The stories they tell: How third year medical students portray patients,family members,physicians, and themselves in difficult encounters

Background: Physicians have long had patients whom they have labeled “difficult”, but little is known about how medical students perceive difficult encounters with patients.

Methods: In this study, we analyzed 134 third year medical students’ reflective essays written over an 18-month period about difficult student–patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students’ observations and reflections.

Results: Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed “nonmedical” problems; fearful, worried, withdrawn, or “disinterested” in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in “standard” behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions.

Conclusions: These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.     

T1ρ Hip Cartilage Mapping in Assessing Patients With Cam Morphology: How Can We Optimize the Regions of Interest?

Clinical Orthopaedics and Related Research® - T1ρ MRI has been shown feasible to detect the biochemical status of hip cartilage, but various region-of-interest strategies have been used,...     

Muscle tissue atrophy, extramuscular and intramuscular fat accumulation, and fat gradient after delayed repair of the supraspinatus tendon: A comparative study in the rabbit

To investigate the atrophy of supraspinatus (SSP) muscle tissue and accumulation of extramuscular fat (e‐fat) and intramuscular fat (i‐fat) after delayed repair of the SSP tendon, and to correlate CT findings with histology. One SSP tendon of 36 rabbits was transected, then repaired in groups of 12 at 4, 8, or 12 weeks and then followed for 12 weeks. Thirty‐six normal shoulders served as controls. We compared the SSP muscle, e‐fat weights and volumes, muscle tissue and i‐fat areas on histology, e‐fat and attenuation values on CT between the experimental and control shoulders. CT‐to‐histology correlations were run. SSP muscle tissue atrophy, e‐fat and i‐fat accumulation were present after tendon repair delayed by 4, 8, or 12 weeks (all p < 0.05). Both e‐fat and i‐fat accumulation presented increasing proximal‐to‐distal gradients (both p < 0.05). CT depicted the muscle tissue atrophy, e‐fat and i‐fat accumulation, and increasing proximal‐to‐distal gradients (all p < 0.05). We found strong CT‐to‐histology correlations (p < 0.05). SSP muscles showed tissue atrophy, e‐fat and i‐fat accumulation after successful SSP tendon repairs delayed by 4, 8, or 12 weeks. Subtracting i‐fat from the muscle area determined the SSP muscle tissue atrophy. Increasing proximal‐to‐distal fat gradients were diagnostic if not pathognomonic of an initial SSP tendon disruption. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 30:781–786, 2012     

Can T1-rho MRI detect acetabular cartilage degeneration in femoroacetabular impingement?: a pilot study

Advanced MRI cartilage imaging such as T(1)-rho (T1ρ) for the diagnosis of early cartilage degradation prior to morpholgic radiological changes may provide prognostic information in the management of joint disease. This study aimed first to determine the normal T1ρ profile of cartilage within the hip, and secondly to identify any differences in T1ρ profile between the normal and symptomatic femoroacetabular impingement (FAI) hip. Ten patients with cam-type FAI (seven male and three female, mean age 35.9 years (28 to 48)) and ten control patients (four male and six female, mean age 30.6 years (22 to 35)) underwent 1.5T T1ρ MRI of a single hip. Mean T1ρ relaxation times for full thickness and each of the three equal cartilage thickness layers were calculated and compared between the groups. The mean T1ρ relaxation times for full cartilage thickness of control and FAI hips were similar (37.17 ms (SD 9.95) and 36.71 ms (SD 6.72), respectively). The control group demonstrated a T1ρ value trend, increasing from deep to superficial cartilage layers, with the middle third having significantly greater T1ρ relaxation values than the deepest third (p = 0.008). The FAI group demonstrated loss of this trend. The deepest third in the FAI group demonstrated greater T1ρ relaxation values than controls (p = 0.028). These results suggest that 1.5T T1ρ MRI can detect acetabular hyaline cartilage changes in patients with FAI.