Variation in medical humanities program mission statements in United States and Canadian Medical Schools.

PURPOSE: In 2019, the American Association of Medical Colleges (AAMC) identified the discipline of medical humanities as a priority in medical education. Although medical humanities programs have existed in medical and osteopathic schools in the U.S. and Canada since the late 1960's, this interdisciplinary field remains difficult to define. We studied the mission statements of medical humanities programs to identify core themes and priorities. MATERIALS AND METHODS: We conducted a content analysis of U.S. and Canada medical humanities MD and DO mission statements and associated descriptions (n = 56). We compared themes across programs whose directors had a clinical degree versus a terminal research degree, conducted comparisons between medical humanities programs housed in medical schools ranked in Top 20 U.S. News and World Report for Research or Primary Care, and conducted a word frequency analysis. RESULTS: Content analysis revealed five themes: improving patient care, improving the provider experience, generating scholarship, cultivating community relationships, and promoting diversity/sociocultural awareness. 70% of programs emphasized patient care and provider experience. Only 34% included the promotion of diversity/sociocultural awareness as a theme. Word frequency analysis corroborated our findings. CONCLUSIONS: U.S. and Canada medical humanities programs focus primarily on improving patient care and provider wellness.

Revisiting the Exhibits-Medical Student Reflections on Changes to the Institutional Portraiture at a US Medical School.

BACKGROUND: Yale School of Medicine's (YSM) Sterling Hall of Medicine (SHM) has historically been lined with large oil paintings of mostly White men, despite over a century of Black and female enrollment. These spaces can be seen as exclusionary to students underrepresented in medicine, and may result in decreased well-being and adversely affect academic performance. Student-led activism has resulted in recent changes to these walls, including the addition of images of women faculty, and artwork by students, faculty, and staff. OBJECTIVE: We aimed to evaluate how recent changes to longstanding historical portraiture in SHM affected students' reflections on being in that space. DESIGN: This was a qualitative study based on semi-structured interviews conducted virtually. PARTICIPANTS: Second- to fourth-year YSM medical students were interviewed. APPROACH: Qualitative interviews were used to gauge students' impressions of how they perceived both the original and updated artwork and portraiture, as well as the overall physical environment. KEY RESULTS: Nine interviews were conducted, with interviewees describing the portraiture as reflective of YSM's institutional values. They related this to other aspects of an exclusionary environment, and noted that they created belonging at YSM within smaller communities. Students recognized and expressed appreciation for the changes to the portraiture, particularly the increase in diverse representation, and they noted stark contrasts to the prior space. While they describe positive attitudes regarding changes in SHM's exhibited portraiture and art, they also expressed skepticism about whether these changes were performative or whether they reflected true commitment to reform. CONCLUSIONS: This study depicts how the portraiture and physical environment of a medical school affects medical students, and that interventions to reform institutional portraiture can have considerable impact on students' attitudes regarding their medical school experiences.

When it's needed most: a blueprint for resident creative writing workshops during inpatient rotations.

BACKGROUND: Narrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents. OBJECTIVE: To evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings of burnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions. METHODS: We developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford's busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1-7; 3-4 = high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017-2018, weeks 1 and 4), and implementation year (2018-2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators. RESULTS: Residents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n = 16; mean PBWI = 3.0, SD: 1.1) and increased by the final week (n = 15; PBWI = 3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n = 13; PBWI = 3.1, SD: 1.9) but did not rise as much by rotation end (n = 24; PBWI = 3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions. CONCLUSIONS: Inpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.

Educational intervention against biological racism.

INTRODUCTION: Biological race, the fallacy that racial health disparities reflect differences in human biology, exerts undue influence on medicine. Interventions that teach against this myth are largely absent from required medical curricula. Here, we describe and present student and facilitator evaluations of an educational intervention, organised around Dorothy Roberts' book Fatal Invention: How Science, Politics, and Big Business Re-Create Race in the Twenty-First Century that included a discussion of preselected chapters from Fatal Invention, case studies illustrating strategies to prevent the misuse of race in medicine and a question-and-answer session with Dorothy Roberts. METHODS: Online feedback surveys were distributed to students and facilitators to capture their general perceptions of the session, how well it satisfied its objectives and the pre-session training materials provided to facilitators. Quantitative measures were analysed using descriptive statistics, and qualitative responses were evaluated using thematic analysis. RESULTS: Student and facilitator surveys garnered response rates of 59.8% (61/102) and 75% (30/40), respectively, and most expressed satisfaction with the session. Students felt more prepared to address the misuse of race in clinical contexts than in pre-clinical contexts (90.16% vs. 77.05%) and among peers than among superiors (95.08% vs. 72.13%) (p < 0.05). Some students (31.15%) felt that their small group facilitators were unprepared to address microaggressions. DISCUSSION: Our survey responses suggest that this intervention was effective in teaching against biological racism and equipped students with tools to address the misuse of race, particularly in clinical contexts. Future iterations should highlight strategies to confront biological racism in pre-clinical contexts and among superiors.

Blackface in White Space: Using Admissions to Address Racism in Medical Education.

Given the long history and pervasive nature of racism in medical culture, this essay argues that diversifying efforts alone cannot address systemic racism in medical education. Positive affirmation of anti-racist values and racial consciousness in the admissions process is necessary to create a truly inclusive culture in medical education and begin to undo centuries of racial prejudice in medicine. Drawing from historic examples, scholarship on the sociology of racialized space, recent research on race and medical education, and personal experience, we propose that medical educational institutions make a more concerted effort to consider racial attitudes and awareness as part of the admissions process as well as curricular reform efforts. We also provide examples of potential ways to practically implement this proposal in the admissions process.

A novel near-peer reflective writing workshop.

BACKGROUND: Training in clinical medicine involves exposure to complex ethical and emotional situations. Reflection aids in the development of personal belief systems and improves self-awareness. Students may be reluctant to participate when reflection is mandatory and may be concerned about retaliation when the facilitator has a role in evaluations. Near-peers are institutional equals with more experience than the participants and may be well suited to facilitate reflection. METHODS: A quarterly near-peer-facilitated reflective writing workshop (RWW) was implemented in the mandatory clinical curriculum at a single institution. Qualitative feedback forms were solicited and were analysed through an iterative and inductive consensus process. An end-of-year web-based survey was distributed to test the hypotheses generated from our analysis of the feedback forms. RESULTS: There were 82 responses (80%) to the web-based survey and 266 (65%) feedback forms were collected. Although few students reported using writing as a coping mechanism, the RWW was viewed favourably, with 62% indicating that they would attend if optional. The structured prompts aided reflection. Students reported a higher likelihood of discussing difficult topics (doubts about medicine as a career, personal shortcomings, harassment and burnout) in sessions led by a near-peer than by a faculty member. The workshop created a safe space to reflect, increased a sense of camaraderie and helped normalise experiences. [The workshop] humanised the clinical experience, gave new perspective and reminded students of their positive personal accomplishments DISCUSSION: The near-peer-facilitated RWW is a novel intervention aimed at developing reflective practice and coping with the challenges of entering clinical medicine. It is highly structured and has been incorporated into the mandatory curriculum. It was well received by students, is generalisable and is easily implementable.

Practical Tips for Implementing a Student-Led Reflective Writing Workshop Series.

Reflective practice may ameliorate the burnout, empathy loss, and depression that medical students experience during clerkships. We describe a student-led reflective writing workshop in a safe and structured small group setting. We provide twelve tips for implementing such a workshop, informed by the existing literature on reflective writing and near-peer teaching, which include developing writing prompts, guiding student facilitators, and obtaining feedback. Common topics include patient suffering, workplace dynamics, and the joys of practicing medicine. Participants develop camaraderie with peers as well as tools they can carry forward as they continue to process the challenging experiences intrinsic to clinical medicine.

Writing Well: The Long-Term Effect on Empathy, Observation, and Physician Writing Through a Residency Writers' Workshop.

BACKGROUND: Writing narratives during medical training can provide a way to derive meaning from challenging experiences, enhance reflection, and combat burnout. The Yale Internal Medicine Residency Writers' Workshop, an annual 2-day intensive workshop followed by faculty-guided writing revision and publication, has been training resident physicians in the craft of writing since 2003. OBJECTIVE: The study aimed to assess the long-term effects of a craft-focused writers' workshop for residents on empathy, observation skills, and future writing. METHODS: A survey of closed and open-ended questions was sent to former workshop participants (2003-2013), who rated and described the workshop's influence on their observation skills, empathy, improvement in writing, and continued informal and formal writing. A total of 89 of 130 participants (68%) completed the online survey. We identified key themes in written responses and collected quantitative ratings on a 5-point Likert scale of self-reported influence on these factors. Simple statistics and narrative analysis were used to derive results. RESULTS: Most participants agreed or strongly agreed that the workshop influenced their ability for careful observation (72 of 85, 85%); ability to be empathic with patients or colleagues (51 of 77, 66%); quality of writing (69 of 77, 90%); and continued formal or informal writing (52 of 77 [68%] and 41 of 77 [53%], respectively). Participants felt the workshop improved their attention to detail, provided a deeper understanding of others' experiences, and improved their writing. CONCLUSIONS: Participants in a residency writers' workshop experienced lasting effects on observation, empathy, and writing skills.

Gifts.

Born with tuberous sclerosis, Deborah never learned to speak and lived in a group home for the last 25 years of her life. After she died of cancer, her physician sister discovered, from the people whose lives she'd touched, the ways in which Deborah had been a gift.