Found poetry – Finding home: A qualitative study of homeless immigrant women

Longitudinal exploration of students' identity formation during the transition from pre-clinical to clinical training using research poetry

BACKGROUND

Transitions are critical periods that can lead to growth and, or, distress. Transitions are a sociocultural process, yet most approaches to transitions in practice and research do not explore the social or developmental aspects of entering a new training phase. Wenger reminds us that identity development is crucial when newcomers navigate change. In this paper, we use Wenger's modes of identification: engagement, imagination and alignment to explore students' identity development (as a student and professional) during the transition from pre-clinical to clinical training.

METHODS

We enrolled nine 2nd-year medical students who generated 61 entries comprising audio diary (or typed) reflections over 9 months (starting 3 months before clinical clerkships began) and interviewed them twice. We used research poems (transcripts reframed as poetry) to help construct a meaningful, emotive elicitation of our longitudinal data and analysed data using sensitising concepts from Wenger's modes of identification.

RESULTS

Students described their transition as a journey filled with positive and negative emotions and uncertainty about their current and future careers. Students navigated the transition using three mechanisms: (1) becoming more engaged through taking charge, (2) shaping their image of self through engagement and finding role models and (3) learning to flexibly adapt to clerkship norms by managing expectations and adopting a journey mindset.

CONCLUSIONS

We successfully narrated students' identity formation during their transition to clinical training. We learned that students became more engaged over time by learning to take charge. They shaped their image of self by engaging in team activities and reflecting on role models. They learnt to adapt flexibly to clerkship norms by managing expectations and adopting a journey mindset. We suggest that institutions provide a safe opportunity for medical students to reflect, allowing students' transition periods to be lived, reflected on and supported.

Thoughts that breathe, and words that burn: poetic inquiry within health professions education

Qualitative inquiry is increasingly popular in health professions education, and there has been a move to solidify processes of analysis to demystify the practice and increase rigour. Whilst important, being bound too heavily by methodological processes potentially represses the imaginative creativity of qualitative expression and interpretation-traditional cornerstones of the approach. Rigid adherence to analytic steps risks leaving no time or space for moments of 'wonder' or emotional responses which facilitate rich engagement. Poetic inquiry, defined as research which uses poetry 'as, in, [or] for inquiry', offers ways to encourage creativity and deep engagement with qualitative data within health professions education. Poetic inquiry attends carefully to participant language, can deepen researcher reflexivity, may increase the emotive impact of research, and promotes an efficiency of qualitative expression through the use of 'razor sharp' language. This A Qualitative Space paper introduces the approach by outlining how it may be applied to inquiry within health professions education. Approaches to engaging with poetic inquiry are discussed and illustrated using examples from the field's scholarship. Finally, recommendations for interested researchers on how to engage with poetic inquiry are made, including suggestions as to how to poetize existing qualitative research practices.

A phenomenological study of new doctors' transition to practice, utilising participant-voiced poetry

Transition to practice can be a turbulent time for new doctors. It has been proposed transition is experienced non-linearly in physical, psychological, cultural and social domains. What is less well known, however, is whether transition within these domains can contribute to the experience of moral injury in new doctors. Further, the lived experience of doctors as they transition to practice is underexplored. Given this, we asked; how do newly qualified doctors experience transition from medical school to practice? One-to-one phenomenological interviews with 7 recently qualified UK doctors were undertaken. Findings were analysed using Ajjawi and Higgs' framework of hermeneutic analysis. Following identification of secondary concepts, participant-voiced research poems were crafted by the research team, re-displaying participant words chronologically to convey meaning and deepen analysis. 4 themes were identified: (1) The nature of transition to practice; (2) The influence of community; (3) The influence of personal beliefs and values; and (4) The impact of unrealistic undergraduate experience. Transition to practice was viewed mostly negatively, with interpersonal support difficult to access given the 4-month nature of rotations. Participants describe relying on strong personal beliefs and values, often rooted in an 'ethic of caring' to cope. Yet, in the fraught landscape of the NHS, an ethic of caring can also prove troublesome and predispose to moral injury as trainees work within a fragmented system misaligned with personal values. The disjointed nature of postgraduate training requires review, with focus on individual resilience redirected to tackle systemic health-service issues.

“You’re the One That Was on Uncle’s Wall!”: Identity, Whanaungatanga and Connection for Takatāpui (LGBTQ+ Māori)

Takatāpui (Māori LGBTIQ+) challenge static notions of relationality and belonging or whanaungatanga for Māori. Explorations of Māori and LGBTIQ+ identity can often polarise experiences of family as either nurturing spaces or sites comprised of actors of spiritual and physical violence. However, such framing ignores the ways in which cultural practices for establishing relationality for takatāpui extend beyond dichotomies of disconnection or connection within families and into spaces of new potential. In this paper we outline a bricoleur research praxis rooted in Māori ways of being which underpins the research. We engage in photo-poetry as an analytic tool, constructing poetry from our interviews with Waimirirangi, a twenty-year-old whakawahine (Māori term for trans woman or trans femme) and bring them into conversation with the images she provided as part of the broader research project. As the interface between her ancestors and future generations, Waimirirangi demonstrates the potentiality of whanaungatanga as a restorative practice for enhancing takatāpui wellbeing.

Understanding the health and housing experiences of refugees and other migrant populations experiencing homelessness or vulnerable housing: a systematic review using GRADE-CERQual

BACKGROUND

A growing number of migrants experience precarious housing situations worldwide, but little is known about their health and housing experiences. The objective of this study was to understand the enablers and barriers of accessing fundamental health and social services for migrants in precarious housing situations.

METHODS

We conducted a systematic review of qualitative studies. We searched the databases of MEDLINE, PsycINFO, CINAHL, Scopus, Web of Science, Social Sciences, Canadian Business & Current Affairs and Sociological Abstracts for articles published between Jan. 1, 2007, and Feb. 9, 2020. We selected studies and extracted data in duplicate, and used a framework synthesis approach, the Bierman model for migration, to guide our analysis of the experiences of migrant populations experiencing homelessness or vulnerable housing in high-income countries. We critically appraised the quality of included studies using the Critical Appraisal Skills Programme checklist and assessed confidence in key findings using the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach.

RESULTS

We identified 1039 articles, and 18 met our inclusion criteria. The studies focused on migrants from Asia and Africa who resettled in Canada, Australia, the United States, the United Kingdom and other European countries. Poor access to housing services was related to unsafe housing, facing a family separation, insufficient income assistance, immigration status, limited employment opportunities and lack of language skills. Enablers to accessing appropriate housing services included finding an advocate and adopting survival and coping strategies.

INTERPRETATION

Migrants experiencing homelessness and vulnerable housing often struggle to access health and social services; migrants may have limited proficiency with the local language, limited access to safe housing and income support, and ongoing family insecurities. Public health leaders could develop outreach programs that address access and discrimination barriers.

PROSPERO REGISTRATION

CRD42018071568.

Composing Sexuality in the Midst of Adolescent Cancer

A cancer diagnosis heralds the onset of significant life changes. The various experiences of diagnosis, treatment, and recovery from cancer during adolescence and young adulthood are complex and disruptive. Emphasis on treatment and recovery often overshadows other social and developmental imperatives for adolescents and young adults. Acknowledging, exploring, and crafting one’s own sexual identity is a significant milestone achieved during this time, and it is one that is interrupted by the arrival and treatment of cancer. There is value in understanding how adolescents and young adults compose sexuality amid cancer experiences, and how this composition contributes to their ongoing stream of life experiences after recovery. As part of a larger study of sexuality and adolescent cancer, we undertook a narrative inquiry with Anna and Mark, two young adults who experienced cancer during adolescence. Over 14 months, we met with Anna and Mark, drawing on different narrative inquiry approaches to explore their past and ongoing experiences and to build negotiated stories of those experiences. We explored resonant threads between the stories, which help show the depth and complexity of sexuality as it is experienced in the midst of and after cancer. Two resonant threads are discussed: inward and outward looking, and sexuality and survival. The inquiry reveals the richness of self-composition amid competing stories of cancer treatment, disruptions to family and socialization, survivorship, what it means to be a young man or woman in the world, and the sense of a developing sexual self.