement from intercultural dilemmas, highlighting a possible need for more attention on intercultural competence training in Taiwan. The advocacy/inquiry framework may help educators to address similar disconnects between Western medicine and non-Western cultures in other contexts.Item Lapses in professionalism in Sri Lankan doctors and their impact on patient outcomes(Sri Lanka Medical Association, 2015) Chandratilake, M.N.; Ho, M.; Rees, C.; Monrouxe, L.INTRODUCTION AND OBJECTIVES: Today, the provision of optimal patient care and patient safety are the primary goals of healthcare delivery. Professionalism of doctors has an impact on achieving this goal. METHOD: This study was conducted as the Sri Lankan component of a collaborative qualitative research project with Taiwan on professionalism dilemmas faced by medical students. 64 Sri Lankan medical students described stories (narratives) of lapses in professionalism observed by them in clinical settings, at Focus Group Discussions (FGDs). The FGDs were audio-recorded and the transcripts were thematically analysed to explore the nature of lapses in professionalism and resulting patient outcomes. RESULTS: The students' narratives comprised lapses in communication, respect towards patients, accountability, integrity and probity, interprofessional relationships, compassion and care, acting within limitations, commitment to duty, managing conflicts of interests and ethical conduct in doctors in different grades. Such lapses have seemingly caused a variety of adverse patient outcomes: psychological distress, suboptimal treatment and even suicides and unwanted deaths. In almost all instances incidents were not reported, discussed or reflected upon to prevent future occurrences. Medical students appeared to suffer from high levels of moral distress due to observing such incidents but tended not to express their concerns due to their lowly status within the hierarchy. CONCLUSION: Lapses in professionalism in doctors appear to threaten patient safety and the provision of optimal patient care in Sri Lanka. The situation is unlikely to improve unless the hierarchical working culture changes to help students and doctors challenge such lapses.