Anorexia nervosa in a patient with congenital adrenal hyperplasia.

Life stressors and hormonal dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis are common factors that play a role in both anorexia nervosa (AN) and congenital adrenal hyperplasia (CAH). The complexity of combined CAH and AN on the HPA axis has not, to our knowledge, been previously illustrated. We present a report of an adolescent with CAH who developed AN, requiring hospitalized management. We use this case to review the pathophysiology of CAH and AN as it relates to the stress response and hormonal dysregulation within the HPA axis. We then highlight the interplay between these conditions, and provide support to the theory that AN acts as a chronic stressor in patients with CAH, leading to HPA axis hyperactivity and elevated levels of androgen precursors. It is prudent for the medical team to monitor and modify CAH steroid dosing during the acute phase of AN, weaning appropriately with AN treatment success.

A medical student's perspective of participation in an interprofessional education placement: an autoethnography.

Interprofessional education (IPE) has emerged as a critical pedagogy for promoting interprofessional collaboration (IPC) within healthcare. However, the literature includes few reports of students' perspectives on IPE experiences. Understanding students' experiences is critical, as they are the crux of IPE's culture change agenda. This paper presents an autoethnographic account of my experiences as a medical student participating in an IPE placement within a Canadian academic hospital. During the five-week placement, I collected data using participant observation and reflective journaling on all placement experiences. I expanded my notes using the emotional recall technique and conducted thematic analysis. Using a series of narrative vignettes, this paper explores the relationships between my personal experience and the cultural and educational issues underpinning IPE. The first vignette explores the relationship between students' patient access and our status in tutorial discussion. The second vignette considers the impact of shadowing on my appreciation of another professional's practice. The last vignette portrays my experience learning about the complex politics that shape IPC. The conclusion suggests that the IPE placements incorporate reflexive activities (i.e., journaling and interviewing) to enhance the students' appreciation and understanding of roles, responsibilities and professional perspectives, and to promote critical thinking and professional growth.