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Micro-mentors, Communication Ninjas, and the DNR Fairy: Stories of Becoming in Hospice and Palliative Medicine

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Background: The transformative evolution of ‘becoming’ a Hospice and Palliative Medicine (HPM) physician requires learners to integrate knowledge from prior training while learning to “think, act, and feel” [1] like a palliative care physician. The drivers of professional identity formation (PIF) among HPM physicians are not well understood and their impact on training is unknown [2-3]. This study aims to identify factors that impact PIF of HPM physicians.

Objectives: Identify experiences that impact professional identity formation for HPM physicians. Construct a model of factors that impact professional identity in HPM.

Methods: We conducted semi-structured interviews with fellowship-trained HPM physicians practicing in the Southwest. We performed thematic analysis using NVivo software (QSR International) in an iterative, team-based process.

Results: We interviewed 10 HPM fellowship-trained physicians who were non-Hispanic white (100%), 70% female and 30% male, and trained in five primary disciplines. Our preliminary analysis identified three key themes associated with PIF for HPM physicians: (1) formal curriculum; (2) interactions with interdisciplinary team members (particularly chaplains and social workers); and (3) role models/mentors. Interviewees spoke extensively about role models who were supportive, patient-centered, modeled good communication, were compassionate, and encouraged learning.

Conclusion: Interviewees were universally impacted in their PIF by role models who were supportive and patient-centered. Formal didactics and communication curriculum also contributed to PIF.

Implications: HPM is a relatively new specialty and information gained from this study can provide a model for PIF in palliative medicine, can serve as groundwork for HPM fellowship training curriculum and educator development, and can aid HPM educators in nurturing PIF among learners.

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