A Common Trajectory Toward a Professional Identity as a Faculty Developer.

BACKGROUND AND OBJECTIVES: Professional identity formation is a complex construct that continually evolves in relation to an individual's experiences. The literature on educators identifying as faculty developers is limited and incompletely addresses how that identify affects other identities, careers, and influences on teaching. Twenty-six health professionals were trained to serve as faculty developers within our educational system. We sought to examine the factors that influence the professional identity of these faculty developers and to determine whether a common trajectory existed. METHODS: We employed a constructivist thematic analysis methodology using an inductive approach to understand the experiences of faculty developers. We conducted semistructured recorded interviews. Coding and thematic analysis were completed iteratively. RESULTS: We identified eight primary themes: (1) initial invitation, (2) discovery of faculty development as a professional activity, (3) discovery of educational theory, skills, and need for more education, (4) process of time and experience, (5) fostering relationships and community, (6) transfer of skills to professional and personal roles, (7) experiences that lead to credibility, and (8) sense of greater impact. CONCLUSIONS: An individual's journey to a faculty developer identity is variable, with several shared pivotal experiences that help foster the emergence of this identity. Consideration of specific programmatic elements to support the themes identified might allow for a strategic approach to faculty development efforts in health professions education.

A Critical Review of Professional Identity Formation Interventions in Medical Education.

PURPOSE: Professional identity formation (PIF) can be defined as the integration of the knowledge, skills, values, and behaviors of a profession with one's preexisting identity and values. Several different, and sometimes conflicting, conceptualizations and theories about PIF populate the literature; applying these different theories in PIF curricula and pedagogic strategies can profoundly impact the PIF of future physicians. The authors conducted a critical review of the recent literature on PIF interventions in medical education to explore the conceptualizations of and theoretical approaches to PIF that underlie them. METHOD: The authors searched articles on PIF educational interventions published in 5 major medical education journals between 2010 and March 2021. The articles' context and findings were extracted, analyzed, and summarized to identify conceptualizations and theoretical approaches to PIF. RESULTS: The authors identified 43 studies examining medical education interventions aimed at influencing PIF. The majority of the studies (n = 31) focused on undergraduate medical education. Reflective writing and the use of narrative reflections were the dominant modes of student activity in PIF interventions, supporting the dominant individualist approach to PIF. Less commonly PIF was understood as a socialization process or as an active process with both individually and socially focused influences. CONCLUSIONS: Relying on reflective writing as the intervention of choice to impact PIF feeds the dominant individualist perspective on PIF. An unintended consequence of this individualist orientation is that cultural problems embedded in the profession can become burdens for individual physicians to personally bear. Future education and research into PIF should account for theoretical preferences and the impact of these preferences.

New Perspectives in Rheumatology: Avoiding Antimalarial Toxicity.

This report inaugurates New Perspectives in Rheumatology, a series of authoritative articles that focus on recent scientific and clinical developments and their potential to reshape rheumatology practice. Anticipated topics include the implementation of new guidelines and emerging information from clinical and translational research. Richard J. Bucala, MD, PhDEditor-in-ChiefRobert Terkeltaub, MDCo-Editor and Review Article Editor.

An End-of-Year Oral Examination for Internal Medicine Residents: An Assessment Tool for the Clinical Competency Committee.

BACKGROUND: Comprehensive evaluations of clinical competency consume a large amount of time and resources. An oral examination is a unique evaluation tool that can augment a global performance assessment by the Clinical Competency Committee (CCC). OBJECTIVE: We developed an oral examination to aid our CCC in evaluating resident performance. METHODS: We reviewed tools used in our internal medicine residency program and other training programs in our institution. A literature search failed to identify reports of a similar evaluation tool used in internal medicine programs. We developed and administered an internal medicine oral examination (IMOE) to our postgraduate year-1 and postgraduate year-2 internal medicine residents annually over a 3-year period. The results were used to enhance our CCC's discussion of overall resident performance. We estimated the costs in terms of faculty time away from patient care activities. RESULTS: Of the 54 residents, 46 (86%) passed the IMOE on their first attempt. Of the 8 (14%) residents who failed, all but 1 successfully passed after a mentored study period and retest. Less than 0.1 annual full-time equivalent per faculty member was committed by most faculty involved, and the time spent on the IMOE replaced regular resident daily conference activities. CONCLUSIONS: The results of the IMOE were added to other assessment tools and used by the CCC for a global assessment of resident performance. An oral examination is feasible in terms of cost and can be easily modified to fit the needs of various competency committees.

Critical ostial left main and right coronary artery stenosis secondary to takayasu arteritis in a young female simulating pulmonary embolism at presentation.

A 28-year-old Caucasian female presented to the Emergency Department (ED) with sudden-onset chest pain. Thirty-six hours earlier, she was diagnosed with a pulmonary embolism, for which anticoagulation was started. Evaluation was significant for atrial fibrillation, elevated cardiac biomarkers, and echocardiography demonstrating a new wall motion abnormality. Symptoms resolved with spontaneous conversion to normal sinus rhythm and the patient was initiated on intravenous heparin and eptifibatide, followed by admission. Shortly after admission, the patient experienced recurrent chest pain with dynamic electrocardiographic (ECG) changes that prompted emergent cardiac catheterization. Prior to angiography, the patient developed pulseless cardiac arrest for which advanced cardiac lifesaving (ACLS) techniques were initiated. Coronary angiography showed critical ostial stenosis of the left main coronary artery. Despite transient periods of hemodynamic stability after successful stenting, the patient decompensated and was pronounced dead. Postmortem findings were consistent with Takayasu arteritis (TA). TA involving the coronary arteries is rare, presenting in fewer than 5% of cases. Diagnosis relies heavily on clinical suspicion. For our patient, dynamic ECG changes with wall motion abnormalities visible on echocardiography prompted diagnostic/therapeutic cardiac catheterization and stenting. Management involves high-dose systemic steroid therapy. However, due to recurrence of disease and adverse effects of prolonged steroid use, additional disease-modifying agents such as methotrexate, azathioprine, or cyclophosphamide may be used. With appropriate therapy, short-term prognosis is favorable. This case underlines the importance of having a high clinical suspicion for TA in the young female population with ischemic symptoms in order to allow early diagnosis in hopes of preventing further complications.

Antiphospholipid syndrome in a 21-year-old with Klinefelter syndrome.

We describe a patient with Klinefelter syndrome presenting with recurrent arterial thromboses secondary to the antiphospholipid syndrome. Previous case reports noted association of Klinefelter syndrome with systemic lupus erythematosus including some cases with antiphospholipid syndrome. Clinicians should consider autoimmune processes, including the antiphospholipid syndrome, when patients with Klinefelter syndrome present with recurrent thrombosis or additional features of a systemic autoimmune disorder.

Modification of the pyridine moiety of non-peptidyl indole GnRH receptor antagonists.

The synthesis of a number of indole GnRH antagonists is described. Oxidation of the pyridine ring nitrogen, combined with alkylation at the two position, led to a compound with an excellent in vitro activity profile as well as oral bioavailability in both rats and dogs.

2-Arylindoles as gonadotropin releasing hormone (GnRH) antagonists: optimization of the tryptamine side chain.

A series of 2-arylindoles containing novel heteroaromatic substituents on the tryptamine tether, based on compound 1, was prepared and evaluated for their ability to act as gonadotropin releasing hormone (GnRH) antagonists. Successful modifications of 1 included chain length variation (reduction) and replacement of the pyridine with heteroaromatic groups. These alterations culminated in the discovery of compound 27kk which had excellent in vitro potency and oral efficacy in rodents.