Medical students' personal experience of high-stakes failure:case studies using interpretative phenomenological analysis

Abstract (provisional): Background Failing a high-stakes assessment at medical school is a major event for those who go through the experience. Students who fail at medical school may be more likely to struggle in professional practice, therefore helping individuals overcome problems and respond appropriately is important. There is little understanding about what factors influence how individuals experience failure or make sense of the failing experience in remediation. The aim of this study was to investigate the complexity surrounding the failure experience from the student’s perspective using interpretative phenomenological analysis (IPA). Methods The accounts of 3 medical students who had failed final re-sit exams, were subjected to in-depth analysis using IPA methodology. IPA was used to analyse each transcript case-by-case allowing the researcher to make sense of the participant’s subjective world. The analysis process allowed the complexity surrounding the failure to be highlighted, alongside a narrative describing how students made sense of the experience. Results The circumstances surrounding students as they approached assessment and experienced failure at finals were a complex interaction between academic problems, personal problems (specifically finance and relationships), strained relationships with friends, family or faculty, and various mental health problems. Each student experienced multi-dimensional issues, each with their own individual combination of problems, but experienced remediation as a one-dimensional intervention with focus only on improving performance in written exams. What these students needed to be included was help with clinical skills, plus social and emotional support. Fear of termination of the their course was a barrier to open communication with staff. Conclusions These students’ experience of failure was complex. The experience of remediation is influenced by the way in which students make sense of failing. Generic remediation programmes may fail to meet the needs of students for whom personal, social and mental health issues are a part of the picture.

Learning to live with Parkinson’s disease in the family unit:an interpretative phenomenological analysis of well-being

We investigated family members’ lived experience of Parkinson’s disease (PD) aiming to investigate opportunities for well-being. A lifeworld-led approach to healthcare was adopted. Interpretative phenomenological analysis was used to explore in-depth interviews with people living with PD and their partners. The analysis generated four themes: It’s more than just an illness revealed the existential challenge of diagnosis; Like a bird with a broken wing emphasizing the need to adapt to increasing immobility through embodied agency; Being together with PD exploring the kinship within couples and belonging experienced through support groups; and Carpe diem! illuminated the significance of time and fractured future orientation created by diagnosis. Findings were interpreted using an existential-phenomenological theory of well-being. We highlighted how partners shared the impact of PD in their own ontological challenges. Further research with different types of families and in different situations is required to identify services required to facilitate the process of learning to live with PD. Care and support for the family unit needs to provide emotional support to manage threats to identity and agency alongside problem-solving for bodily changes. Adopting a lifeworld-led healthcare approach would increase opportunities for well-being within the PD illness journey.

Teamwork and well-being:the role of social support

This thesis explores, in a team context, using the Michigan Model, the relationship between social support, stress and well-being outcomes. The studies reported were carried out in Post Office Ltd. Study one examines differences in social support source and type for employees working in teams and quasi teams. Analysis was carried out at the individual level. The results supported previous work on well-being in teams: individuals working in teams report significantly higher levels of well-being, job satisfaction and organisational commitment than those individuals in quasi teams. Members of teams reported greater satisfaction with support from their manager and colleagues, and all types of support compared to members of quasi teams. Manager support and specific types of support mediated the relationship between team working and well-being outcomes. In terms of stressors, satisfaction with manager support and emotional challenge predicted greater influence which was positively related to the well-being outcomes. Study two conducted at the team level builds on relationships established in study one. Stage one explored teamness, the extent to which, along a continuum the team was well-defined. Stage two explored teamness agreement, the extent to which the team agreed on their teamness. The extent to which the Branch Office were a well-defined team had a positive effect on team functioning; participation, innovation and commitment to task excellence. Team functioning was associated with higher levels of satisfaction with manager and team support and all types of support. Working in a well-defined team was associated with job satisfaction, mediated by positive team functioning and social support. Teamness agreement predicted team well-being, clarity of objectives, work demands and satisfaction with reality check. Working in a team was not associated with performance. This thesis advances understanding in the area of team working and processes within teams, advancing understanding of the specifics of social support from different so urces and types of support. The studies reveal the key role of team functional characteri stics in creating the vehicle through which supportive interactions take place. which contribute to positive outcomes associated with working in a well-defined team.

The role of emotional labour and role stress on burnout and psychological strain in high contact service employees

This study examines the relationships between job demands (in the form of role stressors and emotional management) and employee burnout amongst high contact service employees. Employees in customer facing roles are frequently required to manage overwhelming, conflicting or ambiguous demands, which they may feel ill-equipped to handle. Simultaneously, they must manage the emotions they display towards customers, suppressing some, and expressing others, be they genuine or contrived. If the in-role effort required of employees exceeds their inherent capacity to cope, burnout may result. Burnout, in turn, can have serious detrimental consequences for the psychological well being of employees. We find that both emotional management and role stressors impact burnout. We also confirm that burnout predicts psychological strain. In line with the Job Demands and Resources Model, we examine the mitigating impact of perceived support on these relationships but do not find a significant mitigating impact.

Organizational learning and emotion:constructing collective meaning in support of strategic themes

Missing in the organizational learning literature is an integrative framework that reflects the emotional as well as the cognitive dynamics involved. Here, we take a step in this direction by focusing in depth over time (five years) on a selected organization which manufactures electronic equipment for the office industry. Drawing on personal construct theory, we define organizational learning as the collective re-construal of meaning in the direction of strategically significant themes. We suggest that emotions arise as members reflect on progress or lack of progress in achieving organizational learning. Our evidence suggests that invalidation - where organizational learning fails to correspond with expectations - gives rise to anxiety and frustration, while validation - where organizational learning is aligned with or exceeds expectations - evokes comfort or excitement. Our work aims to capture the key emotions involved as organizational learning proceeds. © The Author(s) 2012.

Disabling a family? Emotional dilemmas experienced in becoming a parent of a child with learning disabilities

Becoming the parent of a child diagnosed with learning disabilities can have a dramatic impact. Chrissie Rogers, the author of this article, is both a lecturer in education studies at Keele University and the mother of a daughter who has learning disabilities. She argues here that the pressures on mothers to produce ‘perfect’ babies and to meet all their needs are immense. These pressures arise from both internalised norms and societal expectations and, in the face of these pressures, parents may feel shock, loss and disappointment. These feelings may lead, in turn, to denial, anxiety and conflict affecting both the parents and the professionals involved with the family. Drawing on a series of in-depth interviews and personal narratives, Chrissie Rogers makes a powerful case for the importance of support, whether that support is formal or informal. She suggests that, without the right levels of support and understanding, having a child with a diagnosis of learning disability can disable the whole family.

An empirical examination of emotional and cognitive responses to threat appeals

Advertising and other forms of communications are often used by government bodies, non-government organisations, and other institutions to try to influence the population to either a) reduce some form of harmful behaviour (e.g. smoking, drunk- driving) or b) increase some more healthy behaviour (e.g. eating healthily). It is common for these messages to be predicated on the chances of some negative event occurring if the individual does not either a) stop the harmful behaviour, or b) start / increase the healthy behaviour. This design of communication is referred to by many names in the relevant literature, but for the purposes of this thesis, will be termed a ‘threat appeal’. Despite their widespread use in the public sphere, and concerted academic interest since the 1950s, the effectiveness of threat appeals in delivering their objective remains unclear in many ways. In a detailed, chronological and thematic examination of the literature, two assumptions are uncovered that have either been upheld despite little evidence to support them, or received limited attention at all, in the literature. Specifically, a) that threat appeal characteristics can be conflated with their intended responses, and b) that a threat appeal always and necessarily evokes a fear response in the subject. A detailed examination of these assumptions underpins this thesis. The intention is to take as a point of departure the equivocality of empirical results, and deliver a novel approach with the objective of reducing the confusion that is evident in existing work. More specifically, the present thesis frames cognitive and emotional responses to threat appeals as part of a decision about future behaviour. To further develop theory, a conceptual framework is presented that outlines the role of anticipated and anticipatory emotions, alongside subjective probabilities, elaboration and immediate visceral emotions, resultant from manipulation of the intrinsic message characteristics of a threat appeal (namely, message direction, message frame and graphic image). In doing so, the spectrum of relevant literature is surveyed, and used to develop a theoretical model which serves to integrate key strands of theory into a coherent model. In particular, the emotional and cognitive responses to the threat appeal manipulations are hypothesised to influence behaviour intentions and expectations pertaining to future behaviour. Using data from a randomised experiment with a sample of 681 participants, the conceptual model was tested using analysis of covariance. The results for the conceptual framework were encouraging overall, and also with regard to the individual hypotheses. In particular, empirical results showed clearly that emotional responses to the intrinsic message characteristics are not restricted to fear, and that different responses to threat appeals were clearly attributed to specific intrinsic message characteristics. In addition, the inclusion of anticipated emotions alongside cognitive appraisals in the framework generated interesting results. Specifically, immediate emotions did not influence key response variables related to future behaviour, in support of questioning the assumption of the prominent role of fear in the response process that is so prevalent in existing literature. The findings, theoretical and practical implications, limitations and directions for future research are discussed.

Hope comes in many forms:out-group expressions of hope override low support and promote reconciliation in conflicts

In conflicts, political attitudes are based to some extent on the perception of the outgroup as sharing the goal of peace and supporting steps to achieve it. However, intractable conflicts are characterized by inconsistent and negative interactions, which prevent clear messages of outgroup support. This problem calls for alternative ways to convey support between groups in conflict. One such method is emotional expressions. The current research tested whether, in the absence of outgroup support for peace, observing expressions of outgroup hope induces conciliatory attitudes. Results from two experimental studies, conducted within the Israeli-Palestinian conflict, revealed support for this hypothesis. Expressions of Palestinian hope induced acceptance of a peace agreement through Israeli hope and positive perceptions of the proposal when outgroup support expressions were low. Findings demonstrate the importance of hope as a means of conveying information within processes of conflict resolution, overriding messages of low outgroup support for peace.