How iranian medical trainees approach their responsibilities in clinical settings; a grounded theory research

Background: It seems we are now experiencing [responsibility problems] among medical trainees [MTs] and some of those recently graduated from medical schools in Iran. Training responsible professionals have always been one of the main concerns of medical educators. Nevertheless, there is a dearth of research in the literature on [responsibility] especially from the medical education point of view. Therefore, the present study was carried out with the aim of presenting a theoretical based framework for understanding how MTs approach their responsibilities in educational settings

Method: This qualitative study was conducted at Shiraz University of Medical Sciences [SUMS] using the grounded theory methodology. 15 MTs and 10 clinical experts and professional nurses were purposefully chosen as participants. Data was analyzed using the methodology suggested by Corbin and Strauss, 1998

Results: [Try to find acceptance toward expectations], [try to be committed to meet the expectations] and [try to cope with unacceptable expectations] were three main categories extracted based on the research data. Abstractly, the main objective for using these processes was [to preserve the integrity of student identity] which was the core category of this research too. Moreover, it was also found that practically, [responsibility] is considerably influenced by lots of positive and negative contextual and intervening conditions

Conclusion: [Acceptance] was the most decisive variable highly effective in MTs' responsibility. Therefore, investigating the [process of acceptance] regarding the involved contextual and intervening conditions might help medical educators correctly identify and effectively control negative factors and reinforce the constructive ones that affect the concept of responsibility in MTs

Medical paraclinical standards, political economy of clinic, and patients' clinical dependency: a critical conversation analysis of clinical counseling in south of Iran

Despite its benefits and importance, clinical counseling affects the patient both psychosocially and socially. Illness labeling not only leads to many problems for patient and his/her family but also it imposes high costs to health care system. Among various factors, doctor-patient relationship has an important role in the clinical counseling and its medical approach. The goal of this study is to evaluate the nature of clinical counseling based on critical approach. The context of research is the second major medical training center in Shiraz, Iran. In this study, Critical Conversation Analysis was used based on the methodologies of critical theories. Among about 50 consultation meetings digitally recorded, 33 were selected for this study. Results show that the nature of doctor-patient relationship in these cases is based on paternalistic model. On the other hand, in all consultations, the important values that were legitimated with physicians were medical paraclinical standards. Paternalism in one hand and standardization on the other leads to dependency of patients to the clinic. Although we can't condone the paraclinical standards, clinical counseling and doctor-patient relationship need to reduce its dominance over counseling based on interpretation of human relations, paying attention to social and economical differences of peoples and biosocial and biocultural differences, and focusing on clinical examinations. Also, we need to accept that medicine is an art of interaction that can't reduce it to instrumental and linear methods of body treatment