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Fisher J, Mordi NG, Thomson R. Clinical teachers' toolbox article: Harnessing narrative medicine to learn from underserved populations. CLINICAL TEACHER 2024; 21:e13761. [PMID: 38514454 DOI: 10.1111/tct.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Affiliation(s)
- James Fisher
- School of Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Northumbria Healthcare NHS Foundation Trust, Ashington, Northumberland, UK
| | - Nony G Mordi
- Specialty Doctor Renal Medicine, NHS Fife, Kirkcaldy, Scotland
| | - Richard Thomson
- School of Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Northumbria Healthcare NHS Foundation Trust, Ashington, Northumberland, UK
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2
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Kumar V. Medical education and creative writing: Poetry and how it can assist trainees in developing psychiatric formulation skills. Australas Psychiatry 2024; 32:365-369. [PMID: 38597339 DOI: 10.1177/10398562241246638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To reflect on the importance of teaching formulation skills in psychiatry training and explore how creative writing, particularly writing poetry, can help achieve this goal. CONCLUSIONS It is vital that formulation skills are embedded throughout psychiatry training. Formulations have an artistic element, and writing poetry can help foster a capacity for curiosity that can assist trainees in developing these skills.
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Affiliation(s)
- Varun Kumar
- Older Persons Mental Health Service, Kirwan Health Campus, Townsville, QLD, Australia
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Wasmuth S, Belkiewitz J, Miech E, Li CY, Harris A, Hernandez J, Horsford C, Smith C, Bravata D. A Hybrid Type III Analysis of a Filmed Story-Telling Intervention's Impact on Provider Stigma. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241260022. [PMID: 39086138 DOI: 10.1177/15394492241260022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Identity Development Evolution and Sharing (IDEAS) reduces provider stigma, but few have been trained to implement IDEAS, highlighting a need for implementation strategies that facilitate uptake. We evaluated whether external facilitation successfully supported IDEAS implementation and whether IDEAS reduced provider stigma within and across sites irrespective of implementation barriers and facilitators. Key informants from 10 sites completed interviews and surveys of appropriateness, acceptability, and feasibility. Interviews were analyzed using the Consolidated Framework for Implementation Research guidelines. Intervention effectiveness was measured via paired t tests of pre-/post-quantitative data on provider stigma completed by practitioners who attended the training. Ten sites successfully implemented IDEAS via external facilitation; 58 practitioners from nine sites completed pre- and post-surveys. Data showed significant decreases in stigma after the intervention. IDEAS, supported by external facilitation, is a feasible, acceptable, and appropriate means of reducing stigma among occupational therapy practitioners.
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Affiliation(s)
| | | | | | - Chih-Ying Li
- University of Texas Medical Branch, Galveston, USA
| | - Alex Harris
- Indiana University Health, Indianapolis, USA
| | | | | | | | - Dawn Bravata
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
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Lanocha N, Taub S, Webb JA, Wood M, Tate T. It Starts With a Story: A Four-Step Narrative-Based Framework for Serious Illness Conversations. J Palliat Med 2024. [PMID: 38968377 DOI: 10.1089/jpm.2024.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024] Open
Abstract
Background: As a key component of advance care planning, serious illness conversations form a core intervention in palliative care. To achieve effective serious illness conversations, acknowledgment and inclusion of patient sense of self and identity are critical. However, no framework exists to describe how goals, values, and choices relate to patient identity. This conceptual gap hinders the advancement of palliative care education and practice. Objective: This philosophical investigation aimed to explicate two items: first, a novel conceptual framework for serious illness conversations; second, a structured approach to optimize these conversations within the palliative care clinical context. Methods: A philosophical and theoretical analysis was performed within an interdisciplinary context, by scholars in palliative care, medical humanities, philosophy, and bioethics. Key literature in psychology, qualitative research on the experience of serious illness, medical ethics, and choice architecture in medical decision-making were reviewed, and a structured conceptual and narrative analysis was performed. Results: An original and innovative identity-centered conceptual framework for serious illness conversations was developed. The framework consists of a four-step, reproducible approach: (1) attend to patient narrative identity, (2) identify values, (3) cocreate goals, and (4) actively promote choices. In short: attend, identify, create, and promote (AICP). Discussion: By using this conceptual framework and four-step approach, clinicians can accomplish goal-concordant serious illness care and build rich clinical relationships that foster trust and goodwill.
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Affiliation(s)
| | - Sara Taub
- Knight Cancer Institute, Portland, Oregon, USA
| | - Jason A Webb
- Oregon Health and Science University, Portland, Oregon, USA
- University of Oregon, Eugene, Oregon, USA
| | - Mary Wood
- University of Oregon, Eugene, Oregon, USA
| | - Tyler Tate
- Stanford University School of Medicine, Palo Alto, California, USA
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Dulloo P, Vedi N, Patel M, Singh S. Empowering Medical Education: Unveiling the Impact of Reflective Writing and Tailored Assessment on Deep Learning. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2024; 12:163-171. [PMID: 39175585 PMCID: PMC11336193 DOI: 10.30476/jamp.2024.101594.1938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/17/2024] [Indexed: 08/24/2024]
Abstract
Introduction Reflective thinking offers learners insight and encourages deeper understanding by leveraging past experiences. This study explores the impact of reflective writing, a self-assessment tool, on undergraduate medical students. The focus is on training students using author-specific reflection rubrics based on Moon's model. Methods A mixed-methods study involving 32 volunteered students undertaking an interactive 3-hour session on reflective thinking and writing (RT&W). 19 students submitted reflections, which were self-graded by students and two faculties independently. The perceptions of students were gathered through questionnaires and focus group discussions. The analysis was done using the mean, inter-class correlational coefficient, and thematic analysis. Results Inter-rater reliability and inter-class correlation coefficient for reflective writing rubric scores was 63.2%, i.e. below the acceptable threshold. Cronbach's Alpha for the learner perception questionnaire was 0.90. The outcome of the student's perception questionnaire recognized the value of reflective writing in terms of professional skills enhancement (4.83±0.39) and improvement after feedback (4.17±0.72). However, satisfaction with overall training was comparatively lower (2.5±0.52). Focus group discussions revealed six themes. Conclusion Reflective writing enhances the learning outcomes, deepens understanding, and refines judgment. The author-specific reflection rubric, though reliable, warrants empirical validation with a larger and more diverse participant pool. Undergraduate programs should prioritize mastery of reflection and meta-cognitive learning approaches to optimize educational outcomes.
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Affiliation(s)
- Puja Dulloo
- Department of Physiology, PIMSR, Faculty of Medicine, Parul University, Vadodara, Gujarat, India
| | - Neeraj Vedi
- Department of Anatomy, PIMSR, Faculty of Medicine, Parul University, Vadodara, Gujarat, India
| | - Minal Patel
- Department of Physiology, PSMC, Bhaikaka University, Karamsad, Gujarat, India
| | - Suman Singh
- Department of Microbiology, PSMC, Bhaikaka University, Karamsad, Gujarat, India
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6
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Kissler MJ, Porter S, Knees M, Kissler K, Keniston A, Burden M. Attention Among Health Care Professionals : A Scoping Review. Ann Intern Med 2024; 177:941-952. [PMID: 38885508 DOI: 10.7326/m23-3229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The concept of attention can provide insight into the needs of clinicians and how health systems design can impact patient care quality and medical errors. PURPOSE To conduct a scoping review to 1) identify and characterize literature relevant to clinician attention; 2) compile metrics used to measure attention; and 3) create a framework of key concepts. DATA SOURCES Cumulated Index to Nursing and Allied Health Literature (CINAHL), Medline (PubMed), and Embase (Ovid) from 2001 to 26 February 2024. STUDY SELECTION English-language studies addressing health care worker attention in patient care. At least dual review and data abstraction. DATA EXTRACTION Article information, health care professional studied, practice environment, study design and intent, factor type related to attention, and metrics of attention used. DATA SYNTHESIS Of 6448 screened articles, 585 met inclusion criteria. Most studies were descriptive (n = 469) versus investigational (n = 116). More studies focused on barriers to attention (n = 387; 342 descriptive and 45 investigational) versus facilitators to improving attention (n = 198; 112 descriptive and 86 investigational). We developed a framework, grouping studies into 6 categories: 1) definitions of attention, 2) the clinical environment and its effect on attention, 3) personal factors affecting attention, 4) relationships between interventions or factors that affect attention and patient outcomes, 5) the effect of clinical alarms and alarm fatigue on attention, and 6) health information technology's effect on attention. Eighty-two metrics were used to measure attention. LIMITATIONS Does not synthesize answers to specific questions. Quality of studies was not assessed. CONCLUSION This overview may be a resource for researchers, quality improvement experts, and health system leaders to improve clinical environments. Future systematic reviews may synthesize evidence on metrics to measure attention and on the effectiveness of barriers or facilitators related to attention. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Mark J Kissler
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.J.K., S.P., M.K., A.K., M.B.)
| | - Samuel Porter
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.J.K., S.P., M.K., A.K., M.B.)
| | - Michelle Knees
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.J.K., S.P., M.K., A.K., M.B.)
| | - Katherine Kissler
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado (K.K.)
| | - Angela Keniston
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.J.K., S.P., M.K., A.K., M.B.)
| | - Marisha Burden
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado (M.J.K., S.P., M.K., A.K., M.B.)
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Cattaneo RA, González N, Leafe A, Fleishman R. Pediatric Resident Perceptions of a Narrative Medicine Curriculum. THE JOURNAL OF MEDICAL HUMANITIES 2024; 45:157-169. [PMID: 38051391 DOI: 10.1007/s10912-023-09817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 12/07/2023]
Abstract
Training residents to become humanistic physicians capable of empathy, compassionate communication, and holistic patient care is among our most important tasks as physician educators. Narrative medicine aims to foster those highly desirable characteristics, and previous studies have shown it to be successful in fostering self-reflection, emotional processing, and preventing burnout. We aimed to evaluate pediatric residents' perceptions of a novel narrative medicine curriculum. After the initiation of a longitudinal narrative medicine curriculum, focus groups were conducted with residents who participated in at least one narrative medicine session. The curriculum was viewed positively, and residents found the sessions to be helpful in developing empathy, offering a space for reflection, and introducing new perspectives. Challenges noted were perception of relevance, timing of sessions, and interpretation by non-native English-speaking residents. With attention to linguistics and thematic undertones, narrative medicine is a feasible, replicable, and accepted teaching modality for pediatric residents to foster empathy, process emotions, and participate in self-reflection.
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Affiliation(s)
- Raymond A Cattaneo
- Department of Pediatric and Adolescent Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Natalie González
- Department of Pediatric and Adolescent Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Abby Leafe
- New Leafe Research, 103 Hillborn Drive, Newtown, PA, 18940, USA
| | - Rachel Fleishman
- Department of Pediatric and Adolescent Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA, 19141, USA.
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8
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Kaye EC. The Power of Story. J Clin Oncol 2024; 42:1322-1325. [PMID: 38471047 DOI: 10.1200/jco.24.00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
Oncology is a field driven by evidence. But data alone are not enough, we need stories to find our way.
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Affiliation(s)
- Erica C Kaye
- St Jude Children's Research Hospital, Memphis, TN
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9
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Pien J, Ali TK, Schlozman S, Jamal A, Bucknor MD, Srinivasan M. Participation in a Physician Creative Writing Community: 15-Year Program Survey Outcomes at an Academic Medical Center. J Gen Intern Med 2024; 39:815-817. [PMID: 38196073 PMCID: PMC11043248 DOI: 10.1007/s11606-023-08595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Jennifer Pien
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Palo Alto, CA, USA.
| | - Tayyeba K Ali
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
- Palo Alto Medical Foundation, Sutter Health, Sunnyvale, CA, USA
| | - Sofia Schlozman
- Narrative Medicine Program, Columbia University, New York City, NY, USA
| | - Armaan Jamal
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew D Bucknor
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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10
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Paul TK, Reddy Y, Gnanakumar A, England R, Superdock A, Malipeddi D, Wrigley J, Reardon E, Weaver MS, Kaye EC. Narrative medicine interventions for oncology clinicians: a systematic review. Support Care Cancer 2024; 32:241. [PMID: 38512594 DOI: 10.1007/s00520-024-08434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE As narrative medicine interventions are integrated increasingly into medical practice, growing evidence indicates benefits for healthcare professionals. Presently, the prevalence and impact of narrative medicine interventions in the field of oncology remain unknown. This systematic review synthesizes published data on narrative medicine interventions in oncology and reports current knowledge on feasibility, acceptability, and impact on cancer care professionals. METHODS Following PRISMA guidelines, we searched Ovid Medline, Embase, Scopus, Web of Science, Cochrane, and ClinicalTrials.gov databases from inception through February 2024. Eligible articles were published in English and contained original data on feasibility, acceptability, and/or impact of a narrative medicine intervention for oncology professionals. Database searches identified 2614 deduplicated articles, from which 50 articles were identified for full-text assessment and 11 articles met inclusion criteria. Two additional articles were identified through manual review of references. RESULTS Thirteen articles described 12 unique narrative medicine interventions targeting cancer care professionals. All studies described their respective interventions as feasible, acceptable, and impactful for participants. Interventions involved writing, reading, reflection, and other narrative-based strategies. Standardized validated tools evaluated outcomes including burnout, empathy expression, secondary trauma, quality of humanistic care, and well-being. Participants reported appreciation of opportunities for reflection, perspective sharing, and bearing witness, which they perceived to strengthen wellness and community. CONCLUSION Narrative medicine interventions are feasible and acceptable and may bolster oncology clinicians' functioning across domains. Multi-site, prospective, randomized studies are needed to investigate the broader impact of narrative medicine interventions and advance the science of narrative medicine in oncology. TRIAL REGISTRATION ClinicalTrials.gov Identifier: CRD42022369432.
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Affiliation(s)
- Trisha K Paul
- Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, USA.
| | | | | | - Rebecca England
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alexandra Superdock
- Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, USA
| | | | - Jordan Wrigley
- Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, USA
| | | | | | - Erica C Kaye
- Department of Oncology, Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, USA
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Butchart L, Parsa S. Narrative Medicine Theory and Practice: the Double Helix Model. MEDICAL HUMANITIES 2024; 50:153-161. [PMID: 37852746 DOI: 10.1136/medhum-2023-012648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
The genesis of the medical humanities as a discrete academic discipline engendered a need for a theoretical framework, a function taken on by the growing narrative medicine movement. More recently, scholars have begun to develop a critical medical humanities, an analytical movement that emphasises the fundamental enmeshment of the sciences and humanities. Building on Helene Scott-Fordsmand's work on reversing the medical humanities, this paper develops an alternative to the current version of narrative medicine. We propose a new interpretive heuristic, the Double Helix Model, and place it in critical dialogue with the Columbia School's close reading based-approach. Through this new conceptual frame, we suggest that critical narrative medicine may empower clinicians to contribute to the reorientation of the roles of the sciences and humanities, benefiting providers, scholars and patients.
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Affiliation(s)
- Liam Butchart
- Center for Medical Humanities, Compassionate Care, and Bioethics, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
| | - Shabnam Parsa
- Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
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Talib MA, Greene RE, Winkel AF. A narrative analysis of clerkship reflections: Medical student identity development in a changing world. CLINICAL TEACHER 2024; 21:e13652. [PMID: 37694819 DOI: 10.1111/tct.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Medical students' written reflections on their clinical experiences can be a useful tool for processing complex aspects of development as physicians. To create educational programs that scaffold adaptive professional identity development, it is essential to understand how medical students develop as professionals and process the dynamic sociocultural experiences of the current moment. OBJECTIVE To explore the developing professional consciousness of medical students through clerkship reflections. DESIGN Narrative analysis of written reflections are produced by clerkship students, who were asked to tell a story that resonated with the physician's relationship with patient, self and colleagues. Two independent readers applied inductive labels to generate a homogenous codebook, which was used to generate themes that were then used to construct a conceptual model. KEY RESULTS Four themes were identified in the data that describe relationships between medical students' developing professional identities and the norms of their future professional and personal communities. These included: medical students as outsiders, conflict between the student identifying with the patient versus the healthcare team, medical students' own value judgements and, finally, the changing societal mores as they relate to social and racial injustice. The conceptual model for this experience depicts the medical student as pulled between patients and the social context on one side and the professional context of the medical centre on the other. Students long to move towards identification with the healthcare team, but reject the extremes of medical culture that they view on conflict with social and racial justice. CONCLUSIONS Medical students in clinical training identify strongly with both patients and the medical team. Rather than viewing professional identity development as a longitudinal journey from one extreme to another, students have the power to call attention to entrenched problems within medical culture and increase empathy for patients by retaining their strong identification with the important issues of this time.
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Affiliation(s)
- Mahino A Talib
- New York University School of Medicine, New York City, New York, USA
| | - Richard E Greene
- New York University School of Medicine, New York City, New York, USA
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Armitage JS, Nash SP, Hanson JT. It's "not black and white": Students' perceptions of "altruism" content in preclinical medical education. MEDICAL TEACHER 2024; 46:126-131. [PMID: 37542359 DOI: 10.1080/0142159x.2023.2240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
OBJECTIVE This study investigated how students as stakeholders viewed behavioral and social science (BSS) content in a preclinical longitudinal course entitled "Medicine, Body, and Society" (MBS) at UT Health San Antonio Long School of Medicine (LSOM). We present students' perceptions of successes and challenges tied to "altruism" and other non-biomedical objectives outlined by this institution. METHODS We conducted a qualitative thematic analysis of MBS course evaluation data. Two researchers independently performed initial coding followed by interrater reliability checks to revise codes and a final MAXQDA lexical search to refine three themes. RESULTS Three major themes emerged: (1) Students shared pedagogical preferences strongly favoring stories. (2) Students detected deficits in the module content tied to identities. (3) Students labelled BSS content as "soft," "subjective," and "siloed" which confounded its role in the course. CONCLUSIONS Advancing altruism aligned with BSS content in preclinical medical education remains a challenge. A closer review of student evaluations framed as learner-centeredness is key to a greater understanding and resolution of competency issues in preclinical curriculum and its impact on mastery in subsequent clinical education and practice.
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Affiliation(s)
| | - Sue P Nash
- Department of Sociology, St. Mary's University, TX, USA
| | - Joshua T Hanson
- UT Health San Antonio Long School of Medicine, Long School of Medicine, TX, USA
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14
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Mathieu IP, Martin BJ. The art of equity: critical health humanities in practice. Philos Ethics Humanit Med 2023; 18:19. [PMID: 38087361 PMCID: PMC10716923 DOI: 10.1186/s13010-023-00149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The American Association of Medical Colleges has called for incorporation of the health humanities into medical education, and many medical schools now offer formal programs or content in this field. However, there is growing recognition among educators that we must expand beyond empathy and wellness and apply the health humanities to questions of social justice - that is, critical health humanities. In this paper we demonstrate how this burgeoning field offers us tools for integrating social justice into medical education, utilizing the frameworks of critical consciousness and structural competency. PRACTICE OF HEALTH HUMANITIES Critical health humanities can be applied at multiple levels of learners, and in a variety of contexts. We are two physician-writers who have developed several educational programs that demonstrate this. We taught a seminar that introduced first-year and second-year undergraduates to concepts such as social determinants of health, intergenerational trauma, intersectionality, resilience, and cross-cultural care through works of fiction, poetry, film, podcasts, stand-up comedy, and more. Through creative projects and empathic reflection, students engaged with the complexities of structural forces that create and maintain health disparities. Medical students in their clinical years can engage in critical health humanities learning experiences as well. We teach several multidisciplinary electives that address social (in)justice in medicine, as well as mentor fourth-year students engaged in independent electives that foster critical awareness around health equity and ethics. Beyond the classroom, we have actively engaged in critical health humanities practices through story slams, literary journal clubs, conference presentations, and Grand Rounds. Through these activities we have included learners at GME and CME levels. These examples also demonstrate how community engagement and multidisciplinary partnerships can contribute to the practice of critical health humanities. CONCLUSION In this paper, we explore the growing field of critical health humanities and its potential for teaching health equity through narrative practices. We provide concrete examples of educational activities that incorporate critical consciousness and structural competency - frameworks we have found useful for conceptualizing critical health humanities as a pedagogical practice. We also discuss the strengths and challenges of this work and suggest future directions.
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Affiliation(s)
- Irène P Mathieu
- Department of Pediatrics; Program in Health Humanities, Center for Health Humanities & Ethics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA.
| | - Benjamin J Martin
- Department of Internal Medicine; Program in Health Humanities, Center for Health Humanities & Ethics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
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Quah ELY, Chua KZY, Lin CKR, Vijayan AV, Abdul Hamid NAB, Owyong JLJ, Satku N, Woong N, Lim C, Phua GLG, Ong EK, Fong W, Krishna LKR. The role of patients' stories in medicine: a systematic scoping review. BMC Palliat Care 2023; 22:199. [PMID: 38087237 PMCID: PMC10714554 DOI: 10.1186/s12904-023-01319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Patients' stories provide Palliative Care physicians with a glimpse into the former's lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients' stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this 'care influencing' practice in medicine. METHODS This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach's concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion. RESULTS Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns. CONCLUSION Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this 'care influencing' practice.
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Affiliation(s)
- Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Casper Keegan Ronggui Lin
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
- Division of Outpatient Pharmacy, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Andrew Vimal Vijayan
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Nur Amira Binte Abdul Hamid
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Neeta Satku
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
| | - Natalie Woong
- Department of Internal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Road, Singapore, 574627, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC C/O Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
- Health Data Science, University of Liverpool, Whelan Building The Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK.
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Yuan J, Zeng X, Cheng Y, Lan H, Cao K, Xiao S. Narrative medicine in clinical internship teaching practice. MEDICAL EDUCATION ONLINE 2023; 28:2258000. [PMID: 37722672 PMCID: PMC10512813 DOI: 10.1080/10872981.2023.2258000] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
Objective: To explore the effect on empathy skills of integrating narrative medicine instruction into clinical internship undergraduate medical education.Methods: One hundred clinical undergraduate students who were transferred to gynecology and obstetrics in 2016 were selected as subjects and divided into two groups. The control group adopted the traditional practice teaching mode, while the experimental group adopted a narrative medicine integrated with traditional teaching mode. The impact of the narrative medicine course was evaluated using the Davis Empathy Scale, and the students' acceptance of the course was investigated using a self-developed questionnaire.Results: After completion of the rotation, the empathy scores of the experimental group were higher than those of the control group (p < 0.05). Students in the experimental group rated the integration of narrative medicine into the internship class highly, and most students thought that the narrative medicine course was of great benefit with respect to the humanistic quality of medical teaching.Conclusion: The application of narrative medicine teaching in the clinical practice teaching of obstetrics and gynecology promoted students to improve their empathy ability.
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Affiliation(s)
- Jing Yuan
- Department of Obstetrics and Gynecology, the Third Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Xiangyang Zeng
- Department of Obstetrics and Gynecology, the Third Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Yan Cheng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hua Lan
- Department of Obstetrics and Gynecology, the Third Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- Department of Obstetrics and Gynecology, Changsha Central Hospital of University of South China, Changsha, China
| | - Ke Cao
- Department of Oncology, the Third Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Songshu Xiao
- Department of Obstetrics and Gynecology, the Third Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
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Florijn BW, Kloppenborg R, Kaptein AA, Bloem BR. Narrative medicine pinpoints loss of autonomy and stigma in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:152. [PMID: 37914740 PMCID: PMC10620172 DOI: 10.1038/s41531-023-00593-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
Parkinson's disease characteristics can create a self-perceived sense of stigmatization and disapproval by others, thereby affecting self-perceived autonomy. This study investigated the metaphors related to the loss of autonomy and stigma in stories and drawings of Parkinson's disease. We compare a contemporary first-person illness narrative and -drawing from a person with Parkinson's disease, with two novels (Jonathan Franzen's The Corrections and Claudia Piñeiro's Elena Knows), a graphic novel (Peter Dunlap-Shohl's My Degeneration: A Journey Through Parkinson's), a non-fiction book (Oliver Sacks' Awakenings) and a first-person illness narrative (John Palfreman's The Bright Side of Parkinson's). Metaphors in the patient narrative, novels, and non-fiction work were reviewed and a list of themes or categorizations common to 2 of the metaphors was generated. Parkinson's disease metaphors indicate a 'Parkinson's prism' thereby depicting extreme experiences (24.4%) like a 'fall by mischance', a 'tantrum of selfish misery' or a 'bottomless darkness and unreality' (Table 1). Both novels signify a sense of 'betrayal and disconnection' in the Parkinson's disease experience while non-fiction of Parkinsonism depicts a space in which one feels 'caged and deprived'. This makes the Parkinson's disease narrative a chaos story that could influence the decision to initiate treatment and treatment adherence. We conclude that narrative medicine can help to focus the medical consultations with affected individuals on issues that matter most to them, thereby improving self-perceived autonomy and stigma. As such, it is a critical component of the much-needed move towards personalized medicine in Parkinson's disease, achieved through the reciprocity of thinking with stories.
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Affiliation(s)
- Barend W Florijn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
- Department of Neurology, Hague Medical Center Westeinde, The Hague, the Netherlands.
- Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden, the Netherlands.
| | - Raoul Kloppenborg
- Department of Neurology, Hague Medical Center Westeinde, The Hague, the Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
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Gill GK, Ng SL, Kangasjarvi E, Crukley J, Kumagai A, Simpson JS. From skillful to empathic: evaluating shifts in medical students' perceptions of surgeons through a combined patient as teacher and arts-based reflection program. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:14-21. [PMID: 38045079 PMCID: PMC10690007 DOI: 10.36834/cmej.76536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Introduction The purpose of this study was to identify whether the incorporation of a combined Patient as teacher (PAT) and arts-based reflection (ABR) program during a surgical clerkship rotation could influence more humanistic perceptions of surgeons, using an innovative evaluation approach. Methods A novel, single question evaluation tool was created. Third year medical-students were asked to "list the top 5 attributes of a surgeon, in order of perceived importance" both before and after their surgical clerkship rotations and participation in the PAT/ABR program. Attributes identified by students were coded as either "humanistic" or "non-humanistic," which were then analyzed using generalized linear regression models under a Bayesian framework. Results After participation in the PAT/ABR program, the predicted probability of students ranking a humanistic characteristic as the most important attribute of a surgeon had increased by 17%, and the predicted probability of students ranking a humanistic characteristic amongst their top three attributes for a surgeon had increased by 21%. Conclusion This innovative evaluative method suggested the success of a combined PAT/ABR program in encouraging a humanistic perspective of surgery and this approach could potentially be explored to evaluate other humanistic education initiatives.
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Affiliation(s)
- Gurjot K Gill
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Stella L Ng
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Emilia Kangasjarvi
- Centre for Faculty Development, University of Toronto at St. Michael’s Hospital, Unity Health Toronto, Ontario, Canada
| | - Jeff Crukley
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Arno Kumagai
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Women’s College Hospital, University of Toronto, Ontario, Canada
| | - Jory S Simpson
- Department of Surgery, University of Toronto Faculty of Medicine, Ontario, Canada
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Leijenaar E, Eijkelboom C, Milota M. "An invitation to think differently": a narrative medicine intervention using books and films to stimulate medical students' reflection and patient-centeredness. BMC MEDICAL EDUCATION 2023; 23:568. [PMID: 37563708 PMCID: PMC10416442 DOI: 10.1186/s12909-023-04492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Narrative medicine purports to improve medical students' communication skills, self-reflection, empathy and professional development. These interpersonal skills and attitudes can facilitate more patient-centered care and positively impact patients' treatment outcomes. However, current studies report mainly on small study populations, leaving the efficacy of narrative medicine in larger study groups unknown. Therefore, this study aimed to evaluate a mandatory narrative medicine lesson in a large sample of medical students. We assessed if this narrative medicine lesson stimulated meaningful self-reflection on patient-centeredness in medical students. METHODS All fourth-year medical students of a Dutch medical school participated in this mandatory narrative medicine lesson. The four-step activity consisted of an introductory lecture, close reading and watching of a book and film, a discussion group and a short reflective writing exercise. Students were divided over three thematic pairings (or book and film combinations): 'The doctor as a patient,' 'The mysterious brain,' and 'Until death do us part.' A mixed-methods design was used. First, we qualitatively analyzed the content of 203 essays from the reflective writing exercise. A quantitative analysis of the reflective quality was conducted using a scoring-system based on the REFLECT rubric. RESULTS Students demonstrated reflection on a professional level and connected this to future intentions as medical practitioners, for example to use specific communication strategies or to deliver healthcare in a broader sense. They also reflected on a personal level by questioning their own worldview or beliefs. Furthermore, they stressed the importance of individual patient stories to gain understaning of patients' perspectives. Approximately half of the students showed an in-depth and authentic reflection, according to the REFLECT rubric. Additionally, reflection levels differed between book and film pairings. CONCLUSIONS This study supports the value of narrative medicine in the medical curriculum by validating its outcomes in a larger study population and in a mandatory course. Students reflected on themes related to the principles of patient-centeredness, namely personal attitudes towards patients and the uniqueness of patient stories. In additon, the majority of students demonstrated higher levels of reflection, which suggests that this exercise contributes to self-awareness and self-reflection, important qualities for delivering patient-centered healthcare.
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Affiliation(s)
- Elsemarijn Leijenaar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Charlotte Eijkelboom
- Department of Pediatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Megan Milota
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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20
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Malik Z, Ahn J, Schwartz A, Blackie M. Narrative medicine workshops for emergency medicine residents: Effects on empathy and burnout. AEM EDUCATION AND TRAINING 2023; 7:e10895. [PMID: 37485471 PMCID: PMC10357272 DOI: 10.1002/aet2.10895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023]
Abstract
Background Emergency medicine (EM) residents face unique affective challenges and barriers to interpersonal connection in their clinical environment which may contribute to decreased empathy and increased burnout. Narrative medicine (NM) might address these barriers and has had beneficial impacts in various populations but has never been studied in EM residents. In this study, we sought to evaluate the effect of NM workshops on burnout and empathy and to assess resident perceptions of the workshops. Methods We performed a quasi-experimental study at two EM residencies from June to October 2020. Residents at the intervention site participated in two NM workshops led by EM faculty that were composed of a close reading of a literary text, reflective writing, and group discussion. Residents were asked to complete the abbreviated Interpersonal Reactivity Index (IRI) and a single-item burnout measure pre- and postintervention. We fitted linear regression models to IRI subscores; we treated burnout as an ordinal variable and fitted a conditional logistic regression model. Residents completed a postintervention survey that we analyzed using summary statistics. Results A total of 46.7% of control (28/60) and 100% of intervention (48/48) residents responded (n = 76). While all respondents demonstrated worsening burnout with time (p = 0.001), residents at the intervention site exhibited less severe increases (interaction p < 0.001). Empathy remained unchanged. A total of 50% of intervention residents (24/48) responded to the postintervention survey; most (n = 20, 83.3%) agreed that the workshops should be a standard part of EM didactics. Conclusions These findings establish the feasibility and desirability of NM in residency education and offers a model for EM-centered narrative workshops. Additionally, while our outcomes are limited, we found that exposure to an NM curriculum may be protective against worsening burnout.
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Affiliation(s)
- Zayir Malik
- Department of Emergency MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - James Ahn
- Section of Emergency Medicine in the Department of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Alan Schwartz
- Department of Medical EducationUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Michael Blackie
- Department of Medical EducationUniversity of Illinois at ChicagoChicagoIllinoisUSA
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Nash W, Erondu M, Childress A. Expanding Narrative Medicine through the Collaborative Construction and Compelling Performance of Stories. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:207-225. [PMID: 36690776 PMCID: PMC9870772 DOI: 10.1007/s10912-022-09779-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 05/07/2023]
Abstract
This essay proposes an expansion of the concept of narrative competence, beyond close reading, to include two more skills: the collaborative construction and compelling performance of stories. To show how this enhanced form of narrative competence can be attained, the essay describes Off Script, a cocurricular medical storytelling program with three phases: 1) creative writing workshop, 2) dress rehearsal, and 3) public performance of stories. In these phases, Off Script combines literary studies, creative writing, reflective practice, collegial feedback, and drama. With increased narrative competence, Off Script participants are likely better equipped to engage in more impactful health advocacy and partner with patients more effectively.
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Affiliation(s)
- Woods Nash
- Department of Behavioral and Social Sciences, University of Houston Fertitta Family College of Medicine in Houston, Houston, TX, USA.
| | | | - Andrew Childress
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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22
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Liao J, Wu Z. Narrative medicine in surgery: necessity or hindrance? Int J Surg 2023; 109:653-654. [PMID: 37093104 PMCID: PMC10389448 DOI: 10.1097/js9.0000000000000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/26/2023] [Indexed: 04/08/2023]
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Brosnahan MM. Life, Death, and Humanity in Veterinary Medicine: Is it Time to Embrace the Humanities in Veterinary Education? JOURNAL OF VETERINARY MEDICAL EDUCATION 2023; 50:e20220118. [PMID: 36626246 DOI: 10.3138/jvme-2022-0118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Medical humanities is a multidisciplinary, interdisciplinary field of study that has experienced explosive growth in the United States since the 1960s. Two key components of medical humanities include first, the use of literature, poetry, and visual arts in the education of medical students, and second, the representation or examination of medical culture by scholars in the humanities, arts, and social sciences such as literary and film creators, sociologists, and anthropologists. The American Association of Medical Colleges recently reported that as of 2018, approximately 94% of medical schools had core or elective humanities offerings in their curricula. The examination of the medical milieu by scholars across the humanities has resulted in the emergence of important specialty fields such as end-of-life care, disability studies, and health disparities research. Veterinary medicine has been slow to embrace the humanities as relevant to our profession and to the education of our students. Only sporadic, isolated attempts to document the value of the arts and humanities can be found in the veterinary literature, and valuable observations on our profession made by scholars in diverse disciplines of the humanities are largely buried in publications not often accessed by veterinarians. Here a case is made that the time is right for the emergence of a more cohesive field of veterinary humanities. Embracing the observations of humanities scholars who engage with our profession, and appreciating the ways in which the humanities themselves are effective tools in the education of veterinary professionals, will bring many benefits to our evolving profession.
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Affiliation(s)
- Margaret M Brosnahan
- Equine Medicine in Midwestern University College of Veterinary Medicine, 19555 N. 59th Avenue, Glendale, AZ 85308 USA
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Lim JY, Ong SYK, Ng CYH, Chan KLE, Wu SYEA, So WZ, Tey GJC, Lam YX, Gao NLX, Lim YX, Tay RYK, Leong ITY, Rahman NDA, Chiam M, Lim C, Phua GLG, Murugam V, Ong EK, Krishna LKR. A systematic scoping review of reflective writing in medical education. BMC MEDICAL EDUCATION 2023; 23:12. [PMID: 36624494 PMCID: PMC9830881 DOI: 10.1186/s12909-022-03924-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Reflective writing (RW) allows physicians to step back, review their thoughts, goals and actions and recognise how their perspectives, motives and emotions impact their conduct. RW also helps physicians consolidate their learning and boosts their professional and personal development. In the absence of a consistent approach and amidst growing threats to RW's place in medical training, a review of theories of RW in medical education and a review to map regnant practices, programs and assessment methods are proposed. METHODS A Systematic Evidence-Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure the two concurrent reviews. Independent searches were carried out on publications featured between 1st January 2000 and 30th June 2022 in PubMed, Embase, PsychINFO, CINAHL, ERIC, ASSIA, Scopus, Google Scholar, OpenGrey, GreyLit and ProQuest. The Split Approach saw the included articles analysed separately using thematic and content analysis. Like pieces of a jigsaw puzzle, the Jigsaw Perspective combined the themes and categories identified from both reviews. The Funnelling Process saw the themes/categories created compared with the tabulated summaries. The final domains which emerged structured the discussion that followed. RESULTS A total of 33,076 abstracts were reviewed, 1826 full-text articles were appraised and 199 articles were included and analysed. The domains identified were theories and models, current methods, benefits and shortcomings, and recommendations. CONCLUSIONS This SSR in SEBA suggests that a structured approach to RW shapes the physician's belief system, guides their practice and nurtures their professional identity formation. In advancing a theoretical concept of RW, this SSR in SEBA proffers new insight into the process of RW, and the need for longitudinal, personalised feedback and support.
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Affiliation(s)
- Jia Yin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Simon Yew Kuang Ong
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Chester Yan Hao Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Karis Li En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Song Yi Elizabeth Anne Wu
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Wei Zheng So
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Glenn Jin Chong Tey
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Yun Xiu Lam
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Nicholas Lu Xin Gao
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Yun Xue Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Ryan Yong Kiat Tay
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Ian Tze Yong Leong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Nur Diana Abdul Rahman
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Vengadasalam Murugam
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Rd, Singapore, 574627, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Rajagopalan A, Chew QH, Sim K. Medical Humanities in Undergraduate Psychiatry Teaching: Learner Assessment and Mediators of Better Learning Outcomes. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231214393. [PMID: 38025022 PMCID: PMC10644729 DOI: 10.1177/23821205231214393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES Previous studies have found that the inclusion of medical humanities in medical education was associated with improvements in learner reflectivity and empathy. There is less data, however, on the impact of medical humanities on perceived patient care and mediators of learner outcomes. Our study aimed to determine the impact of medical humanities on perceived learner well-being and patient care, and the mediators of these outcomes in medical undergraduates undergoing psychiatric training. METHODS This cross-sectional study was conducted from August 2021 to December 2022 within undergraduate medical students undergoing psychiatry rotations and who attended sessions entitled "Humanities in Psychiatry." Both quantitative and qualitative data were obtained through anonymized online feedback forms. Path analysis was performed to examine the relationship between learners' perception of the medical humanities writing activity and its potential to improve their well-being, patient care, as well as mediators of these outcomes. RESULTS Overall, 97 medical undergraduates (response rate 67.4%) participated in the study and more than four-fifths reported improvements in listening, reflection, empathy, personal well-being, and perceived patient care. Males showed more interest in additional medical humanities sessions (mean rank 57.9 vs 42.5, P = .005) and greater improvements in personal well-being (mean rank 55.1 vs 44.5, P = .044). Path analysis showed that reflective capacity of learners mediated the relationship between reflective writing and perceived improvements in learner well-being (β = 0.596, 95% CI = 0.409-0.737) and patient care (β = 0.557, 95% CI = 0.379-0.702). CONCLUSIONS Our study found that the majority of learners responded positively to the medical humanities sessions, which suggests that its use could be beneficial in fostering empathy, reflection, learner well-being, and improved patient care. Using the PRISM model, we present practical implications for educators to consider when using medical humanities in relation to psychiatry training.
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Affiliation(s)
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Kang Sim
- West Region, Institute of Mental Health, Singapore, Singapore
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Fleishman R, McAdams RM, Carter BS, Gautham KS. Narrative neonatology: integrating narrative medicine into the neonatal intensive care unit. J Perinatol 2022:10.1038/s41372-022-01565-5. [PMID: 36414736 DOI: 10.1038/s41372-022-01565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Rachel Fleishman
- Department of Pediatrics, Einstein Medical Center Philadelphia, Philadelphia, PA, USA.
| | - Ryan M McAdams
- Department of Pediatrics, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Brian S Carter
- Department of Medical Humanities & Bioethics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kanekal S Gautham
- Department of Pediatrics, Nemours Children's Hospital, Orlando, FL, USA
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Neilson S. A logical development: biomedicine's fingerprints are on the instrument of close reading in Charonian Narrative Medicine. MEDICAL HUMANITIES 2022; 48:e9. [PMID: 35086960 PMCID: PMC9411901 DOI: 10.1136/medhum-2021-012301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
Narrative Medicine as originated by Rita Charon began as an attempt to redress the unopposed biomedicalisation of the medical profession. Although the movement has been self-positioned as a corrective to deliver an ideal of care, it began within the rhetorical framework of biomedicine and not outside of it. Thus, Narrative Medicine justifies itself in biomedical terms, invoking instrumental rationales for its use. This seeming 'scientification' of narrative is only half of the biomedicine-indebted Narrative Medicine story. An equally important but as-yet unmentioned debt is the quasi-scientific origin story of Narrative Medicine's signature method of close reading. Thus, there is an inherent paradox at the heart of the Narrative Medicine movement: designed to resist a reductive biomedicine, it exists in a dependent relationship on biomedicine at the level of justification and at the level of praxis. Thus, it is an open question if the Narrative Medicine movement is the proper vehicle for a rebalancing of humanities and biomedicine.
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Affiliation(s)
- Shane Neilson
- Department of English, University of Ottawa, Ottawa, Ontario, Canada
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Historical empathy and medicine: Pathography and empathy in Sophocles’ Philoctetes. MEDICINE, HEALTH CARE AND PHILOSOPHY 2022; 25:561-575. [PMID: 35449242 PMCID: PMC9022738 DOI: 10.1007/s11019-022-10087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/24/2022]
Abstract
The aim of this article is to explore the ways in which the engagement with Greek tragedy may contribute fruitfully to the unfolding of empathy in medical students and practitioners. To reappraise the general view that classical texts are remote from modern experience because of the long distance between the era they represent and today, I propose an approach to Greek tragedy viewed through the lens of historical empathy, and of the association between past situations and similar contemporary experiences, in particular. After a brief examination of the concept of empathy, its links with literary reading, and the discussion of these interrelations within the training of narrative medicine, and narrative ethics in particular, the focus turns to selected parts of Sophocles’ Philoctetes, such as the disease scene—an ancient example of pathography. Here Neoptolemus’ empathy for Philoctetes’ situation and its consequences are explored with specific interest in the modern readers’ affective response in connection with their own experiences in medical practice. Neoptolemus’ ethical conflict, which is resolved by his decision to care for Philoctetes, and the problematic nature of this attitude are both indicative of the aim of Greek tragedy to problematize universal issues and thus to point towards the instability of human life and the fluidity of human nature. Realizing through historical empathy the precariousness of human existence may lead to a better understanding and hence better care for others and open new perspectives in the development of empathy within the context of contemporary medical education and practice.
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Wasmuth S, Belkiewitz J, Bravata D, Horsford C, Harris A, Smith C, Austin C, Miech E. Protocol for evaluating external facilitation as a strategy to nationally implement a novel stigma reduction training tool for healthcare providers. Implement Sci Commun 2022; 3:88. [PMID: 35962426 PMCID: PMC9372956 DOI: 10.1186/s43058-022-00332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Identity Development Evolution and Sharing (IDEAS) is a theatre-based intervention for reducing healthcare provider stigma. IDEAS films are created by collecting narratives from people who have experienced discrimination and healthcare inequity, partnering with professional playwrights to create theatrical scripts that maintain the words of the narratives while arranging them into compelling storylines involving several interviews, and hiring professional actors to perform and record scenes. IDEAS implementation requires a moderator to establish a respectful learning environment, play the filmed performance, set ground rules for discussion, and moderate a discussion between healthcare providers who viewed the film and invited panelists who are members of the minoritized population being discussed. IDEAS’ impact on provider stigma is measured via pre/post Acceptance and Action Questionnaire – Stigma (AAQ-S) data collected from participating providers. The objectives of this manuscript are to provide narrative review of how provider stigma may lead to healthcare inequity and health disparities, describe the conceptual frameworks underpinning the IDEAS intervention, and outline methods for IDEAS implementation and implementation evaluation.
Methods
This manuscript describes a hybrid type 3 design study protocol that uses the Consolidated Framework for Implementation Research (CFIR) to evaluate external facilitation, used as an implementation strategy to expand the reach of IDEAS. CFIR is also used to assess the impact of characteristics of the intervention and implementation climate on implementation success. Implementation success is defined by intervention feasibility and acceptability as well as self-efficacy of internal facilitators. This manuscript details the protocol for collection and evaluation of implementation data alongside that of effectiveness data. The manuscript provides new information about the use of configurational analysis, which uses Boolean algebra to analyze pathways to implementation success considering each variable, within and across diverse clinical sites across the USA.
Discussion
The significance of this protocol is that it outlines important information for future hybrid type 3 designs wishing to incorporate configurational analyses and/or studies using behavioral or atypical, complex, innovative interventions. The current lack of evidence supporting occupational justice-focused interventions and the strong evidence of stigma influencing health inequities underscore the necessity for the IDEAS intervention.
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After Dying Alone: The Restorative Power of Narrative Practice. Anesthesiology 2022; 137:366-369. [PMID: 35802858 DOI: 10.1097/aln.0000000000004298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hsu PT, Chen JJ, Ho YF. The effects of narrative pedagogy on increasing nursing students' willingness to practice older people care: A mixed-methods research. Nurse Educ Pract 2022; 62:103356. [DOI: 10.1016/j.nepr.2022.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/29/2022] [Accepted: 04/23/2022] [Indexed: 11/30/2022]
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Lampl C, Sacco S, Martelletti P. Narrative-based medicine in headache disorders. J Headache Pain 2022; 23:66. [PMID: 35690726 PMCID: PMC9188204 DOI: 10.1186/s10194-022-01437-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/04/2022] [Indexed: 01/07/2023] Open
Abstract
In this editorial we aim to provide an overview of Narrative-based Medicine (NBM) and highlight what it may offer to the care of individuals with headache disorders.
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Affiliation(s)
- Christian Lampl
- Department of Neurology and Headache Medical Centre, Konventhospital Barmherzige Brüder Linz, Linz, Austria.
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Lewis J, Shapiro J. Speaking with Frankenstein. THE JOURNAL OF MEDICAL HUMANITIES 2022; 43:267-282. [PMID: 32820412 PMCID: PMC7441016 DOI: 10.1007/s10912-020-09653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This collaborative essay experimentally applies the insights of Mary Shelley's 1818 gothic fantasy Frankenstein to clinical interactions between present-day physicians and the patients they, akin to Shelley's human protagonist, so often seem to bring (back) to life. Because that process is frequently fraught with unspoken elements of ambivalence, disappointment, frustration, and failure, we find in Shelley's speculative fiction less a cautionary tale of overreach than a dynamic parable of the role that the unspoken, the invisible, and the unknown might play in contemporary physician/patient relationships. Playing with that parable, we consider its relevance to four often unacknowledged dynamics that shape physician/patient interaction: commitment to a false binary of life and death; the tyranny of normative aesthetics; shared negative affect; and the ethics of care and care-denial. To "speak with Frankenstein" is, we show, to make space for the otherwise unspeakable. The result is a more complete model of narrative medicine that accommodates to its ideal of open communication and full attention the persistence of what cannot be said, seen, or known--only imagined and approximated.
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Affiliation(s)
- Jayne Lewis
- Department of English, University of California, Irvine, 92697, USA.
| | - Johanna Shapiro
- School of Medicine, University of California, Irvine, 92697, USA
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Narrative Kompetenzen = Ethische Kompetenzen? Die Interventionsmethode der Narrativen Medizin. Ethik Med 2022. [DOI: 10.1007/s00481-022-00702-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Remein CD, Childs E, Beard J, Demers LB, Benjamin EJ, Wingerter SL. "Getting Started": A Pilot Introductory Narrative Writing Session for Interprofessional Faculty in Academic Health Sciences. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:265-274. [PMID: 35313635 PMCID: PMC8934153 DOI: 10.2147/amep.s350246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/02/2022] [Indexed: 05/23/2023]
Abstract
PURPOSE We designed and implemented a pilot introductory narrative writing session with the two-fold goal of fostering the dissemination of faculty writing for submission to peer-reviewed journals and other publication venues while simultaneously creating a framework for establishing collaborative and empathic interprofessional teams by enhancing narrative-related competencies. METHODS The session was open to interprofessional faculty at our academic health sciences center. Participants were accepted via a competitive application process, with group size limited to 18 individuals due to the workshop-style format. Learners were reflective of our diverse campus regarding sex, race/ethnicity, department, rank, and professional role. The session began with an experiential seminar providing instruction on writing theory and practice, discussion questions, and reflective writing prompts. The seminar was followed by a writing workshop. We conducted a mixed-methods evaluation to gauge participant satisfaction and educational efficacy. RESULTS The mixed-methods evaluation revealed that faculty reported high satisfaction with the session as a designated space to contemplate, discuss, practice, share, and critique narrative writing. All learners (18, 100%) rated it "very good" or "excellent" in overall quality and value as well as in relevance to personal growth. Participants reported growth in communication (13, 72%), self-reflection (12, 67%), active listening (12, 67%), writing confidence (11, 61%), perspective-taking (11, 61%), writing skills (10, 56%), and empathy (8, 44%). DISCUSSION Faculty valued the session as a venue for improving their writing skills and sharing with a diverse group of colleagues about the significance of narrative in relation to their professional lives. CONCLUSION Seminar outcomes suggest that narrative-based education for interprofessional health sciences faculty can be effective in achieving the two-fold goal of enhancing writing competencies while simultaneously fostering essential skills for building collaborative and empathic teams to promote high-quality education, research, and whole person clinical care.
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Affiliation(s)
- Christy D Remein
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Ellen Childs
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jennifer Beard
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Lindsay B Demers
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Sarah L Wingerter
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Cerceo E, Zimmerman M, DeLisser HM. Diversity, Equity, and Inclusion: Moving from Performance to Transformation Through the Arts and Humanities. J Gen Intern Med 2022; 37:944-946. [PMID: 34993859 PMCID: PMC8904695 DOI: 10.1007/s11606-021-07225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
Effective engagement on issues of diversity, equity, and inclusion (DEI) requires activities that promote deep introspection and group conversations that serve to complement and build upon formal DEI presentations. The arts and humanities by their nature allow for intentional and sustained reflection and have the potential to be transformative of thinking. We therefore propose that the next phase of institutional pro-equity/anti-racism efforts includes arts- and humanities-based initiatives to facilitate reflection and that serve to complement and build upon formal DEI didactic presentations, implicit bias workshops, and anti-racism training.
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Affiliation(s)
- Elizabeth Cerceo
- Department of Hospital Medicine, Cooper Medical School of Rowan University, Cooper University Healthcare, Camden, NJ, USA.
| | | | - Horace M DeLisser
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Gottlieb-Smith R, Sullivan GM, Yarris LM. Publishing in the "On Teaching" Category: Powerful Creative Writing. J Grad Med Educ 2022; 14:1-3. [PMID: 35222810 PMCID: PMC8848883 DOI: 10.4300/jgme-d-21-01149.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Rachel Gottlieb-Smith
- Rachel Gottlieb-Smith, MD, MHPE, is Clinical Assistant Professor, Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, and Associate Editor, Journal of Graduate Medical Education (JGME)
| | - Gail M. Sullivan
- Gail M. Sullivan, MD, MPH, is Editor-in-Chief, JGME, and Associate Director for Education, Center on Aging, and Professor of Medicine, University of Connecticut Health Center
| | - Lalena M. Yarris
- Lalena M. Yarris, MD, MCR, is Professor of Emergency Medicine, Oregon Health & Science University, and Deputy Editor, JGME
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Bracken RC, Major A, Paul A, Ostherr K. Reflective Writing about Near-Peer Blogs: A Novel Method for Introducing the Medical Humanities in Premedical Education. THE JOURNAL OF MEDICAL HUMANITIES 2021; 42:535-569. [PMID: 33871756 PMCID: PMC8664789 DOI: 10.1007/s10912-021-09693-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 06/10/2023]
Abstract
Narrative analysis, creative writing, and interactive reflective writing have been identified as valuable for professional identity formation and resilience among medical and premedical students alike. This study proposes that medical student blogs are novel pedagogical tools for fostering peer-to-peer learning in academic medicine and are currently underutilized as a near-peer resource for premedical students to learn about the medical profession. To evaluate the pedagogical utility of medical student blogs for introducing core themes in the medical humanities, the authors conducted qualitative analysis of one hundred seventy-six reflective essays by baccalaureate premedical students written in response to medical student-authored narrative blog posts. Using an iterative thematic approach, the authors identified common patterns in the reflective essays, distilled major themes, coded the essays, and conducted narrative analysis through close reading. Qualitative analysis identified three core themes (empathic conflict, bias in healthcare, and the humanity of medicine) and one overarching theme (near-peer affinities). The premedical students' essays demonstrated significant self-reflection in response to near-peer works, discussed their perceptions of medical professionalism, and expressed concerns about their future progress through the medical education system. The essays consistently attributed the impact of the medical student narratives to the authors' status as near-peers. The authors conclude that reading and engaging in reflective writing about near-peer blog posts encourages premedical students to develop an understanding of core concepts in the medical humanities and promotes their reflection on the profession of medicine. Thus, incorporating online blogs written by medical trainees as narrative works in medical humanities classrooms is a novel pedagogical method for fostering peer-to-peer learning in academic medicine.
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Affiliation(s)
- Rachel Conrad Bracken
- Department of Family and Community Medicine, Northeast Ohio Medical University, 4209 St. Rte. 44, Rootstown, OH, 44272, USA.
| | - Ajay Major
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Aleena Paul
- Department of Medicine and Department of Pediatrics, Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Hempstead, NY, USA
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Shapiro J, McMullin J, Miotto G, Nguyen T, Hurria A, Nguyen MA. Medical Students' Creation of Original Poetry, Comics, and Masks to Explore Professional Identity Formation. THE JOURNAL OF MEDICAL HUMANITIES 2021; 42:603-625. [PMID: 34779996 PMCID: PMC8664798 DOI: 10.1007/s10912-021-09713-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 05/09/2023]
Abstract
INTRODUCTION This study examines differences in students' perceived value of three artmaking modalities (poetry, comics, masks) and whether the resulting creative projects offer similar or different insights into medical students' professional identity formation. METHODS Mixed-methods design using a student survey, student narrative comments and qualitative analysis of students' original work. RESULTS Poetry and comics stimulated insight, but masks were more enjoyable and stress-reducing. All three art modalities expressed tension between personal and professional identities. DISCUSSION Regardless of type of artmaking, students express concern about encroachments of training on personal identity but hoped that personal and professional selves could be integrated.
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Affiliation(s)
- Johanna Shapiro
- Department of Family Medicine, School of Medicine, UC Irvine Medical Center, University of California Irvine, rte 81, bldg. 200, rm 835, 101 City Dr. South, Orange, CA, 92868, USA.
| | - Juliet McMullin
- Department of Anthropology, University of California Riverside, Riverside, CA, USA
| | | | - Tan Nguyen
- Department of Family Medicine, School of Medicine, UC Irvine Medical Center, University of California Irvine, rte 81, bldg. 200, rm 835, 101 City Dr. South, Orange, CA, 92868, USA
| | - Anju Hurria
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine, Orange, CA, 92868, USA
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Edwards LM, Kim Y, Stevenson M, Johnson T, Sharp N, Reisman A, Srinivasan M. When it's needed most: a blueprint for resident creative writing workshops during inpatient rotations. BMC MEDICAL EDUCATION 2021; 21:535. [PMID: 34670565 PMCID: PMC8529814 DOI: 10.1186/s12909-021-02935-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Narrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents. OBJECTIVE To evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings of burnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions. METHODS We developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford's busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1-7; 3-4 = high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017-2018, weeks 1 and 4), and implementation year (2018-2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators. RESULTS Residents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n = 16; mean PBWI = 3.0, SD: 1.1) and increased by the final week (n = 15; PBWI = 3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n = 13; PBWI = 3.1, SD: 1.9) but did not rise as much by rotation end (n = 24; PBWI = 3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions. CONCLUSIONS Inpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.
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Affiliation(s)
- Lauren Michelle Edwards
- Division of Primary Care and Population Health, Stanford University School of Medicine, 960 North San Antonio Road, Suite 101, Los Altos, CA, 94022, USA.
| | - Yeuen Kim
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Matthew Stevenson
- Division of Primary Care and Population Health, Palo Alto Veterans Administration Hospital, Palo Alto, CA, USA
| | - Tyler Johnson
- Division of Hematology and Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Nora Sharp
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Palo Alto, CA, USA
- Computational and Systems Biology Interdepartmental Program, University of California, Westwood, Los Angeles, CA, USA
| | - Anna Reisman
- Department of Internal Medicine (General Medicine), Yale School of Medicine, New Haven, CT, USA
| | - Malathi Srinivasan
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
- Stanford Center for Asian Health Research and Education, Stanford University School of Medicine, Palo Alto, CA, USA
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Roest B, Milota M, Leget C. Developing new ways to listen: the value of narrative approaches in empirical (bio)ethics. BMC Med Ethics 2021; 22:124. [PMID: 34530832 PMCID: PMC8447625 DOI: 10.1186/s12910-021-00691-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/31/2021] [Indexed: 11/20/2022] Open
Abstract
The use of qualitative research in empirical bioethics is becoming increasingly popular, but its implementation comes with several challenges, such as difficulties in aligning moral epistemology and methods. In this paper, we describe some problems that empirical bioethics researchers may face; these problems are related to a tension between the different poles on the spectrum of scientific paradigms, namely a positivist and interpretive stance. We explore the ideas of narrative construction, ‘genres’ in medicine and dominant discourses in relation to empirical research. We also reflect on the loss of depth and context that may occur with thematic or content analyses of interviews, and discuss the need for transparency about methodologies in empirical bioethics. Drawing on insights from narrative approaches in the social sciences and the clinical-educational discipline of Narrative Medicine, we further clarify these problems and suggest a narrative approach to qualitative interviewing in empirical bioethics that enables researchers to ‘listen (and read) in new ways’. We then show how this approach was applied in the first author’s research project about euthanasia decision-making. In addition, we stress the important ethical task of scrutinizing methodologies and meta-ethical standpoints, as they inevitably impact empirical outcomes and corresponding ethical judgments. Finally, we raise the question whether a ‘diagnostic’, rather than a ‘problem-solving’, mindset could and should be foregrounded in empirical ethics, albeit without losing a commitment to ethics’ normative task, and suggest further avenues for theorizing about listening and epistemic (in)justice in relation to empirical (bio)ethics.
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Affiliation(s)
- Bernadette Roest
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512 HD, Utrecht, The Netherlands.
| | - Megan Milota
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Kromme Nieuwegracht 29, 3512 HD, Utrecht, The Netherlands
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Cunningham H, Taylor DS, Desai UA, Ender KL, Glickstein J, Krishnan US, Richards BF, Charon R, Balmer DF. Reading the Self: Medical Students' Experience of Reflecting on Their Writing Over Time. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1168-1174. [PMID: 33149084 DOI: 10.1097/acm.0000000000003814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate students' experience (over time) with meta-reflection writing exercises, called Signature Reflections. These exercises were used to strengthen reflective capacity, as part of a 4-year reflective writing portfolio curriculum that builds on a recognized strategy for reflection (narrative medicine) and employs longitudinal faculty-mentors. METHOD In 2018, the authors conducted 5 focus groups with 18 third-year students from the Columbia University Vagelos College of Physicians and Surgeons class of 2019 to examine students' experience with Signature Reflections. Using an iterative, thematic approach, they developed codes to reflect common patterns in the transcripts, distilled conceptually similar codes, and assembled the code categories into themes. RESULTS Three core themes (safe space, narrative experience, mirror of self) and 1 overarching theme (moving through time) were identified. Students frequently experienced relief at having a safe reflective space that promoted grappling with their fears or vulnerabilities and highlighted contextual factors (e.g., trusted faculty-mentors, protected time) that fostered a safe space for reflection and exploration. They often emphasized the value of tangible documentation of their medical school journey (narrative experience) and reported using Signature Reflections to examine their emerging identity (mirror of self). Overlapping with the core themes was a deep appreciation for the temporal perspective facilitated by the Signature Reflections (moving through time). CONCLUSIONS A longitudinal narrative medicine-based portfolio curriculum with pauses for meta-reflection allowed students, with faculty support, to observe their trajectory through medical school, explore fears and vulnerabilities, and narrate their own growth. Findings suggest that narrative medicine curricula should be required and sufficiently longitudinal to facilitate opportunities to practice the skill of writing for insight, foster relationships with faculty, and strengthen students' temporal perspectives of their development.
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Affiliation(s)
- Hetty Cunningham
- H. Cunningham is associate professor of pediatrics, Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York; ORCID: https://orcid.org/0000-0003-1686-0497
| | - Delphine S Taylor
- D.S. Taylor is associate professor of medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0002-1999-0388
| | - Urmi A Desai
- U.A. Desai is assistant professor of medicine, Center for Family and Community Medicine, Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Katherine L Ender
- K.L. Ender is assistant professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Julie Glickstein
- J. Glickstein is professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Usha S Krishnan
- U.S. Krishnan is professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York; ORCID: https://orcid.org/0000-0002-5733-6096
| | - Boyd F Richards
- B.F. Richards is professor of pediatrics, Department of Pediatrics, University of Utah, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0002-1864-7238
| | - Rita Charon
- R. Charon is professor of medicine, Department of Medicine, and professor of medical humanities & ethics, Department of Medical Humanities & Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0002-6003-5219
| | - Dorene F Balmer
- D.F. Balmer is associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-6805-4062
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Narratives of Survivorship: A Study of Breast Cancer Pathographies and Their Place in Cancer Rehabilitation. ACTA ACUST UNITED AC 2021; 28:2840-2851. [PMID: 34436015 PMCID: PMC8395399 DOI: 10.3390/curroncol28040249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
The focus on cancer rehabilitation has increased, but breast cancer patients still report unmet rehabilitation needs. Since many women today will live long beyond their diagnosis, there are multiple challenges for the healthcare system in supporting these women in their new life situation. A more individualized approach is seen as necessary to optimize the rehabilitation for survivors. Pathographies, i.e., autobiographical or biographical accounts of experiences of illness, expose us to personal accounts of the journey through illness and treatment, offering us details, emotions, phrasings, and imagery from an individual perspective. In this literary study, we have analyzed two contemporary Swedish-speaking pathographies about breast cancer. In our analysis, we have presented perspectives on survivorship, and the authors’ ways of conveying their breast cancer experiences through narrative. The pathographies envision the prominent impact the breast cancer has on the authors’ lives. Narratives of survivorship have the potential to complement the more general medical knowledge with their nuanced and multifaceted stories of breast cancer. Learning from this type of material may improve the understanding of the complexity of breast cancer survivorship issues. This may be a way to become more attuned to identifying individual needs and preferences of breast cancer patients.
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Abstract
Narrative medicine describes the application of story to medical education and practice. Although it has been implemented successfully in many medical schools as a part of undergraduate medical education, applications to the residency environment have been relatively limited. There are virtually no data concerning the adoption of narrative medicine within surgical residencies. This paper provides a brief introduction to the formal discipline of narrative medicine. We further discuss how storytelling is already used in surgical education and summarize the literature on applications of narrative medicine to residents in other specialties. The relevance of narrative medicine to the ACGME core competencies is explored. We conclude with specific suggestions for implementation of narrative medicine within surgical residency programs.
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Affiliation(s)
- Carol Eh Scott-Conner
- Department of Surgery, University of Iowa Carver College of MedicineIowa City, IA, USA
| | - Divyansh Agarwal
- 14640Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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Huang YK, Chen YT, Chang YC. Initiating narrative medicine into dental education: Opportunity, change, and challenge. J Formos Med Assoc 2021; 120:2191-2194. [PMID: 34183221 DOI: 10.1016/j.jfma.2021.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022] Open
Abstract
Recently, the patient-centered and comprehensive dental treatment are emphasized as the same important competency as traditional clinical skill training in dental education. It is a silver lining to reorganize current dental education and redefine the role of dentistry to dentist, patient, and society. Narrative medicine has emerged as a variant from medical humanities and takes inspiration from philosophy, literature, poetry, art, ethics, and social sciences. Narrative medicine adds humanistic care with empathy and listening to patients in daily care. In this article, we introduce the definition of narrative medicine, the concept of narrative dentistry, implementation of narrative medicine into dental education, and challenges in initiating narrative dentistry. During the current COVID-19 pandemic, it also affords the opportunity to initiate narrative medicine into dental education, dentist could emerge to heal patient holistically, but not simply eliminate oral diseases.
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Affiliation(s)
- Yung-Kai Huang
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Tzu Chen
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Chao Chang
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan; Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Fenstermacher E, Longley RM, Amonoo HL. Finding the Story in Medicine: The Use of Narrative Techniques in Psychiatry. Psychiatr Clin North Am 2021; 44:263-281. [PMID: 34049648 DOI: 10.1016/j.psc.2021.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Narrative medicine is a patient-centered educational approach that promotes humanistic engagement of medical practitioners; it offers a unique framework for understanding medical encounters and promotes empathic connections through enhancement of observation, listening, and reflection. The andragogy of narrative medicine uniquely engages adult learners and may enhance academic learning. This article explores the evidence for narrative medicine and discusses its unique applications and potential within psychiatry. An adaptable narrative medicine curriculum is proposed for use in a 4-year psychiatric residency curriculum to allow for easy adoption of narrative medicine as an underutilized best educational practice.
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Affiliation(s)
- Elizabeth Fenstermacher
- Department of Psychiatry, Denver Health, 660 Bannock St, Suite 4754, Denver, CO 80204, USA; University of Colorado, School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA.
| | - Regina M Longley
- Department of Psychiatry, Massachusetts General Hospital, 125 Nashua Street, Suite #324, Boston, MA 02114, USA
| | - Hermioni L Amonoo
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Psychiatry, Brigham and Women's Hospital, 60 Fenwood Road, 4th Floor, Boston, MA 02115, USA; Department of Psychosocial Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
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Wallace CL, Trees A, Ohs J, Hinyard L. Narrative Medicine for Healthcare Providers: Improving Practices of Advance Care Planning. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:87-102. [PMID: 34011207 DOI: 10.1177/00302228211015596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advance care planning (ACP) conversations about treatment preferences and end-of-life goals relate to positive outcomes for patients and families, though ongoing barriers exist. Additionally, providers personal discomfort and personal experiences may influence how they engage (or avoid) ACP conversations. Narrative medicine (NM) offers one approach to help practitioners develop ability to hear and understand the story of others in ways that may overcome barriers to quality conversations. This study investigated the effectiveness of a 3-hour NM workshop to develop communication skills around ACP and facilitate reflection on the relationship between personal experiences and professional practices in ACP and end-of-life care. Twenty-five participants completed post-assessments of the workshop. Key themes included increased awareness, improved skills for active listening and eliciting stories, and improved understanding of how personal experiences shape professional practice. Results indicate practitioners value the NM approach to ACP suggesting this approach may provide impactful change in practice.
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Affiliation(s)
- Cara L Wallace
- School of Social Work, Saint Louis University, Saint Louis, Missouri, United States
| | - April Trees
- Department of Communication, Saint Louis University, Saint Louis, Missouri, United States
| | - Jennifer Ohs
- Department of Communication, Saint Louis University, Saint Louis, Missouri, United States
| | - Leslie Hinyard
- Department of Health and Clinical Outcomes Research, Advanced HEAlth Data (AHEAD) Institute, Center for Health Outcomes Research, Saint Louis University, Saint Louis, Missouri, United States
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Lanocha N. Lessons in Stories: Why Narrative Medicine Has a Role in Pediatric Palliative Care Training. CHILDREN-BASEL 2021; 8:children8050321. [PMID: 33922034 PMCID: PMC8143552 DOI: 10.3390/children8050321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 01/04/2023]
Abstract
Narrative medicine is introduced and explored as a potential tool for developing competency in medical training, including reduction of burnout, sustaining empathy, and allowing for reflective practice. Developing cultural humility, communication skills, ethics, community building, and advocacy are also reviewed as domains that may be bolstered by training in narrative. Applications specific to pediatric palliative care are suggested, along with avenues for further research.
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Affiliation(s)
- Natalie Lanocha
- Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA
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On the left side: The importance of the narrative of the heart for a better understanding of medicine. Rev Port Cardiol 2021; 40:145. [PMID: 33581949 DOI: 10.1016/j.repc.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/20/2020] [Indexed: 11/20/2022] Open
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Rosário F. On the left side: The importance of the narrative of the heart for a better understanding of medicine. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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