Professional identity formation (PIF) within medical education is the multifaceted, individualized process through which students develop new ways of being in becoming physicians. Personal backgrounds, values, expectations, interests, goals, relationships, and role models can all influence PIF and may account for diversity of both experience and the active constructive process of professional formation. Guided reflection, including reflective writing, has been used to enhance awareness and meaning making within the PIF process for both students and medical educators and to shed light on what aspects of medical education are most constructive for healthy PIF. Student voices about the PIF process now emerging in the literature are often considered and interpreted by medical educators within qualitative studies or in broad theoretical overviews of PIF.In this Commentary, the authors present a chorus of individual student voices from along the medical education trajectory. Medical students (years 1-4) and a first-year resident in pediatrics respond to a variety of questions based on prevalent PIF themes extracted from the literature to reflect on their personal experiences of PIF. Topics queried included pretending in medical education, role of relationships, impact of formal and informal curricula on PIF (valuable aspects as well as suggestions for change), and navigating and developing interprofessional relationships and identities. This work aims to vividly illustrate the diverse and personal forces at play in individual students' PIF processes and to encourage future pedagogic efforts supporting healthy, integrated PIF in medical education.

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Objectives: While electronic health record (EHR) use is becoming state-of-the-art, formal teaching of Health Care Information Technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT but formal pedagogy is sparse. Fundamental challenges include preserving and fostering effective health care provider-patient communication skills in the computerized setting to preserve patient and relationship-centered care and facilitate reciprocity within whole person care. Thus, curriculum innovation with overarching goal of empowering undergraduate medical students’ patient- and relationship-centered interviewing skills, information mastery, electronic documentation skills, and HCIT-supported patient education is needed.Methods: The authors describe innovative, systematic curriculum development for EHR training within a series of clinical skills courses at their institution, informed by Kern et al.’s framework, narrative medicine, and reflective practice. Initially, a didactic and an observed standardized patient encounter were piloted in Year 3. Subsequent surveys of participating faculty both validated the session’s educational value and identified the need for additional practice opportunities.Results: In addition to the existing presentation and individualized practice, second iteration revisions include reflective readings and exercises, relevant “introductory” skills presented in grid format, and opportunities for direct observation of and by mentor physicians in clinical settings. The behavior grid was then expanded to include “advanced” Year 4 skills, i.e. patient participation for chart building, patient education/information sharing, shared decision-making, and sending information to the interprofessional health care team.Conclusions:  Effective triangulation of physician-patient-computer may be optimized with medical education curriculum developing competencies of effective EHR use preserving patient-and relationship-centered care, reflection, and narrative medicine. Systematic, longitudinal monitoring of learners' skill development by faculty, standardized patient, self-assessment, and reflective writing will inform our innovative multi-faceted, longitudinal, transferable curriculum presented herein. Further research is needed on formal pedagogy for EHR use by learners.

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Reflective learning and practice foster personal, professional, and interprofessional identity development within health professions education to encourage humanistic, competent patient care. Reflection on experience nurtures mindful presence and adaptive expertise/”practical wisdom,” enabling the health care professional to recognize and address patients’ and families’ emotional, psychosocial, cultural, and spiritual needs for optimizing whole person care (WPC). By heightening awareness of strengths, values, biases, and/or limitations, reflection also helps the provider bring more of his/her “whole person” to WPC, strengthening the provider-patient therapeutic relationship (reciprocity for healing). The use of reflective writing (RW) to augment reflective practice is well documented. RW in the small group setting fosters narrative competence (hearing/responding to a patient’s story, awareness of one’s own stories), self-assessment, moral sensitivity, empathy, emotional processing, and provider well-being. At Alpert Med, we have implemented an “interactive reflective writing” (IRW) paradigm of guided individualized feedback from interdisciplinary faculty to students’ RW in a Doctoring course and Family Medicine clerkship (with small group peer-based narrative sharing and collaborative feedback). Frameworks for enhancing educational value of feedback (BEGAN and REFLECT-reflective level evaluation rubric) were developed, incorporated into student and faculty guides, and applied in faculty development.INTERACTIVE WORKSHOP OBJECTIVES: 1) Participants will be familiarized with constructs of reflective learning/practice and IRW, 2) Participants will apply BEGAN and REFLECT to a student’s reflective essay as exemplar, 3) Participants will engage in interactive dialogue with medical student presenters on positive learning outcomes of IRW for WPC 4) Participants will consider and share merits, limitations, and possible utility of presented curricula/evaluative tools for their settings. FORMAT/ACTIVITIES:1. Didactic - Reflective Learning/Practice for WPC2. Participants provide feedback to student’s RW3. Discussion4. Introduce BEGAN/REFLECT frameworks5. Participants re-craft feedback with frameworks/Discuss6. Student/faculty presenters share experiences of IRW pedagogy for fostering reflection and WPC7. Wrap-up/Q and A.