Personal awareness work is a unique learning opportunity offered at this course. We offer several options for personal awareness learning, so that you may choose one that meets your learning needs and style. The following section discusses the rationale for this work, and presents information that will help you decide which approach might best suit you. The approaches used are:

· Integrated Groups- modeling combined exploration of personal awareness and skills learning

· Narrative Groups

· Case-Based Groups - modeled after the work of Michael Balint

· Family of Origin Groups- modeled on discussion of genograms

· Groups for Intact Teams

· Leadership Groups

Why pursue personal awareness at a faculty development course?

Personal awareness (PA) is central to effective teaching and clinical practice. Self-reflection is the basis of both personal growth and practice improvement. Clinicians problem-solve by applying learning from previous experiences to current clinical dilemmas "automatically,” without conscious direction of thought. We know little about whether the same process occurs when we face relational, psychosocial or affective dilemmas. Feelings evoked by work with patients and students are among the most intimate and exhilarating or difficult that people face. We are all aware of barriers to self-reflection, such as time pressures, predominance of the biomedical model, physicians' and educators need for compartmentalization for survival, and burnout. It is becoming increasingly clear that if we leave feelings unexamined, they can become additional barriers to effective patient care or to competent teaching. One cornerstone of professionalism is to integrate our affective experiences in order to foster personal learning with subsequent benefits to our patients and students. Few chances for this kind of exploration and integration exist in traditional medical education.

Personal awareness groups are opportunities for conversation about meaningful events (either from work at home with patients and students or from events within the course), and the effect of the feelings these events evoke on the work of healthcare provision, teaching, job satisfaction, and learning within the course. All AACH PA groups use as their essential model the teachings of Carl Rogers (widely recognized as the founder of the person-centered approach, the basis of many applications in education, group/organizational work, and counseling) and follow three group principles to create trust and safety that support personal discussion:

· the conversation of the group remains confidential - what is said in the group should remain within the group

· each participant decides how much or how little to say, and says as much or as little as s/he wishes

· each participant speaks for him/herself, not for others

• Integrated Groups- combined exploration of personal awareness and skills learning

The Medical Interview Teachers Association (MITA) developed this model in the United Kingdom. MITA is a group whose mission is similar to that of AACH. The model's working assumption is that personal awareness issues are best addressed in the context of daily work, rather than at specified times in a curriculum. As an example, imagine that during a discussion of an interview, the interviewer comments on the frustration s/he feels when coping with patients who somatize. This "integrated” group might decide to not only discuss and/or role play useful skills for helping with patients who somatize, but also choose to reflect on the source of the interviewer's frustration and how to cope with such feelings. Since emotions frequently arise when working with patients and learners, there are plentiful opportunities to explore this domain throughout the week. This group has the flexibility to divide into whatever configurations and for whatever length of time it determines will properly balance the skills learning goals of the participants with the personal awareness goals.

AACH integrated groups are composed of 8-10 course participants, 2 facilitators, and up to 2 co-facilitators.

• Narrative Groups

Each participant in this group will be asked to be prepared to share (spoken informally, read from pieces s/he has written previously, or written in the moment) 2-3 vignettes that may include the following domains:

· Stories of Celebration (Tell about an experience with a patient or a learner when you felt creative, connected, or felt you made an important and helpful impact)

· My Most Meaningful Patient or Learner¹ (Tell about an experience with a patient or a learner that was meaningful to you. Explain why this experience made an impact, and what you learned.)

· Critical Incident Report² (Tell about an experience with a patient or a learner in which there was conflict, or the outcome was not what you hoped for. What did you learn that you have carried forward in your practice or teaching?)

Participants will explore the extent to which narratives resonate with their own experience, and explore themes of professionalism illuminated by the stories.

¹ Lichtstein PR, Young G. "My Most Meaningful Patient.” Reflective Learning on a General Medicine Service. J Gen Intern Med 1996;11:406-409.
² Branch W, Pels RJ, Lawrence RS, Arky R. Becoming a doctor: critical-incident reports from third-year medical students. N Engl J Med 1993;329:1130-1132.

• Case-Based Groups - modeled after the work of Michael Balint

Michael and Enid Balint developed this approach to personal awareness in Great Britain in the 1950's. Participants in case-based groups discuss particular clinical cases, enabling participants to become more sensitive to and understanding of their patients' experience and use this understanding for enhanced effectiveness.

The AACH has adapted this case-based approach to include teacher-learner relationships and to facilitate more exploration of the doctor/teacher's personal reactions. Participants bring into the group case-based dilemmas, and the group decides which cases will be presented at each session. Participants respond to presentations by offering perspective and empathic support.

AACH Case-Based groups are composed of 8-10 course participants, 2 facilitators, and up to 2 co-facilitators.

• Family of Origin Groups

All of us have family experiences with illness, loss, health behaviors, health beliefs and interactions around dealing with the uncertainty of medicine, loss and death. Styles for tolerating and dealing with affect around these issues are learned in our family of origin. Current problems or unresolved issues within one's family of origin can interfere with working with patients and teaching about working with patients.

All of us have "hot buttons.” These are interactions that take place with certain patients or learners that catch us reacting in ways that we really don't want to. After the initial automatic reaction, when there is time to reflect, we may wish we had behaved differently. Although we may later try to justify the behavior, the nagging feeling of regret is a reliable guide to identifying "hot buttons.”

On the other hand, all of us have strengths. Many clinicians may be drawn into medicine because their upbringing resulted in a highly developed sense of empathy, responsibility and /or altruism. For example, many clinicians filled the role of caretaker in their family of origin and were highly valued and this has ultimately led to a commitment to serving others. This historical role can be both a strength and a weakness. It can be a weakness when it leads to blurred boundaries or inappropriate response to the families we treat. Our family experiences as caretakers can be a strength in developing our empathic skills and our sensitivity to people's needs for help.

The purpose of this group is to take the first step in exploring the relationship between one's family of origin and one's current "hot buttons” and strengths. In this self awareness group we will use our own genograms as a tool to explore how this history led to or maintains our current "hot buttons” and strengths. We will explore whether these reactions still serve us in ways that are useful in our professional roles as providers or teachers of healthcare.

• Groups for Intact Teams

After last year's successful introduction, we invite intact interdisciplinary teams to attend as a group and focus on internal strengthening and team building within your system. Learning groups will focus on enhancing skills and personal awareness among your individual members and the team working on issues that are alive and present for your team. Facilitators will use diverse skills and personal awareness modalities to optimize team function.

• Leadership Groups

An application of the "case-based groups” outlined above, participants in leadership case-based groups will discuss particular management and leadership issues, enabling participants to become more sensitive to and understanding of their direct reports' experiences, and to use this understanding for enhanced effectiveness. This case-based approach will facilitate more exploration of leaders' personal reactions. Participants will bring into the group case-based dilemmas, and the group will decide which cases will be presented at each session. Participants respond to presentations by offering perspective and empathic support.

AACH leadership case-based groups are composed of 8-10 course participants, up to 2 facilitators, and up to 2 co-facilitators.