Examining within simulated and real patients personal space: bringing clarity to the blurred lines
Oral Presentation 6
Miss Chara Banks-McGovern, Dr Diane Wilson, Prof Gerard J Gormley, Dr Grainne P Kearney
Examining within simulated and real patients personal space: bringing clarity to the blurred lines
INTRODUCTION The physical examination is an integral part of medicine. Yet any examination has the ability to encroach upon a patient’s personal space. Failings in communication during examinations can lead to examinations being misconstrued as inappropriate advances towards patients. Society has grown intolerant to the unsolicited breaking of personal boundaries following the #MeToo movement; medical education needs to reflect this same intolerance in their professional studies and practice - including working with simulated patients (SPs).
OBJECTIVES This study aimed to gain insight into the lived experiences of medical students when working within the boundaries of a individuals’ personal space in their training, including working with SPs. This builds on previous research from the perspective of the simulated participants. This knowledge could guide further teaching of physical examinations skills to minimise any breakdown of trust in this vital interaction.
METHODS This qualitative study employed hermeneutic phenomenology to explore the lived experiences of medical students when working within patients (both simulated and real) personal space. Data was collected from seven medical students in Queen’s University Belfast (QUB) through semi-structured interviews. This data was thematically analysed using Template Analysis in a reflexive approach.
OUTCOMES Four main themes were constructed from our analysis (1) Transitioning into a privileged position; (2) Negative role modelling: emphasising the physical; (3) Consent: a dynamic and fragile state; (4) A simple act or a complex performance?
CONCLUSIONS This study provided a unique insight into the lived experiences of medical students when working within an individual’s personal space. The physical examination is a complex process influenced by a multitude of mediating factors. Medical educators need to reflect this complexity in teaching, mirroring societal interest around the boundaries of consent. The perspective gained from medical students has potential to shape this learning. Students need a pedological and psychological safe space to develop their interpersonal skills and to prevent adoption of the “clinical gaze” (i.e. when the clinical aspects of care are separated from the patient as a whole.) Insights from this research have already began shaping education in QUB in which educators are focusing on developing the pedological space needed to create more consciously engaged doctors. Based on this study, students are provided with student-centric guidance on how to approach patients (whether real or simulated) personal space and in partnership with that person, to enter this space for their benefit of their professional training and practice.