Emotions and identity in the figured world of becoming a doctor

CONTEXT: There is little room in clerkship curricula for students to express emotions, particularly those associated with the development of a caring identity. Yet it is recognised that competence, alone, does not make a good doctor. We therefore set out to explore the relationship between emotions and identity in clerkship education. Our exploration was conceptually oriented towards Figured Worlds theory, which is linked to Bakhtin's theory of dialogism.

METHODS: Nine female and one male member of a mixed student cohort kept audio-diaries and participated in both semi-structured and cognitive individual interviews. The researchers identified 43 emotionally salient utterances in the dataset and subjected them to critical discourse analysis. They applied Figured Worlds constructs to within-case and cross-case analyses, supporting one another's reflexivity and openness to different interpretations, and constantly comparing their evolving interpretation against the complete set of transcripts.

RESULTS: Students' emotions were closely related to their identity development in the world of medicine. Patients were disempowered by their illnesses. Doctors were powerful because they could treat those illnesses. Students expressed positive emotions when they were granted positions in the world of medicine and were able to identify with the figures of doctors or other health professionals. They identified with doctors who behaved in caring and professionally appropriate ways towards patients and supportively towards students. Students expressed negative emotions when they were unable to develop their identities.

CONCLUSIONS: Critical discourse analysis has uncovered a link between students' emotions and their identity development in the powerful world of becoming and being a doctor. At present, identity development, emotions and power are mostly tacit in undergraduate clinical curricula. We speculate that helping students to express emotions and exercise power in the most effective ways might help them to develop caring identities.

A realistic evaluation of track and trigger systems and acute care training for early recognition and treatment of deteriorating ward-based patients: research protocol.

Aim The aim of the study is to evaluate factors that enable or constrain the implementation and service delivery of early warnings systems or acute care training in practice. Background To date there is limited evidence to support the effectiveness of acute care initiatives (early warning systems, acute care training, outreach) in reducing the number of adverse events (cardiac arrest, death, unanticipated Intensive Care admission) through increased recognition and management of deteriorating ward based patients in hospital [1-3]. The reasons posited are that previous research primarily focused on measuring patient outcomes following the implementation of an intervention or programme without considering the social factors (the organisation, the people, external influences) which may have affected the process of implementation and hence measured end-points. Further research which considers the social processes is required in order to understand why a programme works, or does not work, in particular circumstances [4]. Method The design is a multiple case study approach of four general wards in two acute hospitals where Early Warning Systems (EWS) and Acute Life-threatening Events Recognition and Treatment (ALERT) course have been implemented. Various methods are being used to collect data about individual capacities, interpersonal relationships and institutional balance and infrastructures in order to understand the intended and unintended process outcomes of implementing EWS and ALERT in practice. This information will be gathered from individual and focus group interviews with key participants (ALERT facilitators, nursing and medical ALERT instructors, ward managers, doctors, ward nurses and health care assistants from each hospital); non-participant observation of ward organisation and structure; audit of patients' EWS charts and audit of the medical notes of patients who deteriorated during the study period to ascertain whether ALERT principles were followed. Discussion & progress to date This study commenced in January 2007. Ethical approval has been granted and data collection is ongoing with interviews being conducted with key stakeholders. The findings from this study will provide evidence for policy-makers to make informed decisions regarding the direction for strategic and service planning of acute care services to improve the level of care provided to acutely ill patients in hospital. References 1. Esmonde L, McDonnell A, Ball C, Waskett C, Morgan R, Rashidain A et al. Investigating the effectiveness of Critical Care Outreach Services: A systematic review. Intensive Care Medicine 2006; 32: 1713-1721 2. McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Outreach and Early Warning Systems for the prevention of Intensive Care admission and death of critically ill patients on general hospital wards. Cochrane Database of Systematic Reviews 2007, Issue 3. www.thecochranelibrary.com 3. Winters BD, Pham JC, Hunt EA, Guallar E, Berenholtz S, Pronovost PJ (2007) Rapid Response Systems: A systematic review. Critical Care Medicine 2007; 35 (5): 1238-43 4. Pawson R and Tilley N. Realistic Evaluation. London; Sage: 1997

Moving Out of Conflict: Negotiating Social Identity in Response to Segregation in Northern Ireland

This paper examines the impact of territoriality on young people’s everyday experiences in Northern Ireland’s segregated communities. It shows how urban encounters are reproduced through negotiating differences and the ways in which living in divided communities escalates moods of social inequality and spatial imbalances. The empirical study undertaken in the city of Derry shows how individuals and community groups position and identify themselves under the impact of social segregation. Building on Gordon Allport’s (1954) theories of contact, I explain how people in Derry have established their own sense of belonging, of who they are, based on their group memberships which eventually became an important source of pride and selfesteem. They also presented their own intertextual references as a cause of routine survival and belonging, allowing them to be more constructive about their future. Under deeply rooted segregation in Northern Ireland, the young generations are sought to provide lasting change to foster peace and integration between the two communities.

Self and identity in women with symptoms of borderline personality: A qualitative study

Identity disturbance has been suggested to be a core feature of borderline personality disorder (BPD). However, there is little known about the identity of individuals with symptoms of BPD from the participant’s perspective. This study availed of in-depth lightly structured life story interviews with five female participants. Thematic analysis was utilized to derive three themes of identity: connection, distance between us, and hurt and healing. Results provided support for multiple and flexible conceptualizations of identity in comparison to the idea of a unitary self/identity. Results also suggested that participants were able to establish differing connections to others ranging from disconnection to intimacy and care. Participants reported that their identities were impacted upon by historical and current family/relationship dysfunction, but life stories also illustrated the positive impact of healing relationship experiences. Findings provide support for psychological theories that consider a multiple and relational self/identity and the empowerment of healthy aspects of the self in BPD recovery. Studies that assess the association between insight and change may further our knowledge into this complex population.

Interpretations of national identity in post-conflict Northern Ireland: A comparison of different school settings

It is generally accepted that education has a significant role to play in anysociety transitioning from conflict to a more peaceful dispensation. Indeed,some have argued that the education system potentially represents the singlemost effective agent of social change with the capacity to bridge ethnicdivision in conflict affected countries. Despite the potential, educationalpolicy-makers grapple with the dilemma as to precisely how school systemscan best facilitate this agenda. This paper thus attempts to shed lightupon the dilemma by exploring pupil identity and associated intergroupattitudes across various school types in Northern Ireland. Five schools wereselected for the study with each one representing a particular sector withinthe Northern Irish education system (maintained grammar, maintainedsecondary, controlled grammar, controlled secondary, integrated). This led toa total sample size of 265 pupils. The main findings show that children acrossseparate Catholic, separate Protestant and mixed Catholic and Protestanteducational contexts construct and interpret identity differently. At thesame time, our data suggest that no one school setting has supremacy inpromoting social cohesion. The implications of these findings are discussed.

How to promote professional competence and identity in social work students

Background: Field placement experiences are frequently cited in the literature as having most impact on a student social worker’s learning as they emerge into the profession. Placements are integral to the development of practice competence and in acquiring a sense of social work identity. However research on the effectiveness of educational strategies used to deliver learning and assess competence during placement are scarce. Internationally, pressures to meet increasing numbers of student enrolments have raised concerns about the potential impact on the quality of placements and practice teaching provided. These pressures may also impact on the appropriate transfer and application of learning to the student’s practice.
Aim: To identify learning activities rated most useful for developing professional practice competence and professional identity of social work students.
Method: Data were collected from 396 students who successfully completed their first or final placement during 2013-2014 and were registered at one of two Universities in Northern Ireland. Students completed a self-administered questionnaire which covered: placement setting and service user group; type of supervision model; frequency of undertaking specific learning activities; who provided the learning; which activities contributed to their developing professional competence and identity and their overall satisfaction.
Our findings confirmed the centrality of the supervisory relationship as the vehicle to enable quality student learning. Shadowing others, receiving regular supervision and receiving constructive feedback were the tasks that students reported as ‘most useful’ to developing professional identity, competence and readiness to practice. Disturbingly over 50% of students reported that linking practice to the professional codes, practice foci and key roles were not valued as ‘useful’ in terms of readiness to practice, feeling competent and developing professional social work identity. These results offer strong insights into how both the University and the practice placement environment needs to better prepare, assess and support students during practice placements in the field.

Introduction: Embodiment, Identity, and the Patient’s Story

This introduction looks at the links between medicine and narrative, arguing that patients’ stories have a valuable role to play in patient-centered healthcare. Two particular areas are addressed: first, the ways in which first-person expressions of embodied experience may contribute to medicine’s empathetic endeavor; and second, the lack of research to date into autopathography in the French-speaking world.

Ritual, identity and nation: when the historian becomes the high priest of commemoration

This paper questions the use of 'memory', 'remembering' and 'collective memory' as a conceptual tool in historical study. It will ague that a synchronic model for commemorative practice needs to be highlighted, and in doing so questions the role of historians in commemorative practice.

Identity of a Tilapia Pheromone Released by Dominant Males that Primes Females for Reproduction

Knowledge of the chemical identity and role of urinary pheromones in fish is scarce, yet it is necessary in order to understand the integration of multiple senses in adaptive responses and the evolution of chemical communication [1]. In nature, Mozambique tilapia (Oreochromis mossambicus) males form hierarchies, and females mate preferentially with dominant territorial males, which they visit in aggregations or leks [2]. Dominant males have thicker urinary bladder muscular walls than subordinates or females and store large volumes of urine, which they release at increased frequency in the presence of subordinate males or preovulatory, but not postspawned, females [3–5]. Females exposed to dominant-male urine augment their release of the oocyte maturation-inducing steroid 17α,20β-dihydroxypregn-4-en-3-one (17,20β-P) [6]. Here we isolate and identify a male Mozambique tilapia urinary sex pheromone as two epimeric (20α- and 20β-) pregnanetriol 3-glucuronates. We show that both males and females have high olfactory sensitivity to the two steroids, which cross-adapt upon stimulation. Females exposed to both steroids show a rapid, 10-fold increase in production of 17,20β-P. Thus, the identified urinary steroids prime the female endocrine system to accelerate oocyte maturation and possibly promote spawning synchrony. Tilapia are globally important as a food source but are also invasive species, with devastating impact on local freshwater ecosystems [7, 8]. Identifying the chemical cues that mediate reproduction may lead to the development of tools for population control [9–11].

Bush and Lula's political identity constructions: are they so different? A critical discourse analysis of presidential speeches of North and South America

Dissertação de mest., Linguística, Faculdade de Ciências Humanas e Sociais, Universidade do Algarve, 2007

The discursive construction of place-identity: british lifestyle migrants in the Algarve

Tese dout., Philosophy, Lancaster University, 2011