At the precipice: a prospective exploration of medical students' expectations of the pre-clerkship to clerkship transition.

Medical learners face many challenging transitions. We prospectively explored students' perceptions of their upcoming transition to clerkship and their future professional selves. In 2013, 160/165 end-of-second-year medical students wrote narrative reflections and 79/165 completed a questionnaire on their perceptions of their upcoming transition to clerkship. Narratives were separately analyzed by four authors and then discussed to identify a final thematic framework using parsimonious category construction. We identified two overarching themes: (1) "Looking back": experiences which had helped students feel prepared for clerkship with subthemes focused on of patient care, shadowing, classroom teaching and the pre-clerkship years as foundational knowledge, (2) "Looking forward": anticipating the clerkship experience and the journey of becoming a physician with subthemes focused on death and dying, hierarchy, work-life balance, interactions with patients, concerns about competency and career choice. Questionnaire data revealed incongruities around expectations of minimal exposure to death and dying, little need for independent study and limited direct patient responsibility. We confirmed that internal transformations are happening in contemplative time even before clerkship. By prospectively exploring pre-clerkship students' perceptions of the transition to clerkship training we identified expectations and misconceptions that could be addressed with future curricular interventions. While students are aware of and anticipating their learning needs it is not as clear that they realise how much their future learning will depend on their own inner resources. We suggest that more attention be paid to professional identity formation and the development of the physician as a person during these critical transitions.

Narrative reflective practice in medical education for residents: composing shifting identities.

As researchers note, medical educators need to create situations to work with physicians in training to help them attend to the development of their professional identities. While there is a call for such changes to be included in medical education, educational approaches that facilitate attention to the development of medical students' professional identities, that is, who they are and who they are becoming as physicians, are still under development. One pedagogical strategy involves narrative reflective practice as a way to develop physician identity. Using this approach, medical residents first write narrative accounts of their experiences with patients in what are called "parallel charts". They then engage in a collaborative narrative inquiry within a sustained inquiry group of other residents and two researcher/facilitators (one physician, one narrative researcher). Preliminary studies of this approach are underway. Drawing on the experiences of one medical resident in one such inquiry group, we show how this pedagogical strategy enables attending to physician identity making.

Creating pedagogical spaces for developing doctor professional identity.

OBJECTIVES: Working with doctors to develop their identities as technically skilled as well as caring, compassionate and ethical practitioners is a challenge in medical education. One way of resolving this derives from a narrative reflective practice approach to working with residents. We examine the use of such an approach. METHODS: This paper draws on a 2006 study carried out with four family medicine residents into the potential of writing, sharing and inquiring into parallel charts in order to help develop doctor identity. Each resident wrote 10 parallel charts over 10 weeks. All residents met bi-weekly as a group with two researchers to narratively inquire into the stories told in their charts. RESULTS: One parallel chart and the ensuing group inquiry about the chart are described. In the narrative reflective practice process, one resident tells of working with a patient and, through writing, sharing and inquiry, integrates her practice and how she learned to be a doctor in one cultural setting into another cultural setting; another resident affirms her relational way of practising medicine, and a third resident begins to see the complexity of attending to patients' experiences. CONCLUSIONS: The process shows the importance of creating pedagogical spaces to allow doctors to tell and retell, through narrative inquiry, their stories of their experiences. This pedagogical approach creates spaces for doctors to individually develop their own stories by which to live as doctors through narrative reflection on their interwoven personal, professional and cultural stories as they are shaped by, and enacted within, their professional contexts.

Revisiting the journal club.

BACKGROUND: Recent descriptions of journal clubs identify their purpose as reading current medical literature, critically appraising it for validity and applicability to the readers' patient population, and distilling the best available clinical evidence. A clinical problem or question from practice within a discipline is identified, and relevant literature is selected and critically appraised. The process addresses the first tenet of evidence-based medicine; that is, gathering the best evidence from research data, but there is little information about when and how the second and third tenets (namely, incorporating individual clinician's expertise and individual patient's perspective) are addressed. AIMS: The study aim was to explore the value, for physician-learners, of reading physician-authored books within the context of an ongoing conversation group. This paper draws on the results of a year-long study with a group of medical students, residents, and novice physicians who read physician-authored books about their practice areas and subsequently met in a conversation group. DESCRIPTION: The study process facilitated learning around two neglected tenets of evidence-based medicine: the integration of clinical expertise, and incorporating patients' perspectives into clinical decision-making. It also fulfilled an earlier purpose of journal clubs, namely the fostering of collegiality and the development of professional identity in physicians. CONCLUSION: This study shows the value of reading a type of medical literature that is different, but complementary, to the kind read in contemporary journal clubs.