Introduction: Teaching residents how to reflect and providing ongoing experience in reflection may aid their development into adaptable, life-long learning professionals. We introduced an ongoing reflective exercise into the curriculum of a family medicine residency program. Residents were provided 15 minutes, three times a week, to complete these reflective exercises. We termed these reflective exercises "clinical blogs" since they were entered into a web-based computer portfolio, though they were not publicly available. The aim of this study is to explore family medicine residents' responses to the introduction of an ongoing reflective exercise and examine strengths and challenges of the reflective process. Methods: We invited a cohort of family medicine residents (8 residents) who had all participated in the reflective exercises as part of their residency to participate in one of two offered focus groups to share their experience with the reflective exercise. An investigator not connected to the training program led each focus group using minimal structure in order to allow for the breadth of residents' experiences to be revealed. The focus groups were audio recorded, and the recordings were transcribed verbatim without identifying participants. We used a grounded theory approach, using open coding to analyze the focus group transcripts and to identify themes. Results: Four residents participated in each focus group. We identified four main themes regarding family medicine residents' responses of the reflective practice exercises: (1) Residents viewed blogging (reflecting) as a method of enhanced personal and professional self-development; (2) Despite the reflective exercises being valued as self-development, residents see an inherent conflict between self-development and professional duties; (3) Residents recognize their emotional responses, but writing about emotional issues is difficult for some residents; and (4) Clinical blogging in our residency has not reached its potential due to the way it was introduced. Discussion: The themes indicate that future efforts at integrating reflective practice should further test the methods through which regular reflective practices are introduced. Identified themes provide evidence for reflection as enhancing capacity for self-development and suggest the potential for clinical blogging as a method to build a cornerstone for the capacity for reflective practice in medicine.

Introduction: A guide for a partnership style of doctor-patient communication tailored to a Southeast Asian culture was previously developed and validated. We introduced the guide to clinical teachers in Indonesia through a participatory approach. Evaluation was based on teachers' demonstrated comprehension and ability to teach the guide. Methods: Three junior researchers invited twelve senior clinical teachers to learn about the guide by writing a chapter on doctor-patient communication using their clinical expertise, reflections on the guide, and the international literature. A participatory study comprised of two cycles (producing first and second drafts of the chapters) was conducted over 18 months with guidance from researchers and written feedback from an expert in communication skills. Qualitative content-analysis was used to assess the content of the submitted chapters. Results: The clinical teachers understood the concept of partnership style doctor-patient communication but demonstrated limited reflection on the Southeast Asian culture. Teachers had difficulty translating the guide into a written learning guide. However, teachers proposed an adapted guide with a simpler structure, tailored to their clinical environment characterized by high patient load and limited time for doctor-patient communications. Discussion: The adapted guide was proof of the teachers' willingness to learn about a partnership style of doctor-patient communications. However, the process of introducing the guide was hindered by the wide power distance between participants throughout all aspects of the study, including communication between senior teachers and more junior researchers.

Introduction: Helping students learn to apply their newly learned basic science knowledge to clinical situations is a long-standing challenge for medical educators. This study aims to describe how medical students' knowledge of the basic sciences is construed toward the end of their medical curriculum, focusing on how senior medical students explain the physiology of a given scenario. Methods A group of final-year medical students from two universities was investigated. Interviews were performed and phenomenographic analysis was used to interpret students' understanding of the physiology underlying the onset of fatigue in an individual on an exercise bicycle. Results: Three categories of description depict the qualitatively different ways the students conceptualized fatigue. A first category depicts well integrated physiological and bio-chemical knowledge characterized by equilibrium and causality. The second category contains conceptions of finite amount of substrate and juxtaposition of physiological concepts that are not fully integrated. The third category exhibits a fragmented understanding of disparate sections of knowledge without integration of basic science and clinical knowledge. Discussion: Distinctive conceptions of fatigue based with varying completeness of students' understanding characterized the three identified categories. The students' conceptions of fatigue were based on varying understanding of how organ systems relate and of the thresholds that determine physiological processes. Medical instruction should focus on making governing steps in biological processes clear and providing opportunity for causal explanations of clinical scenarios containing bio-chemical as well as clinical knowledge. This augments earlier findings by adding descriptions in terms of the subject matter studied about how basic science is applied by students in clinical settings.

Introduction: Interprofessional education (IPE) has been internationally recognized. In the Philippines, however, there is limited experience with IPE. This paper describes the activities of interprofessional teams and the student participants' perceptions of the pilot implementation of the Family Case Management, an IPE initiative of the University of the Philippines Community Health and Development Program in partnership with the Municipality of San Juan, Batangas. Methods: Five teams composed of medical, nursing, occupational therapy, physical therapy and speech pathology students participated. They provided health services to families with complex health needs in the community. Their activities were: (1) orientation of the team, (2) choosing the patient and family, (3) patient and family engagement, (4) assessment and goal-setting, (5) patient and family intervention, and (6) monitoring of outcomes. Students completed a self-administered questionnaire exploring their (1) overall experience, (2) perceptions of the project's most and least useful aspects, and (3) recommendations for improvement. Quantitative and qualitative data analyses were performed. Results: Data showed high ratings of the experience. Themes on the useful aspect of the project were (1) learning about collaboration, (2) appreciation of roles, (3) holistic care, (4) service to the community, and (5) unique learning experience. Themes on the least useful aspects were (1) coordination requirement, (2) patient management, (3) program structure, and (4) community-setting limitations. Recommendations included improvements in communication, orientation, patient management, available resources and supervision. Discussion: The students' appreciation of the Family Case Management demonstrated the opportunity and challenges for IPE implementation in the Philippines.

Introduction: In Australia, recent changes in mental health emergency care (MHEC) service delivery models highlight the need for clinicians to increase their knowledge and skills in mental health. A workplace training program was developed and implemented across the state of New South Wales (NSW) between 2009 and 2010. The program focused on the assessment, management, and support of people who present to Emergency Departments with common mental health problems. The study sought to assess whether there was a change in the knowledge, confidence, and skills of clinicians as a result of the workplace training program. Methods: A total of 127 (89.4%) mental health and emergency department staff returned precourse and postcourse surveys that measured their self-reported confidence in specific mental health skills areas, and perceived self-efficacy in dealing with aggressive behaviors. A 15-item researcher-developed test evaluated mental health knowledge. Perceptions of learning and connectedness were also assessed. Differences in scores were measured using parametric (matched pairs t-tests) and nonparametric (Wilcoxon matched-pairs signed-ranks test), with the magnitude of the effect determined using Cohen's d. Results: Despite challenges in ensuring the involvement of emergency department staff, statistically significant improvements (P < 0.001) were detected in all confidence and skills questionnaire items, perceived self-efficacy in dealing with aggressive behaviors and the knowledge test, with medium to large effect sizes. Discussion: It is noteworthy that even when delivered primarily with mental health staff the program was highly beneficial. The significant investment in new models of MHEC across NSW and recruitment of less experienced staff highlights a need for further research and implementation of the program.

Introduction: Training for new and existing researchers in community-based participatory research (CBPR) approaches requires flexibility and a departure from traditional research methods courses. The literature has not fully reported how universities teach CBPR or the impact of CBPR courses on students and researchers. Method: In this paper, I use a reflective, inquiry-based methodology to find meaning from my experience in a doctoral level CBPR course offered by a southeastern university. Results: Five recommendations, complementary to guiding CBPR principles emerge. These include: Know the inherent challenges, find meaning and purpose, seek to understand complexities, recognize the implications, and use CBPR as a means to redress power. Discussion: The reflection process and recommendations may be useful for institutions, funding agencies, policy makers, and community-engaged researchers.

Introduction: Mentorship is a critical element of capacity-building for health research as it can support career counseling, promote interest in health research and build professional networks. Few studies of mentorship have taken place in low- and middle-income countries. This paper explores the mentorship dimension of the Fogarty International Center's (FIC) support to research training in Kenya and Uganda. Methods: This exploratory study documents the nature of mentoring that occurred within FIC programs, considers the outcomes of mentoring, and the strengths and weaknesses of FIC trainee mentorship during and after training. Two case studies were conducted, at the University of Nairobi in Kenya and Makerere University in Uganda. Semi-structured interviews were conducted with former trainees, principal investigators and institutional leaders, exploring their perceptions of mentoring and its effects. Results: Mentoring aspects of FIC programs were highly valued. Respondents felt that following formal training in the US there was much still to learn about conducting research, and mentoring relationships provided support in applying for and implementing research grants. Mentoring arrangements were initially with US collaborators, but over time relationships with senior African colleagues became critical, particularly in terms of navigating university administrative systems. Mentees were typically highly motivated to pass their skills on to others, and became eager mentors later in their careers. A minority of respondents raised concerns about directive approaches to mentorship that reflect more hierarchical rather than egalitarian approaches. Discussion: Mentorship during and after FIC research training programs, while largely informal in nature, appears to have very positive impacts upon career development and inclination to remain in health research. Local African mentors often play a critical mentorship role, and their contributions should be better recognized.

Introduction: Students' clinical, communication, and professionalism skills are best assessed when faculty directly observe clinical encounters with patients. Prior to 2009, third-year medical students at our institution had one observed clinical encounter by clinic-based faculty during a required internal medicine clerkship. These observations averaged 45 minutes, feedback was not standardized, and student and faculty satisfaction was low. Methods: Two hospital-based faculty members redesigned a shorter, standardized exercise during which a faculty member observed the student making rounds on a hospitalized patient that they were actively following. On a checklist, faculty recorded observations about communication (8 items), physical examination (5 items), and professionalism (4 items). Faculty provided immediate feedback. Results: Faculty's direct observation of medical students prerounding on hospitalized internal medicine patients averaged 27 minutes including the feedback to students. In one year, 67/71 (94%) students completed the exercise; records were available for 66 (99%) of these encounters. Time of observation averaged 13.5 minutes (range 3-26 minutes). Feedback averaged 13.4 minutes (range 8-25 minutes). Faculty provided feedback in the following areas (proportion of students): Communication (66/66, 100%); examination skills (63/66, 95%); and professionalism (65/66, 98%). Forty-three students (64%) completed an anonymous satisfaction survey. Thirty-nine of these (91%) found the exercise useful or very useful (average 5-point Likert score = 4.30) and 38 (88%) found it easy or very easy to schedule (average 5-point Likert score = 4.30). Discussion: Students found this exercise useful and easy to schedule. Faculty consistently provided feedback to students in areas of communication, physical examination, and professionalism.