Lindsay R Baker1, Maria Athina Tina Martimianakis, Yasmin Nasirzadeh, Elizabeth Northup, Karen Gold, Farah Friesen, Anuj Bhatia, Stella L Ng. 1. L.R. Baker is assistant professor, Department of Psychiatry, scientist, Li Ka Shing Knowledge Institute, and lead educator-researcher, Centre for Faculty Development, Faculty of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. M.A. Martimianakis is associate professor and director of medical education scholarship, Department of Paediatrics, and scientist and strategic lead international, Wilson Centre, University of Toronto, Toronto, Ontario, Canada. Y. Nasirzadeh is a first-year resident, Department of Psychiatry, Mount Sinai Hospital, Toronto, Ontario, Canada. The author was a third-year medical student, MD Program, University of Toronto, Toronto, Ontario, Canada, at the time of the study. E. Northup is a first-year law student, Dalhousie University, Halifax, Nova Scotia, Canada. The author was a graduate student, Professional Communications Program, Ryerson University, Toronto, Ontario, Canada, at the time of the study. K. Gold is clinical program specialist, Women's College Hospital, and affiliated scientist, Centre for Ambulatory Care Education, University of Toronto, Toronto, Ontario, Canada. F. Friesen is education knowledge broker and program coordinator, Centre for Faculty Development, Faculty of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. A. Bhatia is associate professor, Department of Anesthesia, Faculty of Medicine, University of Toronto, and director, Clinical Chronic Pain Services, University Health Network and Women's College Hospital, Toronto, Ontario, Canada. S.L. Ng is director of research, Centre for Faculty Development; Arrell Family Chair in Health Professions Teaching, St. Michael's Hospital; and scientist, Centre for Ambulatory Care Education, University of Toronto, Toronto, Ontario, Canada.
Abstract
PURPOSE: Health professions education and practice have seen renewed calls to restore compassion to care. However, because of the ways evidence-based practice (EBP) has been implemented in health care, wherein research-based knowledge is privileged, the dominance of EBP may silence clinician and patient experience-based knowledge needed for compassionate care. This study explored what happens when the discourses of compassionate care and EBP interact in practice. METHOD: Chronic pain management in Canada was selected as the context for the study. Data collection involved compiling an archive of 458 chronic pain texts, including gray literature from 2009-2015 (non-peer-reviewed sources, e.g., guidelines), patient blog posts from 2013-2015, and transcripts of study interviews with 9 clinicians and postgraduate trainees from local pain clinics from 2015-2016. The archive was analyzed using an interpretive qualitative approach informed by critical discourse analysis. RESULTS: Four manifestations of the discourse of compassionate care were identified: curing the pain itself, returning to function, alleviating suffering, and validating the patient experience. These discourses produced particular subject positions, activities, practices, and privileged forms of knowledge. They operated in response, partnership, apology, and resistance, respectively, to the dominant discourse of EBP. These relationships were mediated by other prevalent discourses in the system: patient safety, patient-centered care, professional liability, interprofessional collaboration, and efficiency. CONCLUSIONS: Medical education efforts to foster compassion in health professionals and systems need to acknowledge the complex web of discourses-which carry with them their own expectations, material effects, and roles-and support people in navigating this web.
PURPOSE: Health professions education and practice have seen renewed calls to restore compassion to care. However, because of the ways evidence-based practice (EBP) has been implemented in health care, wherein research-based knowledge is privileged, the dominance of EBP may silence clinician and patient experience-based knowledge needed for compassionate care. This study explored what happens when the discourses of compassionate care and EBP interact in practice. METHOD:Chronic pain management in Canada was selected as the context for the study. Data collection involved compiling an archive of 458 chronic pain texts, including gray literature from 2009-2015 (non-peer-reviewed sources, e.g., guidelines), patient blog posts from 2013-2015, and transcripts of study interviews with 9 clinicians and postgraduate trainees from local pain clinics from 2015-2016. The archive was analyzed using an interpretive qualitative approach informed by critical discourse analysis. RESULTS: Four manifestations of the discourse of compassionate care were identified: curing the pain itself, returning to function, alleviating suffering, and validating the patient experience. These discourses produced particular subject positions, activities, practices, and privileged forms of knowledge. They operated in response, partnership, apology, and resistance, respectively, to the dominant discourse of EBP. These relationships were mediated by other prevalent discourses in the system: patient safety, patient-centered care, professional liability, interprofessional collaboration, and efficiency. CONCLUSIONS: Medical education efforts to foster compassion in health professionals and systems need to acknowledge the complex web of discourses-which carry with them their own expectations, material effects, and roles-and support people in navigating this web.
Authors: Stella L Ng; Jeff Crukley; Ryan Brydges; Victoria Boyd; Adam Gavarkovs; Emilia Kangasjarvi; Sarah Wright; Kulamakan Kulasegaram; Farah Friesen; Nicole N Woods Journal: Adv Health Sci Educ Theory Pract Date: 2022-01-01 Impact factor: 3.629
Authors: Alina Pavlova; Clair X Y Wang; Anna L Boggiss; Anne O'Callaghan; Nathan S Consedine Journal: J Gen Intern Med Date: 2021-09-20 Impact factor: 5.128
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