Storylines of family medicine V: ways of thinking-honing the therapeutic self.

Storylines of Family Medicine is a 12-part series of thematically linked essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'V: ways of thinking-honing the therapeutic self', authors present the following sections: 'Reflective practice in action', 'The doctor as drug-Balint groups', 'Cultivating compassion', 'Towards a humanistic approach to doctoring', 'Intimacy in family medicine', 'The many faces of suffering', 'Transcending suffering' and 'The power of listening to stories.' May readers feel a deeper sense of their own therapeutic agency by reflecting on these essays.

Reducing obesity prejudice in medical education.

BACKGROUND: Healthcare worker attitudes toward obese individuals facilitate discrimination and contribute to poor health outcomes. Previous studies have demonstrated medical student bias toward obese individuals, but few have examined effects of the educational environment on these prejudicial beliefs. We sought to determine whether an innovative educational intervention (reading a play about obesity) could diminish obesity prejudice relative to a standard medical lecture. METHODS: We conducted a randomized, controlled trial enrolling medical students (n = 129) from three universities. Students were assigned to play-reading or a standard lecture. Explicit attitudes and implicit bias toward obese individuals were assessed prior to intervention and after four months. RESULTS: At baseline, students demonstrated moderate explicit and implicit bias toward obese people despite high scores on empathy. Students randomized to the play-reading group had significantly decreased explicit fat bias (P = 0.01) at follow-up, while students in the lecture group showed increased endorsement of a prescriptive model of care at the expense of a patient-centered approach (P = 0.03). There was a significant increase in empathy for those in both the theater (P = 0.007) and lecture group (P = 0.02). The intervention had no significant effect on implicit bias or regard for obesity as a civil rights issue. DISCUSSION: Dramatic reading may be superior to traditional medical lectures for showcasing patient rights and preferences. The present study demonstrates for the first time that play-reading diminishes conscious obesity bias. Further research should determine whether nontraditional methods of instruction promote improved understanding of and care for obese patients.

The challenge of promoting professionalism through medical ethics and humanities education.

Given recent emphasis on professionalism training in medical schools by accrediting organizations, medical ethics and humanities educators need to develop a comprehensive understanding of this emphasis. To achieve this, the Project to Rebalance and Integrate Medical Education (PRIME) II Workshop (May 2011) enlisted representatives of the three major accreditation organizations to join with a national expert panel of medical educators in ethics, history, literature, and the visual arts. PRIME II faculty engaged in a dialogue on the future of professionalism in medical education. The authors present three overarching themes that resulted from the PRIME II discussions: transformation, question everything, and unity of vision and purpose.The first theme highlights that education toward professionalism requires transformational change, whereby medical ethics and humanities educators would make explicit the centrality of professionalism to the formation of physicians. The second theme emphasizes that the flourishing of professionalism must be based on first addressing the dysfunctional aspects of the current system of health care delivery and financing that undermine the goals of medical education. The third theme focuses on how ethics and humanities educators must have unity of vision and purpose in order to collaborate and identify how their disciplines advance professionalism. These themes should help shape discussions of the future of medical ethics and humanities teaching.The authors argue that improvement of the ethics and humanities-based knowledge, skills, and conduct that fosters professionalism should enhance patient care and be evaluated for its distinctive contributions to educational processes aimed at producing this outcome.

Resident doctors' understanding of their roles as clinical teachers.

INTRODUCTION: Limited data illuminate how resident doctors view their important roles as teachers, supervisors and role models. Analysing qualitative data about resident teachers' self-perceptions can offer helpful insights. METHODS: One year after a randomised trial of a residents-as-teachers curriculum at a university medical centre, we invited its 23 resident participants to participate in semistructured interviews. We interviewed 21 third year residents from internal medicine, family medicine and paediatrics, including 12 intervention residents who had been randomly assigned to receive a 13-hour teacher training programme and 9 control residents who had received no training. We used grounded theory techniques. Two investigators independently content-analysed the transcribed interviews for emerging themes and we then developed a schema for a third investigator to code the transcripts. RESULTS: Three key themes consistently emerged: enthusiasm for teaching (current and future), learner-centredness, and self-knowledge about teaching. Compared with control residents, the intervention residents expressed greater enthusiasm for teaching, more learner-centred and empathic approaches, and a richer understanding of teaching principles and skills. Most intervention residents wanted to continue teaching during and after training. Fewer control residents enjoyed their current teaching, and fewer still wanted to teach in the future. The control residents seemed easily frustrated by time constraints and they often expressed cynicism and blame toward learners. DISCUSSION: One year after participating in a randomised trial of a residents-as-teachers curriculum, generalist residents revealed fairly consistent perceptions of their teaching roles. Teacher training may offer residents lasting benefits, including improved teaching skills and satisfaction.