Storylines of family medicine XI: professional identity formation-nurturing one's own story.

is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'XI: professional identity formation-nurturing one's own story', authors address the following themes: 'The social construction of professional identity', 'On becoming a family physician', 'What's on the test?-professionalism for family physicians', 'The ugly doc-ling', 'Teachers-the essence of who we are', 'Family medicine research-it starts in the clinic', 'Socially accountability in medical education', 'Personal philosophy and how to find it' and 'Teaching and learning with '. May these essays encourage readers to find their own creative spark in medicine.

Identity construction in medical student stories about experiences of disgust in early nursing home placements: a dialogical narrative analysis.

Objectives: To explore medical students' reflective essays about encounters with residents during preclinical nursing home placements.

Design: Dialogical narrative analysis aiming at how students characterise residents and construct identities in relation to them.

Setting: Medical students' professional identity construction through storytelling has been demonstrated in contexts including hospitals and nursing homes.

Emerging models for successful treatment of complex regional pain syndrome in children and young adults.

Complex regional pain syndrome (CRPS) is a relatively common condition that is often not well recognised or treated adequately. Patients are usually referred to multidisciplinary pain services, but outcomes remain variable. This case report describes a recent patient with CRPS who was treated quickly and effectively through a simple explanation of the relationship between mind and body, and who then was able to modify her own thought processes and behaviours.

Experience-based learning: junior medical students' reflections on end-of-life care.

Context: Experience-based learning may contribute to confidence, competence and professional identity; early experiences may be particularly formative. This study explored how pre-clinical students make sense of their participation in the provision of end-of-life care within community settings.

Methods: We performed dialogic narrative analysis on essays written by junior medical students in New Zealand.

Challenges in the doctor-patient relationship: 12 tips for more effective peer group discussion.

In New Zealand, almost all general practitioners are members of peer groups, which provide opportunities for both clinical discussion and collegial support. This article proposes that peer groups can also be a useful medium for exploring specific challenges within the doctor-patient relationship. However, the peer group culture needs to be receptive to this particular goal.

Republished original viewpoint: complaints, shame and defensive medicine.

While the complaints process is intended to improve healthcare, some doctors appear to practise defensive medicine after receiving a complaint. This response occurs in countries that use a tort-based medicolegal system as well as in countries with less professional liability. Defensive medicine is based on avoiding malpractice liability rather than considering a risk-benefit analysis for both investigations and treatment.

Complaints, shame and defensive medicine.

While the complaints process is intended to improve healthcare, some doctors appear to practise defensive medicine after receiving a complaint. This response occurs in countries that use a tort-based medicolegal system as well as in countries with less professional liability. Defensive medicine is based on avoiding malpractice liability rather than considering a risk-benefit analysis for both investigations and treatment.

Role modeling the doctor-patient relationship in the clinical curriculum.

Background And Objectives: Training in relationship skills relies heavily on role modeling: students observing clinicians at work. This study explored student and faculty perceptions of student learning about relationship skills in hospital and ambulatory settings.

Methods: Qualitative data from focus groups and long interviews were coded by the authors through an iterative dialogic process.

In search of professionalism: implications for medical education.

This is the seventh article in an education series, discussing some of the 'hot topics' in teaching and learning in medicine. Historically, 'professionalism' was defined by the social structures of medicine, but has moved on to represent the expected behaviours and attributes of practitioners. Well publicised cases of professional misconduct, the rise of medical ethics as a discipline, and the move to a more patient-centred approach have driven the profile of professionalism into mainstream medical education.

Faculty and medical students' perceptions of teaching and learning about the doctor-patient relationship.

Objective: To explore student and faculty perceptions of how students are learning doctor-patient relationship skills in their clinical medical education.

Methods: Exploratory qualitative study involving data from interviews and focus groups with students and interviews with teaching faculty.

Results: Respondents reported that pre-clinical relationship skills curricula were not well-coordinated with clinical curricula.

The revised 'Early Learning in Medicine' curriculum at the University of Otago--focusing on students, patients, and community.

This article describes recent changes to years 2 and 3 of undergraduate medical education at the University of Otago, now termed 'Early Learning in Medicine'. These changes focus on learning that is contextually relevant, student centred, horizontally and vertically integrated, and community based. Three new programmes have been introduced to the course; Integrated Cases, Clinical Skills, and Healthcare in the Community.

Co-locating primary care facilities within emergency departments: brilliant innovation or unwelcome intervention into clinical care?

The management of a regional hospital in New Zealand is proposing to co-locate a primary care facility within the local emergency department (ED). This article reviews the reasons for this proposal which include overcrowding of ED, so-called 'inappropriate' attendees, and provision of 24-hour primary medical services for Dunedin City. While the proposal seems to have some intuitive merit, the attribution of overcrowding in ED to attendance by GP-type patients is simplistic; it does not address how patients are processed within ED or how they are transferred to wards later if required ('access block').

Using significant event analysis in dental and medical education.

As part of a new professional development teaching strand at the University of Otago's School of Dentistry, final-year dental students were each asked to write a "thought-provoking episode report" (TPER). These TPERs formed the basis for group discussion in a professional development course. This article outlines the main content themes of the reports, comparing them with similar reports written by medical students from the same university.

Shame, guilt and the medical practitioner.

The underlying positivist philosophy of medicine and the emphasis on 'knowing' can induce a shame response when doctors perceive they have failed. In contrast to guilt, shame affects the whole of the self and may diminish the doctor's ability to accept his or her own illness, respond to a disciplinary complaint, or consider clinical supervision. Consideration of the polarities of practice can help doctors respond to mistakes, errors, or wrongdoing with guilt rather than with shame.