Chrystal Jaye

‘Do as I say, not as I do’: Medical Education and Foucault's Normalizing Technologies of Self

Medical training as a process of professional socialization has been well explored within the fields of medical education, medical sociology and medical anthropology. Our contribution is to outline a bio-power, more specifically an anatomo-politics, of medical education. The current research aimed to explore perspectives on what is commonly termed the ‘hidden curriculum’. We conducted interviews with pre-clinical medical students, clinical teachers and medical educators within a New Zealand medical school. In this paper, we outline ways that respondents described the juxtaposition of the undeclared or hidden aspects of medical education with the formal declared curriculum. Our respondents were aware of incongruencies across these components that resulted in mixed messages to students. Curricula initiatives aim to encourage new forms of subjectivity so that students are often expected to be the kinds of doctors that their teachers are not. However, the success of such initiatives is dependent on the degree of alignment between informal and formal components of the curriculum.

Communities of clinical practice and normalising technologies of self: learning to fit in on the surgical ward

This paper reports observational research of Fourth Year medical students in their first year of clinical training doing their surgical attachment. Previously, the authors have argued that medical curricula constitute normalising technologies of self that aim to create a certain kind of doctor. Here, they argue that a key mechanism through which these normalising technologies are exercised in the workplace is Etienne Wengers communities of practice. In the clinical environment the authors identify communities of clinical practice (CoCP) as groups of health professionals that come together with the specific and common purpose of patient care. Fourth Year medical students join these transient communities as participants who are both peripheral and legitimate. Communities of clinical practice are potent vehicles for student learning. They learn and internalise the normative professional values and behaviours that they witness and experience within the disciplinary block of the medical school and teaching hospital; specifically, the authors suggest, it is through their participation in communities of clinical practice that medical students learn how to ‘be one of us’.

Changes in clinical practice and patient disposition following the introduction of point-of-care testing in a rural hospital.

OBJECTIVES To determine whether the practical impact of point-of-care (POC) laboratory testing justifies its use in a remote rural hospital. METHODS Test indication, pre-test differential diagnosis and planned patient disposition were recorded over 6 months before and after POC test use in Rawene hospital, in New Zealands remote north. Doctors recorded impacts on patient treatments (no change, some change or a significant change). Comparisons were made using paired t-tests or chi(2) tests. An analysis of cost versus tangible benefits was also undertaken. RESULTS 269 POC tests were undertaken for 177 patients. POC tests significantly increased diagnostic certainty (2.5 diagnoses pre-test versus 1.3 diagnoses post-test (p<0.001)), and altered disposition for 43% of patients (p<0.001) by reducing transfers to base hospital by 62% (52 pre-test and 20 post-test) and increasing discharges by 480% (7 pre-test and 34 post-test). Substantial treatment change was reported in 75% of cases, some change in 22%, and no change in 3%. Overall financial benefits amounted to

When General Practitioners Become Patients

452,360 annually. CONCLUSIONS POC testing helps address inequity in acute health care provision for a disadvantaged rural community by allowing rural clinicians access to necessary and critical investigations in a clinically relevant turn-around time.

Barriers to safe hot tap water: results from a national study of New Zealand plumbers

There is little known about the lived experiences of general practitioners (GPs) who become patients, despite good documentation of their health problems. This study provides a qualitative perspective on issues identified by GPs when they tell stories about their experiences of illness, including their interactions with attending physicians. Respondents articulated several tensions inherent in their experiences of being patients. These can best be described as competing discourses, both overt and covert, which intersect in ideas about patienthood, professionalism and competency. GPs are reluctant to admit to illness and find it difficult to relinquish control, while the consulting doctor knows the patient has medical expertise and is aware that his/her consulting style and choice of management will be scrutinized closely. Both doctors can experience role discomfort, even role ambiguity, but this is rarely articulated. This can lead to difficulties in shared management of the illness.

GP obstetricians' views of the model of maternity care in New Zealand

Introduction—Many countries still have unacceptably high hospitalizations and deaths from scalds from hot tap water. Prevention strategies implemented in some countries may not work in others. Legislation aimed at changing environments that are conducive to hot tap water scalds may not be effective in many situations for a number of reasons, including lack of acceptability and practicality. Method—A qualitative study of a purposefully selected group of craftsman plumbers across New Zealand was conducted using a structured format with open ended questions. The questionnaire was administered by telephone. Information was sought on the opinions, knowledge, and practice of these plumbers regarding hot tap water safety in homes. Results—Several barriers to hot tap water safety in homes were identified by the plumbers. These included common characteristics of homes with unsafe hot tap water, such as hot water systems heated by solid fuel, and public ignorance of hot tap water safety. Other factors that emerged from the analysis included a lack of knowledge by plumbers of the hazards of hot tap water, as well as a lack of importance given to hot tap water safety in their plumbing practice. Shower performance and the threat to health posed by legionella were prioritized over the prevention of hot tap water scalds. Conclusion—The findings of this study allow an understanding of the practical barriers to safe hot tap water and the context in which interventions have been applied, often unsuccessfully. This study suggests that plumbers can represent a barrier if they lack knowledge, skills, or commitment to hot tap water safety. Conversely, they represent a potential source of advocacy and practical expertise if well informed, skilled, and committed to hot tap water safety.

‘Are We One Body?’ Body Boundaries in Telesomatic Experiences

The Lead Maternity Carer (LMC) model of maternity care, and independent midwifery practice, was introduced to New Zealand in the 1990s. The LMC midwife or general practitioner obstetrician (GPO) has clinical and budgetary responsibility for womens primary maternity care.

Defining Decision Making: A Qualitative Study of International Experts’ Views on Surgical Trainee Decision Making

This paper explores the embodiedness of body boundaries in the telesomatic experiences of 20 adult twins. Respondents were recruited through snowball sampling resulting in 16 in-depth face-to-face interviews. Interviews were analysed using an immersion-crystallization approach within a meaning-centred interpretive framework. Respondents often experienced trouble making subject–object distinctions between themselves and their co-twins that often resulted in them posing the question, ‘Are we (myself and my co-twin) one body?’ Their experiences suggest that, sometimes symptoms of one illness are experienced as shared between two people, and their experiences highlight the ethical nature of individualism in western cultures as twins frequently do not view a greater level of attachment to their co-twins as pathological but as something special. We suggest that controversy regarding the ontological status of parapsychological phenomena has resulted in anthropologists being slow to consider these and similar experiences in western cultures as topics worthy of research.

Embodying occupational overuse syndrome

BackgroundDecision making is a key competency of surgeons; however, how best to assess decisions and decision makers is not clearly established. The aim of the present study was to identify criteria that inform judgments about surgical trainees’ decision-making skills.MethodsA qualitative free text web-based survey was distributed to recognized international experts in Surgery, Medical Education, and Cognitive Research. Half the participants were asked to identify features of good decisions, characteristics of good decision makers, and essential factors for developing good decision-making skills. The other half were asked to consider these areas in relation to poor decision making. Template analysis of free text responses was performed.ResultsTwenty-nine (52%) experts responded to the survey, identifying 13 categories for judging a decision and 14 for judging a decision maker. Twelve features/characteristics overlapped (considered, informed, well timed, aware of limitations, communicated, knowledgeable, collaborative, patient-focused, flexible, able to act on the decision, evidence-based, and coherent). Fifteen categories were generated for essential factors leading to development of decision-making skills that fall into three major themes (personal qualities, training, and culture). The categories compiled from the perspectives of good/poor were predominantly the inverse of each other; however, the weighting given to some categories varied.ConclusionsThis study provides criteria described by experts when considering surgical decisions, decision makers, and development of decision-making skills. It proposes a working definition of a good decision maker. Understanding these criteria will enable clinical teachers to better recognize and encourage good decision-making skills and identify poor decision-making skills for remediation.

The spiritual environment in New Zealand hospice care: identifying organisational commitment to spiritual care

This article explores the ways in which embodiedness has become problematic for New Zealand sufferers of occupational overuse syndrome (OOS). While successful rehabilitation could lead back to employment, this was based on the biographical continuity of a bodily hexus that ignored persistent pain. The reality of OOS involved a liminal fragility associated with social isolation, loss of identities, pain and functional disability that was incorporated into re-negotiated identities and biographies with the result that respondents became exquisitely self-absorbed, exercising constant bodily surveillance and discipline in order to manage their symptoms.