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. 2019 Feb 15;19(1):59.
doi: 10.1186/s12909-019-1493-2.

Disciplinary boundaries and integrating care: using Q-methodology to understand trainee views on being a good doctor

E Muddiman  1 , A D Bullock  2 , J M Hampton  2 , L Allery  3 , J MacDonald  3 , K L Webb  2 , L Pugsley  3
Affiliations

Disciplinary boundaries and integrating care: using Q-methodology to understand trainee views on being a good doctor

E Muddiman et al. BMC Med Educ. .

Abstract

Background: Rising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care. However, intra-professional boundaries and silos within the medical profession may challenge holistic approaches to patient care.

Methods: We used Q methodology to examine how postgraduate trainees (n = 38) on a range of different specialty programmes in England and Wales could be grouped based on their rankings of 40 statements about 'being a good doctor'. Themes covered in the Q-set include: generalism (breadth) and specialism (depth), interdisciplinarity and multidisciplinary team working, patient-centredness, and managing complex care needs.

Results: A by-person factor analysis enabled us to map distinct perspectives within our participant group (P-set). Despite high levels of overall commonality, three groups of trainees emerged, each with a clear perspective on being a good doctor. We describe the first group as 'generalists': team-players with a collegial and patient-centred approach to their role. The second group of 'general specialists' aspired to be specialists but with a generalist and patient-centred approach to care within their specialty area. Both these two groups can be contrasted to those in the third 'specialist' group, who had a more singular focus on how their specialty can help the patient.

Conclusions: Whilst distinct, the priorities and values of trainees in this study share some important aspects. The results of our Q-sort analysis suggest that it may be helpful to understand the relationship between generalism and specialism as less of a dichotomy and more of a continuum that transcends primary and secondary care settings. A nuanced understanding of trainee views on being a good doctor, across different specialties, may help us to bridge gaps and foster interdisciplinary working.

Keywords: Complex care; Medical generalism; Multidisciplinary; Multimorbidity; Professional identity; Q methodology.

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Conflict of interest statement

Ethics approval and consent to participate

This study received ethical approval from Cardiff University Postgraduate Medical and Dental Education Ethics Committee (02/10/13). Written consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The Q-sorting grid
See this image and copyright information in PMC

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