Welcome to the Peninsula Medical School

1
its that mixture of the social and the kind of
science that appeals to me in medicine
Medical Students Epistemological Development
and Identity Formation
Lynn Knight 1 Kieran Sweeney 2 1 Institute of
Clinical Education and 2Health Complexity Group,
Peninsula Medical School, Universities of Exeter
Plymouth, UK.
Introduction Personal beliefs about what
knowledge is and how we understand, integrate and
apply knowledge (epistemological beliefs EB) is
an essential aspect of medical students
development, entrenched in the process of
decision-making.1 Evidence Based Medicine in all
its forms, along with the drive towards patient
centred medicine, demands an ever more
sophisticated appreciation of individual
patients perspectives and scientific
perspectives within the clinical encounter.2,3
Current theories of EB focus on scientific ways
of knowing knowledge is abstracted and
logical.1,4 Knight Mattick (2006)5 investigated
medical students EBs at the end of their 2nd
year. Students appeared to express predominantly
naïve levels of EBs according to current models.
They found that the development of
epistemological thinking, together with
professional identity formation, brought together
both scientific and experiential ways of knowing
in a way that has largely been ignored by current
theorists in the domain of personal
epistemology. This 3-year study investigates the
dynamic interplay between epistemological
development and professional identity formation
using an innovative methodology that we are
currently developing. The audio diary technique
was designed to investigate how medical students
make sense of everyday events, working out what
they are to mean in practice, from both
synchronic (single point) and diachronic (over
time) perspectives to better understand the
dynamic complexities within their epistemological
thinking.
Method Initial meetings were held in groups
of 3-6 where we explored why the participants
wanted to be a doctor, what a doctor is and
aspects of epistemological beliefs. Participants
were asked to keep a diary of events and given
free reign over what they chose to discuss. We
simply asked Tell us a story of whats happened
since your last message, all the events and
experiences that were important to you
personally, how this impacts on your perception
of the world and on you as a future doctor
Ethical Issues This new methodology brings with
it a number of ethical issues.6 For example, the
richness and extreme sensitivity of some of the
data received is sometimes very emotionally
charged and consequently evokes emotions in us as
researchers. The methodology of the audio-diary
technique makes this even more apparent voices
speaking to us from the quiet of a room can feel
intimate and personal. The principle at stake
is what it might do in terms of defining our
relationship as researchers to them as
participants. The sensitive nature of the data is
touching us as people and this can be
problematic, particularly as the researchers also
teach at the school. The researchers are careful
to maintain professional boundaries. Openly
discussing these issues between us has helped us
achieve this.
This research has been supported by the
Nuffield Foundation, Small Grant Scheme and
Support for Science, awarded to Dr LV Knight
Data Analysis We received 111 messages between
24th October 2005 28th February 2006 (and
continue to receive them regularly). We aim to
analyse the data at a number of different levels.
Framework analysis7 will initially be undertaken
to identify themes within the data. Other
analyses will include a rhetorical narrative
analysis based in concepts from classical
rhetoric and semiotics opposition and enthymeme.
This method reveals implicit underlying logics in
the stories people tell and is particularly
useful for understanding epistemological beliefs
embedded within narrative. 8
References 1 King P Kitchener K (1994)
Developing reflective judgment Understanding and
promoting intellectual growth and critical
thinking in adolescents and adults. San
Francisco Jossey-Bass. 2 Evidence-Based Working
Group (1992) Evidence-based medicine A new
approach to teaching the practice of medicine.
Journal of the American Medical Association, 268,
2420-2425. 3 Barbour R (2000) The role of
qualitative research in broadening the 'evidence
base' for clinical practice. Journal of
Evaluation in Clinical Practice, 6, 155-163. 4
Schommer-Aikins M (2004) Explaining the
Epistemological Belief System Introducing the
Embedded Systemic Model and Coordinated Research
Approach. Educational Psychologist, 39, 19-29. 5
Knight LV Mattick K (in press) When I first
came here, I thought medicine was black and
white Making sense of medical students ways of
knowing. Social Science and Medicine. 6 Knight
LV Sweeney K (2006) Something happened over
this weekend Using diaries in medical education
research. Paper to be presented at the 12th
International Ottawa Conference on Clinical
Competence. 7 Ritchie J Spencer L (1994)
Qualitative data analysis for applied policy
research. In Bryman, A., Burgess, R.G. (Eds.),
Analysing Qualitative Data. Routledge, London. 8
Knight LV Sweeney K (2006) Understanding
transitions in medical students epistemological
thinking using a rhetorical narrative analysis.
Paper to be presented at the 12th International
Ottawa Conference on Clinical Competence.