Narrative Medicine Rounds: Promoting Student Well-Being during the Third Year of Medical School.

OBJECTIVES: Narrative medicine allows physicians and other health providers to share stories and reflect on the practice of medicine. Through the process of reflection and shared storytelling, narrative medicine may promote strategies for well-being and the prevention of physician burnout. Designed to foster skills to promote physician wellness, the required narrative medicine rounds activity during the family medicine clerkship at the Herbert Wertheim College of Medicine at Florida International University includes a written assignment and a small group session, during which students share their stories with their peers. METHODS: During the 2018-2019 academic year, a postsession survey asked students to identify strategies learned in the session that could be applied to future patient care and personal well-being; a thematic analysis of students' responses was conducted using inductive coding. Likert-style questions asked whether students learned something about themselves in this session, believed that they would write in the future, and understood the value of discussing significant patient encounters with peers. RESULTS: Identified themes for strategies for patient care fell into two categories: approaches to improve the patient care experience and methods for reflecting on patient interactions. Themes for strategies for future well-being fell into three categories: strategies to promote mental health, changes to interpersonal interactions, and self-reflection. Most students "strongly agreed" or "agreed" that this session taught them something about themselves and showed them the value of discussing significant patient encounters with peers, and that they would be likely to write about patient cases in the future. CONCLUSIONS: There was significant overlap in the themes related to strategies for personal well-being and those for patient care. Students were able to identify multiple, specific strategies to promote their own future well-being. These findings suggest that even a brief narrative medicine session may have an impact on students' understanding of strategies to prevent burnout and improve future patient care.

Active Learning to Promote Early and Effective Physician Interaction with Pharmaceutical Industry Marketing Practices.

BACKGROUND: Interactions with pharmaceutical companies influence physicians' prescribing behavior. Less than half of US family medicine residency programs have educational curricula addressing their influence. However, medical students have extensive exposure to pharmaceutical industry marketing during their early years of training. We developed a successful and required active learning curriculum for medical students during their first-year of medical school. METHODOLOGY: A philosopher bioethicist lectured to first-year medical students on the ethical issues surrounding the interactions with pharmaceutical representatives and outlined the three principles approach to clinical ethics as presented in the American Board of Internal Medicine Physician Charter (2002). The lecture also described the eight physician types offered by Fugh-Berman et al. Students watched two fictitious physician-pharmaceutical representative interactions. To promote active learning, students were provided a 3 × 3 Bingo card with each physician type. The bioethicist facilitated a discussion addressing the interactions. RESULTS: Two hundred twenty-nine first-year medical students participated in this required intervention. Fifty-two percent of first-year medical students had already interacted with pharmaceutical representatives. The session changed students' opinions of pharmaceutical representatives and their ability to identify strategies to mitigate their influence. Students articulated ethical issues involved in the interaction, techniques used by pharmaceutical representatives, and techniques that could be used by medical students or physicians. Ninety-one percent of students believed they could independently find reliable information about a drug. CONCLUSION: The session was effective to start the conversation regarding the ethical issues involved with the interaction between medical students/physicians and pharmaceutical representatives in the first year of medical school.

It Is Time for Zero Tolerance for Sexual Harassment in Academic Medicine.

While more women are in leadership positions in academic medicine now than ever before in U.S. history, evidence from recent surveys of women and graduating medical students demonstrates that sexual harassment continues in academic health centers. Academic medicine's ability to change its culture is hampered by victims' fear of reporting episodes of harassment, which is largely due to fear of retaliation. In this Perspective, the authors describe efforts in scientific societies to address the issue of sexual harassment and to begin to establish safe environments at national meetings. The authors contend that each institution must work to make it safe for individuals to come forward, to provide training for victims and for bystanders, and to abolish "locker room" talk that is demeaning to women.

Striving for Gender Equity in Academic Medicine Careers: A Call to Action.

Women represent approximately half of students entering medical schools and more than half of those entering PhD programs. When advancing through the academic and professional fields, however, women continually face barriers that men do not. In this Commentary, the authors offer ideas for coordinating the efforts of organizations, academic institutions, and leaders throughout the scientific and medical professions to reduce barriers that result in inequities and, instead, strive for gender parity. Specific areas of focus outlined by the authors include facilitating women's access to formal and informal professional networks, acknowledging and addressing the gender pay gap as well as the lack of research funding awarded to women in the field, and updating workplace policies that have not evolved to accommodate women's lifestyles. As academic institutions seek access to top talent and the means to develop those individuals capable of generating the change medicine and science needs, the authors urge leaders and change agents within academic medicine to address the systemic barriers to gender equity that impede us from achieving the mission to improve the health of all.

Twelve tips for teaching social determinants of health in medicine.

BACKGROUND: There has been a recent movement towards social accountability in medical schools, which includes integrating the social, economic, and cultural determinants of health into the curriculum. Medical schools and their guiding bodies have met this challenge of educating future physicians to provide effective care to diverse populations with varying response and successes. Because these topics have not been systematically taught in most medical school curricula, strategies are needed to teach them alongside clinical sciences. AIM AND METHOD: We provide 12 tips on how to teach social determinants of health and cultural competency to undergraduate medical students. These recommendations are based on a review of the literature and our experience in developing and delivering a longitudinal course over the last five years. CONCLUSION: Medical students must be taught to think critically about the social and cultural issues impacting health, and the intersection with the basic biology and clinical skills. Teaching social determinants of health in medicine requires keeping the material concrete and applicable. Educators must engage students in active learning strategies, reflection, and focus on how to make the material relevant to the clinical care of patients.