title: The role of relationships in the professional formation of physicians: case report and illustration of an elicitation technique.
abstract: OBJECTIVE
  Studies of physicians' professional development highlight the important effect that the learning environment has in shaping student attitudes, behaviors, and values. The objective of this study was to better understand the interplay among relationships and experiences in mediating the effects of the learning environment.
  
  
  METHODS
  We randomly recruited 2nd- and 4th-year students from among volunteers at each of five medical schools. One interviewer at each school conducted a face-to-face, open-ended, semi-structured interview with each student. The interviewers used a method called 'life-circle diagramming' to direct the student to draw a picture of all of the relationships in his/her life that had an influence on the sort of doctor that each student saw him/herself becoming. Interviews lasted between 60 and 120 min. Using a narrative framework that focuses on elements of students' stories (e.g., setting, characters, plot), we analyzed transcripts through an iterative process of individual reading and group discussion to derive themes and relationships among themes.
  
  
  RESULTS
  Twenty students completed interviews. These students are embedded in complex webs of relationships with colleagues, friends, family, role models, patients, and others. Most students entered medical school with formed notions of what they wanted to 'be like' as physicians. While students generally gravitated toward relationships with like-minded people, their experiences varied, and some students could sense themselves changing as they moved through school. Such changes were often related to important events or issues. The relationships that students found themselves in during the context of these events had an important effect on students' beliefs about what kinds of behaviors and attitudes were possible and desirable in their future practice.
  
  
  CONCLUSIONS
  Students proceed through medical school embedded in complex webs of relationships that exert a powerful influence (both positive and negative) on their formation as physicians.
  
  
  CONCLUSIONS
  Educational interventions that foster adoption of professional values need to acknowledge the influence of relationships, and assist students to harness and shape relational effects on their growth and development. The life-circle diagramming activity holds potential to promote reflection and self-knowledge, and to provide a foundation for professional growth.
authors.affiliation: The Houston Center for Quality of Care and Utilization Studies, the DeBakey Veterans Affairs Medical Center, and Baylor College of Medicine, 2002 Holcombe Blvd (152), Houston, TX 77030, United States. phaidet@bcm.tmc.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Haidet
authors.forename: David S
authors.initials: DS
authors.lastname: Hatem
authors.forename: Mary Lynn
authors.initials: ML
authors.lastname: Fecile
authors.forename: Howard F
authors.initials: HF
authors.lastname: Stein
authors.forename: Heather-Lyn A
authors.initials: HL
authors.lastname: Haley
authors.forename: Barbara
authors.initials: B
authors.lastname: Kimmel
authors.forename: David L
authors.initials: DL
authors.lastname: Mossbarger
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Inui
mesh_terms: D003376:Counseling / Q000379:methods*; D004501:Education, Medical; D006801:Humans; D007398:Interpersonal Relations; D033262:Narration; D015279:Organizational Culture; D018802:Patient-Centered Care; D010819:Physician's Role; D010817:Physician-Patient Relations; D012951:Socialization; D012963:Sociometric Techniques; D014481:United States