Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education).

The University of Texas System established the Transformation in Medical Education (TIME) initiative to reconfigure and shorten medical education from college matriculation through medical school graduation. One of the key changes proposed as part of the TIME initiative was to begin emphasizing professional identity formation (PIF) at the premedical level. The TIME Steering Committee appointed an interdisciplinary task force to explore the fundamentals of PIF and to formulate strategies that would help students develop their professional identity as they transform into physicians. In this article, the authors describe the task force's process for defining PIF and developing a framework, which includes 10 key aspects, 6 domains, and 30 subdomains to characterize the complexity of physician identity. The task force mapped this framework onto three developmental phases of medical education typified by the undergraduate student, the clerkship-level medical student, and the graduating medical student. The task force provided strategies for the promotion and assessment of PIF for each subdomain at each of the three phases, in addition to references and resources. Assessments were suggested for student feedback, curriculum evaluation, and theoretical development. The authors emphasize the importance of longitudinal, formative assessment using a combination of existing assessment methods. Though not unique to the medical profession, PIF is critical to the practice of exemplary medicine and the well-being of patients and physicians.

Perceptions of long-term care, autonomy, and dignity, by residents, family and care-givers: the Houston experience.

Houston, Texas, is a major U.S. city with, like many, a growing aging population. The purpose of this study and ultimate book chapter is to explore the views and perceptions of long-term care (LTC) residents, family members and health care providers. Individuals primarily in independent living and group residential settings were interviewed and studied. Questions emphasized the concepts of personal autonomy, dignity, quality and location of care and decision making. Although a small sample of participants were involved, consistency was noted. Keeping the elderly in caring and loving home situations (theirs or family) was most preferred. Personal choice and independence were emphasized by residents, but family members needed to act as advocates. We also noted that the legal system emphasizes family control over individual decision making as competency declines with aging. Optimal personal decision making in the residents' best interest also became more difficult with loss of individual mental capacity.

Measuring what medical students think about complementary and alternative medicine (CAM): a pilot study of the complementary and alternative medicine survey.

With increasing national and international support for the development of Complementary and Alternative Medicine (CAM) curricula in American medical schools, it is essential to measure what learners know and believe about CAM in order to assess outcomes of new teaching efforts. This paper describes the development and initial results of a survey designed for those purposes. The survey is constructed so that earlier single-institution studies of students' attitudes toward CAM topics, preferred ways of learning about CAM, and students' use of CAM therapies for self-care might be replicated and extended. A pilot test of the Complementary and Alternative Medicine ( CAM) Survey was conducted with third-year medical students at the University of Texas Medical Branch. Validity and reliability studies of the survey were conducted. Findings were compared to those of previously published studies. Interpretable subscales were constructed from survey questions. Students' attitudes toward CAM-related topics were generally favorable. More students were familiar with biological-based therapies than with other CAM therapies. The majority of respondents listed lectures as their preferred way to learn about CAM. Respondents' own CAM use varied; minority and economically-disadvantaged students were more likely to use CAM therapies than other students. The survey is a promising assessment of student attitudes toward and knowledge of CAM therapies.

Prescribing viagra in an ethically responsible fashion.

Sildenafil citrate (Viagra) and other newly released pharmaceuticals that assist erectile dysfunction may be one of the most important categories of drugs released in the past decade. Sildenafil is distinctive because it creates a new therapeutic relationship not only between patient and physician, but also with sexual partner(s). Physicians must first evaluate the patient comprehensively, addressing not only erectile function and sexual performance, but overall physical and mental health. Since the drug does impact others, an expanded model for informed consent needs to be considered. Three models to consider include the public health one, ethically justified limits on confidentiality, and a biopsychosocial one. The biopsychosocial model may be preferred because it expands the patient-physician dyad to directly include others. Physicians also need to distinguish between professional, role-related obligations and personal conscience when treating patients whose sexual beliefs and practices differ from their own. Other ethical issues include inappropriate prescribing over the Internet, dealing with unrealistic patient expectations, and fairness in paying for treatment for sexual conditions in both men and women. With these proposed guidelines, physicians can continue to provide steady, reliable guidance for patients while working with yet another scientific advance in medicine.

Observations of physician, patient and family perceptions of informed consent in Houston, Texas.

Informed consent is one of the most important ethical and legal principles in the United States, including Texas, and reflects a profound respect for individuals and their ability to make decisions in their own best interest. It is also a critical underpinning of medical practice, although how it is actually carried out has not been well studied. A survey was conducted in the private practices and a hospital in the Texas Medical Center in Houston, Texas to ascertain how physicians, patients and patient's family members perceive and demonstrate the elements of informed consent. In-depth interviews of twelve physicians, three patients and three family members were carried out. For physicians, consent was an explicit and implicit aspect of virtually all medical practice. Physicians would seek patient input concerning medical decisions whenever possible and might also discuss care choices with families. However, they often made decisions based upon what they perceived as the patient's best interests. Patients expected the physician to involve them in the decision process, but whether they turned to family members, or even others to assist them, varied considerably. Although Texas physicians respect the competent patient as the primary decision maker, they may bypass a formal surrogate decision maker to gain input from others, including their own view of what is in the patient's best interest.