Research Report
Do Medical Students’ Narrative Representations of “The Good Doctor”
Change Over Time? Comparing Humanism Essays From a National
Contest in 1999 and 2013
Pooja C. Rutberg, MD, Brandy King, MLIS, Elizabeth Gaufberg, MD, MPH, Pamela Brett-MacLean, PhD, Perry Dinardo,
and Richard M. Frankel, PhD
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Abstract
Mi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 04/05/2024
Purpose
To explore medical students’ conceptions
of “the good doctor” at two points in
time separated by 14 years.
Method
The authors conducted qualitative
analysis of narrative-based essays.
Following a constant comparative
method, an emergent relational
coding scheme was developed which
the authors used to characterize
110 essays submitted to the Arnold
P. Gold Foundation Humanism in
Medicine Essay Contest in 1999 (n
= 50) and 2013 (n = 60) in response
to the prompt, “Who is the good
doctor?”
Editor’s Note: Although the winning Arnold P. Gold
Foundations essays were not published in Academic
Medicine until 2001, those who are interested in
reading the winners from the 2013 essay contest
that asked students, “Who is the good doctor?” can
access them by searching for “2013 essay contest”
on the Academic Medicine Web site.
I will tell you something about stories …
They aren’t just entertainment. Don’t be
fooled. They are all we have, you see, all
we have to fight off illness and death.
―Leslie Marmon Silko, Ceremony1
C
onceptions of the “good doctor”
have helped shape the story of medicine
since the time of Hippocrates.2 In the
past several decades, numerous studies
Please see the end of this article for information
about the authors.
Correspondence should be addressed to Pooja C.
Rutberg, Cambridge Health Alliance–Pediatrics
Department, 1493 Cambridge St., Cambridge, MA
02139-1047; telephone: (617) 665-1497; e-mail:
prutberg@challiance.org; Twitter: @GoldFdtn.
Acad Med. 2017;92:537–543.
First published online December 20, 2016
doi: 10.1097/ACM.0000000000001531
Academic Medicine, Vol. 92, No. 4 / April 2017
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
Results
The authors identified five relational
themes as guiding the day-to-day
work and lives of physicians: doctor–
patient, doctor–self, doctor–learner,
doctor–colleague, and doctor–system/
society/profession. The authors noted
a highly similar distribution of primary
and secondary relational themes for
essays from 1999 and 2013. The
majority of the essays emphasized
the centrality of the doctor–patient
relationship. Student essays focused
little on teamwork, systems innovation,
or technology use—all important
developments in contemporary
medicine.
and reports have explored the question
of who and what the “good doctor” is
in the context of contemporary medical
practice.3–7 While these reports have
been valuable in outlining community
norms and guiding educational
programming, few studies have
explored how different societal contexts
across time may influence medical
students’ conceptions of the “good
doctor.”2–5
Additionally, numerous authors have
described the use of written reflective
narratives in medical education,
particularly in relation to supporting
students’ professional identity
formation.8–11 Written narratives also
offer important means for medical
educators to understand students’
developmental trajectory as physicians in
training.
The annual Arnold P. Gold Foundation
(APGF) essay contest invites medical
students to engage in a reflective
writing exercise around a theme or
quote related to humanism in medicine.
Since its inception in 1999, medical
Conclusions
Medical students’ narrative reflections
are increasingly used as rich sources of
information about the lived experience
of medical education. The findings
reported here suggest that medical
students understand the “good doctor”
as a relational being, with an enduring
emphasis on the doctor–patient
relationship. Medical education would
benefit from including an emphasis on
the relational aspects of medicine. Future
research should focus on relational learning
as a pedagogical approach that may
support the formation of caring, effective
physicians embedded in a complex array
of relationships within clinical, community,
and larger societal contexts.
students from the United States and
Canada have responded with rich
narratives that provide insight into
how students who are learning how to
be doctors are supported or hindered
in their understanding and expression
of humanism. In both 1999 and 2013
the Gold Foundation used the prompt
“Who is the good doctor?” for its essay
contest.
The use of the same prompt with a
14-year gap has provided a unique
opportunity to study medical students’
conceptions of whom they consider the
“good doctor” to be at two distinct points
in time. Given the profound changes that
have influenced medicine over the past
decade and a half, including a growing
emphasis on patient-centered care, social
accountability, interprofessional team-
based care, and the use of computer-
based technologies, we compared
conceptions of the “good doctor” as
described in 1999 with those described
in 2013, and we explored whether the
descriptions in 2013 more closely reflect
the realities of contemporary medical
practice.
537
 Research Report
Method
To explore changes in medical students’
views of “good doctors” at two points in
time separated by 14 years, we reviewed
all essays submitted to the APGF essay
contest in 1999 and 2013. At both
points in time, the prompt for the
essay was, “Who is the good doctor?”
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Students submitted 198 essays in 1999
and 191 in 2013. The institutional
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review board of Cambridge Health
Alliance granted an exemption to the
study and waived the need for informed
consent for analysis and publication
of deidentified quotes from the essays.
When students submitted their essays
to the APGF, they signed a waiver
allowing publication of parts or all of
their essays. All essays were anonymized
prior to analysis.
In our initial review of the data, we
observed that some essays described
highly respected role models whom the
writers considered to be “good doctors.”
Other submissions were abstract
philosophical essays comprising lists
of traits and qualities that characterize
the ideal “good doctor”; these did not
include a portrayal of any specific, actual
individual physician. As compared with
lists (“A good doctor is thoughtful,
empathic, and puts the patient’s needs
before his or her own”), narratives (“I was
impressed as Dr. Jones reached for Mrs.
Smith’s hand and sat with her in silence
as she absorbed the news”) have been
described as “the basic medium in which
human beings speak, think, grow into
selves, and understand others.”12 We chose
to focus on the narrative essays since,
compared with abstract descriptions or
lists of facts and attributes, they offered
a more robust and nuanced opportunity
to explore and compare students’
perspectives.13
We conducted a qualitative analysis of
the essays using the constant comparative
method recommended by Glaser and
Strauss.14 All of us (save one [P.D.])
began the process by individually reading
the same randomly selected sample
of 25 essays from 1999 and 25 essays
from 2013. We collectively identified
provisional “thematic elements” such
as compassion and empathy, treating
the whole person, privilege to serve,
and reflective practice. At the next level
of abstraction, we developed a coding
scheme into which we organized the
538
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
thematic elements into an emergent
relational coding framework, similar
to those used by Rita Charon15 and by
Carol P. Tresolini and the Pew Fetzer
Task Force.16 We continued this process,
reading additional essays, until we
achieved thematic saturation (i.e., no
new themes emerged).
Once we had established a coding
framework that included both relational
themes and associated thematic elements,
we used an iterative consensus-building
approach to analyze all the essays in the
sample. Each essay was independently coded
by two or more authors who assigned:
1. A single primary relational theme,
defined as the central message of
the narrative.
2. Where present, up to two
secondary relational themes,
defined as adding significant
supplementary detail to describe
the “good doctor.”
3. Supporting thematic elements for
each relational theme.
Each of us highlighted specific sentences
or text fragments in support of the
themes and thematic elements we
assigned to each essay. We discussed
this coding during in-person and
phone meetings, and we reconciled any
discrepancies through group-based
discussion and consensus. As a final step,
we entered the coded data into NVivo 10
qualitative data analysis software (QSR
International Pty Ltd., Version 10, 2012).
We also used simple descriptive statistics
to summarize and compare the frequency
of primary and secondary relational
themes and associated thematic elements
between 1999 and 2013.
Results
We analyzed a total of 110 essays
containing narrative representations or
portrayals of actual physicians: 50 from
1999 (25.2% of the 198 submitted that
year) and 60 from 2013 (31.4% of the
191 submitted). Table 1 summarizes
the demographic characteristics of the
students whose essays we analyzed.
At both time periods, the essays were
evenly distributed between preclerkship
and clerkship students. In both 1999
and 2013, the described “good doctors”
were primarily characterized as male
physicians practicing in a first-world
hospital or clinical setting (Table 2).
Thematic analysis
We identified five relational themes as
guiding the day-to-day work and lives of
physicians described in the essays:
1. Doctor–patient
2. Doctor–self
3. Doctor–learner
4. Doctor–colleague
5. Doctor–system/society/profession
We observed a highly similar distribution
of primary and secondary relational
themes for the essays in both 1999 and
2013 (see Table 3). We detected no
difference in the number of themes
assigned to the essays at the two time
periods. We assigned a single primary
relational theme to about a third of
the essays (n = 29); we assigned both
a primary and a secondary theme to
about 40% of the essays (n = 47); and we
assigned one primary and two secondary
themes to about a third of the essays (n
= 34). On average, we assigned the essays
from both 1999 and 2013 two themes.
We have provided illustrative quotes
associated with the five relational themes
in Table 4, and a summary of thematic
elements associated with each relational
theme in Table 5.
Relational theme 1: The doctor–patient
relationship
The doctor–patient relationship was
the primary theme in 38 (76.0%) of the
1999 and 47 (78.3%) of the 2013 essays.
Together with secondary themes, almost all
essays (48 [92.0%] of the 1999 essays and
56 [92.3%] of the 2013 essays) contained
thematic content related to the doctor–
patient relationship. As illustrated by the
sample quotes in Table 4, students provided
nuanced portrayals of the various ways
“good doctors” interacted with patients.
Students described physicians whose
“entire heart and soul were immersed in
the desire to help people,” and who were
“not only concerned with murmurs of the
valves but other murmurs that arise from
sorrow, sadness, and depression.” These
essays highlighted clinical excellence, as
well as key aspects of patient-centered care,
such as compassion and empathy, treating
the whole person, and partnering with
patients and families. The distribution of
various thematic elements associated with
the doctor–patient relationship theme,
Academic Medicine, Vol. 92, No. 4 / April 2017
 Research Report

described a wide range of emotions and

Table 1 characteristics relating to the personhood
Demographic Characteristics of Medical Students Submitting to the Arnold P. Gold of the “good doctor” (Table 5). Of note,
Foundation Essay Contest, by Yeara humility was the most common thematic
1999, no. 2013, no.
element in this theme. The student
Characteristic (% of 50) (% of 60) essayists also frequently described the
“good doctor” as being accepting of
Gender
others, “willing to learn, to be affected,
 Male 19 (38.0) 29 (48.3)
and to be humbled by” patients.
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 Female 21 (42.0) 14 (23.3)

 Gender unknown 10 (20.0) 17 (28.3) Relational theme 3: The doctor–learner
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Year of medical relationship

school
The doctor–learner relationship was a
 First 9 (18.0) 21 (35.0) primary theme in 5 (10.0%) of the 1999
 Second 17 (34.0) 12 (20.0) and 4 (6.7%) of the 2013 essays, and a
 Third 12 (24.0) 19 (31.7) secondary theme in 5 (14.3%) of the
 Fourth 11 (22.0) 7 (11.7) 1999 and 14 (32.6%) of the 2013 essays.
 Other 1 (2.0) 1 (1.7) Interestingly, 2013 student essayists more
frequently described exemplary physicians
a
In both 1999 and 2013, the essay contest prompt was, “Who is the good doctor?” Note that the sum of the
as inspiring role models—“equal part
percentages may not equal 100 because of rounding.
healer and advocate”—compared with
their 1999 counterparts: 12 (66.7%) in
summarized in Table 5, highlight its secondary theme in 24 (68.6%) essays 2013, compared with 3 (30.0%) in 1999.
complexity. in 1999 and 25 (58.1%) in 2013. As
illustrated by the quotes in Table 4, Relational theme 4: The doctor–
Relational theme 2: The doctor–self students recognized the complex colleague relationship
relationship personal qualities of physicians who
Including both primary and secondary
The doctor–self relationship was the strived to be caring, compassionate,
themes, only 8 (16.0%) of the 1999
primary theme in 3 (6.0%) essays in and skilled practitioners. Essays that
essays and 4 (6.7%) of the 2013 essays
1999 and 5 (8.3%) in 2013; it was the included doctor–self thematic content included thematic content related to
the doctor–colleague relationship. This
Table 2 relational theme was not well articulated;
Demographic Characteristics Associated With Physicians Described as Exemplars of essay descriptions were limited to
the “Good Doctor” in Narrative Essays Submitted to the Arnold P. Gold Foundation collegial communication, teamwork, and
Essay Contest, by Yeara leadership (see Table 5).
1999, no. 2013, no.
Characteristic (% of 50) (% of 60) Relational theme 5: The doctor–system/
society/profession relationship
Gender
 Female 10 (20.0) 13 (21.7) Even as attention to social accountability
 Male 38 (76.0) 37 (61.7)
in medicine is increasing, we identified
relational activity associated with systems-
 Both male and female physicians mentioned 2 (4.0) 8 (13.3)
based and societal concerns as a primary
 Unknown 0 2 (3.3) theme in only 3 (6.0%) of essays in 1999
Geographical setting and 3 (5.0%) in 2013, and as a secondary
 Rural 9 (18.0) 11 (18.3) theme in only 4 (11.4%) of the essays in
 Suburban 2 (4.0) 1 (1.7) 1999 and 10 (23.3%) in 2013. Awareness
 Urban 4 (8.0) 10 (16.7) of social determinants of health, health
 Multiple settings mentioned 1 (2.0) 2 (3.3) inequities, and commitment to social
justice was a prominent feature of the
 Unknown 34 (68.0) 36 (60.0)
essays which included this thematic
Global/economic setting
content (Table 5). Students described
 First-world nations 46 (92.0) 49 (81.7) doctors who help “human beings break
 Developing nations 3 (6.0) 10 (16.7) the cycle of addiction and homelessness,
 Both or multiple settings 1 (2.0) 1 (1.7) which binds them to their current state”
Medical practice setting and physicians whose work “transcends
 Hospital or clinic 41 (82.0) 50 (83.3) the hospital.”
 House call or other community setting 8 (16.0) 8 (13.3)
 Multiple settings or other 1 (2.0) 2 (3.3) Discussion
a
In both 1999 and 2013, the essay contest prompt was, “Who is the good doctor?” Note that the sum of the The annual APGF essay contest offers
percentages may not equal 100 because of rounding. a unique opportunity to learn about

Academic Medicine, Vol. 92, No. 4 / April 2017 539

Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
 Research Report
Table 3
Relational Themes Identified Within Narrative Essays Submitted to the Arnold P.
Gold Foundation Essay Contest, by Yeara
Primary relational
themes
Doctor–patient
Doctor–self
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Doctor–learner
Doctor–colleague
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Doctor–system/society/profession
Secondary relational themesb
Doctor–patient
Doctor–self
Doctor–learner
Doctor–colleague
Doctor–system/society/profession
a
In both 1999 and 2013, the essay contest prompt was, “Who is the good doctor?”
b
Some essays contain two secondary themes, so the sum of percentages is greater than 100.
medical students’ understandings of and
insights into humanism in medicine.
The essays we analyzed offer a rich
source of comparative information about
permanence and change in medical
students’ perspectives of the “good
doctor” at two points in time (1999 and
2013), and the extent to which changing
social norms are reflected in students’
representations.
Relational framework
Our analysis of the 1999 and 2013
narrative-based essays (n = 110) resulted
in a coding framework that included
five cardinal relationships: doctor–
patient, doctor–self, doctor–learner,
doctor–colleague, and doctor–system/
society/profession. While others have
described the role of the doctor in
relational terms,15,16 this is the first study
we are aware of in which an emergent
relational framework has been used to
explore and compare medical students’
conceptualization of the “good doctor”
at two points in time. Notably, an earlier
study at five different medical schools
found that faculty valued the positive
relational aspects of their institutions,
even as they recognized that such
settings tended to value individual
productivity, self-promotion, and
hierarchical structures.17 Specifically,
similar to the students in our analysis,
faculty members asserted that they
valued positive relationships with
patients and learners and collaboration
with colleagues.17
540
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
1999, 2013,
no. (% of 50) no. (% of 60)
38 (76.0) 47 (78.3)
3 (6.0) 5 (8.3)
5 (10.0) 4 (6.7)
1 (2.0) 1 (1.7)
3 (6.0) 3 (5.0)
1999, 2013,
no. (% of 35) no. (% of 43)
10 (28.6) 9 (20.9)
24 (68.6) 25 (58.1)
5 (14.3) 14 (32.6)
7 (20.0) 3 (7.0)
4 (11.4) 10 (23.3)
Role and influence of relationships
on professional identity formation:
Implications for medical education
Our findings suggest that students
understand the complexities of good
doctoring and its implications for
their own professional development
in terms of relationships, rather than
individual heroic acts or isolated
behaviors. There is literature to support
this perspective: Monrouxe18 has drawn
attention to interactional aspects of
identity, asserting that “identities are
developed in relational settings through
activities” and that “relationships are the
central components of identification.”
This view contrasts with skills-based
competency frameworks (such as the
Accreditation Council for Graduate
Medical Education’s milestones) that
cast professional development as an
individual achievement, rather than an
ongoing, relationally engaged endeavor.
Striving to learn more from students
about their perceptions of the “good
doctor” and how those perceptions relate
to identity formation may be useful both
in developing curricula that address the
educational needs of an increasingly
diverse medical student body, and for
preparing medical students to work
effectively in complex health care systems
to meet the changing needs of society.
Meeting students where they are in their
professional development is a primary
precept of adult learning theory.19
Understanding and acknowledging
differences in time, space, and experience
among various cohorts of students
and faculty may help educators as they
develop curricula and create educational
environments that support students in
developing their professional identities
in an ever-evolving practice landscape.
The essays we analyzed provide evidence
that medical students appreciate
that excellence in clinical practice is
critically dependent on the ability to
learn and work relationally.20,21 Given
this emphasis, we wonder how current
educational strategies can support
the professional identity formation of
students in ways that strengthen the
development of the “relational being”
in medicine.22 Relational learning as a
pedagogical approach may support the
formation of caring, effective physicians.
Our findings also highlight the need
to ensure that relationships with role
models, patients, and other members
of the health care team are highlighted
dimensions of the formal and informal
curriculum.16
Notably, the majority of the “good
doctors” described in the essays were
male doctors practicing in first-world
settings. It is important for students
to have diverse role models who allow
them to imagine themselves as successful
physicians in the future.23 Greater than
50% of current medical students are
female, and we wonder how and when
cultural stereotypes within medical
education and the broader culture will
begin to reflect this reality.
Evolution over 14 years
Much as others have explored new
physicians’ preparedness for practice,24–26
we wondered if conceptions of the “good
doctor” held by a recent, compared with
an earlier, cohort of medical students
reflected the realities of contemporary
medical practice. At two points, separated
by a span of 14 years, the single theme
that remained foundational to being a
good doctor, according to the medical
student essayists in our study, is the
doctor–patient relationship. Despite the
changes that have occurred in medicine,
health care, and society over the last
decade and a half, we found a highly
similar distribution of primary and
secondary themes between the two time
periods in which essays were collected.
The lack of emphasis on the doctor–
colleague relationship, especially in the
Academic Medicine, Vol. 92, No. 4 / April 2017
 Research Report

2013 essays, is noteworthy given the role of a physician as a system innovator analyzed, despite the increasing emphasis
increasing importance of teamwork in and/or effective technology user was not placed on these roles.
clinical practice. In addition, the broader significantly featured in the essays we
Limitations
We are aware of a number of limitations
Table 4 in our study. The essay authors are self-
Sample Quotations Illustrating Relational Themes Identified Within Narrative selected individuals who were aware that
Essays Submitted to the Arnold P. Gold Foundation Essay Contest, by Yeara the APGF is an organization dedicated
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Relational theme Sample quotation (year; thematic elements) to promoting humanism in medicine.
Most, if not all, of the students entered the
Doctor–patient He is good because he had understood her, had talked to her, had rubbed
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her sore leg and embraced her before she left. She had come for medicines
competition hoping that their submission
as well as the solace and comfort of another human being. The practice of would win. Some may have written “to
medicine by pen and form is unfamiliar to him. The practice of medicine the test,” providing thematic content
using mind, hand and heart is his skill and forte. (1999; compassion & they believed would conform to what the
empathy, doctor–patient communication) judges would view as valuable.27 As such,
Imagine, Dr. Jones sharing bad news that a miscarriage has robbed an those who submitted essays are likely not
excited couple of their first child. He does not simply enter the room with
reports and documentation proving his assumption, but he stops his day. representative of all medical students in
This doctor pulls over a chair, sits next to the bed, and comforts.… The the United States and Canada. In addition,
words uttered convey a sense of knowledge and empathy of how it feels we chose to analyze a small proportion
to be lying in that hospital bed. (2013; compassion & empathy, doctor– (about 30%) of the total essays, specifically
patient communication, presence)
those that included descriptive portrayals
Doctor–self He had a title which many consider prestigious, but did not need or seek of actual exemplary physician role
fanfare or glory. He was content in the knowledge that he spent each day
doing all he could to help people. (1999; humility, managing uncertainty, models. Although some may believe that
role models) restricting our inquiry to only narrative
She knows she cannot predict the circumstances to which she will have to configurations of the “good doctor”
rise … and she knows that some days she will fall short or may even fail. might constitute a limitation, we believe
Yet the good doctor does not let uncertainty or the fear of failure become this choice afforded us an important
an obstacle. She continues to strive for excellence in patient care … she opportunity to explore and begin a
is constantly committed to self-improvement. (2013; humility, lifelong
learning, managing uncertainty) dialogue about the relational aspects of
identify formation in medical education.
Doctor–learner He loved to refer to his medical students as his “wingmen”—eager young
doctors who are full of knowledge and limited experience, but ready to
go into “combat” anyway. Yet, it was also a two-way street of teamwork. Future research
As much as he watched us, he expected his wingman to watch his
back or “six o’clock” also. He instilled in us that he believed and trusted
What does the “good doctor” in the 21st
in our ability, and the idea of true teamwork. (1999; doctor–learner century look like? As we seek answers
communication, teamwork) to this question for the present and the
Afterward, Dr. C pulled me aside, knowing I needed to debrief. She future, medical students are a source
involved me in several other heartbreaking codes on children who of idealism and optimism. Given our
should have been at school, not dying in an urban cholera hospital from findings, future research might include
preventable conditions. When I became curious about certain conditions
we saw during rounds, Dr. C directed me to the appropriate literature, so I
investigation of the relational aspects of
could learn from these experiences. (2013; role models, learner-centered) identity formation, as well as investigation
Doctor–colleague “This is terrible,” he said. “How am I going to give him this news?” … of the ways in which students learn
one of his patients, a 41-year-old healthy man, had come in a month ago about, adjust to, and make sense of the
with headaches.… He spent a good part of the morning asking colleagues contemporary realities of medicine, while
and staff, “How would you want to be told that you have a brain tumor?” attempting to hold onto their hopes
(1999; doctor–colleague communication, doctor–patient communication,
compassion & empathy)
and idealism for the future. Analysis of
APGF student essays containing lists of
She maintains a tone to urge the importance of a task while not
demeaning any member of the team. For example, Dr. Ali controlled
characteristics of the “good doctor,” as
the actions of the team while standing at the head of the bed after a well as student essays describing the “good
traumatic accident left a young man incapacitated and in shock.… She doctor” obtained from diverse groups
communicated with clarity and brevity providing the support and direction (e.g., underrepresented minority students,
the room needed. (2013; teamwork, doctor–colleague communication,
students in other health professions,
calm under pressure)
residents and fellows, clinical preceptors,
Doctor–system/ Her clinic not only treats people, but also supports a primary school and
society/profession boarding school for orphaned and abandoned children, as well as women’s
the public), would also be useful in
organizations in the nearby refugee camps. (1999; system innovator) establishing the generalizability of our
The good doctor … sees a patient whose insurance will cover the payment relational framework within and across
of certain branded medicines, but not others. Though she is not required disciplines, levels of learning, and society.
to, the good doctor works as a liaison between medicine and the business
of medicine.… She recognizes that her profession may require her to
exercise skills that she was not specifically trained for, but her commitment Conclusions
to her patients has her take on the role. (2013; social justice and advocacy)
Rita Charon15 has argued that “the
a
In both 1999 and 2013, the essay contest prompt was, “Who is the good doctor?”
effective practice of medicine requires

Academic Medicine, Vol. 92, No. 4 / April 2017 541

Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
 Research Report

narrative competence, that is, the ability
to acknowledge, absorb, interpret, and
act on the stories and plights of others.”
Medical students’ stories and narratives
provide important means of conveying
and understanding how they learn
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their craft and become the doctors they
hope to become. Stories are also the
primary medium through which faculty
preceptors and role models relate their
experiences to students and one another.
Through this research, in response to
reading and reflecting on the student
essays we were analyzing, we frequently
found ourselves telling stories of our
own professional development. As we
reflexively developed our consensus-
based interpretive framework we were
also, in essence, communicating across
generations with medical students at
two points in time as we compared

Table 5 our hopes, dreams, perspectives,

Relational Themes and Associated Thematic Elements Identified Within Narrative
Mi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 04/05/2024

Essays Submitted to the Arnold P. Gold Foundation Essay Contest, by Yeara

and understandings with theirs.
Although not our formal purpose, one
1999, 2013, unanticipated outcome of our narrative
Theme: Doctor–patient no. (% of 46) no. (% of 56) inquiry was that we drew closer to the
Accommodation 10 (21.7) 8 (14.3) writers, and perhaps their generations,
Active listening 9 (19.6) 15 (26.8) as we read and re-read their essays.
Altruism 5 (10.9) 4 (7.1) Immersed within the relationships
Clinical excellence 13 (28.3) 17 (30.4)
highlighted in their narrative essays,
we were heartened by the enduring
Compassion & empathy 26 (56.5) 37 (66.1)
prominence of the doctor–patient
Cultural competence 5 (10.9) 1 (1.8)
relationship even as we noted
Dedication 5 (10.9) 9 (16.1) disconnects with contemporary medical
Doctor–patient communication 30 (65.2) 24 (42.9) practice. As Bleakley28 has noted, “There
Patients & families as partners 19 (41.3) 27 (48.2) are no doctors without patients.” We are
Presence 9 (19.6) 7 (12.5) hopeful that in becoming more attuned
Treating the whole person 16 (34.8) 16 (28.6) to the exquisite observations the student
essayists made about good doctors,
1999, 2013,
Theme: Doctor–self no. (% of 27) no. (% of 30)
as well as those that were missing, all
of us may be more fully prepared to
Accepting of others 9 (33.3) 6 (20.0)
develop identity constructions informed
Authenticity 5 (18.5) 4 (13.3) by societal and health care system
Calm under pressure 2 (7.4) 3 (10.0) challenges and opportunities while
Ethical 1 (3.7) 1 (3.3) remaining grounded in an ecosystem of
Humility 11 (40.7) 17 (56.7) relationships (with patients, learners,
Humor 2 (7.4) 2 (6.7) colleagues, and self). Our hope is
Lifelong learning 1 (3.7) 3 (10.0) that relational intelligence becomes
woven into the fabric of medical
Managing uncertainty 2 (7.4) 2 (6.7)
education and that medical education
Mindfulness 0 3 (10.0)
recognizes medicine’s social contract
Privilege to serve 4 (14.8) 5 (16.7) and humanism as key to good doctoring
Reflective practice 5 (18.5) 4 (13.3) today and in the future.29
Work–life balance 1 (3.7) 1 (3.3)
Acknowledgments: The authors wish to thank the
1999, 2013, Arnold P. Gold Foundation.
Theme: Doctor–learner no. (% of 10) no. (% of 18)
Doctor–learner communication 7 (70.0) 6 (33.3) Funding/Support: None reported.
Learner-centered 3 (30.0) 6 (33.3) Other disclosure: None reported.
Medical education 2 (20.0) 2 (11.1)
Ethical approval: The institutional review board
Role models 3 (30.0) 12 (66.7)
of Cambridge Health Alliance waived the need
1999, 2013, for informed consent for analysis of the essays.
Theme: Doctor–colleague no. (% of 8) no. (% of 4)
Doctor–colleague communication 4 (50.0) 4 (100) Disclaimer: The winning Arnold P. Gold
Foundation essays have been published in
Leader 2 (25.0) 1 (25.0) Academic Medicine each year since 2001.
Teamwork 5 (62.5) 1 (25.0)
Previous presentations: Previous versions of
1999, 2013, this have been presented at Creating Space IV:
Theme: Doctor–system/society/profession no. (% of 7) no. (% of 13)
Exploring Paradigms of Scholarship and Practice,
Commitment to the profession 4 (57.1) 4 (30.8) Presymposium, Canadian Conference on Medical
Social justice and advocacy 6 (85.7) 9 (69.2) Education, April 2014, Ottawa, Ontario, Canada,
and at the Gold Humanism Honor Society
Systems innovator 2 (28.6) 2 (15.4)
Biennial National Conference on Humanism:
a
In both 1999 and 2013, the essay contest prompt was, “Who is the good doctor?” In some cases the total Advancing Humanism in the Age of Technology,
percentage may exceed 100 because some essays contain two secondary themes. October 2014, Atlanta, Georgia.

542 Academic Medicine, Vol. 92, No. 4 / April 2017

Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.

P.C. Rutberg is clinical instructor, Department of
Pediatrics, Harvard Medical School, Boston, and
pediatric residency site director, Cambridge Health
Alliance, MassGeneral Hospital for Children, Boston,
Massachusetts.
B. King is head, Information Services, Arnold P.
Gold Foundation Research Institute, Cambridge,
Massachusetts.
E. Gaufberg is associate professor of medicine
Downloaded from http://journals.lww.com/academicmedicine by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4X
and psychiatry, Harvard Medical School,
Boston, Massachusetts; Jean and Harvey Picker
Director, Arnold P. Gold Foundation Research
Mi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 04/05/2024
Institute, Cambridge, Massachusetts; director,
Cambridge Health Alliance Center for Professional
Development, Cambridge, Massachusetts; and
leader, Patient–Doctor Course, Harvard Medical
School Cambridge Integrated Clerkship, Cambridge,
Massachusetts.
P. Brett-MacLean is associate professor of
psychiatry, director, Arts & Humanities in Health
& Medicine program, Faculty of Medicine &
Dentistry, and adjunct associate professor, John
Dossetor Health Ethics Centre, University of Alberta,
Edmonton, Alberta, Canada.
P. Dinardo is research intern, Arnold P. Gold
Foundation Research Institute, Cambridge,
Massachusetts.
R.M. Frankel is professor of medicine and
geriatrics, Indiana University School of Medicine,
Indianapolis, Indiana; senior scientist, Regenstrief
Institute Center for Health Services Research and
Richard L. Roudebush VA Center for Healthcare
Information and Communication, Indianapolis,
Indiana; and staff, Cleveland Clinic Education
Institute, Cleveland Ohio.
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