Cultivating compassion in medicine: a toolkit for medical students to improve self-kindness and enhance clinical care

BACKGROUND

Compassionate care lies at the foundation of good patient care and is a quality that patients and providers continue to value in the fast-paced setting of contemporary medicine. Compassion is often discussed superficially in medical school curricula, but the practical aspect of learning this skill is often not taught using a formal framework. In the present work, the authors present an 8-session curriculum with a mindfulness-based approach to compassion that addresses this need. It is hypothesized that students in this curriculum will improve in their levels of compassion based on validated scales.

METHODS

The curriculum was delivered to fourth-year medical students at Renaissance School of Medicine at Stony Brook University who had just completed their clerkship year. It was developed as a customizable set of modules that could be delivered in various ways. The students were taught with evidence-based cognitive exercises followed by group discussions and written reflections based on compassion-focused thematic questions. All students completed a pre- and post-Self-Compassion Scale, Compassion Scale, and Toronto Mindfulness Scale. Students in this course were compared with students in different courses about non-clinical topics delivered at the same time. Wilcoxon Signed Rank tests and Mann Whitney U tests were used to assess potential associations between pre- and post-survey responses for the validated scales and subscales.

RESULTS

17 fourth-year medical students completed pre- and post-course tests, 11 participated in the compassion curriculum while 6 participated from the other courses. Before any of the courses began, all students performed similarly on the pre-test across all scales. The students in the compassion curriculum demonstrated a significant increase in their total Self-Compassion score by 8.7 [95% CI 4.3 to 13.2] points (p = 0.008), total Compassion score by 6.0 [95% CI 1.4 to 10.6] points (p = 0.012), and the curiosity component of the Toronto Mindfulness Scale by 4.4 [95% CI 1.0 to 7.7] points (p = 0.012). There was no statistically significant difference between pre- and post-tests among the non-compassion curriculum students in the aforementioned scales (p = 0.461, p = 0.144, p = 0.785, respectively).

CONCLUSIONS

Our results indicate that the students in our course developed an enhanced ability to engage in self-compassion, to understand the shared human experience, and to be motivated to act to alleviate suffering. Regardless of a program's existing compassion education, this customizable model allows for easy integration into a medical student's crowded curriculum. Furthermore, although teaching compassion early and often in a clinician's training is desirable, our study that targeted fourth-year medical students suggests an additional benefit of rekindling the loss of compassion well described in a medical student's clinical years.

Generation of a Maximally Entangled State Using Collective Optical Pumping

We propose and implement a novel scheme for dissipatively pumping two qubits into a singlet Bell state. The method relies on a process of collective optical pumping to an excited level, to which all states apart from the singlet are coupled. We apply the method to deterministically entangle two trapped ^{40}Ca^{+} ions. Within 16 pumping cycles, an initially separable state is transformed into one with 83(1)% singlet fidelity, and states with initial fidelity of ⪆70% converge onto a fidelity of 93(1)%. We theoretically analyze the performance and error susceptibility of the scheme and find it to be insensitive to a large class of experimentally relevant noise sources.

Case report: Metastatic metaplastic breast cancer with choriocarinomatous features: Targeting the choriocarcinoma component for cure

Breast cancer with choriocarcinomatous features (BCCF) is a rare and aggressive breast cancer. BCCF carries a poor prognosis and there is unfortunately scant literature to guide treatment beyond surgical resection with most patients receiving standard regimens for breast cancer. In our case, we present a 42-year-old female with an initial hCG of 2,324 and two suspicious lesions of the right breast. On biopsy, each lesion had distinct histopathology with the larger lesion diagnosed as BCCF and the smaller lesion being an invasive ER/PR positive ductal carcinoma. The diagnosis of BCCF rather than metastatic choriocarcinoma was confirmed using DNA typing. Salvage chemotherapy targeting choriocarcinoma resulted in marked clinical and biomarker success including normalization of the hCG. After recurrent brain metastases were diagnosed, high dose chemotherapy with methotrexate was administered resulting in long term remission.

Exploring the epidemiology of gastric cancer in a Tibetan population

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Background: Gastric cancer is the 3rd leading cause of death from cancer and the 5th most common cancer world-wide. It is the primary cause of death for people of Tibetan origin in the Himalayan belt, with incidence (and death) rates between 60-140/100,000 people per year. Despite such a high disease burden, the epidemiology of gastric cancer has not been studied in this population. In this study, we explore gastric cancer risk factors among Tibetan refugees residing in India. Methods: Patients diagnosed with gastric cancer were identified by reviewing admission, discharge and out-patient endoscopy records between 2013-2019 at the Tibetan Delek hospital in Dharamshala, India. Risk factors not captured in the records were collected through interviews of patients or their relatives. Results: A total of 52 gastric cancer cases were identified, mostly males (77%). Median age was 78 (range: 30-91 years). Of the gastric cancer cases, 32% (n = 12/37) were retired military, 19% (n = 7/37) were monks or nuns, and 95% (n = 36/38) were born in Tibet. Sixty-five percent (n = 34/52) of the cases had histories of dyspepsia, 49% (n = 21/43) had used alcohol, and 40% (n = 17/43) were past smokers. Ninety-five percent (n = 20/21) of cases had been treated with traditional Tibetan medicines for various reasons in the past. Of the 17 patients (or relatives) interviewed for dietary risk factors, 76% (n = 13) reported frequent ingestion of stale and unrefrigerated food, 30% (n = 5) did not eat fresh fruit, and 47% (n = 8) reported intake of fresh fruit < 3 times per month. Most (83%, n = 24/29) patients had non-cardia cancers located in the fundus/body (n = 12) and antrum/pylorus (n = 12). Fifty-two percent (n = 16/31) had been treated with either chemotherapy, radiotherapy, or surgery, and 34% (n = 11/32) of the patients were receiving traditional Tibetan medicine as treatment for gastric cancer. Conclusions: Tibetan people have socio-cultural, behavioral and dietary risk factors that may be associated with gastric cancer. Investigations of causal factors (genetic, infective ( Helicobacter pylori), environmental) with possible synergistic interactions could inform clinical and public health practice for this population and globally.

Organization and delivery of long-term care in Singapore: present issues and future challenges

This paper focuses on the Singaporean model of long-term care for older people. With only about 2% of the older population living in institutions, the mainstay of long-term care is community care. The reader is provided an overview of the Singaporean services, including case management, followed by a discussion of the current issues and future challenges. In keeping with the prospect of a rapidly aging population profile, the Singapore government plays a leading role in framing policy and planning for future needs of this sector of the population.

Prescription drug advertising trends: a study of oral hypoglycemics

A content analysis of oral hypoglycemic drug advertisements was performed in selected medical journals published in the United States from 1963 to 1986. The 665 advertisements subsequently examined were studied for certain predetermined parameters in order to indicate trends. The trend results may be summarized as follows. As an extension of prescription drug advertising trends in general, oral hypoglycemic drug advertising showed an increasing length along with a subsequent decrease in the amount of space devoted to the copy portion of the advertisement. They also showed a decrease in the use of statistical information and rarely made references to competitors. Nongender specific, colored advertisements with product and use related appeals have become more common with the passage of time. Although the rationale and purpose behind advertising is unchanged, the format has changed considerably. These changes are primarily due to the enhancement of print technology and to some extent, the changing social environment.