Destabilising institutions to make healthcare more equitable: Clinicians, educators, and researchers co-producing change

May combine two claims.

Subtle changes in the subject of educational activity can catalyse change; a simple intervention changed medical students from observers becoming competent for practice into residents-in-waiting becoming capable by participating in practice.

“Subtle changes in the subject of educational activity can also catalyse change; for example, a simple intervention changed medical students from observers, becoming competent for practice, into residents-inwaiting, becoming capable by participating in practice (Gillespie et al. 2020).”

• cites Gillespie et al. 2020Not checked yet

  Not checked in the free run.

May combine two claims.

There is hierarchical social positioning, fragmented practice communities, and irrational variation in practice.

“We describe hierarchical social positioning, fragmented practice communities, and irrational variation in practice.”

May combine two claims.

There are tensions and ruptures between specialties, and between specialism and generalism.

“We identify tensions and ruptures between specialties, and between specialism and generalism.”

May combine two claims.

CHAT helped authors change the patriarchal institution of Obstetrics and Gynaecology, addressing bullying and harassment of trainees and abuse of women for training purposes, and turning interprofessional rivalry into a collaborative focus on the best interests of women in labour.

“CHAT helped a number of authors change the famously patriarchal institution of Obstetrics and Gynaecology.They addressed the bullying and harassment of trainees (Morris et al. 2020) and the abuse of women for training purposes (Grilo Diniz et al. 2020), and turned interprofessional rivalry into a collaborative focus on the best interests of women in labour (Varpio and Teunissen 2020).”

• cites Morris et al. 2020Not checked yet

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• cites Grilo Diniz et al. 2020Not checked yet

  Not checked in the free run.

• cites Varpio and Teunissen 2020Not checked yet

  Not checked in the free run.

May combine two claims.

Written instruments had a pivotal role in improving collaboration between GPs and specialists, and between practitioners caring for elderly people with complex needs.

“Written instruments, another example of a mediating tool, had a pivotal role in improving collaboration between GPs and specialists, and between the many practitioners caring for elderly people with complex needs (Engeström and Pyörälä 2020;Meijer et al. 2020).”

• cites Engeström and Pyörälä 2020Not checked yet

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• cites Meijer et al. 2020Not checked yet

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May combine two claims.

Unofficial rules influenced educational activity by perpetuating medical students' unsafe participation in practice and trivialising patient-centred behaviour.

“Unofficial rules also influenced educational activity; for example, by perpetuating medical students' unsafe participation in practice (Gillespie et al. 2020) and trivialising patient-centred behaviour (Reid et al. 2020).”

• cites Gillespie et al. 2020Not checked yet

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• cites Reid et al. 2020Not checked yet

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May combine two claims.

Making patients the object helped socially disadvantaged Brazilian women be treated respectfully rather than used as tools for obstetric residents' learning, resulting in highly effective, continuing systemic change.

“It helped socially disadvantaged Brazilian women be treated respectfully, rather than used as tools for obstetric residents' learning; a highly effective, continuing systemic change resulted.(Grilo Diniz et al. 2020)”

• cites Grilo Diniz et al. 2020Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A fundamental contradiction between exchange value and use value affects activities in all societies.

“Karl Marx argued that a fundamental contradiction between the 'exchange value' (what you can sell something for) and 'use value' (how useful it is in your own hands) affects activities in all societies.(Engeström 2018)”

• cites Engeström 2018Not checked yet

  Not checked in the free run.

May combine two claims.

Transition into practice is the weakest link in the translational model of contemporary medical education, and complexity challenges it.

“This complexity challenges the weakest link in the translational model of contemporary medical education: transition into practice.”

• AssumptionRests on an assumption: The linear, hierarchical translational model is the prevailing model in contemporary medical education.

Probably not a substantial claim: may not pass S4 (based).

Structurally accumulated tensions in care, education, and research arise from the unopposed effects of neoliberal politics, evidence, and/or theory.

“We use CHAT to identify 'structurally accumulated tensions' in care, education, and research, resulting from the unopposed effects of neoliberal politics, 'evidence', and/or theory.”

• AssumptionRests on an assumption: Neoliberalism globally dominates public sector ideology.

Probably not a substantial claim: may not pass S3 (load-bearing).

New Public Management puts into practice neoliberal principles.

“'New Public Management' ([NPM]; Hood 1991, Griffith and Smith 2014) puts into practice neoliberal principles”

• cites Hood 1991Not checked yet

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• cites Griffith and Smith 2014Not checked yet

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Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

The global dominance of neoliberalism explains why the institution of medical education is misdirecting its effort.

“The global dominance of neoliberalism explains why it may not be too far-fetched to suggest that the institution of medical education is, as the previous paragraph suggests, misdirecting its effort.”

• AssumptionRests on an assumption: Neoliberalism globally dominates public sector ideology.

Probably not a substantial claim: may not pass S2 (checkable).

Reliable measurement dominates a commodity market of medical education.

“Reliable measurement dominates a 'commodity market' of medical education.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Politicians have turned professionalism into staffing the production lines of state-controlled and private for-profit institutions.

“We hope this explanation of contemporary ideology will help clinicians and educators understand the 'mission creep', whereby politicians have turned 'professionalism' into staffing the production lines of state-controlled and private for-profit institutions.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Stable institutions tend to fossilise, and their stability becomes an unassailable normal.

“We used the emotive word 'destabilising' in our title to remind readers of the tendency for stable institutions to fossilise, and for their stability to become an unassailable 'normal'.”

Classified as probably not a substantial claim.

CHAT is orientated towards social justice: a fair and equal society in which each individual matters.

“CHAT (Engeström and Pyörälä 2020) is orientated towards social justice: a fair and equal society in which each individual matters.”

• cites Engeström and Pyörälä 2020Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Neoliberalism is guided by the ideology that the market and market-based solutions are the most efficient and effective way to address public sector problems.

“Neoliberalism is guided by the ideology that the 'market', and hence market-based solutions, are the most efficient and effective way to address public sector problems.(Kearney et al., 2019)”

• cites Kearney et al., 2019Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Undergraduate, postgraduate, and continuing education can help patients and practitioners learn together to practise well, rather than teaching students and doctors to be competent but not necessarily capable.

“Rather than teaching students and doctors to be competent but not necessarily capable, we show how undergraduate, postgraduate, and continuing education can help patients and practitioners learn together to practise well.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Students and patients are idiosyncratic human beings, not commodities.

“Students and patients, though, are idiosyncratic human beings, not commodities.”

Classified as probably not a substantial claim.

Institutions' politically elevated positions afford power to organise people's work whilst remaining detached from on-the-ground actualities.

“She urged critical scrutiny of how institutions' politically elevated positions 'on the 14 th Floor' (Smith 2008) afford power to organise people's work whilst remaining detached from on-the-ground actualities.”

• cites Smith 2008Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

CHAT provided a lens to examine interprofessional collaboration and to show why followership is as important to leadership as the reverse.

“CHAT provided a lens through which to examine interprofessional collaboration, in all its on-the-ground fluidity, and to show why followership is as important to leadership as the reverse (Varpio and Teunissen 2020).”

• cites Varpio and Teunissen 2020Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable).

A conjoint practice of caring, learning, and research is achievable.

“We suggest that a conjoint practice of caring, learning, and research is achievable.”

May combine two claims.

The translational model of medical education is theoretically simplistic and practically ineffective.

“Eight articles in this issue of Medical Teacher use Engeström's seminal theory of Expansive Learning (part of a broader framework known as Cultural-Historical Activity Theory [CHAT] (Engeström and Pyörälä 2020)) to show that the translational model can be theoretically simplistic and practically ineffective.”

• cites Teodorczuk et al. 2017Not checked yet

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• AssumptionRests on an assumption: The linear, hierarchical translational model is the prevailing model in contemporary medical education.

Probably not a substantial claim: may not pass S2 (checkable).

Communal destabilisation for patient benefit can restore professional vitality rather than anarchy.

“We have shown how communal destabilisation for patient benefit can restore professional vitality rather than the anarchy that conservative thinkers might fear.”

Classified as probably not a substantial claim. May combine two claims.

New Public Management includes hands-on professional management, applying private-sector principles to professional practice, a stress on results rather than procedures, and promoting competition to cut costs.

“(Kearney et al., 2019), which include: hands-on professional management; applying private-sector principles -including explicit standards and measures of performance -to professional practice; a stress on results rather than procedures; and promoting competition to cut costs.(Hood, 1991)”

• cites Hood, 1991Not checked yet

  Not checked in the free run.