Table 3 Example of how embedding audience responses influenced the final expression of the meta-ethnography
Views of authors of papers included in synthesis | Views of synthesis team initial expression | PatMed participant views and ‘data responses’ to meta-ethnography models. Stage 7a | Views of synthesis team: final expression | Implications of 3rd order, 2nd level interpretations on how we understand ‘brokering’ within medical education |
|---|---|---|---|---|
Stage 5 & 6 | Stage 7 | Stage 7a | Stage 7b | Stage 7c |
2nd order 1st level | 3rd order 1st level | 1st order 2nd level | 3rd order 2nd level | Conceptual Insights |
In Primary care teaching spaces, The GP is responsible for setting up and managing the spatial arrangements and therefore controls the patient and student access to membership in the community of practice. For example, deciding where the student would sit during the teaching consultation; GP being responsible for getting (or failing to get) patient consent. | The GP as broker. This refers to how GPs set the stage of learning and guard gateway of consent. The GP is mediator and controls the nature of interactions between patient and student, as well as allowing and over-seeing membership of the community of practice. | ‘Sometimes the patient is the broker, ‘cos they’re the expert on their condition, so they’re teaching the doctor a bit and they’re teaching the student a bit and they’re kind of taking control and deciding who does what and how things work.’ (S8) ‘… at my GPs, they weren’t really acting as a broker in any sense, because I would be the person who’d tell them [the patient] that they’d be seeing me first – I’d have my own room, so I’d set up a whole environment. I’d ask them if they were happy to see me before talking to the GP and explain what was going to happen.’ (S6) ‘But interestingly, on my final day … my GP tutor had been off sick, so I had to sit in with a locum who I hadn’t sat in with before, so it went back to being very passive. And you know when you’re just kind of sat observing and you don’t really get involved as much, and it felt very regressive to go back.’ (S7) | As a result of 1st order, 2nd level constructs we re-interpreted ‘The GP as broker’ with the construct: ‘Fluidity of Brokering’ Fluidity of brokering is dependent upon: (i). Patient expert knowledge (ii). Temporal student seniority (iii). Student currency (e.g. whether the student is known by the GP and therefore trusted; the gender match between student and patient) | We identified (i) the 3-dimensinoal and relational nature of brokering (ii) the flexibility between positions to ‘be broker’ |