Drawing on experience: exploring the pedagogical possibilities of using rich pictures in health professions education

A picture's worth a thousand words: Enhancing qualitative data collection with rich pictures

The use of qualitative research methods is growing among scholars interested in exploring and understanding the distinct context of anatomy education. While verbal and text-based methods like interviews and focus groups are frequently used for data collection, anatomy education scholars may benefit from including visual methods such as photovoice or diagramming in their data collection toolbox. Often used in conjunction with oral, language-based qualitative methods, visual methods aid researchers in exploring phenomena which may be difficult for participants to express. Rich pictures are a type of visual method which has gained popularity in the health professions education literature. Generated through asking participants to draw a detailed representation of a particular situation, rich pictures can afford researchers deeper insight into participants' perspectives and experiences while exploring complex phenomena within the context of teaching and learning. This article provides a four-part description of rich pictures to support the application of this visual method within qualitative anatomical sciences education research by: (1) describing the background and offering an overview of this method, (2) explaining how to use rich pictures as an elicitation tool during interviews to stimulate participants' reflections and responses, (3) offering two analysis strategies for interpreting the visual content created through rich pictures (i.e., visual grammar for systematically analyzing the features of a participant's drawing, and gallery walks for engaging research teams in collaborative analysis of the collection of all study participants' drawings), and (4) providing reflections on the use of rich pictures in anatomic science education's qualitative studies.

Identity Work: A Qualitative Study of Residents' Experiences Navigating Identity Struggles

Introduction

Medical training traditionally holds a deterministic view of professional socialization wherein many medical learners struggle to construct a professional identity. Previous research has demonstrated the dysfunctional norms and conflicting ideologies that create identity struggle, disproportionally affecting women and individuals underrepresented in medicine. Symbolic interactionism can help explain identity struggles, emphasizing the influence of socio-contextual factors on identity construction. The purpose of this study was to explore how residents navigate identity struggles during residency training.

Method

We conducted a qualitative exploration of 12 residents in three specialties at three academic institutions in the United States. Participants engaged in rich picture drawings followed by one-on-one interviews. We coded transcript data and met regularly to identify themes related to residents' experiences with navigating professional identity struggles.

Results

We identified three main themes on navigating identity struggles: the weight of identity work, the isolating nature of identity work, and the navigation that occurs with and against socio-contextual currents. Residents described identity work as navigation like a boat at sea. This work felt weighty and at times overwhelming and residents often felt unable to discuss their identity struggles with others. Residents utilized what agency they had to either navigate with the current, navigating towards acceptable-albeit imperfect-paths forward, or attempting to go against the current to forge new paths through resistance.

Discussion

This study highlights how context enables and constrains identity construction, how contextual constraints can create dissonance between identities, and the considerable effort required to reconcile dissonance and construct professional identities. Training program adjustments, enhanced resident support, and cultural shifts are required to sustain residents' identity work. Medical professionals should engage in collective identity work to reimagine the profession's identity by addressing dysfunctional cultural norms.

Set Up to Fail? Barriers Impeding Resident Communication Training in Neonatal Intensive Care Units

PURPOSE

Learning to navigate difficult clinical conversations is an essential feature of residency training, yet much of this learning occurs "on the job," often without the formative, multisource feedback trainees need. To generate insight into how on-the-job training influences trainee performance, the perspectives of parents and health care providers (HCPs) who engaged in or observed difficult conversations with Neonatal Intensive Care Unit (NICU) trainees were explored.

METHOD

The iterative data generation and analysis process was informed by constructivist grounded theory. Parents (n = 14) and HCPs (n = 10) from 2 Canadian NICUs were invited to participate in semistructured interviews informed by rich pictures-a visual elicitation technique useful for exploring complex phenomena like difficult conversations. Themes were identified using the constant comparative approach. The study was conducted between 2018 and 2021.

RESULTS

According to participants, misalignment between parents' and trainees' communication styles, HCPs intervening to protect parents when trainee-led communication went awry, the absence of feedback, and a culture of sole physician responsibility for communication all conspired against trainees trying to develop communication competence in the NICU. Given beliefs that trainees' experiential learning should not trump parents' well-being, some physicians perceived the art of communication was best learned by observing experts. Sometimes, already limited opportunities for trainees to lead conversations were further constricted by perceptions that trainees lacked the interest and motivation to focus on so-called "soft" skills like communication during their training.

CONCLUSIONS

Parents and NICU staff described that trainees face multiple barriers against learning to navigate difficult conversations that may set them up to fail. A deeper understanding of the layered challenges trainees face, and the hierarchies and sociocultural norms that interfere with teaching, may be the start of breaking down multiple barriers trainees and their clinician supervisors need to overcome to succeed.

Expanding the advocacy lens: using photo-elicitation to capture patients' and physicians' perspectives about health advocacy

Heath advocacy (HA) remains a difficult competency to train and assess, in part because practicing physicians and learners carry uncertainty about what HA means and we are missing patients' perspectives about the role HA plays in their care. Visual methods are useful tools for exploring nebulous topics in health professions education; using these participatory approaches with physicians and patients might counteract the identified training challenges around HA and more importantly, remedy the exclusion of patient perspectives. In this paper we share the verbal and visual reflections of patients and physicians regarding their conceptualizations of, and engagement in 'everyday' advocacy. In doing so, we reveal some of HA's hidden dimensions and what their images uncovered about the role of advocacy in patient care. Constructivist grounded theory guided data collection and analysis. Data was collected through semi-structured interviews and photo-elicitation, a visual research method that uses participant generated photographs to elicit participants knowledge and experiences around a particular topic. We invited patients living with chronic health conditions (n = 10) and physicians from diverse medical and surgical specialties (n = 14) to self-select photographs representing their experiences navigating HA in their personal and professional lives. Both groups found taking photographs useful for revealing the nuanced and circumstantial factors that either enabled or challenged their engagement in HA. While patients' photos highlighted their embodiment of HA, physicians' photos depicted HA as something quite elusive or as a complicated and daunting task. Photo-elicitation was a powerful tool in eliciting a diversity of perspectives that exist around the HA role and the work advocates perform; training programs might consider using visuals to augment teaching for this challenging competency.

The ‘Rich Pictures’ Method: Its Use and Value, and the Implications for HRD Research and Practice

Embracing new and innovative qualitative methods has helped researchers in a number of fields to access aspects of the lived experience that traditional methods cannot easily reach. This paper explores the use and value of one such method – ‘rich pictures’: a technique whose origins lie in ‘soft systems’ engineering but which has been successfully applied in a broader range of contexts in recent years including health, medicine and education. Despite its use in these disciplines, however, recent studies suggest that HRD research continues to rely on established methods and that uptake of visual methods – and ‘rich pictures’ in particular – is virtually non-existent. The aim of this paper therefore is to shed light on this underused method and encourage HRD researchers to recognize its potential for studying human development.