Training the eye, virtually: adapting an art in medicine curriculum for on-line learning

Training the Eye: Improving the Art of Physical Diagnosis is an elective fine art-based medical humanities course at Harvard Medical School held at the Museum of Fine Arts, Boston that aims to improve skills of observation. Due to COVID-19, this curriculum was converted from in-person to a virtual format for the first time in 2020. Students enrolled in the course prior to the pandemic and completed one session in person before transitioning unexpectedly to nine remote sessions through Zoom. Students were surveyed anonymously and TAs and faculty were interviewed regarding their perceptions of the strengths, weaknesses and future preferences of the virtual arts education at the course completion. Strengths identified in the virtual platform were being able to include participants irrespective of their location, incorporating most relevant artwork from any collection, harnessing virtual tools for enhanced art viewing, time-efficiency, and having a private, safe space for engaging in this type of learning. However, the experience in the galleries and the social interactions therein were noted to be impossible to fully recapitulate. Personal connections of the class were felt to be diminished and convenience increased. Both advantages (e.g., increased reach relative to types and locations of art works) and disadvantages (e.g., intimacy and connectivity promoted by in-gallery setting) of teaching arts-based medical humanities virtually were identified. A hybrid model may be able reap the benefits of both formats when it is safe to host such courses in person. Parallel lessons may be applicable to optimizing telemedicine encounters. Supplementary Information The online version contains supplementary material available at 10.1007/s43545-022-00442-4.

The Parent Version of the Sensitivity to Pain Traumatization Scale (SPTS-P): A Preliminary Validation.

Sensitivity to pain traumatization (SPT) is defined as the propensity to develop responses to pain that resemble a traumatic stress reaction. To date, SPT has been assessed in adults with a self-report measure (Sensitivity to Pain Traumatization Scale (SPTS-12)). SPT may also be relevant in the context of parenting a child with chronic pain, as many of these parents report clinically elevated posttraumatic stress symptoms (PTSS). This study aimed to develop and validate a measure of parent SPT by adapting the SPTS-12 and evaluating its psychometric properties in a sample of parents whose children have chronic pain. In total, 170 parents (90.6% female) and children (aged 10-18 years, 71.2% female) were recruited from a tertiary chronic pain program. Parents completed the parent version of the SPTS-12 (SPTS-P) and measures of PTSS, depression, and parenting behaviors. Youth completed measures of pain. Consistent with the SPTS-12, the SPTS-P demonstrated a one-factor structure that accounted for 45% of the variance, adequate to good reliability and moderate construct validity. Parent SPT was positively related to their protective and monitoring behaviors but was unrelated to youth pain intensity, unpleasantness, and interference. These results provide preliminary evidence for the psychometric properties of the SPTS-P and highlight the interaction between parent distress about child pain and parent responses to child pain.

Remote buprenorphine-naloxone initiation as an essential service for people with chronic pain and opioid dependence during the COVID-19 pandemic: Case reports, clinical pathways, and implications for the future.

Many health care professions have reacted swiftly to the COVID-19 pandemic. In-person care has been ramped down and telemedicine/telehealth has been thrust to the forefront of clinical care. For people living with chronic pain and often concomitantly dealing with opioid-related issues, this is a time of great stress. With population-wide movements to shelter in place, people living with pain are more isolated, more stressed, and more vulnerable to mental health concerns like depression and anxiety that can increase pain-related suffering. This article presents two case reports of patients struggling with chronic pain and opioid dependence in which a telemedicine-based buprenorphine-naloxone conversion was chosen as a treatment option by two Canadian programs: The Transitional Pain Service at the Toronto General Hospital in Toronto, Ontario, and The Opioid Deprescribing Program in Calgary, Alberta. Both cases presented highlight the use of telemedicine during the COVID-19 pandemic and suggest that there will be substantial need for these services well beyond the apex of the crisis. A buprenorphine-naloxone home induction protocol is presented and we provide insight into important lessons learned regarding the appropriate selection of patients with chronic pain struggling with opioid use disorder for buprenorphine-naloxone conversion. The provision of health care during the COVID-19 pandemic has rapidly forced practitioners to evolve novel health care practices, and these changes will have long-term implications.

De nombreuses professions de santé ont réagi rapidement à la pandémie de COVID-19. Les soins en personne ont diminué, tandis que la télémédecine et la télésanté ont été propulsées au premier plan des soins cliniques. Pour les personnes vivant avec la douleur chronique, souvent confrontées de manière concomitante à des problèmes liés aux opioïdes, il s'agit d'une période de grand stress. Avec les mouvements de confinemen de la population mis en place, les personnes vivant avec la douleur sont plus isolées, plus stressées et plus vulnérables aux problèmes de santé mentale comme la depression et l'anxiété, qui peuvent augmenter la souffrance liée à la douleur. Cet article présente deux rapports de cas de patients aux prises avec la douleur chronique et la dépendance aux opioides où la conversion à la buprénorphine-naloxone par télémédecine a été choisie comme option de traitement par deux programmes canadiens : Le Service de la douleur transitoire de l'Hôpital général de Toronto, en Ontario, et le Programme de déprescription des opioides à Calgary, Alberta. Les deux cas présentés mettent en évidence l'utilisation de la télémédecine pendant la pandémie de COVID-19 et indiquent qu'il y aura un besoin important pour ces services bien au-delà du sommet de la crise. Un protocole d'induction de la buprénorphine-naloxone à domicile est présenté et nous donnons un aperçu des seignemens tirés quant à la selection appropriée de patients souffrant de douleur chronique et d'un trouble lié à l'usage d'opioïdes pour la conversion à la buprénorphine-naloxone. La prestation de soins de santé durant la pandémie de COVID-19 a rapidement obligé les praticiens à mettre au point de nouvelles pratiques de soins de santé, et ces changements auront des implications à long terme.