Cold Heart, Warm Heart : On fiction, interaction, and emotion in medical education

Abstract: Fiction is used for educational purposes in various fields such as engineering, law and higher education. In medical education, the theories of medical humanities and narrative medicine propose that engaging with fictional works can provide opportunities for medical students and physicians to develop central professional skills such as emotional awareness and empathy, which can help mitigate the documented empathy decline which occurs during medical training. Despite extensive research about fiction inclusion in medical education, there is very limited research on the insitu processes of fiction use, and how emotional aspects of the medical profession can be conceptualized in fiction discussions. This thesis investigates the intersection of fiction, interaction and emotion in medical education. The purpose of the study is to contribute knowledge on the ways emotion can be constructed in medical education as affective stances and as professional emotions that medical students need to learn how to manage. Discursive psychology (DP) forms the theoretical and methodological framework to analyse 58 hours of videoand audiorecorded fiction seminars from two Swedish medical schools. Emotion from a DP perspective is understood not as a reflection of an inner experience, but as an interactionally achieved phenomenon, deployed in the formation of social action. Results show that reflection and reflective practices are imbedded in fiction seminars, and that affective stances are constructed as a student resource to manage intensity, control, assessment and accountability. Furthermore, the professional emotions of physicians are constructed as emotional labour which students need to prepare for, and the feeling rules of the medical profession are constructed as calibrations of emotions which are both fluid and changeable. The task of learning professional emotion is oriented to as troublesome by students as it might interfere with their focus on managing student identities.