Fences, gates, and contested terrain: overcoming identity-based differentiation between anaesthesiologists and surgeons

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Ramsden, David J.
Professional identity , Differentiation , Integrative behaviors
Integrative behaviours in professional medical practice are those actions taken by a physician to better coordinate practice with other physicians to ensure that the most appropriate care is offered to patients. It has long been argued that the nature of differentiation measured between collaborating physicians affects such integrative activities and integrative success. This research employs professional identity as a basis for describing the nature of differentiation between members of two medical specialists – general surgeons and anesthesiologists – and then examines the impact of such differentiation on integrative behaviours in medical practice. A qualitative approach, employing an embedded case design, was used to observe the practice of anesthesiologists, general surgeons, and their respective residents over a period of eight months. A model of identity-in-use comprising three co-mingled and overlapping identities (professional, role, personal) is developed, and then used to describe the implications for Integrative practice. The demands of medical practice experienced by the general surgeons and anesthesiologists are powerful, almost factory-like in the value placed on speed of action and efficiency of patient throughput. These demands shaped and increased the strength of the contribution role identity made to each participants’ identity-in-use. Personal identity appears to play an important role in blunting the harshness of role demands in at least some of the participants. Personal identity also appears to draw out elements of the professional identity in some individuals, fed by curiousity, empathy, and the ability to be self-reflective. Despite observing little successful integrative behaviour, there are indications that differences in identity are associated with participants’ willingness to collaborate and possession of the skills necessary to collaborate. Potential implications for both the training and development of medical practitioners and the design of hospital work are outlined.
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