PurposeThere have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on ‘doing the work of a physician’ rather than identity formation and ‘being a physician.’ This study aims to understand how competency-based education impacts the development of a medical student’s identity.MethodsThree ceramic models representing three core competencies ‘medical knowledge,’ ‘patient care,’ and ‘professionalism’ were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes.ResultsStudents across all four years of medical school related to the ‘professionalism’ competency domain (50%). They reflected that ‘being an empathetic physician’ was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized ‘professionalism’ as a competency.ConclusionStudents perceive ‘professionalism’ as a competency that impacts their identity formation in the social role of ‘being a doctor,’ albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception.

Sarcomas in cytology fluids are uncommon, accounting for an estimated 3-6% of malignant effusions. High-grade endometrial stromal sarcomas are uncommon malignancies, whose true frequency is not well defined. We present a case of high-grade endometrial stromal sarcoma with a BCOR translocation metastatic to the pleural fluid. A 31-year-old female with a long-standing history of abnormal uterine bleeding underwent needle core biopsy, which showed a high-grade endometrial stromal sarcoma with a BCOR translocation. In the months following her diagnosis, the patient underwent multiple cycles of chemotherapy along with radiation therapy, but had disease progression. She then presented with bilateral pleural effusions. Cytology from the pleural effusions showed single cells and three-dimensional clusters of spindle-shaped to epithelioid cells. The cell block showed many groups of the atypical cells. The histologic and immunophenotypic features were consistent with metastatic endometrial stromal sarcoma. Ten months after initial diagnosis and two months after positive pleural fluid cytology the patient was deceased. Malignant pleural fluids with sarcoma metastases are not common. Endometrial stromal sarcomas are infrequent malignancies and those with BCOR translocations are recently described with a small number of cases reported. Pleural fluid metastasis of high-grade endometrial stromal sarcoma with BCOR translocation has not, to our knowledge, been described in the literature.

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