Twelve tips on teaching and learning humanism in medical education

A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore

INTRODUCTION

Nurturing professional identities instils behavioural standards of physicians, and this in turn facilitates consistent professional attitudes, practice and patient care. Identities are socioculturally constructed efforts; therefore, we must account for the social, cultural and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aimed to forward a programme to nurture professionalism among physicians in Singapore.

METHODS

A three-phase, evidenced-based approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created based on the findings of the SSR. Third, a modified Delphi approach, which involved local experts to identify socioculturally appropriate elements to nurture professionalism, was used.

RESULTS

A total of 124 articles were identified from the SSR; these articles revealed definitions, knowledge, skills and approaches to nurturing professionalism. Through the modified Delphi approach, we identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms.

CONCLUSION

The results of this study formed the basis for a holistic and longitudinal programme focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. The findings will be of interest to medical communities in the region and beyond.

Using machine learning to identify key subject categories predicting the pre-clerkship and clerkship performance: 8-year cohort study

BACKGROUND

Medical students need to build a solid foundation of knowledge to become physicians. Clerkship is often considered the first transition point, and clerkship performance is essential for their development. We hope to identify subjects that could predict the clerkship performance, thus helping medical students learn more efficiently to achieve high clerkship performance.

METHODS

This cohort study collected background and academic data from medical students who graduated between 2011 and 2019. Prediction models were developed by machine learning techniques to identify the affecting features in predicting the pre-clerkship performance and clerkship performance. Following serial processes of data collection, data preprocessing before machine learning, and techniques and performance of machine learning, different machine learning models were trained and validated using the 10-fold cross-validation method.

RESULTS

Thirteen subjects from the pre-med stage and 10 subjects from the basic medical science stage with an area under the ROC curve (AUC) >0.7 for either pre-clerkship performance or clerkship performance were found. In each subject category, medical humanities and sociology in social science, chemistry, and physician scientist-related training in basic science, and pharmacology, immunology-microbiology, and histology in basic medical science have predictive abilities for clerkship performance above the top tertile. Using a machine learning technique based on random forest, the prediction model predicted clerkship performance with 95% accuracy and 88% AUC.

CONCLUSION

Clerkship performance was predicted by selected subjects or combination of different subject categories in the pre-med and basic medical science stages. The demonstrated predictive ability of subjects or categories in the medical program may facilitate students' understanding of how these subjects or categories of the medical program relate to their performance in the clerkship to enhance their preparedness for the clerkship.

The heart of anaesthesiology: revitalising humanism in the age of technology

Technological innovation has greatly aided modern medicine, and anaesthesiology in particular, but also contributes to dehumanising influences that promote physician burnout and dissatisfaction among patients. Here we advocate for a profound reaffirmation of humanistic principles-empathy, compassion, and communication-in perioperative medicine. We propose adaptable strategies to bolster humanism in practice, such as curricular offerings, simulation training, role modelling, and recognition. As perioperative technologies continue to evolve, the threat of depersonalisation in anaesthetic care looms, making commitments to humanism a crucial precondition for healing in the communities in which we work and live.

Interprofessional palliative and end-of-life education: short-term and long-term outcomes - mixed-methods analysis

ObjectiveInterprofessional care is integral to end-of-life (EOL) and palliative care (PC) and may be suited for EOL and PC education.We evaluate the impact of an interprofessional EOL care curriculum on participants, during the course, on completion and 4 years laterusing quantitative (questionnaires) and qualitative (open-ended questions and interviews) methods.The course included 14 fifth and sixth-year medical students, 9 social work students and 7 nursing students enrolled in master's degree programmes. Seventeen participants completed questionnaires 4 years later and eight participated in interviews.On postcourse questionnaires, participants attributed high value to interprofessional education (IPE) (4.77/5±0.50 on a Likert scale). Four years later, participants reported that IPE impacted their professional (3.65/5±1.11) and personal lives (3.94/5±1.09) and found PC IPE important (4.88/5±0.33).Conventional content analysis showed that the course enabled discussion of death and dying and provided an opportunity for a personal-emotional journey. It offered an approach to EOL care and an opportunity to experience interprofessional teamwork at the EOL resulting in behavioural change.Interprofessional EOL education resulted in meaningful and lasting self-reported personal and professional behavioural outcomes.

In their own words: impact of donor information and personal statements on humanization of donors in a gross anatomy course

Humanization of donors in gross anatomy courses has been reported to facilitate professional behavior in healthcare students. However, there is a lack of research investigating whether students' knowledge of donor information is associated with humanization of whole body donors. To address this gap, the present study aimed to 1) determine whether knowledge of donor information is associated with greater humanization of donors and 2) investigate student perceptions of receiving donor information. Donor information was provided to students at the beginning of the course (cohort A) or at midsemester (cohort B). Questionnaires utilized quantitative and qualitative methods to assess humanization and student perceptions at the beginning, middle, and end of the semester. Independent t tests demonstrated that there was no statistically significant difference in mean humanization scores between cohorts A and B before the first dissection [t(37) = 0.449, P = 0.656], at midsemester [t(35) = -1.546, P = 0.131], or at the end of the semester [t(28) = 0.004, P = 0.997]. Thematic analysis demonstrated that as the semester progressed students' view of dissection as an invasion of privacy and the donor as a patient decreased. Themes delineated from students' open-ended responses revealed that students felt a connection with their donors; that the donors' consenting information gave permission to dissect; and that the information gave students an invaluable learning experience. Students demonstrated detached concern toward their donor, viewing the donor as a learning tool or educator rather than a patient. However, their responses also indicated the development of a deeper, personal connection to donors.NEW & NOTEWORTHY A look at the use of donor personal statements and information to humanize donors and how it influenced students' experiences in a gross anatomy laboratory.

Twelve tips for mindful teaching

Medical educators' stressors continue to increase, and they increasingly find themselves removed from their learners. This distance is thought to contribute to the disenchantment many educators feel. The challenge for educators is to reengage with their learners and restore their satisfaction in teaching. Mindful teaching can help educators meet this challenge. Mindful teaching is not an instructional technique; rather, it is a way of being that the teacher embodies. Mindful teachers practice awareness, acceptance and curiosity. They recognize the needs of their learners, engaging with learners who are 'at the ready'; encouraging those who might not be engaged; and advocating for those who need support. These educators are less susceptible to burnout and help learners develop their own mindfulness. The Tips noted in this article can help educators make deeper connections with their learners, garner greater sense of personal accomplishment and become invigorated by their learners' achievements.

Medical Students' Participation in Extracurricular Activities: Motivations, Contributions, and Barriers. A Qualitative Study

INTRODUCTION

Extracurricular activities in medical education are defined as any social, philanthropic, non-mandatory, and unpaid activities. These activities promote interactions between students and the community in ways that both provide care and create learning opportunities and experiences for both students and the community at large. This study elaborates on the motivational aspects, learnings, and barriers that occur when students participate in these activities.

METHODS

This is a cross-sectional study of medical students in their first to fifth years. Qualitative analyses have been used to understand the motivation, barriers, and contributions associated with extracurricular activities participation.

RESULTS

Of the 586 students enrolled in the medical course, 462 students agreed to participate in the research. The students reported that they were motivated to participate in contributing to society, support their professional choices, integrate their knowledge, gain life experience, develop communication and leadership skills, learn to work in a team, and become more responsible, empathetic, and resilient. Barriers to participation were the limited number of available positions, selection criteria, lack of support from those involved, personal issues, poor time management, risk of lowered academic performance, and lack of physical and financial resources.

DISCUSSION

Medical students are motivated to participate in Community-based extracurricular activities (CBEA) and this experience leads to improvement in the curriculum and can develop fundamental skills and attitudes such as leadership, commitment, and responsibility. To maximize the benefits of these activities, schools must support students and ensure that they have the time and chance to participate without physical strain, that were barriers mentioned by the academics.

"From doing to knowing": medical students' experiences of working as Healthcare Assistants

There is growing recognition that doctors need to deliver person-centered care. More evidence is needed on how to best equip students in an already busy curriculum. Providing medical students with the opportunity to work as Healthcare Assistants (HCAs) can help them develop the desired skills. This study examined medical students' experiences of working as HCAs and perceived impact on their future practice. Adopting an Interpretative Phenomenological Analysis approach, we analyzed narratives from two focus groups of 13 'Year 0' and 'Year 1' medical students, who had completed an HCA project. This project allowed participants to experience a new dimension of patient care whereby learning by "doing" evolved to a deeper level of "knowing" patients, the HCA role and the wider team. Four major themes were identified: seeing the doctor: gaining new perspectives; building confidence: learning from and about patients; understanding the overall patient experience: providing personal care; finding "the person behind the patient": exploring beyond the diagnosis. This study suggests that working as an HCA enables participants to develop sustainable skills that equip them for their future role as doctors able to deliver person-centered care as part of an interprofessional team. Recommendations for inclusion of this type of intervention into the medical curriculum are discussed.

Teaching and Learning Core Values in General Practice/Family Medicine: A Narrative Review

General Practice/Family Medicine (GP/FM) is a key discipline within primary health care and so by extension for the whole health care system. An essential condition for effective GP/FM care is a work force that is highly qualified. As society is changing rapidly, a revision of the GP/FM definition is ongoing, in addition to a recent movement of identifying related core values. In this paper, we want to give an overview on how these new paths and perspectives are currently reflected in GP/FM teaching and training. We selected four core values that fit in with possible future visions: person-centered care, continuity of care, cooperation in care, and community-oriented care. By a narrative review, we observed that GP/FM education toward core values is often built around overarching topics. Teaching and learning take place in specific contexts, most of all through placements within communities, primary care settings, or hospital wards. Mixed teaching- and training methods are used combining knowledge, skills, and attitude. Furthermore, collaboration with other health professionals and peers is stressed, in addition to the importance of role models, a holistic focus and the involvement of patients. Since these core values are important within GP/FM and rather few studies on the educational aspects and learning tools were found we advocate encouraging each other more to share good practices, certainly the innovative ones specifically related to GP/FM.

I am not a doctor, but… A reflection on training doctors in communication skills without being one

Over the last 15-20 years, the scope of medical education has broadened to include disciplines other than the biomedical. Many educators from the humanities and social sciences are thus currently teaching in the faculty of medicine. But how should we understand and communicate the position from which we - as 'non-doctors' - teach in this field? This article provides a reflection on how both doctors and 'non-doctors' in medical education seem to confirm and reproduce an underlying norm, namely that doctors are the most suitable teachers in medical education. I argue that these norms could and should be challenged. I provide examples of how a 'gaze from the outside' is fruitful and may be necessary in medical education, and highlight the potential strength of cross-disciplinary teaching that involves medical educators 'within and outside' medicine.

A Medical Education Recommendation for Improving Sexual Health and Humanism and Professionalism

INTRODUCTION

Sexual health in the United States is poor, yet most physicians do not address the topic. Sexual health education (SHE) guidelines are available but not used. The lack of SHE in undergraduate medical education (UME) impacts sexual and general health outcomes, as SHE in UME increases physicians' awareness of and ability to address sexual health, which is bidirectionally correlated with other health.

OBJECTIVE

To design and assess the need, feasibility, and outcomes of an educational recommendation for increased incorporation of SHE in UME.

METHODS

Comprehensive literature review was used to assess current and future needs of SHE in UME and humanism and professionalism education (HPE). Qualitative analysis was used to assess a potential solution. The main outcome measure was an educational recommendation based on qualitative analysis of (1) the benefits of SHE and HPE in UME, (2) the SHE and HPE overlap, and (3) the potential effect of a formally combined delivery on UME and patient and practitioner outcomes.

RESULTS

Available literature on medical SHE supports increased SHE is necessary and should be incorporated into existing HPE whenever possible, secondary to numerous intersections. Qualitative analysis supports HPE could be enhanced when consistently exemplified through SHE, and this approach could be beneficial for (1) increased understanding, retention, application, and advocacy of both topics; (2) long-term improvement of sexual and general health at the patient and population levels; and (3) increased practice of humanism and professionalism, potentially resulting in better patient outcomes and professional satisfaction for physicians.

CONCLUSION

Cross-disciplinary qualitative analysis supports using SHE as the primary topic to teach HPE is a viable method to increase SHE and potentially creates physicians who address sexual health and practice with increased humanism and professionalism, leading to population-level sexual and general health improvements. Gordon EG. A Medical Education Recommendation for Improving Sexual Health and Humanism and Professionalism. Sex Med Rev 2021;9:23-35.

Humanism in clinical education: a mixed methods study on the experiences of clinical instructors in Iran

BACKGROUND

Medical education is currently more considerate about the human dimension. The present qualitative study aimed to explain the experiences of clinical professors with regard to humanism in clinical education in Iran.

METHODS

This mixed methods study had two phases, a quanitative phase of scientometrics and a qualitative phase of a content analysis. In the scientometrics phase, Ravar PreMap and VOSviewer software programs were utilized for plotting the conceptual networks. The networks were analyzed at the micro-level based on centrality indices (closeness, degree, and betweenness). The conceptual network was plotted and the prominent topics in clinical education were identified using co-word analysis. In the second qualitative phase on the topic, based on the scientometrics phase, semi-structured interviews were conducted with clinical professors. The interviews were transcribed verbatim and analyzed.

RESULTS

On the basis of the analysis of titles, abstracts, and keywords of the retrieved articles on clinical education from ISI Web of Science, Scopus, and PubMed, 1412 keywords were extracted. After the refining process, 356 keywords with 6741 relations remained. Upon plotting the conceptual network, 19 conceptual clusters related to clinical education were obtained. Then, micro-level network analysis (centrality criteria) indicated that the keyword humanism with the frequency of 137 had the highest rate (97.753), closeness (97.802), and betweenness (13.407). Moreover, from the interview data analysis, two themes of "intertwined nature of the human spirit in clinical education" and "humanistic behavior of professors in clinical education" were extracted.

CONCLUSION

As a part of the educational culture, humanistic values must be intertwined with the medical education curriculum. In this regard, humanism and clinical reasoning are the two major clusters of clinical teaching; moreover, altruism and adherence to humanistic values, and scientific qualification are other main pillars that should be considered as the criteria for the selection of clinical professors and medical students.

Unveiling the Hurdles in Cultivating Humanistic Physicians in the Clinical Setting: An Exploratory Study

Background

The importance of cultivating a humanistic physician has gained attention in medical education. Humanistic values are established in early education and medical schools should provide a suitable environment to nurture and grow these values into professional identity. The clinical setting has a significant impact due to its direct involvement of students in real-life situations.

Objectives

The present study aims to explore the hurdles in cultivating humanistic physicians in the clinical setting.

Methods

We conducted a qualitative study involving medical students in the clinical phase, as well as residents, clinical teachers, and module administrators in the clinical setting under study.

Results

Respondents from different groups of stakeholders shared the same definition for 'humanistic physician': a physician who provides patient-centred care while demonstrating empathy, respect, compassion, integrity, knowledge, competence and a collaborative spirit. Despite changes in the healthcare system and technological advancements, humanistic physicians are still needed.

Conclusion

Cultivating humanistic physicians is a complex process, requiring various methods and assessments. Role models play a significant role in this process, which included not only clinical teachers but also peers. Feedback from peers was perceived as an important factor. The key hurdles identified were negative role models, and a less humanistic learning environment and the students' personal backgrounds.

Transformation and Closure for Anatomical Donor Families that Meet Medical Students

The University of Oklahoma College of Medicine has conducted an annual Anatomical Donor Luncheon where families of the anatomical donors met anatomy dissection groups of medical students. The luncheon presented an opportunity for donor family members to share the life story of their loved one with the medical students prior to the start of the anatomy course. This study was designed to understand the impact of the Anatomical Donor Luncheon on families of the donors. Seven families in two different focus groups were included to explore the reactions and attitudes of the donor families to meeting the medical students. Conversations were digitally recorded and transcribed. Qualitative analysis of textual data were coded by three investigators using the Constant Comparative Method. To provide evidence of validity, a form of member checking was utilized. For further triangulation, an analyst not involved in conducting the focus groups or analyzing the data, re-coded all data. This analyst used categories and themes identified by the original analysts, ensuring validity of the themes and any negative cases (data not supporting or contradictory of the established categories and themes). One meta-theme and three sub-themes were identified. The meta-theme was Donor Family Participants Experience Transformation and Closure, and sub-themes were Motivators for Participation, Optimal Venue Factors, and Optimal Medical Student-Anatomical Donor Family Interactions. Study findings indicated the Anatomical Donor Luncheon facilitated closure on the death of their loved one, and transformed their apprehension about the luncheon and body donation into an attitude of gratitude and appreciation.

The Benefits of Honoring Patients as Teachers: A Qualitative Study

INTRODUCTION

Medical training could not occur without the contributions of patients. Few programs are available that recognize patients for their essential role in medical education, and even fewer explore their impact. The Patients as Teachers (PaT) program was developed to provide an opportunity for medical students to formally honor patients for their contributions and to evaluate their effect on students' medical education.

METHODS

This qualitative study involved the evaluation of transcripts of audiotaped interviews conducted with students and their honorees following participation in the PaT program in 2015 and 2016. Two different sets of authors independently examined transcripts from each year utilizing a descriptive coding strategy. Consensus was reached on theme selection and relationships between themes explored for theory development. A third author ensured grounding of the concepts in the data analyzed.

RESULTS

Four themes emerged: (1) appreciating humanism in medicine, (2) expressing gratitude, (3) connecting patients and students, and (4) experiencing a unique event.

CONCLUSION

The Patients as Teachers program provides meaningful benefits to both students and patients and has the potential to infuse elements of humanism into medical training.

Climate Study of the Learning Environment for Faculty, Staff, and Students at a U.S. Dental School: Foundation for Culture Change

The aim of this study was to assess the culture and climate for diversity and inclusion and the humanistic learning environment for students, faculty, and staff at the University of Michigan School of Dentistry. From July 2014 to June 2015, two committees of 16 faculty members, staff members, and students, in partnership with trained program evaluators, used a participatory program evaluation (PPE) process to conduct the assessment using key informant interviews, surveys, and focus groups. The topics addressed were humanistic environment, learning environment, diversity and inclusion, microaggressions and bullying, and activities and space. All staff members, all faculty members (both full- and part-time), and all students in all four years were invited to participate in the parallel but distinctive versions of the survey from November 10 to 25, 2014. Response rates for each group were as follows: 50% (318/642) for students, 68% (217/320) for staff, and 40% (147/366) for faculty; numbers responding to individual items varied. Among the respondents, the majority (76% faculty, 67% staff, 80% students) agreed that the environment fostered learning and personal growth and that a humanistic environment was important (97% faculty, 95% staff, 94% students). Many reported having experienced/witnessed a micro-aggression or bullying. Many also reported having "ever had" dissatisfaction with the learning environment (44% faculty, 39% staff, 68% students). The students sought better relationships with the faculty; the staff and faculty members sought opportunities for professional development and mentoring. Recommendations included cultural sensitivity training, courses for interpersonal skills, leadership and team-building efforts, addressing microaggressions and bullying, creating opportunities for collaboration, and increasing diversity of faculty, staff, and students. These recommendations were incorporated into the school's strategic plan. In this study, a utilization-focused PPE process using mixed methods was effective for evaluating the dental school's climate for diversity and inclusion, as well as the learning environment for faculty, staff, and students.

A Study of Core Humanistic Competency for Developing Humanism Education for Medical Students

The authors conducted a survey on essential humanistic competency that medical students should have, and on teaching methods that will effectively develop such attributes. The participants consisted of 154 medical school professors, 589 medical students at Seoul National University College of Medicine, 228 parents, and 161 medical school and university hospital staff. They answered nine questions that the authors created. According to the results, all groups chose "morality and a sense of ethics," a "sense of accountability," "communication skills," and "empathic ability" were selected as essential qualities. According to the evaluation on the extent to which students possess each quality, participants believed students had a high "sense of accountability" and "morality," whereas they thought students had low "empathic ability," "communicate," or "collaborate with others". In terms of effective teaching methods, all sub-groups preferred extracurricular activities including small group activities, debates, and volunteer services. With regard to the speculated effect of humanism education and the awareness of the need for colleges to offer it, all sub-groups had a positive response. However the professors and students expressed a relatively passive stance on introducing humanism education as a credited course. Most participants responded that they preferred a grading method based on their rate of participation, not a relative evaluation. In order to reap more comprehensive and lasting effects of humanism education courses in medical school, it is necessary to conduct faculty training, and continuously strive to develop new teaching methods.

Insisting on the Healer's Art: The Implications of Required Participation in a Medical School Course on Values and Humanism

THEORY

Elective courses, by definition, allow medical students to self-select for participation in the class. In a small-group learning setting, students uninterested or not ready for a particular learning topic might change the educational experience ("poison the well") for those students most interested in the topic. It is not known how medical students required to take a course in humanism (that they otherwise would not have elected to take) might be impacted by the course or how their presence might affect students originally interested in the course.

HYPOTHESES

Medical students in a required course on humanism and values in medicine will have different experiences based on whether a particular student might have or not have elected to enroll in the course. Students uninterested in taking a course in humanism and values, but required to enroll, will limit the benefit of the course for those students originally interested in participating.

METHOD

In 2012, all 1st-year students at a U.S. medical school were required to take the Healer's Art, an elective on professional values and humanism offered at more than 90 other schools in the United States and internationally. Students completed pre/postcourse surveys assessing emotional exhaustion, work engagement, positive emotions, and cynicism. We analyzed differences between those who would have elected to take the course (Elective students) and those who would not have elected to take it (Required students).

RESULTS

Elective students did not differ from Required students in baseline demographic characteristics, emotional exhaustion, work engagement, or positive emotions. At baseline, Elective students did report feeling safer to talk openly, a greater sense of community, and higher levels of cynicism. Over time, there were no differences in course evaluations or outcomes between Elective and Required students.

CONCLUSIONS

Required students do not differ greatly from those who would have elected to take Healer's Art, and all students appear to have similar experiences in the course.

The current landscape of television and movies in medical education

BACKGROUND

Using commercially available television and movies is a potentially effective tool to foster humanistic, compassionate and person-centred orientations in medical students.

AIM

We reviewed pedagogical applications of television and movies in medical education to explore whether and why this innovation holds promise.

METHODS

We performed a literature review to provide a narrative summary on this topic.

RESULTS

Further studies are needed with richer descriptions of innovations and more rigorous research designs.

CONCLUSION

As we move toward evidence-informed education, we need an evidence- based examination of this topic that will move it beyond a 'show and tell' discussion toward meaningful implementation and evaluation. Further exploration regarding the theoretical basis for using television and movies in medical education will help substantiate continued efforts to use these media as teaching tools.

Humanism and professionalism education for pediatric hematology-oncology fellows: A model for pediatric subspecialty training

BACKGROUND

Humanism and professionalism are virtues intrinsic to the practice of medicine, for which we lack a standard, evidence-based approach for teaching and evaluation. Pediatric hematology-oncology (PHO) fellowship training brings new and significant stressors, making it an attractive setting for innovation in humanism and professionalism training.

PROCEDURE

We electronically surveyed a national sample of PHO fellows to identify fellows' educational needs in humanism and professionalism. Next, we developed a case-based, faculty-facilitated discussion curriculum to teach this content within pilot fellowship programs. We assessed whether fellowships would decide to offer the curriculum, feasibility of administering the curriculum, and satisfaction of fellow and faculty participants.

RESULTS

Surveys were completed by 187 fellows (35%). A minority (29%) reported that their training program offers a formal curriculum in humanism and/or professionalism. A majority desires more formal teaching on balancing clinical practice and research (85%), coping with death/dying (85%), bereavement (78%), balancing work and personal life (75%), navigating challenging relationships with patients (74%), and depression/burn out (71%). These six topics were condensed into four case-based modules, which proved feasible to deliver at all pilot sites. Ten fellowship programs agreed to administer the novel curriculum. The majority (90%) of responding fellows and faculty reported the sessions touched on issues important for training, stimulated reflective communication, and were valuable.

CONCLUSIONS

Pediatric hematology-oncology fellows identify numerous gaps in their training related to humanism and professionalism. This curriculum offers an opportunity to systematically address these educational needs and can serve as a model for wider implementation. Pediatr Blood Cancer 2015;62:335-340. © 2014 Wiley Periodicals, Inc.