Dr Clare Morris EdD MA(Ed) BSc (Hons) FHEA
Earlier this week I had the opportunity to present research ‘work in progress’ at the ASME conference. The study is still in its early stages, but as a small grant recipient, I was invited to share insights emerging, in a short presentation with Q and A. One of the delegates tweeted from the audience, sharing two slides (see below).
This tweet has evoked a wide range of responses from twitter users (most of whom were not at the conference). Perhaps I will share my reflections on the nature of these responses in another blog. In short, they tend to mis-interpret the slide on the right as being some kind of reported ‘truth’ or as being the opinion of either participants or researchers. This blog attempts to place the tweet above in context.
The study is called Not a doctor: Factors shaping the professional identity formation of physician associate students in the UK. It is a small scale, pilot study, taking a longitudinal design (more of that later). The impetus for the study came from a Department of Health (2012) definition of the physician associates as ‘a new healthcare professional who, while not a doctor works to the medical model’ [my emphasis]. I was struck by the ways in which physician associates are ‘othered’ i.e. defined in relation to what they are not rather than what they are, or what they may become, given their relatively recently entry into the UK workforce. Dr Zuleyka Zevallos provides a useful introduction to the idea of otherness noting it is ‘central to the sociological analysis of how majority and minority identities are constructed (…) because the representation of different groups within any society is controlled by groups that have greater political power.’
I didn’t have to search far to find further examples of this apparent othering of physician associates, be it in twitter discussions, in published and grey literatures…or the tabloid newspapers. (The Daily Mail has twice reported on the growth of the PA workforce, referring to them as ‘doctors on the cheap‘ and ‘cut price physicians’. ) The BMA in 2012 reported that ‘a considerable amount of fear and concern has been generated among the medical profession as to what PAs mean for the future of the role of doctors’.
So, in this context, our study asks what are the factors shaping the professional identity formation of physician associate students? It is a qualitative study, using semi-structured interviews over a two year period, exploring physician associate students experiences of becoming physician associates. This includes exploration of the ways they are introduced to patients by other members of the healthcare team, the questions they are asked about being a physician associate and the types of work activity they are invited to engage in on placement. Our work could be described as a socio-cultural enquiry, where we understand learning to involve more than the acquisition of knowledge and skills, involving processes of becoming (a physician associate) and belonging (to the healthcare team). In short, we are interested in how this newly emerging professional group self-categorise their identity (‘who I think I am’) and negotiate this in relation to ‘other’ professions (‘who I think you think I am’) (See Monrouxe 2010).
So, to the context of the tweeted slide.
We interviewed physician associate students 6 weeks and 6 months into their course. At the first interview point, they had experience of weekly GP placements. At 6 months they had also undertaken their first block placements in hospital environments. What we noticed happening was that in each interview the students imagine what it might mean to be a PA by drawing comparisons with others they encounter in their placement environments. So, in the first interview they talk about how they might work with GPs in the future, how some of what they might do will be similar. They talk too about how they are introduced to patients (mini-GPs, future colleagues, PA students and in some cases as medical students).
In the second interview, they talk about how different members of the healthcare teams react to them – including a degree of suspicion. They report being told they are there ‘to steal medical jobs’ or that they will ‘forever be doing the work of junior doctors’. In this context the students talk about the uncertainties of their careers, their tentative understandings of what it means to be a PA and their lived experiences of seeking out opportunities to do things on the wards. It is in this context they talk about parallels between the work they do on placement, often alongside FY1 doctors and the work they might do in future. It is in this context they share comments that have been made to them, by consultants and nurses, about their engagement with ward and work-based learning activities (these same consultants and nurses will sometimes compare them to medical students).
The participants in this study are clearly trying to make sense of what is said to them, what is said about them and the comparisons other healthcare professionals make between them and other groups of students, in particular medical students. In doing this, they appear to be testing out the ways in which they are, and are not, like GPs, like junior doctors and like medical students.
This is the context of the shared slide and the wider context of our ongoing research.