Indicators of the dimensions of trust (and mistrust) in early primary care practice: a qualitative study.

Background: Trust occurs when persons feel they can be vulnerable to others because of the sincerity, benevolence, truthfulness and sometimes the competence they perceive. This project examines the various types of trust expressed in written reflections of developing healthcare clinicians. Our goal is to understand the roles trust plays in residents' self-examination and to offer insight from relationship science to inform the teaching and clinical work for better trust in healthcare.

Preparing for the End of Life: Medical Students Completing Their Own Advance Directives Described Increased Empathy for Patients.

Background And Objectives: Family medicine offers the opportunity to integrate advance care planning into routine primary care, connecting relationship-centered orientation with thoughtful action before a terminal diagnosis. However, physicians are undertrained in end-of-life counseling and care. To address this educational gap, we had clerkship students complete their own advance directives and submit a written reflection about the experience.

"Alexa, Can You Be My Family Medicine Doctor?" The Future of Family Medicine in the Coming Techno-World.

Even before social distancing disrupted normative expectations and prompted an immediate shift to remote doctor/patient interactions, technology companies-Amazon, Apple, and Google-were preparing to disrupt medical care through the innovative use of technology. This article presents a possible scenario for how technology, in the near future, will completely up-end primary care practice. What does face-to-face interaction accomplish that cannot be done remotely? What do family physicians offer that cannot be accomplished by technology? More than just relationship, family medicine brings the therapeutic use of the self to engage with people, an ability to advocate for patients, and the ability to step back and reflect on the power of relationships.

Cultivating the Inner Life of a Physician Through Written Reflection.

All of us have an "inner life" that forms the core of who we are. It shapes and is shaped by our actions and experiences. During physician training, attention to residents' inner life requires a focus on their beliefs and emotions as well as their ethical and spiritual development, topics often considered to be outside the realm of clinical training and practice.

On the Inner Life of Physicians: Analysis of Family Medicine Residents' Written Reflections.

This qualitative study introduces the broad and inclusive concept of the "inner life of physicians" and analyzes the written reflections (N = 756) of family medicine residents (N = 33) during their residency as indicative of the physicians' inner lives. Residents completed reflective entries without specific prompts. Researchers describe unsolicited emergent categorical themes indicative of a robust inner life of the physician.

Attention without intention: explicit processing and implicit goal-setting in family medicine residents' written reflections.

Background: Reflection, a process of self-analysis to promote learning through better understanding of one's experiences, is often used to assess learners' metacognitive ability. However, writing reflective exercises, not submitted for assessment, may allow learners to explore their experiences and indicate learning and professional growth without explicitly connecting to intentional sense-making.

Aim: To identify core components of learning about medicine or medical education from family medicine residents' written reflections.

Learning to See Beneath the Surface: A Qualitative Analysis of Family Medicine Residents' Reflections About Communication.

Patients share straightforward statements with physicians such as describing their fears about their diagnosis. Physicians need to also understanding implicit, indirect, subtle communication cues that give broader context to patients' illness experiences. This project examines physicians' written reflections that offer insight into their interpretation of both the stated and the tacit aspects of their observations about communication, their resulting responses, and their intended actions.

Family medicine residents' reactions to introducing a reflective exercise into training.

Introduction: Teaching residents how to reflect and providing ongoing experience in reflection may aid their development into adaptable, life-long learning professionals. We introduced an ongoing reflective exercise into the curriculum of a family medicine residency program. Residents were provided 15 minutes, three times a week, to complete these reflective exercises.

Navigating ethics of physician-patient confidentiality: a communication privacy management analysis.

The ethics of physician-patient confidentiality is often fraught with contradictions. Privacy boundaries are not always clear, and patients can leave an interaction with their physicians feeling uncomfortable about the security of their private medical information. The best way to meet confidentiality and privacy management expectations that patients have may not be readily apparent.

When rapport building extends beyond affiliation: communication overaccommodation toward patients with disabilities.

Introduction: Physician rapport with patients is described as a vital component of relationship-centered care, but rapport-building communication behaviors may exceed boundaries and instead indicate patronizing behavior toward patients with disabilities. This paper addresses the types of communication behaviors and contexts for interpreting when rapport building extends beyond boundaries toward patients with disabilities.

Methods: Videotaped interactions between third- and fourth-year medical students (N = 142) and standardized patient educators with physical disabilities were qualitatively analyzed.

How do I ask about your disability? An examination of interpersonal communication processes between medical students and patients with disabilities.

Medical student behaviors were examined through digital recordings of interpersonal skills communication training framed around a brief curriculum on disability within a family medicine clerkship. This analysis focuses on interpersonal communication processes and ways medical students ask standardized patient educators about visually apparent disability (N = 142). Primary themes of asking about or avoiding disability were identified with regard to language and nonverbal communication in how medical students asked and whether they integrated chronic disability with new musculoskeletal pain complaints.

What can I learn from this interaction? A qualitative analysis of medical student self-reflection and learning in a standardized patient exercise about disability.

Patients with disabilities receive fewer health services than the general population, yet they have greater health needs. Similarly, physicians report limited training in disability. The current project examines medical students' learning about disability in a project using individuals with disabilities as medical educators.

Reinforcement and punishment of substance abuse during ongoing interactions: a conversational test of inconsistent nurturing as control theory.

This study is the first to examine inconsistent nurturing as control (INC) theory during ongoing interpersonal influence episodes between substance-abusive individuals and their romantic partners. This study sought to determine how nonverbal (i.e.

Understanding interpersonal communication processes across health contexts: advances in the last decade and challenges for the next decade.

Interpersonal communication processes are central to the provider-patient interaction and in relationships with someone who is ill or needs care. The last decade of research has documented the ways communication processes predict better outcomes in the provider-patient interaction and key constructs for consideration in close relationships in which a health issue in some way defines the relationship. The current article highlights findings from the previous decade and the ways previous findings serve as a theoretical and methodological foundation for more sophisticated analysis of interpersonal communication processes in health contexts.

Bringing the physician back in: communication predictors of physicians' satisfaction with managed care.

Data from a survey of physicians in a west coast city (n = 356) are used to measure physicians' extra-occupational sources of dissatisfaction. Data revealed a significant relationship between physicians' satisfaction and their managed care experience, their communication with managed care organizations, and views of managed care practice. Results suggest that managed care currently plays a large and significant role in predicting physicians' satisfaction.