Medicine: the science and the art

Through the looking glass: qualitative study of critical care clinicians engaging in humanities

PURPOSE

Critical care medicine is facing an epidemic of burnout and consequent attrition. Interventions are needed to re-establish the medical field as a place of professional growth, resilience, and personal well-being. Humanities facilitate creation, reflection, and meaning-making, holding the promise of personal and community transformation. This study aimed to explore how clinicians engage with a humanities program, and what role and impact do the humanities play in their individual and collective journey.

METHODS

This is a qualitative study employing a phenomenological approach. Participants were faculty and trainees who participated in the program. Data consisted of (a) 60-h observations of humanities evenings, (b) more than 200 humanities artifacts brought by participants, and (c) 15 in-depth participant interviews. Data were analyzed inductively and reflectively by a team of researchers.

RESULTS

Participants were motivated to engage with the humanities curriculum because of past experiences with art, identifying a desire to re-explore their creativity to make meaning from their clinical experiences and a wish to socialize with and understand their colleagues through a different lens. The evenings facilitated self-expression, and inspired and empowered participants to create art pieces and re-engage with art in their daily lives. More importantly, they found a community where they could be vulnerable and supported, where shared experiences were discussed, emotions were validated, and relationships were deepened between colleagues.

CONCLUSIONS

Humanities may impact resilience and personal and community well-being by facilitating reflection and meaning-making of challenging clinical work and building bonds between colleagues.

Cased-based education rounds-the eternal heart of an international training program

Case-based teaching or "Morning Rounds" have been used in medical education for more than a century and remain a cornerstone for teaching in many training programs. Our Pediatric Critical Care Medicine (PCCM) program was established forty years ago and has retained this form of teaching since its inception. Case-based rounds have consistently had the highest evaluation of all curricula in our program. Here we review the history of how these rounds were introduced in medical education, provide data from the learners' evaluation of these case-based rounds, and discuss the strengths and potential drawbacks of this form of teaching from an educational theories perspective with the hope that they can be used by other Pediatric Critical Care training programs.

Reversing the medical humanities

The paper offers the concept of reversing the medical humanities In agreement with the call from Kristeva et al to recognise the bidirectionality of the medical humanities, I propose moving beyond debates of attitude and aptitude in the application and engagement (either friendly or critical) of humanities to/in medicine, by considering a reversal of the directions of epistemic movement (a reversal of the flow of knowledge). I situate my proposal within existing articulations of the field found in the medical humanities meta-literature, pointing to a gap in the current terrain. I then develop the proposal by unfolding three reasons why we might gain something from exploring a reversed knowledge flow. First, a reversed knowledge flow seems to be an inherent-but still to be articulated-possibility in medical humanities and thus provides an opportunity for more knowledge. Second, the current unidirectionality of the field is founded on an inconsistency in the depiction of the connection between medicine and humanities, which risks creating the very divide that medical humanities set out to bridge. Practising a reversal may help avoid this divide. And third, a reversal might help rebalance the internal epistemic power, so as to motivate less external scepticism and in turn displace more external epistemic power towards medical humanities. I end the paper with a remark on precursors for a reversal, and ideas for where to go from here.

Tales of treatment and new perspectives for global health research on antimicrobial resistance

Global health champions modernism and biomedical knowledge but tends to neglect knowledge, beliefs and identities of rural communities in low-income and middle-income countries. The topic of antimicrobial resistance represents these common challenges, wherein the growing emphasis on public engagement offers a yet underdeveloped opportunity to generate perspectives and forms of knowledge that are not typically incorporated into research and policy. The medical humanities as an interdisciplinary approach to illness and health behaviour play a central role in cultivating this potential-in particular, through the field's emphasis on phenomenological and intersubjective approaches to knowledge generation and its interest in dialogue between medicine, the humanities and the broader public.We present a case study of public engagement that incorporates three medical humanities methods: participatory co-production, photographic storytelling and dialogue between researchers and the public. Situated in the context of northern Thailand, we explore subcases on co-production workshops with villagers, tales of treatment shared by traditional healers and dialogue surrounding artistic display in an international photo exhibition. Our starting assumption for the case study analysis was that co-produced local inputs can (and should) broaden the understanding of the sociocultural context of antimicrobial resistance.Our case study illustrates the potential of medical humanities methods in public engagement to foreground cultural knowledge, personal experience and 'lay' sensemaking surrounding health systems and healing (including medicine use). Among others, the engagement activities enabled us to formulate and test locally grounded hypotheses, gain new insights into the social configuration of treatment seeking and reflect on the relationship between traditional healing and modern medicine in the context of antimicrobial resistance. We conclude that medical-humanities-informed forms of public engagement should become a standard component of global health research, but they require extensive evaluation to assess benefits and risks comprehensively.

Who am I? Narratives as a window to transformative moments in critical care

Critical care clinicians practice a liminal medicine at the border between life and death, witnessing suffering and tragedy which cannot fail to impact the clinicians themselves. Clinicians' professional identity is predicated upon their iterative efforts to articulate and contextualize these experiences, while a failure to do so may lead to burnout. This journey of self-discovery is illuminated by clinician narratives which capture key moments in building their professional identity. We analyzed a collection of narratives by critical care clinicians to determine which experiences most profoundly impacted their professional identity formation. After surveying 30 critical care journals, we identified one journal that published 84 clinician narratives since 2013; these constituted our data source. A clinician educator, an art historian, and an anthropologist analyzed these pieces using a narrative analysis technique identifying major themes and subthemes. Once the research team agreed on a thematic structure, a clinician-ethicist and a trainee read all the pieces for analytic validation. The main theme that emerged across all these pieces was the experience of existing at the heart of the dynamic tension between life and death. We identified three further sub-themes: the experience of bridging the existential divide between dissimilar worlds and contexts, fulfilling divergent roles, and the concurrent experience of feeling dissonant emotions. Our study constitutes a novel exploration of transformative clinical experiences within Critical Care, introducing a methodology that equips medical educators in Critical Care and beyond to better understand and support clinicians in their professional identity formation. As clinician burnout soars amidst increasing stressors on our healthcare systems, a healthy professional identity formation is an invaluable asset for personal growth and moral resilience. Our study paves the way for post-graduate and continuing education interventions that foster mindful personal growth within the medical subspecialties.

An innovative method of data analysis: Using art as a lens through which to view pharmacy undergraduate students' learning and assessment practices

BACKGROUND

It has been argued in the literature that pharmacy is a unique integration of art and science. This paper addresses the art aspect of this and draws on the existence of multiple philosophies, theories and belief systems and describes the methodological process of use fine art (paintings) as a lens through which to view thematic data about a 'scientific' concept; a method which appears to be unique in the literature.

OBJECTIVES

To explore pharmacy students' assessment practices and any influence on their learning practices. To explore how feedback influences pharmacy students' learning practices. To determine whether the affective dimension impacts on pharmacy students' learning. To evaluate whether fine can art be used as a lens to make sense of thematic data.

METHODS

Data collection took the form of individual semi-structured interviews and was underpinned by an interpretivist qualitative approach. Analysis of data involved exploring the themes relating to assessment. Initially, thematic analysis of the data was carried out using an inductive approach and mind-mapping then Pierre Bonnard's art was used as a 'lens' through which to view the themes.

RESULTS

Eighteen pharmacy students in one UK School of Pharmacy were interviewed. Themes relating to assessment practices which are discussed in this paper and compared to Pierre Bonnard's paintings are: conceptions of assessment (compared with Coffee), the impact of the nature of assessment on learning practices (compared with Dining Room in the Country), feedback (compared with Nude in a Mirror), strategies used in assessment practices (compared with The French Window), the affective dimension of assessment (compared with Red Roos at Le Cannet) and assessment constrains free-thinking (compared with The White Interior).

CONCLUSIONS

Using Bonnard's art in analysis has provided an additional way of extending the analysis of participant's assessment practices. Aligning with Bonnard's technique of foregrounding the unexpected or diverting attention away from the obvious has allowed illumination of these practices and previously un-noticed aspects of pharmacy students' learning practices. There were a number of new insights gained from using this approach as well limitations. By attending to a different perspective that art brings, we have been able to see how assessment practices link to learning as pharmacy students.

Spirituality and Healthcare—Common Grounds for the Secular and Religious Worlds and Its Clinical Implications

The spiritual dimension of patients has progressively gained more relevance in healthcare in the last decades. However, the term “spiritual” is an open, fluid concept and, for health purposes, no definition of spirituality is universally accepted. Health professionals and researchers have the challenge to cover the entire spectrum of the spiritual level in their practice. This is particularly difficult because most healthcare courses do not prepare their graduates in this field. They also need to face acts of prejudice by their peers or their managers. Here, the authors aim to clarify some common grounds between secular and religious worlds in the realm of spirituality and healthcare. This is a conceptual manuscript based on the available scientific literature and on the authors’ experience. The text explores the secular and religious intersection involving spirituality and healthcare, together with the common ground shared by the two fields, and consequent clinical implications. Summarisations presented here can be a didactic beginning for practitioners or scholars involved in health or behavioural sciences. The authors think this construct can favour accepting the patient’s spiritual dimension importance by healthcare professionals, treatment institutes, and government policies.

Health Technology Assessment - science or art?

The founding disciplines of HTA are clearly scientific, and have been firmly based among the natural sciences. However, common definitions of HTA indicate that HTA is something more than the "pure application of science". This article investigates whether this "something" also makes HTA an art. The question of whether HTA is a science or an art is pursued in two specific and historically rich directions. The first is whether HTA is an art in the same way that medicine is described as an art. It has been argued extensively that medicine is based on two different and partly incompatible cultures, i.e., the natural sciences and humanities. Medicine is based on disciplines within the natural sciences, while its value judgments have been placed in the humanities camp. This dichotomy is present in HTA as well, and the first part of the investigation illustrates how HTA is an art in terms of its inherent and constitutive value-judgments. The second part of the science/art-scrutiny leads us to the ancient (Hippocratic) concept of art, téchne, where we find an etymological and a conceptual link between HTA and art. It demonstrates HTA is not an arbitrary process, even though it involves value judgments and relates complex decision making processes. As an art (téchne) HTA has a specific subject matter, requires inquiry and mastery of general rational principles, and is oriented to a specific end. In conclusion, the science-or-art-question makes sense in two specific perspectives, illustrating that HTA is a science based art. This has implications for the practice of HTA, for its education, and for the status of its results.

Somatic fixation: the harm of healing

The term somatic fixation describes a model in which the patient's problems are medicalized both by the patient and by the physician. This phenomenon was described by a group of researchers from the Netherlands, in 1983. This paper discusses somatic fixation and its implications. Somatic fixation should be distinguished from "somatization" or "somatoform disorder", which are psychiatric diagnoses, although there is probably a large degree of overlap. Predisposing factors to somatic fixation include social, cultural and medical circumstances, both related to the patient and to the physician. The medical care system may predispose to somatic fixation by offering prepaid medical care, and by incorporating the "rule out" model in fear of medical law-suits. Preventing somatic fixation is a major aim for every physician; being more aware of its possible occurrence may help, as well as exploring the patient's history and psychosocial background.