J o n n e v a n d e IDENTITY, r Z w e t INTERACTION, AND POWER I D E N T I Explaining the affordances of T Y , doctor-student interaction I N T E during clerkships R A C T I O N , A N D P O W E R JONNE VAN DER ZWET Identity, Interaction, and Power Understanding the affordances of doctor‐student interaction during clerkships The research reported here was carried out at i n the School of Health Professions Education and in the context oÍ research school ICO (lnteruniv ersity Centre for Educational S ciences) © Jonne van der Zwet, Maastricht 2014 Cover design: Jan Willem van Welzenis (www.welzenis.com) Layout: Tiny Wouters Production: Datawyse | Universitaire Pers Maastricht ISBN: 978 94 6159 300 9 Identity, Interaction, and Power Understanding the affordances of doctor‐student interaction during clerkships ter verkrijging van de graad van doctor aan de Universiteit Maastricht, op gezag van de Rector Magnificus, Prof. dr. L.L.G. Soete volgens het besluit van het College van Decanen, in het openbaar te verdedigen op donderdag 30 januari 2014 om 14.00 uur door Leonarda Wilhelmina van der Zwet U P M UNIVERSITAIRE PERSMAASTRICHT Promotor Prof. dr. A.J.J.A. Scherpbier Copromotor Dr. P.W. Teunissen Beoordelingscommissie Prof. dr. D.H.J.M. Dolmans (voorzitter) Prof. dr. A.D.C. Jaarsma (Universiteit van Amsterdam) Prof. dr. M.G.A. oude Egbrink Dr. G. Peeraer (Universiteit Antwerpen, België) Prof. dr. G.J. Wesseling Contents Chapter 1 Introduction 7 Chapter 2 Workplace learning in general practice: supervision, patient mix and 21 independence emerge from the black box once again. Chapter 3 Workplace learning from a socio‐cultural perspective: creating 33 developmental space during the general practice clerkship. Chapter 4 Making sense of how physician preceptors interact with medical 53 students: discourses of dialogue, good medical practice, and relationship trajectories. Chapter 5 Is it a question of hierarchy? Revealing the affordances of 71 doctor‐student interaction during clerkships. Chapter 6 Discussion 95 Summary 117 Samenvatting 127 Dankwoord 139 Curriculum vitae 147 SHE dissertations 151 ICO dissertations 155 7 1 Chapter Introduction 8 Chapter 1
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