Constructing physician's professional identity - explorations of students' critical experiences in medical education

Abstract The formation of a physician's professional identity and conception of him/herself as a doctor is often taken for granted and considered a by-product of learning. During professional socialization, medical students internalize knowledge, skills, attitudes, behavioral models as well as ethical and moral values of medicine. However, certain critical experiences may trigger an active construction of professional identity. The aim of this research was to explore the process of constructing professional identity during medical education in the framework of cultural-historical activity theory. Multiple methods (questionnaires, videotapes of medical students' reflection group sessions, and interviews of the supervisors) were used in data collection and analysis. Medical students were found to have differing orientations towards learning and practising medicine. Some of the students, more commonly females, expressed a need for more support for their professional development. Reflection groups offered medical students a possibility to share their experiences of critical situations. The topics of discussion dealt with career choice, medical education (teaching, patient encounters, communication), working experiences and career opportunities. Medical students' narratives of their experiences in university hospital learning situations revealed the way in which various interaction situations laid the basis for the development of professional identity. In constructing a physician's professional identity, medical students had to solve dilemmas encountered in three different activity systems: Personal life, Medical education and Work. Encountering critical situations is part of the daily practice in medical schools. These situations may induce reflection on action and conscious development of professional identity. Medical students should be provided with more possibilities to elaborate on especially dilemmas concerning professionalism, communication skills, encountering death, and biomedical versus psychosocial aspects of medicine during their medical education

Effectiveness of training in guideline-oriented biopsychosocial management of low-back pain in occupational health services:a cluster randomized controlled trial

Abstract Objective: This study aimed to investigate the effectiveness of brief training in the guideline-oriented biopsychosocial management of low-back pain (LBP) in occupational health services using a cluster-randomized design. A small sample of physiotherapists and physicians from the intervention units (N=12) were given three- to seven-day training focusing on the biopsychosocial management of LBP, while professionals in the control units (N=15) received no such training. Methods: Eligible patients with LBP, with or without radicular pain, aged 18–65, were invited to participate. A web-based questionnaire was sent to all recruited patients at baseline, three months and one year. The primary outcome measure was disability (Oswestry Disability Index, ODI) over one year. Between-group differences were analyzed using linear and generalized linear mixed models adjusted for baseline-response delay as well as variables showing between-group imbalance at baseline. Results: The final study sample comprised 234 and 81 patients in the intervention and control groups, respectively at baseline, and 137 and 47 patients, respectively, at one year. At baseline, the mean duration of pain was longer in the intervention group (P=0.017), and pain-related fear concerning physical activity was lower (P=0.012). We observed no significant difference between the groups’ primary outcome measure (adjusted one-year mean difference in the ODI: 2.3; 95% confidence interval -1.0–5.7; P=0.175) or most secondary outcomes. Conclusions: Brief training in guideline-oriented biopsychosocial management of LBP for occupational health professionals did not appear to be effective in reducing patients’ symptom over one-year follow-up compared to treatment as usual

Evaluation of training in guideline-oriented biopsychosocial management of low back pain in occupational health services:protocol of a cluster randomized trial

Abstract Background: To prevent low back pain (LBP) from developing into a prolonged disabling condition, clinical guidelines advocate early stage assessment, risk-screening, and tailored interventions. Occupational health services recommend guideline-oriented biopsychosocial screening and individualized assessment and management. However, it is not known whether training a limited number of health care professionals improves the management process. The primary objective of this study is to investigate whether training in the biopsychosocial practice model is effective in reducing disability. Furthermore, we aim to evaluate health-economic impacts of the training intervention in comparison to usual medical care. Methods: The occupational health service units will be allocated into a training or control arm in a two-arm cluster randomized controlled design. The training of occupational physiotherapists and physicians will include the assessment of pain-related psychosocial factors using the STarT Back Tool and the short version of the Örebro Musculoskeletal Pain Screening Questionnaire, the use of an evidence-based patient education booklet as part of the management of LBP, and tailored individualized management of LBP according to risk stratification. The control units will receive no training. The study population will include patients aged 18–65 with nonspecific LBP. The primary outcome is a patient-reported Oswestry Disability Index from baseline to 12 months. By estimating group differences over time, we aim to evaluate the effectiveness of the training intervention in comparison to usual medical care, and to undertake an economic evaluation using individual patients’ health care records (participant-level data) and the participating units’ registries (cluster-level data). In addition, through interviews and questionnaires, we will explore the health care professionals’ conceptions of the adoption of, the barriers to, and the facilitators of the implementation of the practice model. Discussion: The evaluation of training in the guideline-oriented biopsychosocial management of LBP in occupational health services is justified because LBP represents an enormous burden in terms of work disability