Inconsistent role modeling of professionalism in family medicine residency: Resident perspectives from 2 Ontario sites.

OBJECTIVE: To explore how family medicine (FM) residents experience role modeling of professionalism by FM preceptors. DESIGN: Qualitative design using semistructured, one-on-one interviews. SETTING: Two FM teaching units at the University of Toronto in Ontario. PARTICIPANTS: Sixteen first- and second-year FM residents. METHODS: This study employed a qualitative description design. The CanMEDS-Family Medicine 2009 framework was used to help design interview questions. Interviews were audiorecorded and transcribed verbatim. Transcripts were coded and themes were developed. MAIN FINDINGS: Some residents described insufficient experience with role modeling in general. Two main findings were that a longitudinal relationship with a role model was important and that residents desired a close working relationship with a role model in a clinical setting. Most participants could identify experiences with role modeling of ethical practice; many examples were in the context of challenging patients. Some, but not all, residents could identify experiences with role modeling of profession-led regulation and reflective practice. Of note, there were mixed responses with respect to role modeling a commitment to personal health. CONCLUSION: Reassuringly, many FM residents described experiences with positive role modeling of professionalism. However, some residents believed that role modeling was limited by the brevity of their interactions with potential role models. To optimize the effect of role modeling, educators should support opportunities for residents to develop close, longitudinal working relationships with faculty.

Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases.

GOALS OF WORK: To explore the major factors important in decision making for whole-brain radiotherapy (WBRT) for patients with brain metastases and their caregivers. PATIENTS AND METHODS: Two parallel qualitative studies, one for patients and one for caregivers of patients with newly diagnosed brain metastases, were conducted. Semistructured interviews were conducted and audiotaped with each participant. Content analysis and theme extraction of the transcripts were undertaken to identify recurring themes and relational patterns. RESULTS: Twenty patients and 19 caregivers (including eight patient and caregiver pairs) were recruited into the study. Four major factors were identified to influence decision making of whole-brain radiation: hope, knowledge, expectations of radiation therapy, and current symptoms. Analysis reveals that patients generally focus on current informational needs, while caregivers want more information about the future (e.g., life expectancy and anticipated symptoms). Caregivers expressed frustration when unable to explore future needs because patients were unprepared to discuss prognostic issues. Participants expressed substantial relief when offered WBRT after the diagnosis, but WBRT is often considered the only available plan rather than an informed choice. CONCLUSIONS: Given the importance of caregivers in the care of patients with brain metastases, fulfilling their unique informational needs appears to require more attention. The blurred boundary between hopes and expectations for WBRT creates unique challenges in joint treatment decision making for patients with brain metastases and their caregivers.