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Addicts and Admits: Metonymy in Medical Students' Reflective Writing.
Mary E Camp1, Alexander G Cole1, John Z Sadler1
1Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA.
Teaching and Learning in Medicine
|May 10, 2019
Summary
Metonymy, using a patient's attribute for their name, appeared infrequently in medical student writing. Essays with metonymy more often described moral distress, particularly concerning substance abuse.
Area of Science:
- Medical Education
- Linguistics
- Medical Ethics
Background:
- Metonymy involves substituting a name with an attribute or adjunct.
- In medicine, metonymy can involve referring to patients by disease, body part, or health status.
- This study examines metonymy in medical students' reflective writing.
Purpose of the Study:
- To explore the phenomenon of metonymy in medical students' reflective essays.
- To identify the themes and contexts associated with metonymy in this writing.
- To analyze the relationship between metonymy and clinical ethics themes.
Main Methods:
- Content analysis of 802 medical student reflective essays.
- Identification and categorization of metonymy instances.
- Fisher's exact test to compare ethics themes in essays with and without metonymy.
Main Results:
- Metonymy occurred 60 times, most frequently related to substance abuse (n=27).
- Other themes included illness, body part, clinical status, reproductive health, and challenging situations.
- Essays with metonymy showed a higher prevalence of moral distress, substance abuse, and pain (p < .05).
Conclusions:
- Metonymy is uncommon in medical student writing and can be perceived as dehumanizing.
- Its use is most prevalent when discussing patients with substance use disorders.
- Metonymy may be more common in ethically challenging or distressing clinical situations.