Storylines of family medicine XI: professional identity formation-nurturing one's own story.

Storylines of Family Medicine is a 12-part series of thematically linked mini-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 'XI: professional identity formation-nurturing one's own story', authors address the following themes: 'The social construction of professional identity', 'On becoming a family physician', 'What's on the test?-professionalism for family physicians', 'The ugly doc-ling', 'Teachers-the essence of who we are', 'Family medicine research-it starts in the clinic', 'Socially accountability in medical education', 'Personal philosophy and how to find it' and 'Teaching and learning with Storylines of Family Medicine'. May these essays encourage readers to find their own creative spark in medicine.

Using significant event analysis in dental and medical education.

As part of a new professional development teaching strand at the University of Otago's School of Dentistry, final-year dental students were each asked to write a "thought-provoking episode report" (TPER). These TPERs formed the basis for group discussion in a professional development course. This article outlines the main content themes of the reports, comparing them with similar reports written by medical students from the same university. While both sets of reports demonstrate students' commitment to high standards of care, there were significant differences in the overall themes. Of the fifty-one dental TPERs, the main themes were "difficult" patients, receiving conflicting advice from different clinical tutors, friends as patients, belittlement, and maintenance of professional standards. Key themes from medical students' TPERs included responding to patient suffering, observing or experiencing belittlement, uncertainty, error and complaints, the role of the undergraduate student, treating family and friends, causing distress in order to learn, and issues with mentoring. Possible interpretations of the similarities and differences in this data include confirmation of the value of personal experience as a basis for student discussion, the necessity for formal programs in professional development, and the presence of a hidden curriculum in dental and medical education.

Role modeling the doctor-patient relationship in the clinical curriculum.

BACKGROUND AND OBJECTIVES: Training in relationship skills relies heavily on role modeling: students observing clinicians at work. This study explored student and faculty perceptions of student learning about relationship skills in hospital and ambulatory settings. METHODS: Qualitative data from focus groups and long interviews were coded by the authors through an iterative dialogic process. Participants were 15 faculty and 35 medical students in clinical training in a New Zealand medical school. RESULTS: Teaching of doctor-patient relationship skills was highly variable, rarely explicit, and heavily dependent on role modeling. Students noted variable focus on relational skills between rotations, incongruity between preclinical training and the behaviors observed in clinical environments, and a need to discern which relational skills were facilitative. Role models who transparently shared their personal experiences of doctoring were more effective in helping students learn relationship skills. CONCLUSIONS: Role modeling alone is insufficient for helping students acquire exemplary doctor-patient relationship skills. Role models must explicitly reflect upon the complex intricacies of interacting with patients to help students understand and incorporate specific skills. Lack of transparency is a barrier to quality role modeling that may be mitigated in ambulatory, primary care settings.

Faculty and medical students' perceptions of teaching and learning about the doctor-patient relationship.

OBJECTIVE: To explore student and faculty perceptions of how students are learning doctor-patient relationship skills in their clinical medical education. METHODS: Exploratory qualitative study involving data from interviews and focus groups with students and interviews with teaching faculty. RESULTS: Respondents reported that pre-clinical relationship skills curricula were not well-coordinated with clinical curricula. Within the clinical curriculum, respondents perceived a disparity between general practice and hospital-based attachments. Teaching of relationship skills on the wards was highly variable, rarely explicit, and primarily dependent on role-modelling. In contrast, general practice runs included explicit teaching with feedback that reinforced skills taught in the pre-clinical curriculum. Respondents recommended increased focus on and assessment of students' interpersonal skills within clinical settings. CONCLUSION: Pre-clinical and clinical relationship skills curricula were not coordinated. The tension between service commitments and student teaching in hospital-based attachments contributed to an insufficient focus on communication and relationship skills acquisition and did not reinforce teaching in pre-clinical and ambulatory clinical settings. PRACTICE IMPLICATIONS: The teaching of doctor-patient relationship skills can be augmented by coordinating pre-clinical and clinical curricula and by requiring observation and structured feedback related to explicit criteria of student skills acquisition across all clinical learning experiences.