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Do Medical Students’ Narrative Representations of “The Good Doctor” Change Over Time? Comparing Humanism Essays From a National Contest in 1999 and 2013

Rutberg, Pooja C. MD; King, Brandy MLIS; Gaufberg, Elizabeth MD, MPH; Brett-MacLean, Pamela PhD; Dinardo, Perry; Frankel, Richard M. PhD

doi: 10.1097/ACM.0000000000001531
Research Reports

Purpose: To explore medical students’ conceptions of “the good doctor” at two points in time separated by 14 years.

Method: The authors conducted qualitative analysis of narrative-based essays. Following a constant comparative method, an emergent relational coding scheme was developed which the authors used to characterize 110 essays submitted to the Arnold P. Gold Foundation Humanism in Medicine Essay Contest in 1999 (n = 50) and 2013 (n = 60) in response to the prompt, “Who is the good doctor?”

Results: The authors identified five relational themes as guiding the day-to-day work and lives of physicians: doctor–patient, doctor–self, doctor–learner, doctor–colleague, and doctor–system/society/profession. The authors noted a highly similar distribution of primary and secondary relational themes for essays from 1999 and 2013. The majority of the essays emphasized the centrality of the doctor–patient relationship. Student essays focused little on teamwork, systems innovation, or technology use—all important developments in contemporary medicine.

Conclusions: Medical students’ narrative reflections are increasingly used as rich sources of information about the lived experience of medical education. The findings reported here suggest that medical students understand the “good doctor” as a relational being, with an enduring emphasis on the doctor–patient relationship. Medical education would benefit from including an emphasis on the relational aspects of medicine. Future research should focus on relational learning as a pedagogical approach that may support the formation of caring, effective physicians embedded in a complex array of relationships within clinical, community, and larger societal contexts.

P.C. Rutberg is clinical instructor, Department of Pediatrics, Harvard Medical School, Boston, and pediatric residency site director, Cambridge Health Alliance, MassGeneral Hospital for Children, Boston, Massachusetts.

B. King is head, Information Services, Arnold P. Gold Foundation Research Institute, Cambridge, Massachusetts.

E. Gaufberg is associate professor of medicine and psychiatry, Harvard Medical School, Boston, Massachusetts; Jean and Harvey Picker Director, Arnold P. Gold Foundation Research Institute, Cambridge, Massachusetts; director, Cambridge Health Alliance Center for Professional Development, Cambridge, Massachusetts; and leader, Patient–Doctor Course, Harvard Medical School Cambridge Integrated Clerkship, Cambridge, Massachusetts.

P. Brett-MacLean is associate professor of psychiatry, director, Arts & Humanities in Health & Medicine program, Faculty of Medicine & Dentistry, and adjunct associate professor, John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta, Canada.

P. Dinardo is research intern, Arnold P. Gold Foundation Research Institute, Cambridge, Massachusetts.

R.M. Frankel is professor of medicine and geriatrics, Indiana University School of Medicine, Indianapolis, Indiana; senior scientist, Regenstrief Institute Center for Health Services Research and Richard L. Roudebush VA Center for Healthcare Information and Communication, Indianapolis, Indiana; and staff, Cleveland Clinic Education Institute, Cleveland Ohio.

Editor’s Note: Although the winning Arnold P. Gold Foundations essays were not published in Academic Medicine until 2001, those who are interested in reading the winners from the 2013 essay contest that asked students, “Who is the good doctor?” can access them by searching for “2013 essay contest” on the Academic Medicine Web site.

Funding/Support: None reported.

Other disclosure: None reported.

Ethical approval: The institutional review board of Cambridge Health Alliance waived the need for informed consent for analysis of the essays.

Disclaimer: The winning Arnold P. Gold Foundation essays have been published in Academic Medicine each year since 2001.

Previous presentations: Previous versions of this have been presented at Creating Space IV: Exploring Paradigms of Scholarship and Practice, Presymposium, Canadian Conference on Medical Education, April 2014, Ottawa, Ontario, Canada, and at the Gold Humanism Honor Society Biennial National Conference on Humanism: Advancing Humanism in the Age of Technology, October 2014, Atlanta, Georgia.

Correspondence should be addressed to Pooja C. Rutberg, Cambridge Health Alliance–Pediatrics Department, 1493 Cambridge St., Cambridge, MA 02139-1047; telephone: (617) 665-1497; e-mail: prutberg@challiance.org; Twitter: @GoldFdtn.

© 2017 by the Association of American Medical Colleges