Narratives of slimming: women and weight management in Irish society

This PhD study presents a feminist sociological analysis of the construction of narratives of slimming in Irish society. Theoretically, the study is informed by three main arguments: firstly, that the pursuit/attainment of a normative lay defined body weight has become one central determinant of social acceptability for women; secondly, the social construction of obesity as \u27crisis\u27; and thirdly, that women\u27s lives are framed by continuities and change in contemporary Ireland. Located in the Northwest of Ireland, the data corpus for the final study is made up of one years observation in four commercial weight loss classes, double interviews with two class leaders and nine women participating n these classes and a narrative analysis of key documents from the weight loss organisation, Slim Ireland. Taking a different approach to previous ethnographic studies of slimming classes this study incorporates a narrative inquiry approach to develop a narrative ethnography. Adapting Gubrium and Holstein\u27s (2009) threefold conceptual framework of the interplay between narrative frameworks, narrative environments and narrative practices, I interrogate the links between institutional storytelling and women\u27s personal narratives of slimming. Deploying the use of exemplars, two of the women\u27s narratives are presented as in-depth case studies. The study advances a rich understanding of the temporal, cyclical and complex nature of weight management for women immersed in slimming classes. The findings reveal that successful slimming is articulated in the slimming classes as a quest for a better body, involving a linear, progressive temporality. This generates a set of limited narrative resources for women that draw from weirder discourses of health, appearance and responsible citizenship. These are implicated in the women\u27s personal narratives which are oriented towards accounting for and claiming a moral self, demonstrating that they are \u27good women\u27 both within and outside the classes. However, two storylines that emerge from the analysis of their narratives, episodic commitment and ambivalent participation, illustrate how the quest narrative is disrupted in women\u27s narratives and further, how weight management contains paradoxical and ambiguous meanings for women. The women have a long and varied history of immersion in slimming and related practices which has had a drofound impact on how they live their everyday lives in Irish society. This study makes important contributions to women\u27s everyday lives in Ireland, to narrative inquiry, and to critical weight studies.2018-11-1

Balancing Demands: Determinants of Burnout Reported by Fellows in Pulmonary and Critical Care Medicine

Background: Burnout is common among physicians who care for critically ill patients and is known to contribute to worse patient outcomes. Fellows training in pulmonary and critical care medicine (PCCM) have risk factors that make them susceptible to burnout; for example, clinical environments that require increased intellectual and emotional demands with long hours. The Accreditation Council for Graduate Medical Education has recognized the increasing importance of trainee burnout and encourages training programs to address burnout. Objective: To assess factors related to training and practice that posed a threat to the well-being among fellows training in PCCM and to obtain suggestions regarding how programs can improve fellow well-being. Methods: We conducted a qualitative content analysis of data collected from a prior cross-sectional electronic survey with free-response questions of fellows enrolled in pulmonary, PCCM, and critical care medicine training programs in the United States. Fellows were asked what factors posed a threat to their well-being and what changes their training program could implement. Responses were qualitatively coded and categorized into themes using thematic analysis. Results: A total of 427 fellows (44% of survey respondents) completed at least one free-response question. The majority of respondents (60%) identified as male and white/non-Hispanic (59%). The threats to well-being and burnout were grouped into five themes: clinical burden, individual factors, team culture, limited autonomy, and program resources. Clinical burden was the most common threat discussed by fellows. Fellows highlighted factors contributing to burnout that specifically pertained to trainees including challenging interpersonal relationships with attending physicians and limited protected educational time. Fellows proposed solutions addressing clinical care, changes at the program or institution level, and organizational culture changes to improve well-being. Conclusion: This study provides insight into factors fellows report as contributors to burnout and decreased well-being in addition to investigating fellow-driven solutions toward improving well-being. These solutions may help pulmonary, PCCM, and critical care medicine program directors better address fellow well-being in the future