Dr Lynn Monrouxe is director of medical education research at the School of Medicine, Cardiff University.
Dr Lynn Monrouxe discusses her research into how people develop their professional values and behaviours as they become patient-centred healthcare professionals.
ALL of us, at some time, will have experiences of being a patient. At such times we might feel vulnerable as we look to doctors, nurses and other healthcare professionals for help and advice.
While most of our experiences will be positive, a significant minority of us will experience difficulties in our interactions with healthcare professionals. For example last year, following a spate of similar reports across the UK, the Older People’s Commissioner for Wales found consistent issues concerning the lack of dignity and respect patients received in hospital.
These situations can cause real distress for patients, undermine the effectiveness of clinical treatment and sometimes impacts on how fast we might recover.
I am interested in how this state of affairs comes about within an NHS that promotes respect, dignity and compassion for all. My research examines what happens to healthcare students during their training in clinical settings that means they sometimes have to be reminded that the person in front of them is a human who deserves compassion and respect.
Today’s healthcare students are explicitly taught about what comprises professional values and behaviours. However, a large part of learning to become a healthcare professional occurs within the NHS as they observe their seniors – who act as powerful role models – interacting with patients. Sometimes these role models were trained many years ago and belong to a different culture of medicine with different ways of doing things.
People who belong to the same cultural group tend to embrace common characteristics such as language, customs and values. In doing this they embrace a common “cultural identity” and achieve a sense of belonging.
Likewise, healthcare students tend to embrace common characteristics of their chosen profession. They look to their seniors for guidance about how to behave. But what if their seniors belong to a different era where things that were acceptable then may no longer be acceptable now?
One strand of my research examines professionalism dilemma situations. These are situations in which healthcare students find themselves witnessing or participating in something unethical or unprofessional. These include witnessing, and sometimes participating in, breaches of patient safety and dignity.
Students often report experiencing distress in such situations as they know the right way to behave, but feel unable to do so for some reason. In their stories, students frequently report feeling unable to speak out for fear of receiving poor grades as their seniors are also their teachers, because they are low in the pecking order or because speaking out might hamper their future career.
So how can we support tomorrow’s healthcare students to become ethical and compassionate professionals?
Revalidation for doctors is coming into force and involves patient and colleague feedback. But our research suggests that, by itself, this is insufficient to change behaviours.
We urge healthcare schools to provide students with a safe place to share their stories with each other and with ethical role models so they can begin to make sense of their experiences, share good practice and ways to resist bad practice. Most of all, we suggest that cultural change should occur from within. Patients, patient advocates, students and healthcare professionals should join together to examine how language, practices and values occurring within clinical settings can be developed to improve patient safety and dignity for all.
If you would like to know more about my research, including how you might get involved yourself, please contact me at firstname.lastname@example.org
This article first appeared in the Western Mail‘s Health Wales supplement on 31st December 2012, as part of the Welsh Crucible series of research profiles.