“To obey or not to obey” - Medical students’ response towards professional dilemmas in a hierarchical and collectivist culture

Background Clinical clerkship programme in medical schools were developed to provide students with direct interactions with patients and observe clinical teachers in practice. However, professional dilemmas are prone to occur due to the nature of experiential learning. Several studies across different cultures showed that medical students responded differently towards professional dilemma. Aims This study aims to explore how medical students respond to professional dilemmas occurred during their clinical clerkships and to what extent culture influences the responses. Method A qualitative descriptive approach was used in this study. We conducted four focus group discussions with final year medical students who were selected using maximum variety sampling method. Thematic analysis was conducted following the transcription of the focus groups. Results We identified the impact of dilemmas on students’ emotions and concerns, students’ responses towards professional dilemmas, and factors affecting responses to dilemmas in clinical clerkship, which confirmed that cultures played roles in how students responded towards professional dilemmas. Conclusion This study has identified that culture, to some extent, influenced the way students responded to professional dilemmas. Therefore, it is paramount to develop a conducive and culturally sensitive educational environment and students’ ability to learn from professional dilemma experienced in the workplace for developing their professional identity.

Europe in the aftermath of the refugee crisis: the effect on forensic psychotherapy

After World War II Germany has repeatedly suffered waves of immigration. With eighteen to twenty per cent of the entire German population now being of foreign descent, it is puzzling that public opinion widely ignores the impact of migration on Germany’s national destiny and identity. As forensic therapists we routinely apply a set of assumptions and routines, by which we address internal and external culture conflicts of migrants. Each wave has challenged the justice system and the legislature, and forensic therapists are used to working around legal boundaries to safeguard that migrants receive treatment and are not deported. The uniqueness of the present wave of migration lies in the overwhelmingly high numbers of arrivals in a very short time span, many of whom were traumatised unaccompanied male minors with ill-informed expectations. Europe in its entirety has seen the breakdown of existing structures for receiving and accommodating refugees alongside a surge of solidarity, but also with some alarming loss of empathy. Public bias against migration is beginning to impinge on our forensic work, as we deal with migrants, whose difficult life situation has had a bearing on their criminal behaviour, while forensic assessments determine whether they are going to be deported or not. We as forensic therapists are therefore caught in a professional dilemma whichever way we turn.

Breaking bad news: tackling cultural dilemmas

Requesting that serious diagnoses be concealed from patients, a widespread phenomenon in many cultures, presents a professional dilemma. Practical and sensitive communication strategies are needed.MethodologyIn this paper, we use analysis of the existing literature to develop a communication tool for practitioners facing requests for diagnostic non-disclosure. Our approach builds on existing strategies, in providing a mnemonic communication tool, permitting more than one outcome, and focusing on the need for mutual understanding and cooperation.ResultsExisting work on this dilemma highlights the need to appreciate the family's standpoint, affirm their benevolent intentions and correct misperceptions. To this end, we have developed a mnemonic tool, 'ARCHES', to be used in situations where the family has requested diagnostic non-disclosure. The model has six stages: acknowledge the request for non-disclosure, build the relationship, find common ground, honour the patient's preferences and outline the harm of non-disclosure, provide emotional support and devise a supportive solution.ConclusionFacing requests for diagnostic non-disclosure is a challenge of communication. The dilemma is particularly marked when practising across cultures. Our model gives a structure for building rapport with the family and realigning their misperceptions while upholding the patient's right to knowledge.

French-Medium Instruction in Anglophone Canadian Higher Education: The Plurilingual Complexity of Students and Their Instructors

In this article, we analyze the plurilingualism of instructors and their students in a program taught through the medium of French at a multilingual, Anglophone university in Western Canada. We employ the lenses of plurilingualism and plurilingual competence in the analysis of data from a one-year qualitative study of plurilingualism across the disciplines at the university. We analyze interview data and students’ writing samples, focusing on how French and other languages are used by instructors and students in classes, and on the professional dilemma that instructors face in such courses: are they disciplinary experts and/or French immersion teachers? In our discussion, we suggest that instructors’ and students’ classroom practices are the result of several factors, including institutional discourses around plurilingualism and the French language, personal beliefs and ideologies, experiences of mobility from France and Quebec to British Columbia (instructors), and normative practices previously experienced in French immersion schools (students).

Never be afraid to question practice: the professional dilemma of a student midwife

As a third-year caseloading student midwife, I experienced a professional dilemma during an intrapartum placement while working on a busy obstetric unit: to use vaginal examination to confirm full dilatation (a medical approach) or advocate normality and a woman-centred approach. This article explores the three influential forces that contributed to the dilemma: the culture of obstetric units, the midwife-woman relationship, and the importance of assertive behaviours to achieve autonomy. Through reflection and use of Gibbs' (1988) reflective cycle, I highlighted the need to develop my assertive skills, which also led me to make amendments to my own practice; this helped me transition from student to a newly qualified midwife.

Optimal relieffor pain at the end of life: a caregiver’s tale

The current opioid crisis—driven partly by medical overprescription and partly by illegal drug abuse—is a significant cultural and professional dilemma in the USA and elsewhere. It has produced a strong reaction in favour of restricting medical use of opioids for pain, especially chronic pain. The author for a quarter century has written about pain from a biocultural perspective, and in this essay—based on his experience as primary caregiver for his late wife—he approaches the question of appropriate opioid use at the end of life.

Sherlock's “Brain-Attic”: Information Culture and the Liberal Professional Dilemma

Situating Arthur Conan Doyle's Sherlock Holmes stories in the context of late Victorian information culture shows how Holmes's professionalism worries the line between information and knowledge, surveillance institutions and liberal society. Because of his information savvy, Holmes has often been considered a figure of surveillance. A closer look at the Holmes narratives, however, reveals that he occupies a more ambiguous place—while his surveillance techniques seem to align him with bureaucratic institutions, he asserts his independence from state institutions and acts as a liberal agent concerned with information sharing and the moral well-being of society. Holmes's cognitive process strikes a balance between data and narrative, allowing him to maintain a critical distance essential to his professionalism and liberalism.

Optimal application of neurocognitive testing in concussion management: A professional dilemma

Optimal application of neurocognitive testing in concussion management: A professional dilemma