TRUST AS A FRAMEWORK FOR ETHICAL ANALYSIS. S.D. Goold 1 ; 1 University of Michigan, Ann Arbor, Michigan PURPOSE: Examine trust as a sociological and philosophical construct. Argue that trust can serve as a valid and useful conceptual framework to examine ethical issues in healthcare. METHODS: It is widely acknowledged that trust is a vital component of and basis for relationships between clinicians and patients and that these interpersonal trust relationships have moral content. Trust is especially important in health care, and is present in relationships with organizations (e.g., hospitals, insurers) as well as with clinicians. In this paper I will describe the nature and elements of trust-based relationships, both between individuals (i.e., interpersonal trust) and between individuals and organizations (i.e., institutional trust), and the relationship between interpersonal and institutional trust. I will argue that trust is a valid foundation for healthcare ethics because healthcare is relational and serves vulnerable parties. I will discuss conditions and actions that may increase or decrease actual trust. I will then compare and contrast these with actions and conditions Ð both for individuals and organizations Ð that may influence trustworthiness. Texas A&M University, College Station, TX PURPOSE: Anthropologists have proposed the concept of explanatory models of illness to explain discrepancies between patients' and physicians' views of the illness experience. Because large socioeconomic differences often exist between VA physicians and patients, we performed this qualitative study to explore variations and common tendencies among veterans' explanatory models of illness and the impact that these models have on veterans' perceptions of health and healthcare. METHODS: We developed an interview guide to elicit patients' perspectives about the cause of, meaning of, severity of, amount of control over, and perceived treatment efficacy for their illness. Using this guide, we conducted 10 in-depth, semi-structured interviews with patients at the Houston VAMC one hour prior to their regularly scheduled primary care visits. We audiotaped and transcribed the interviews. We analyzed these transcripts through 3 iterations of individual reading and team discussion to identify common themes that occurred in our 5 areas of inquiry. RESULTS: All participants identified themselves as Caucasian, with ages ranging from 52 to 81. Most participants were seeking care for at least one chronic illness. While some veterans' responses to our specific questions could be considered to fit a biomedical paradigm (e.g. Interviewer:``What do you think caused your diabetes?'', Patient:``My pancreas quit working.''), we discovered that broader, non-biomedical stories of experience, or metanarratives, existed across our categories of questions. These meta-narratives described themes pertaining to patient fatalism and self-efficacy and preferences for physician roles of acknowledgement, action, and communication during the healing process. In cases where veterans perceived their physicians to not attend to these meta-narratives, veterans were dissatisfied and perceived a poorer quality of life. CONCLUSION: While veterans' answers to specific questions about the experience of illness may follow a biomedical paradigm, broader, non-biomedical narratives emerge when these answers are viewed in aggregate. Physician understanding of these narratives during the medical interview is important for enhancing the patient's ability to cope with chronic illness. PURPOSE: Repeated calls have been made for educators to foster students' personal awareness of attitudes and perspectives that influence their professional practices. As part of an exercise intended to foster such personal awareness, all students at Baylor College of Medicine (BCM) complete several standardized instruments (SI) that measure their views toward the physician ± patient relationship, psychosocial care, and stress from uncertainty. Students complete these instruments in their first and third years and, after an explanation of the constructs that are measured by the instruments, receive feedback consisting of their own scores, the average scores of their classes, and published normative data from physicians in various specialties of medicine. We conducted this qualitative study to explore the meanings that students attribute to this feedback. METHODS: We conducted focus groups with students in each of the classes of 2000, -01, -02, and -03 at BCM (one group for each class). We developed guiding questions that explored the effects of the SI scores on students' perceptions of self-knowledge, abilities, and attitudes (a conceptual framework for personal awareness training proposed by Novack, et al). Focus groups were co-moderated by a sociologist and a physician. All focus groups were audiotaped and transcribed. We developed categories for transcript coding by noting the patterned occurrence of specific behaviors, attitudes, and values in the transcripts. RESULTS: We conducted 4 focus groups with 22 students; focus groups lasted an average of 90 minutes. Students from different classes framed the information provided by SI scores differently. Preclinical students expressed a lack of experience with patient care, and therefore completed the questionnaires relative to their best guess of the answers of an 'ideal' physician. This led to anxiety when these 'ideal' physician scores differed unexpectedly from the normative scores of the class or of practicing physicians. Clinical students completed the SIs relative to their own patient-care experiences and devalued scores that differed from norms that they saw as different from their own emerging professional identity. CONCLUSION: Using a 'trigger' such as SI scores may be a useful means to stimulate student self-reflection. Such feedback, though, should be framed in the context of student experience. Preclinical students struggle with the meaning of feedback given their perceptions of how an 'ideal' physician thinks and acts. Clinical students possess an emerging professional identity and may devalue feedback that is inconsistent with this identity. In order to foster professional attitudes and behaviors using feedback, educators should take into account differences in preclinical and clinical students' perceptions of the meaning and value of feedback.