David Anthony

Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice.

Recent calls for an expanded perspective on medical education and training include focusing on complexities of professional identity formation (PIF). Medical educators are challenged to facilitate the active constructive, integrative developmental process of PIF within standardized and personalized and/or formal and informal curricular approaches. How can we best support the complex iterative PIF process for a humanistic, resilient health care professional? How can we effectively scaffold the necessary critical reflective learning and practice skill set for our learners to support the shaping of a professional identity? The authors present three pedagogic innovations contributing to the PIF process within undergraduate and graduate medical education (GME) at their institutions. These are (1) interactive reflective writing fostering reflective capacity, emotional awareness, and resiliency (as complexities within physician–patient interactions are explored) for personal and professional development; (2) synergistic teaching modules about mindful clinical practice and resilient responses to difficult interactions, to foster clinician resilience and enhanced well-being for effective professional functioning; and (3) strategies for effective use of a professional development e-portfolio and faculty development of reflective coaching skills in GME. These strategies as “bridges from theory to practice” embody and integrate key elements of promoting and enriching PIF, including guided reflection, the significant role of relationships (faculty and peers), mindfulness, adequate feedback, and creating collaborative learning environments. Ideally, such pedagogic innovations can make a significant contribution toward enhancing quality of care and caring with resilience for the being, relating, and doing of a humanistic health care professional.

Clinician Assessment of the Driving Competence of Patients with Dementia

Objectives: To determine the validity and reliability of clinician ratings of the driving competence of patients with mild dementia.

Association between screening family medical history in general medical care and lower burden of cancer worry among women with a close family history of breast cancer

Purpose: Soliciting family medical history (FMH) is the initial step in the process of screening for heritable cancer risk in medical care. We investigate whether recent solicitation of FMH in general medical care is associated with cancer worry among a sample of women having a first-degree relative with a breast cancer diagnosis.Methods: Surveys were mailed to women registered with the Cancer Genetics Network having a first-degree relative with a breast cancer diagnosis and a regular source of medical care. The independent measure consisted of two items for solicitation of FMH based on validated measures of clinical interactions with ones physician; the dependent measure was a novel measure of cancer worry based on validated patient-centered measure of distress; and the secondary measures were 6-point scales for perceived likelihood of developing breast cancer and perceived severity of breast cancer as a health outcome.Results: A total of 353 women responded and met eligibility criteria (76.4% minimum response rate). One fifth reported no cancer worry during the past 4 weeks. After adjustment for age, education, pedigree features, and clustering within families, recent FMH solicitation was associated with lower odds of cancer worry (odds ratio = 0.58; 95% confidence interval = 0.51–0.70). FMH solicitation was associated with lower perceptions of the severity of developing breast cancer but not with the perception of cancer likelihood.Conclusions: Our data do not support the hypothesis that FMH solicitation in general medical practice causes cancer worry. In fact, we observed a protective association possibly explained by influences on perceptions of breast cancer severity. Prospective research among less select populations is necessary.

A manageable approach to integrating personal digital assistants into a family medicine clerkship

Personal digital assistants (PDAs) were incorporated into the six-week Family Medicine Clerkship in 2002 to achieve two major goals: tracking students’ outpatient encounters at preceptor sites and providing opportunities to use PDAs during medical visits. Each student collects information on each patient seen. Data are then retrieved and presented to students individually and as a group twice during the rotation. Each PDA also contains several clinical resources that students use during both small group didactic sessions and real clinical encounters. These results are based on data collected from 85 students who completed the clerkship over the course of one year who recorded information on demographics, presenting problems, procedures, and type of precepting for a total of 11,146 patient encounters. The cumulative results have allowed clerkship faculty and administrators to set standard expectations of individual students and preceptors with respect to numbers of patients seen and type of precepting received. This PDA project is manageable in terms of costs as well as effort on the part of both students and faculty and has numerous benefits to the clerkship, one of which is the ability to provide real-time feedback to clerkship students and thus promote adult learning skills.

Grappling with complexity: Medical students' reflective writings about challenging patient encounters as a window into professional identity formation.

Abstract Aim: Clerkship-specific interactive reflective writing (IRW)-enhanced reflection may enhance professional identity formation (PIF), a fundamental goal of medical education. PIF process as revealed in students? reflective writing (RW) has been understudied. Methods: The authors developed an IRW curriculum within a Family Medicine Clerkship (FMC) and analyzed students? reflections about challenging/difficult patient encounters using immersion-crystallization qualitative analysis. Results: The qualitative analysis identified 26 unique emergent themes and five distinct thematic categories (1. Role of emotions, 2. Role of cognition, 3. Behaviorally responding to situational context, 4. Patient factors, and 5. External factors) as well as an emergent PIF model from a directed content analysis. The model describes students? backgrounds, emotions and previous experiences in medicine merging with external factors and processed during student?patient interactions. The RWs also revealed that processing often involves polarities (e.g. empathy/lack of empathy or encouragement/disillusionment) as well as dissonance between idealized visions and lived reality. Conclusions: IRW facilitates and ideally supports grappling with the lived reality of medicine; uncovering a “positive hidden curriculum” within medical education. The authors propose engaging learners in guided critical reflection about complex experiences for meaning-making within a safe learning climate as a valuable way to cultivate reflective, resilient professionals with “prepared” minds and hearts for inevitable challenges of healthcare practice.

Self-rated breast cancer risk among women reporting a first-degree family history of breast cancer on office screening questionnaires in routine medical care: The role of physician-delivered risk feedback

Purpose: We investigated whether risk-related feedback delivered by ones primary care physician is associated with self-ratings of risk among women found to have a first-degree family history of breast cancer on office screening questionnaires.Methods: Design: Mailed survey of women registered with the Cancer Genetics Network having a first-degree family history of breast cancer. Eligibility: Completion of primary care-based family history screening within the past year. Independent variable: presence of physician feedback about breast cancer risk. Dependent variable: self-rated breast cancer risk. Modifying variable: trust in ones doctor.Results: Three hundred one women met eligibility criteria (73% minimum response rate); feedback was associated with rating ones risk to be “high” in both crude and multivariate analysis. (ORadj = 2.38; 95% CI = 1.30, 4.38). Higher levels of trust in the physician were associated in a dose-dependent fashion with the strength of association between feedback and self-rating ones risk to be high.Conclusions: Physician feedback following the identification of a first-degree family history of breast cancer appears to influence whether or not women categorize themselves to be at high risk and trust is an important modifier of this association.

Electronic Medical Records, Medical Students, and Ambulatory Family Physicians: A Multi-Institution Study

Purpose Medical students commonly encounter electronic medical records (EMRs) in their ambulatory family medicine clerkships, but how students interact with this technology varies tremendously and presents challenges to students and preceptors. Little research to date has evaluated the impact of EMRs on medical student education in the ambulatory setting; this three-institution study aimed to identify behaviors of ambulatory family medicine preceptors as they relate to EMRs and medical students. Method In 2015, the authors sent e-mails to ambulatory preceptors who in the preceding year had hosted medical students during family medicine clerkships, inviting them to participate in the survey, which asked questions about each preceptor’s methods of using the EMR with medical students. Results Of 801 ambulatory preceptors, 265 (33%) responded. The vast majority of respondents used an EMR and provided students with access to it in some way, but only 62.2% (147/236) allowed students to write electronic notes. Of those who allowed students electronic access, one-third did so by logging students in under their own (the preceptor’s) credentials, either by telling the students their log-in information (22/202; 10.9%) or by logging in the student without revealing their passwords (43/202; 21.3%). Conclusions Ambulatory medical student training in the use of EMRs not only varies but also requires many preceptors to break rules for students to learn important documentation skills. Without changes to the policies surrounding student access to and use of EMRs, future physicians will enter residency without the training they need to appropriately document patient care.