We had one case where the person had visited the ED 10 times in the past year and over half of those times she was discharged with narcotics. He (the attending) used the Ohio substance abuse monitoring site and found that the patient receives 120 pills/month from a family doctor and appears to supplement through the ED 3-4 times per month. He politely went in and explained to her that Inhibitors,research,lifescience,medical she has a family doctor who prescribes narcotic medicine for her and he was

uncomfortable doing so. He explained it was not his job to refill narcotic medications when the patient has a physician who prescribes them and that she should make an appointment for the next day. The patient was surprisingly understanding. This narrative is similar to the previously discussed respect story, with a patient using the ED in a way the student feels is inappropriate. However, this narrative focuses more heavily on the aspects of how the conversation

took place and the communication techniques used to professionally Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical convey his message. Professionalism narratives were infrequently categorized under the teaching and learning environment domain. Within this domain, two themes were notable. The first, creating an (un)welcoming environment, contains predominantly negative stories. One student writes: It was my first shift in the ED, which my attending had already grumbled about when she first (met) me, and it happened to be a really busy day. Unfortunately I had been Natural Product Library high throughput waiting Inhibitors,research,lifescience,medical to staff a patient for a while, and she was the only attending around so I approached her. She

was standing, working on a computer, so I walked up and stood several feet away, waiting for a break in what she was doing. I didn’t say anything because I didn’t want to interrupt so I just waited. She eventually turned to Inhibitors,research,lifescience,medical me and says, “You need to chill out!” and angrily turns back to her computer. I understand she was busy but I think there could have been a nicer way to tell me I needed to staff my patient with the other attending. The other theme within the teaching and learning environment domain worth noting is capitalizing on teaching opportunities, which had a majority of positive narratives. Another student explains: I was very impressed by the dedication to excellence shown by one Nature Reviews Cancer attending. Although most attendings will offer brief pearls in order to redirect residents or students when they are staffing patients, I rarely see attendings go beyond this level. During one shift I was surprised when one doc called together all the residents and myself for teaching. He thought that this point was important enough that it warranted breaking the hectic pace of the ED. These two narratives offer completely different attending behaviors when teaching is involved.