From Conceptions to Capacity: Conceptualising the development of medical practitioners' sense of Being a Doctor and Developing as a Doctor, with implications for medical education

Abstract

Abstract: Aims: My research sought to examine variation in medical practitioners' conceptions of (or ways of understanding) what it means to be a doctor, and their development as a doctor over time, with a view to the implications for medical education.

Research questions: 1. What is the range of conceptions doctors have of being a doctor? 2. What is the range of conceptions doctors have of developing as a doctor? 3. What is the relationship between their conceptions of being and developing as a doctor?

Method: I conducted 31 interviews with medical practitioners: 14 general practitioners, 12 physicians and 5 surgeons. Participants were asked to draw a 'concept map' of the concepts they thought important to being a doctor, which was then used as the basis for a semi-structured phenomenographic interview exploring the different components of their map.

Results: Three inclusively expanding conceptions of being a doctor were identified: 1. Being a doctor as treating patients' medical problems; 2. Being a doctor as maximising patients' well-being; and 3. Being a doctor as maximising community health. Six themes of expanding awareness of different dimensions of being a doctor were found to run across the three conceptions that were identified, representing increasingly complex conceptions of being a doctor.

Four inclusively expanding conceptions of developing as a doctor were identified: 1. development as becoming more clinically competent and confident, by acquiring knowledge and skills; 2. development as becoming more productive and efficient at work, by accumulating experience as a doctor; 3. development as becoming a more effective and more patient-oriented practitioner, by actively reflecting on one's practice and experiences; 4. development as broadening one's roles and horizons, by exposing oneself to different ideas and opportunities. Five themes of expanding awareness of different dimensions of development were found to run across the four conceptions that were identified, representing increasingly complex conceptions of being a doctor.

More limited or complex awareness of the nature of being a doctor was associated with more limited or complex awareness of the potential for developing as a doctor. In other words, participants with less complex conceptions of being a doctor envisaged a more limited potential for developing as a doctor. Conversely, participants with more complex conceptions of being a doctor, envisaged a more expanded potential for developing as a doctor.

Implications: The research findings indicate that early training in what it means to be a doctor may lead to lasting conceptions of medical practice and the medical profession. These conceptions may then act to limit the potential for further development as a doctor over one's career. Consequently, addressing a broad range of dimensions of being a doctor as part of medical training is recommended, in order to generate more complex understandings of medical practice and greater potential for future development as a doctor. Implications for curriculum design in medical education are discussed, utilising principles of the phenomenographic Variation Theory of Learning.

Keywords: phenomenography, medical practice, medical education, professional development as a doctor.