Work your way up to structured reviews As your team gets accustomed to working together and sharing feedback, “you need to do a deeper dive into how team members are doing at the individual level,” says Shapiro. Ask each person to prepare specific reviews of colleagues to be read aloud at the next meeting. “Every team member should say one thing they appreciate about the other members and one thing that would be helpful if they did differently.” The aim is to help “people understand how their behavior is impacting others,” she says. “If they hear the same kind of feedback from multiple people, that is powerful.” When it’s your turn, Schwarz recommends validating your observations with others. “Ask: ‘Are you seeing things the same way?’ Get other people’s reactions.”

At the end of a project or when your team is disbanding, schedule a final check-in to discuss “what worked and what didn’t, what should we bring forward and what should we do differently next time,”

“a rep-resentation of self, achieved in stages over time during which the characteristics, values, and norms of the medical profession are internalized, resulting in an individual thinking, acting, and feeling like a physician.”1

found myself not even stopping to think about the physi-ology or the exam-I knew right away what to say and how to say it. It was a combination of a moment of teaching and patient connec-tion that I don’t think I’ll ever forget

I wasn’t acting like a doctor . . . but it was one of the first times during third year that I felt I had provided a real benefit to a patient—that I wasn’t an extraneous member of the team who was burdensome, but rather somebody who fulfilled a need that would otherwise have been neglected.

If left on their own, students can experience a relative silence on their challenges and their PIF, and this silence is felt by

When the resident dismisses the student concern as more than they can address, the student vows to find ways to address these social determinants of health during their career. This determination to live up to their own ideals represents a vital part of PIF, the integration of personal ideals with the values of the profession.

Yet without reflection and conversation with trusted oth-ers, reframing such narratives as essential to being a physician, there is a risk that such behavior will not be, or will be delayed in being, integrated into the student’s skills repertoire.

A research agenda for professional learning communities: movingforward

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