Charlotte Tulinius

Preventing burnout among general practitioners: is there a possible route?

Stress and burnout among general practitioners (GPs) is a serious problem. Some authors suggest supervision groups or Balint groups as a means of preventing burnout and others address how to treat the condition. This paper reports a case study of a supervision group for Danish GPs which, as well as training reflective practice, focuses specifically on the prevention of burnout. The concept of compassion fatigue is extended to cover the circumstances reported by some practitioners in supervision.

Continuing professional development for general practitioners: supporting the development of professionalism

Medical Education 2010: 44: 412–420

When the spiral of action research collapses: Using the arts to interpret and continue the process in collective research dialogues

In the spiral of action research all participants are expected to work together towards a continuously developing fulfillment of the aims of the project. The data collection is supposed to lead to critical reflection, strategy development, and implementation in cycles, actively involving all participants and researchers. However, communicating processes that go wrong can be difficult. Facing the final communication of an action research project on medical education, we were invited to give a keynote lecture at a workshop with other action researchers. We used this invitation as an opportunity to reframe the researcher—practitioner collaborations as the culturally recognizable stories in the gap between research and practice. This allowed us to continue the action research cycle with a group of research peers that had not been part of the original project. Through the use of photos, music and film clips, and in the frame of a fairy tale, we worked as in a socio-drama, constructing two parallel and illustrated narratives, inviting the peer researchers at the workshop to reflect on our experiences, and to bring in their own experiences. This communication strategy helped us and the research peers to work through the emotional impact of our research. It also developed our understanding of the project process, and supported the peer researchers to tell and share their stories, giving them new insight into their own research processes.

“We’re All in the Same Boat:” Potentials and Tensions When Learning Through Sharing Uncertainty in Peer Supervision Groups

Charlotte Tulinius presents some of the challenges of peer supervision groups in Denmark. In providing examples of how groups work, she illustrates core principles across different methods, including the application of reflexivity in the context of a patient-centred approach. Dr. Tulinius explores the cultural conditions and perceptions of GP professionalism that support the development and maintenance of peer supervision groups such as the concept of ‘sameness’. Her focus on the different ways groups are supervised provides insight into how groups can vary in their gain from participating in peer support groups. To illustrate some of the differences, she presents results from a study following three peer supervision groups over time. The chapter concludes with a discussion on the challenges in designing groups for sharing of uncertainty in ways possibly unique to Denmark but indeed relevant to anyone who wants to set up professional development based on uncertainty engagement methods.

Relationships matter: contraceptive choices among HIV-positive women in Tanzania

Efforts to eliminate mother-to-child transmission of HIV in Tanzania are guided by a four-prong strategy advocated by the World Health Organization (WHO). Prong 2, prevention of unintended pregnancies among women living with HIV, has, however, received the least attention and contraceptive use to prevent unintended pregnancies remains low. This study explored the perceived barriers to the use of modern methods of contraception, and factors influencing contraceptive choice among HIV-positive women in urban Dar-es-Salaam, Tanzania. A qualitative multi-site study was conducted, utilising in-depth interviews and focus group discussions with 37 sexually active HIV-positive women aged between 20 and 44 years, attending three health facilities within Dar-es-Salaam. The theoretical framework was a patient centred model. Four barriers were identified: the influence of the women’s spousal relationships; personal beliefs and the relationship of these in understanding her disease; the influence of the social demands on the woman and her relationships; and the importance of a woman’s relationship with her healthcare provider/healthcare system. Being the bearers of bad news (HIV-positive status) the pregnant women experienced conflicts, violence, abandonment and rejection. The loss in negotiating power for the women was in relation to their intimate partners, but also in the patient–healthcare provider relationship. The role of the male partner as a barrier to contraceptive use cannot be understated. Therefore, the results suggest that healthcare providers should ensure patient-focused education and provide support that encompasses the importance of their relationships. Additional research is required to elucidate the functional association between contraceptive choices and personal and social relationships.