MedEdPublish (Aug 2018)
'Compassion, the first emotion ditched when I’m busy’. The struggle to maintain our common humanity
Abstract
Introduction A considerable body of literature has been built around the socialisation of medical students and junior doctors into the culture of medicine, yet our appreciation of how their affective learning is shaped through practice, over time, continues to challenge our understanding and subsequent educational practice. This study addresses this gap by using compassion as a lens to unpack affective learning. Methods This research asked interns undertaking their first year of medical practice ''What have been the main influences (positive and/or negative) in how you have learned to express compassion for your patients when working in the clinical context?" Their individual narratives, generated through reflective journals and unstructured interviews, when thematically analysed, told us how and why they struggled. Findings The eight interns expressed their struggle to maintain their compassionate aspirations when confronted with the complexity and competing demands of their community of practice. Their emotional disquiet triggered their safety ethic resulting in their compassion, a prosocial moral emotion, being replaced by a more reductionist approach where patient care was reframed as patient management. Discussion While neither inevitable nor static, the interns' narratives tell a story where, after a year embedded in their community of practice, their increased self-efficacy, derived primarily from their perceived biomedical competence, enables them to revisit their original aspirations - to be both compassionate and competent - recognising that being a 'good' doctor does not have to eclipse being a kind and caring human being. Conclusions The interns' reflections uncovered a narrative of emotional vulnerability, where fearing failure and seeking perfection, contributed to a diminished self‑efficacy resulting in risk aversive behaviours protecting their doctor identity. In the recommendations the authors propose strategies for safe engaged connection, where self‑understanding replaces self‑criticism and self‑compassion is cultivated to guard against contempt and cynicism.
