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Anaesthetists and Professional Excellence: Specialist and Trainee Anaesthetists’ Understanding of their Work as a Basis for Professional Development, a Qualitative Study
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Why do some anaesthetists perform a better job than others? Why do some trainees grow faster in their professional role than others? These are important questions when the education of anaesthetists is so topical. Research in work pedagogy has shown that competence is related to the way professionals understand their work; the two first interview studies of this thesis are about understanding work. Study I shows that specialist anaesthetists understand work in four different ways, representing four aspects of work. Some of them have a comprehensive understanding, seeing three or all four aspects of work, whereas others have more restricted understandings. In Study II, trainees expressed similar ways of understanding work, some comprehensive, some more restricted. It is important that trainees develop competence in all aspects of work. Therefore, trainees need not only to develop competence by deepening their present understanding, but also by change of understanding, an important but difficult step in competence development.

Reflection is important in professional training. The reflection process should encompass all aspects of work, to enable trainees to develop a broad competence. However, only anaesthetists with a comprehensive way of understanding work have the prerequisites for facilitating trainees’ reflection in all aspects of work.

Study III, focussing on the learning environment, shows that two important principles of professional training are often violated for trainee anaesthetists: making use of the trainee’s curiosity and reducing trainees’ stress level. Trainees very much need support from well educated mentors.

Teachers should not only facilitate trainees’ development of competence but also support young trainees to develop into anaesthetists who enjoy work. Study IV shows that some experienced anaesthetists still enjoy work very much after years of practice. Their advice about how to get to terms with work should be shared with young trainees.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2004. , p. 66
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1369
Keywords [en]
Health services research, Professional training, competence, anaesthesiology, phenomenography, phenomenology
Keywords [sv]
Hälso- och sjukvårdsforskning
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:uu:diva-4518ISBN: 91-554-6023-2 (print)OAI: oai:DiVA.org:uu-4518DiVA, id: diva2:164998
Public defence
2004-10-01, Fåhraeussalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:15
Opponent
Supervisors
Available from: 2004-09-10 Created: 2004-09-10Bibliographically approved
List of papers
1. Professional artist, good Samaritan, servant and co-ordinator:: four ways of understanding the anaesthetist's work
Open this publication in new window or tab >>Professional artist, good Samaritan, servant and co-ordinator:: four ways of understanding the anaesthetist's work
2003 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 47, no 7, p. 787-793Article in journal (Refereed) Published
Abstract [en]

Background: Evaluating clinical competence among anaesthetists has so far focused mostly on theoretical knowledge and practical skills. According to theory, however, the way anaesthetists understand their own work has also greatly influenced the development of professional competence. The aim of this study was to investigate how anaesthetists understand their work.

Methods: Nineteen Swedish anaesthetists were interviewed. The interviews were open and sought answers to three questions 1) When do you feel you have been successful in your work?; 2) What is difficult or what hinders you in your work?; and 3) What is the core of your professional anaesthesia work? Phenomenographic analysis was performed.

Results: Four ways of understanding the anesthesiologists' professional work were found: 1) Give anaesthesia and control the patient's vital functions; 2) Help the patient, alleviate his/her pain and anxiety; 3) Give service to the whole hospital to facilitate the work of other doctors and nurses, caring for severely ill patients; and 4) Organize and direct the operation ward to make the operations list run smoothly.

Conclusions: This study shows that anaesthetists understand their work in qualitatively different ways, which can be assumed to affect their work actions and also the way their competence develops. This has implications for the education of anaesthetists; it is important to find ways of making anaesthetists in training consciously aware of the different ways their work can be understood, as this will give them better prerequisites for future competence development.

Keywords
anesthesiology, anesthetist's work, education, interviews, phenomenography, professional competence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-92048 (URN)10.1034/j.1399-6576.2003.00151.x (DOI)
Available from: 2004-09-10 Created: 2004-09-10 Last updated: 2017-12-14Bibliographically approved
2. Trainee anaesthetists understand their work in different ways: implications for specialist education
Open this publication in new window or tab >>Trainee anaesthetists understand their work in different ways: implications for specialist education
2004 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 92, no 3, p. 381-7Article in journal (Refereed) Published
Abstract [en]

Background. Traditionally, programmes for specialist education in anaesthesia and intensive care have been based on lists of attributes such as skills and knowledge. However, modern research in the science of teaching has shown that competence development is linked to changes in the way professionals understand their work. The aim of this study was to define the different ways in which trainee anaesthetists understand their work.

Methods. Nineteen Swedish trainee anaesthetists were interviewed. The interviews sought the answers to three open-ended questions. (i) When do you feel you have been successful in your work? (ii) What is difficult or what hinders you in your work? (iii) What is the core of your anaesthesia work? Transcripts of the interviews were analysed by a phenomenographic approach, a research method aiming to determine the various ways a group of people understand a phenomenon.

Results. Six ways of understanding their work were defined: giving anaesthesia according to a standard plan; taking responsibility for the patient’s vital functions; minimizing the patient’s suffering and making them feel safe; giving service to specialist doctors to facilitate their care of patients; organizing and leading the operating theatre and team; and developing one’s own competence, using the experience gained from every new patient for learning.

Conclusions. Trainee anaesthetists understand their work in different ways. The trainee’s understanding affects both his/her way of performing work tasks and how he/she develops new competences. A major task for teachers of anaesthesia is to create learning situations whereby trainees can focus on new aspects of their professional work and thus develop new ways of understanding it.

Identifiers
urn:nbn:se:uu:diva-92049 (URN)10.1093/bja/aeh079 (DOI)
Available from: 2004-09-10 Created: 2004-09-10 Last updated: 2017-12-14Bibliographically approved
3. Being a young and inexperienced trainee anaesthetist: a phenomenological study on tough working conditions
Open this publication in new window or tab >>Being a young and inexperienced trainee anaesthetist: a phenomenological study on tough working conditions
2006 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 6, p. 653-8Article in journal (Refereed) Published
Abstract [en]

 

Background: Physicians at the beginning of their specialist education have been reported to be especially exposed to stress and difficult working conditions. Considerable worry has also been caused by reports about anaesthetists dying at a younger age than other specialists as well as by reports about higher than average suicide rates among anaesthetists. Maybe as a consequence, many young doctors are reluctant to choose anaesthesiology as their future specialty. The aim of this study was to investigate what difficulties trainee anaesthetists experience at work.

Methods: Nineteen trainee anaesthetists in six Swedish hospitals were interviewed. Phenomenological analysis of the interview text was performed.

Results: All trainees had experienced considerable, sometimes extreme demands at work. Most of them often felt insufficient and inadequate and had problems with the professional role. Support from consultants was sometimes lacking. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations.

Conclusions: This study shows that trainee anaesthetists have to live up to high work demands, often with very little support. Because too much stress is an obstacle to professional learning, such working conditions are a hindrance to good specialist education. The first measure to be taken should be to ensure that all trainee anaesthetists always have easy access to senior cover.

Background: Physicians at the beginning of their specialist education have been reported to be especially exposed to stress and difficult working conditions. Considerable worry has also been caused by reports about anaesthetists dying at a younger age than other specialists as well as by reports about higher than average suicide rates among anaesthetists. Maybe as a consequence, many young doctors are reluctant to choose anaesthesiology as their future specialty. The aim of this study was to investigate what difficulties trainee anaesthetists experience at work.

Methods: Nineteen trainee anaesthetists in six Swedish hospitals were interviewed. Phenomenological analysis of the interview text was performed.

Results: All trainees had experienced considerable, sometimes extreme demands at work. Most of them often felt insufficient and inadequate and had problems with the professional role. Support from consultants was sometimes lacking. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations.

Conclusions: This study shows that trainee anaesthetists have to live up to high work demands, often with very little support. Because too much stress is an obstacle to professional learning, such working conditions are a hindrance to good specialist education. The first measure to be taken should be to ensure that all trainee anaesthetists always have easy access to senior cover.

Keywords
Anesthesiology/*education, Data Collection, Humans, Interviews, Stress; Psychological/*epidemiology, Sweden
Identifiers
urn:nbn:se:uu:diva-92050 (URN)10.1111/j.1399-6576.2006.01035.x (DOI)16987357 (PubMedID)
Available from: 2004-09-10 Created: 2004-09-10 Last updated: 2017-12-14Bibliographically approved
4. Enjoying work or burdened by it? How anaesthetists experience and handle difficulties at work: a qualitative study
Open this publication in new window or tab >>Enjoying work or burdened by it? How anaesthetists experience and handle difficulties at work: a qualitative study
2007 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 99, no 4, p. 493-499Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to explore difficulties at work from anaesthetists’ own perspective and to examine how anaesthetists handle and cope with situations that are perceived as difficult and potentially stressful.

Methods: Two sets of interviews were conducted with 19 specialist anaesthetists in Sweden. The first set of interviews aimed at finding how the anaesthetists experienced difficulties at work. It consisted of in-depth interviews based on one open-ended question. We analysed the interviews with a phenomenological method, looking for themes in anaesthetists’ descriptions of difficulties at work. In the second set, the interviews were semi-structured with open-ended questions, based on themes found in the first interview set. These interviews aimed at exploring how the interviewees described their ways of handling difficulties and how they coped with potentially stressful situations.

Results: Analysis of the first set of interviews resulted in five themes, describing how the anaesthetists experienced difficulties at work. All interviewees talked about difficulties related to more than one of the themes. The second set of interviews revealed two main categories of ways of handling difficulties. First, problem solving consisted of descriptions of methods for handling difficult situations which aimed at solving problems, and second, coping strategies described ways of appraising potentially stressful situations that minimized stress, despite the problem not being solved.

Conclusions: The anaesthetists interviewed in this study maintained that they enjoyed work and could see no external obstacles to doing a good job. They had arrived at a reconciliation of their work with its inherent difficulties and problems. Getting access to their coping strategies might help young anaesthetists to come to terms with their work.

Keywords
anaesthetist, risks, education, junior staff, stress
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-92051 (URN)10.1093/bja/aem233 (DOI)000250198700006 ()17704090 (PubMedID)
Available from: 2004-09-10 Created: 2004-09-10 Last updated: 2017-12-14Bibliographically approved

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