Nut clusters and crisps: atrocity stories and co-narration in interviews with approved mental health professionals

The puzzle of therapeutic emplotment: creating a shared clinical plot through interprofessional interaction in biopsychosocial pain rehabilitation

Interprofessional collaboration is increasingly encouraged and studied. However, there remains a need to broaden the understanding of professionals' contributions through their day-to-day interactions to minimize the impact of professional boundaries that evoke gaps in patient care. Drawing upon narrative theory emphasizing therapeutic emplotment, this ethnographic study explores how professionals contribute to interprofessional collaboration through social interactions during teamwork. Data collection was undertaken in a biopsychosocial pain rehabilitation ward in a hospital in Norway in 2016, and included participant observation of the ward-based work of two teams, and interviews with professionals from six professions (12) and patients (7). Formal and informal interprofessional interactions and patient encounters were observed. The study found that through interactions, the professionals' shared their understandings across all professions about the successfulness of their own work and of what outsider professionals were doing incorrectly when addressing patients from a biomedical approach. Imbued in these interactions were the pieces of an implicit shared clinical plot for their patients' journeys through rehabilitation and life afterwards. We argue that creating the shared clinical plot enhances conciliation across professions and interpersonal motivation to carry out the work. A struggle between perspectives in interprofessional collaboration should not be prematurely interpreted as an obstruction to collaboration, since the struggle can imbue essential narrative work. This extends the theoretical study of therapeutic emplotment as a central motivational process in interprofessional collaboration in teams.

'Man up': Medical students' perceptions of gender and learning in clinical practice: A qualitative study

CONTEXT

Gender-related inequality and disparity hinders efforts to develop a medical workforce that facilitates universal access to safe, just and equitable health care. Little is known about how medical students perceive the impact of their gender on their learning in clinical practice. Our aim in this study was to address this gap, establishing students' perceptions of the impact of their gender on learning in the clinical context as part of the wider medical education community of practice.

METHODS

We undertook a qualitative study that simultaneously gathered data through narrative individual interviews and online case reports from male and female students (n = 31) from different academic cohorts with prior experience of clinical practice in a Russell Group University medical school in the UK. Interviews were transcribed and analysed thematically alongside case report data.

RESULTS AND DISCUSSION

The participants revealed that there was a culture in clinical practice where their gender influenced how they were taught and supported by senior medical and surgical colleagues. Gender was also said to determine the clinical learning opportunities afforded to students, especially with regards to the care of patients of a different gender. The mentorship and support for learning provided to students in clinical practice was also said to be influenced by the medical student's gender.

CONCLUSION

Our findings suggest that students undergo a gendered clinical apprenticeship within what are in effect gendered communities of practice with some distinct features. These findings underscore the imperative for further work to establish how medical students of all genders can be supported to fulfil their potential in clinical practice.

Survival, Signaling, and Security: Foster Carers' and Residential Carers' Accounts of Self-Harming Practices Among Children and Young People in Care

Research on clinicians' interpretations of self-harming practices has shown that they can often be negative. To date there has been limited consideration of other professionals' narratives, notably those working in social care. This article presents focus group and interview data generated with foster carers ( n = 15) and residential carers ( n = 15) to explore the symbolic meanings ascribed to self-harm among the children and young people they care for. Three repertoires of interpretation are presented: survival, which conceives self-harm as a mechanism for redefining the identity of "looked-after"; signaling, which understands self-harm as a communicative tool for the expression of emotion; and security, which sees self-harming practices as testing the authenticity and safety of the caring relationship. Through their focus on sociocultural narratives, carers position themselves as experts on self-harm due to their intimacy with young people's social worlds. This construction potentially creates distance from health professionals, which is problematic given the current privileging of interprofessional working.