The physician healer track: educating the hearts and the minds of future physicians.

Calls to reform medical education recommend explicit training in professional identity formation to promote the development of humanistic, compassionate physicians. The authors report their experience offering The Physician Healer Track, a 500-contact-hour curricula integrated over 4 years, focusing on self-awareness, reflection, being-with-suffering, communication and professional identity development. The voluntary scholarly-concentration program comprises 4 years of monthly dinner meetings with faculty mentors, a two-month preceptorship in the first year, a one-month immersion course in MS4 and one elective. Training in mindfulness, cognitive behavioral therapy, nonviolent communication, motivational interviewing, spirituality in healthcare, wellness, equanimity, and 'being with suffering' is reinforced across all 4 years. Community building and reflection are integral to the training both in the monthly sessions and the immersion courses. Enrollment has grown from 26 students in the first year (11% of class) to a total of 258 students across our first 6 years (average of 20-26% of each class). Graduates in our first two cohorts of PHT have exceeded the numbers in the eight other scholarly concentrations offered at UTMB. Among students participating in the summer preceptorship, there has been less than 1% attrition. In serial assessments, students report continued growth in personal development, professional development, and the ability to empathize. Offering PHT has resulted in the growth of training for our medical residents, faculty, physical therapy students and the creation of a student healer association. Despite the demands on student's time, they are voluntarily participating in a challenging program of integrated training with the intention of keeping them connected to their humanity during the rigors of medical school training.

Challenges to assessing professional identity in medical students: a tale of two measures.

Background: Professional identity formation (PIF), a foundational process in becoming a physician, includes establishment of values, moral principles, and self-awareness. The purpose of this report is to examine challenges in establishing the validity of measures of identity fusion as one facet of PIF. Method: Utilizing the modern approach of validity as a unitary concept, the authors generated six hypotheses to examine the evidence for the construct validity of the scores of Physician Professional Identity (PPI) and Identity Integration (IdIn), considering relationships of these measures with each other, year of training and data from a larger survey. Results: Responses from 3473 students at 8 medical schools revealed a weak association between the measures with distributions varying by cohort. PPI had a stronger relationship to cohort and IdIn was moderately associated with students' attitudes relevant to social media use. Responses were independent of response format and evidence supported the interpretation of scores for IdIn as indications of integration of identity. Discussion : Sufficient evidence was found to suggest that these measures assess aspects of PIF. Use of these measures as part of a multidimensional, longitudinal approach to refining understanding of the construct of PIF and developing effective assessment strategies.

A Methodological Review of the Assessment of Humanism in Medical Students.

BACKGROUND: Humanism is a complex construct that defies simplistic measurement. How educators measure humanism shapes understanding and implications for learners. This systematic review sought to address the following questions: How do medical educators assess humanism in medical students, and how does the measurement impact the understanding of humanism in undergraduate medical education (UME)? METHOD: Using the IECARES (integrity, excellence, compassion, altruism, respect, empathy, and service) Gold Foundation framework, a search of English literature databases from 2000 to 2013 on assessment of humanism in medical students revealed more than 900 articles, of which 155 met criteria for analysis. Using descriptive statistics, articles and assessments were analyzed for construct measured, study design, assessment method, instrument type, perspective/source of assessment, student level, validity evidence, and national context. RESULTS: Of 202 assessments reported in 155 articles, 162 (80%) used surveys; 164 (81%) used student self-reports. One hundred nine articles (70%) included only one humanism construct. Empathy was the most prevalent construct present in 96 (62%); 49 (51%) of those used a single instrument. One hundred fifteen (74%) used exclusively quantitative data; only 48 (31%) used a longitudinal design. Construct underrepresentation was identified as a threat to validity in half of the assessments. Articles included 34 countries; 87 (56%) were from North America. CONCLUSIONS: Assessment of humanism in UME incorporates a limited scope of a complex construct, often relying on single quantitative measures from self-reported survey instruments. This highlights the need for multiple methods, perspectives, and longitudinal designs to strengthen the validity of humanism assessments.

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.

Professional identity formation in medical education: the convergence of multiple domains.

There has been increasing emphasis on professionalism in medical education over the past several decades, initially focusing on bioethical principles, communication skills, and behaviors of medical students and practitioners. Authors have begun to discuss professional identity formation (PIF), distinguishing it as the foundational process one experiences during the transformation from lay person to physician. This integrative developmental process involves the establishment of core values, moral principles, and self-awareness. The literature has approached PIF from various paradigms-professionalism, psychological ego development, social interactions, and various learning theories. Similarities have been identified between the formation process of clergy and that of physicians. PIF reflects a very complex process, or series of processes, best understood by applying aspects of overlapping domains: professionalism, psychosocial identity development, and formation. In this study, the authors review essential elements of these three domains, identify features relevant to medical PIF, and describe strategies reported in the medical education literature that may influence PIF.