An Empathy and Arts Curriculum During a Pediatrics Clerkship: Impact on Student Empathy and Behavior.

Introduction: Empathy is critical within medicine and improves patient outcomes and satisfaction. Empathy declines during the clerkship years due to the hidden curriculum, where students observe emotional distancing and desensitization by providers. Studies show arts curricula can preserve empathy but are limited by sample bias and preclerkship occurrence. We implemented and evaluated a brief pediatric clerkship arts curriculum to improve empathic behaviors. Methods: We created two 1-hour required small-group sessions for pediatric clerkship medical students. The first session paired arts observation techniques with various paintings. The students then applied these techniques to video-based simulated patient interactions in the second session. We used the Toronto Empathy Questionnaire (TEQ) and an empathy behavior checklist (EBC) as pre/post assessments to gauge self-reported empathy and empathetic behaviors. We compared responses of learners who attended the sessions (curriculum group) to learners unable to attend (control group). Results: Thirty-four students participated in the curriculum; 19 were in the control group. Neither the control nor the curriculum group had a significant change in pre/post TEQ scores. Students with pre-TEQ scores less than 45 who participated in the curriculum had significant improvement in post-TEQ scores compared to their control group counterparts (p = .02). On the EBC, there was a significant difference between the curriculum and control groups for those who explored more about the child/family's experience (p < .05). Discussion: Our work suggests that a brief clerkship arts curriculum is useful for improving self-reported empathy ratings and empathetic skills, particularly for students identified as having below-average empathy.

Where Two or Three Are Gathered.

Remembering Christ's words of His presence when two or three are gathered, a physician and a patient's wife join in prayer, knowing that Christ shares our wounds as much as He heals them.

Randomized Controlled Comparative Effectiveness Trial of Risk Model-Guided Clinical Decision Support for Suicide Screening.

Suicide prevention requires risk identification, appropriate intervention, and follow-up. Traditional risk identification relies on patient self-reporting, support network reporting, or face-to-face screening with validated instruments or history and physical exam. In the last decade, statistical risk models have been studied and more recently deployed to augment clinical judgment. Models have generally been found to be low precision or problematic at scale due to low incidence. Few have been tested in clinical practice, and none have been tested in clinical trials to our knowledge. Methods: We report the results of a pragmatic randomized controlled trial (RCT) in three outpatient adult Neurology clinic settings. This two-arm trial compared the effectiveness of Interruptive and Non-Interruptive Clinical Decision Support (CDS) to prompt further screening of suicidal ideation for those predicted to be high risk using a real-time, validated statistical risk model of suicide attempt risk, with the decision to screen as the primary end point. Secondary outcomes included rates of suicidal ideation and attempts in both arms. Manual chart review of every trial encounter was used to determine if suicide risk assessment was subsequently documented. Results: From August 16, 2022, through February 16, 2023, our study randomized 596 patient encounters across 561 patients for providers to receive either Interruptive or Non-Interruptive CDS in a 1:1 ratio. Adjusting for provider cluster effects, Interruptive CDS led to significantly higher numbers of decisions to screen (42%=121/289 encounters) compared to Non-Interruptive CDS (4%=12/307) (odds ratio=17.7, p-value <0.001). Secondarily, no documented episodes of suicidal ideation or attempts occurred in either arm. While the proportion of documented assessments among those noting the decision to screen was higher for providers in the Non-Interruptive arm (92%=11/12) than in the Interruptive arm (52%=63/121), the interruptive CDS was associated with more frequent documentation of suicide risk assessment (63/289 encounters compared to 11/307, p-value<0.001). Conclusions: In this pragmatic RCT of real-time predictive CDS to guide suicide risk assessment, Interruptive CDS led to higher numbers of decisions to screen and documented suicide risk assessments. Well-powered large-scale trials randomizing this type of CDS compared to standard of care are indicated to measure effectiveness in reducing suicidal self-harm. ClinicalTrials.gov Identifier: NCT05312437.

Veni, Vidi, Scribivi: I Came, I Saw, I Wrote

Narrative medicine talks at the American Academy of Neurology Annual Meeting have included writing prompts to inspire and promote wellness among attendees. The 6-word writing exercise at the 2023 Annual Meeting prompted pithy and powerful stories, which we share in this article.

Localizing My Paralyzed Grandmother.

A neurologist puzzles over the etiology of her physician grandmother's paralysis in an attempt to localize her lesion and discovers what matters most about her grandmother's history and illness.

Online Core Curriculum and Mastery (OCCAM): A Behavioral Neurology & Neuropsychiatry (BNNP) Curricular Needs Assessment.

Behavioral neurology & neuropsychiatry (BNNP) fellowships are accredited by the United Council for Neurologic Subspecialties (UCNS). Programs cover the UCNS-recommended topics differently. A curriculum accessible to all fellowships would standardize education and identify gaps in topics that are less well covered across programs. The purpose of the present needs assessment was to inform the development of the Online Core Curriculum and Mastery: BNNP (OCCAM-BNNP), a website for all UCNS-accredited BNNP programs. Program directors and fellows were surveyed to learn how well topics are covered and identify educational gaps, or specific topics on the UCNS website that are less well represented among programs. Thirty-seven fellowship program directors listed on the UCNS website were invited to take the survey and forward it to both current fellows (graduating in 2021) and recent graduates (graduated from 2015 to 2020). There were 29 responses from 37 programs. Of the 34 topics that respondents rated on a 1-5 Likert scale (from "not covered" to "completely covered"), 15 of 34 (44%) were identified as having >40% of responses as mostly "not covered," "incompletely covered," or "partially covered." Ninety-seven percent of respondents affirmed that it would be useful to have a free web-based resource for BNNP education. Slightly under one-half of all BNNP topics were not well covered. A survey was undertaken to identify and fill the educational gaps indicated by fellowship directors and fellows, and the OCCAM-BNNP website was developed as a repository for relevant content, providing a resource that many BNNP clinicians would find useful.

Holistic care in healthy aging: Caring for the wholly and holy human.

Health care should address the holistic gap between health outcomes, spirituality, religion, and humanistic care to optimize patient care. Treating the whole person encompasses both physical and metaphysical elements. Patients want health care professionals to recognize their spiritual and religious preferences, because these matter in their approach to illness, coping, and long-term outcomes.

Hamstrung in Prayer.

A neurologist reflects upon the function of the hamstring, including kneeling, and being hamstrung, both physically and spiritually.

A Christmas Miracle Pantoum: Weighing Reality and Hope.

Between reality and hope, who am I to questionThe cortical ribbon dancing through your brainYour family praying for a Christmas miracleVisions of sugar plumsThe cortical ribbon dancing through your brainUp on the house top, click click clickVisions of sugar plumsFaithful friends who are dear to us, will be near to us once moreUp on the housetop, click click clickTriphasic waves on EEGFaithful friends who are dear to us, will be near to us once more,Including your deceased nana baking cookies in the hallwayTriphasic waves on EEGEvery time a bell rings, an angel gets its wingsIncluding your deceased nana baking cookies in the hallwayIn your conversations with usEvery time a bell rings, an angel gets its wingsYour wife asks if we have any other possible explanationIn our conversations with you, weTell tales of 14-3-3 and RT-QuICYour wife asks if we have any other possible explanationDown through the chimney with good St. NickTell tales of 14-3-3 and RT-QuICYour son wonders if we can try a Hail Mary pass treatmentDown through the chimney with good St. NickI have no new answers for youYour son wonders if we can try a Hail Mary pass treatmentI pass the giftshop display of the Virgin with ChildI have no new answers for youAs I finish my shift, step into the silent nightI pass the giftshop display of the Virgin with Child,Santa Claus is coming to townAs I finish my shift, step into the silent nightI think of Ms. C, ambulatory with 5/5 strength, disregarding her cervical cord astrocytoma haloSanta Claus is coming to townMy conversation with Mr. L, language spared after complete left MCA infarct1I think of Ms. C, ambulatory with 5/5 strength, disregarding her cervical cord astrocytoma haloDefying expectationsMy conversation with Mr. L, language spared after complete left MCA infarct1These miracles are not lost to meDefying expectations'Tis the season where all things are possibleThese miracles are not lost to meSo hang your stockings and say your prayers'Tis the season where all things are possibleYour family praying for a Christmas miracleSo hang your stockings and say your prayersBetween reality and hope, who am I to question.

Scattered Seed and the Harvest: The Best Things That I've Grown I Never Planted.

A physician struggling to grow in her career finds an apt analogy in being a fledgling gardener and learns to trust that God's hand has been planting the seeds all along.

A case report of acquired synesthesia and heightened creativity in a musician after traumatic brain injury.

INTRODUCTION: We report on a musician who acquired synesthesia, enhanced sensory experience, and improved creativity following traumatic brain injury (TBI). BACKGROUND: Creativity and synesthesia can be acquired from an injury, though both simultaneously has not been frequently documented. NARRATIVE: This case report details heightened creativity and developing synesthesia in a 66-year-old right-handed man following TBI. He developed a "compulsion" to write music. Synesthesia included "seeing" the notation and being able to name chord structures of music he heard, both of which were novel experiences. The Synesthesia Battery revealed a vision-sound synesthesia with higher than average level of Vividness of Visual Imagery (VVIQ-2), and "Absolute Pitch/Perfect Pitch." PATIENT EXPERIENCE: The patient experienced an approximate four-month history of these changes, including musical compositions, developing perfect pitch, and enhanced sensory experience of typical phenomena. DISCUSSION: Both creativity and synesthesia depend on novel connections in the brain, and both have been reported following insults to the brain, including in degenerative conditions. However, the development of both simultaneously is not frequently reported. Evidence for the etiology of one prompting the other has not been described. Brain injury may result in increased creativity and synesthesia. Our fields would benefit from increased awareness of this possible relationship.

R1ρ dispersion in white matter correlates with quantitative metrics of cognitive impairment.

Much previous neuroimaging research in Alzheimer's disease has focused on the roles of amyloid and tau proteins, but recent studies have implicated microvascular changes in white matter as early indicators of damage related to later dementia. We used MRI to derive novel, non-invasive measurements of R1ρ dispersion using different locking fields to characterize variations of microvascular structure and integrity in brain tissues. We developed a non-invasive 3D R1ρ dispersion imaging technique using different locking fields at 3T. We acquired MR images and cognitive assessments of participants with mild cognitive impairment (MCI) and compared them to age-matched healthy controls in a cross-sectional study. After providing informed consent, 40 adults aged 62 to 82 years (n = 17 MCI) were included in this study. White matter ΔR1ρ-fraction measured by R1ρ dispersion imaging showed a strong correlation with the cognitive status of older adults (ßstd = -0.4, p-value < 0.01) independent of age, in contrast to other conventional MRI markers such as T2, R1ρ, and white matter hyperintense lesion volume (WMHs) measured with T2-FLAIR. The correlation of WMHs with cognitive status was no longer significant after adjusting for age and sex in linear regression analysis, and the size of the regression coefficient was substantially decreased (53% lower). This work establishes a new non-invasive method that potentially characterizes impairment of the microvascular structure of white matter in MCI patients compared to healthy controls. The application of this method in longitudinal studies would improve our fundamental understanding of the pathophysiologic changes that accompany abnormal cognitive decline with aging and help identify potential targets for treatment of Alzheimer's disease.

Right Brain: The Purple Scarf and the Cortical Ribbon.

A patient with probable Creutzfeldt Jakob disease (CJD) who was previously a high-functioning financial analyst remains fiercely independent despite her family's concerns about her safety. As a trainee with limited experience in leading these difficult conversations, this neurology resident describes her experience reconciling the viewpoints of herself, the patient, and her family. She reflects on the ability to reframe this delicate conversation from one of loss of independence in a patient with a rapidly progressive, neurodegenerative condition to one of safety, security, and the care of her family.

Pregnancy Fête: Huntington's Pantoum.

A mother's excitement about welcoming a new child into the world is tempered by the fear that her Huntington's disease genes will be passed on to the baby.

This Is My Body: A Reflection on Medical and Spiritual Distancing During the COVID19 Pandemic.

As sentient beings and as patients, clinicians, and Catholics, we long for touch and union. With COVID19, the distancing inherent during the pandemic manifests itself in medical and spiritual ways as we yearn to connect with our patients, our physicians, and the Eucharist. Summary: As sentient beings and as patients, clinicians, and Catholics, we long for touch and union. With COVID19, the distancing inherent during the pandemic manifests itself in medical and spiritual ways as we yearn to connect with our patients, our physicians, and the Eucharist. COVID19 distancing manifests in medical & spiritual ways as we yearn to connect with our patients, our physicians, and the Eucharist.