Browsing by Author "McNamee, Lakshini Sandhya."
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Item Learning processes and identity construction of newly qualified doctors : a narrative study.(2015) McNamee, Lakshini Sandhya.; Rule, Peter Neville.This thesis reports on a narrative research study of medical internship experiences focusing on the learning processes, identity construction and aspirations of newly qualified doctors (NQDs). The aim of the study was a better understanding of how medical graduates negotiate their learning experiences and construct their identities during internship in South Africa. Six doctors who were graduates of a problem‐based learning curriculum participated by reflecting back on their internship experiences. Qualitative data in the form of written reflections three years post‐qualification were initially analysed using socio‐linguistic methods. The same participants were followed up with one‐on‐one, in‐depth interviews at six years post‐qualification. Using interpretive methodology, this qualitative study was underpinned by social constructionist thought. The theoretical framing innovatively combined psychology‐ and sociology‐based theories; for example, the classic theories of Vygotsky and Bourdieu, and more contemporary theories of Situated Learning and Dialogical Self Theory were used. A contemporary philosophy of recognition and disrespect further illuminated the nature of various relationships with regard to positive identity construction. ‘Ways of being’ of doctors were found to impact considerably on the nature and quality of relationships with patients, colleagues, institutions and the self. Insight was gained primarily into networks of relationships, especially with senior colleagues in the context of clinical workplace environments, which enabled or constrained positive identity construction. Tracing the journeys of medically qualified professionals at a more mature stage of their development revealed the importance of personal dispositions and aspirations. Learning processes during medical internship were found essentially to involve significant others. Identities of NQDs were not rigidly organised, and the study developed an understanding of multiple I‐positions in dialogical interaction within the self. Internship communities of practice enabled or constrained not only the development of knowledgeable skill, but also powerfully shaped identities. Strengthening the possibilities for positive identity constructions during internship would be a possible means of transforming medical culture to be more responsive to the needs, beliefs and abilities of NQDs. Deeper consideration for internship learning and promoting mutual recognition between NQDs and healthcare institutions may also lead towards more patient‐centred care.Item Students' perceptions of medico-legal autopsy demonstrations as a learning experience at a South African medical school.(2007) McNamee, Lakshini Sandhya.How do medical students experience autopsy demonstrations that form part of the undergraduate curriculum? This was the primary question guiding this phenomenological study within the interpretive paradigm. Both explicit cognitive outcomes and elements of the “hidden curriculum” associated with autopsies were evaluated. Most previous studies on this topic employed survey questionnaires and were conducted prior to the radical curriculum reformations in medical undergraduate training. Some of these pedagogical changes have threatened the use of autopsies for teaching. More recently some other studies concentrated on aspects that were not directly related to educational outcomes. Burton (2003) conducted a phenomenological study interviewing medical educators about the uses of autopsy in the modern undergraduate curriculum, essentially detailing the “delivered curriculum”. Therefore this study focused on the “received curriculum”. Interviews were conducted with 10 medical students in their 4th year of study, having attended medico-legal autopsy demonstrations forming a central part of a course in Forensic Medicine. The underlying assumption of the study is that ‘student voices’ need to be heard in determining what is taught and how (Brooker & MacDonald, 1999), something typically determined by academic staff. This need is especially highlighted in a climate of “self-directed learning” promoted by modern medical curricula. The data are analysed qualitatively using a theoretical framework of three dimensions of learning (Illeris, 2004): (1) cognitive content dimension, (2) emotional psychodynamic, attitudinal and motivational dimension, (3) social-societal dimension. Findings of the study show that medical students perceive autopsy demonstrations to be of considerable benefit to their learning; both cognitive and affective outcomes are discussed detailing individual contextual factors that influenced the outcomes. Some suggestions regarding curriculum and autopsy-based teaching are made in the light of various factors found to influence students’ attitudes towards autopsies.