Accepted Type
Oral
Code
OG1-2-1
Acceptance Declaration
Accept
Additional Information
I declare I have no actual or potential conflict of interest in relation to this program.
Was this work accepted for CCME 2020?
no
Category
General Call (Workshop, Oral Presentation, Poster Presentation)
Type
Oral
Sub Type
Education Research
Will the presenter be a:
Other
Presenter Other
academic faculty since 2016, tenure track academic faculty since 2019
Affiliation
Considered for Poster
no
Title
Surrounded by slippery slopes: Navigating paradox while living and practising in rural communities
Length of Presentation
Background/Purpose
Rural practitioners who develop a sense of belonging in their community tend to stay; however, belonging means having neighours as patients and makes incidental encounters with patients outside of the clinic unavoidable. Despite its impact on retention, the navigation of overlapping personal and professional relationships remains largely undescribed and educational efforts would benefit from its explication.
Methods
Constructivist grounded theory guided the iterative recruitment and analysis of interviews with 22 physiotherapists (PTs) living and practising in rural, northern or remote communities.
Results
During incidental encounters, PTs wanted to show compassion as a good neighbour while also protecting patient confidentiality. Similarly, they recall practice standards advise referral to avoid overlapping relationships but neighbours sought care from someone they knew and who knew them; plus, referrals could block access to care. Further complicating decisions was the view that outcomes were improved by tailoring care based on knowledge of the patient as a community member; but, mitigation strategies were also needed when judgment was identified as being clouded by overlapping relationships.
Conclusion
Overlapping relationships tend to be seen as a step away from the ethical and towards a slippery slope of poor decisions. For rural PTs it seemed more like being between a rock and a hard place with slippery slopes in sight. Their grappling with the inherent contradictions is consistent with a paradox mindset. Conceptualizing overlapping relationships as paradox offers new possibilities for teaching and critiquing how to be professional while rural.
Keyword 1
rural health ethics
Keyword 2
paradox theory
Keyword 3
retention of rural practitioners
Level of Training
General
Abstract Themes
Distributed Medical Education
Additional Theme (First choice)
Professionalism
Additional Theme (Second Choice)
Inter-professional Education
Additional Theme (Third Choice)
Authors
Presenter
Andrea Gingerich
Term 1
Yes
Term 2
Yes
Term 3
Yes
Term 4
Yes
Term 5
Yes
