A Novel Graphic Medicine Curriculum for Resident Physicians: Boosting Empathy and Communication through Comics.

Curricular design that addresses residency physician competencies in communication skills and professionalism remains a challenge. Graphic Medicine (GM) uses comics, a medium combining text and images, to communicate healthcare concepts. Narrative Medicine, in undergraduate medical education, has limited reported usage in Graduate Medical Education (GME). Given the time constraints and intensity of GME, we hypothesized that comics as a form of narrative medicine would be an efficient medium to engage residents.The authors created a novel curriculum to promote effective communication and professionalism, focusing on empathy, compassion and cultural competency. A four-week curriculum was delivered in a neurology residency program. Excerpts from non-fiction graphic memoirs about neurological conditions were read, discussed, and paired with prompt-driven drawing exercises. Qualitative surveys were used to assess acceptability of comics, usefulness of comics to convey patient illness experience, and perception of patient needs for physician-patient communication.Ninety-seven percent of residents reported the sessions were a good use of their time. Residents identified new symptoms of neurologic disorders, articulated patient communication needs, and expressed increased empathy after participation. Residents participated in drawing exercises, but these were not formally analyzed. Graphic medicine is a well received format that may build communication skills and increase empathy.

Treatment Considerations for Patients with Unresectable Metastatic Melanoma Who Develop Pembrolizumab-Induced Guillain-Barré Toxicity: A Case Report.

Immunotherapy has improved outcomes in many malignancies, most notably in melanoma, lung cancer, and bladder cancer. Understanding the side effects associated with these medications is an important part of managing our patients. Although fatigue, rash, and diarrhea are commonly reported side effects, it is important to be cognizant of rarer ones, such as neuropathy. Amongst the different neurological toxicities that have been reported in the literature, Guillain-Barré-like neuropathies are quite rare. However, the occurrence of such neuropathies in a patient can be life threatening. The problem this poses in treating cancers such as melanoma is that it eliminates an effective class of medication available to the patient, which can ultimately affect their prognosis. We present a case of a 65-year-old female with unresectable metastatic melanoma who developed Guillain-Barré-like neuropathy after two doses of pembrolizumab. Her clinical course was complicated by three separate hospitalizations over 3 months due to recurring bouts of neuropathy, which resulted in a significant decline in performance status and delay in subsequent treatment of her melanoma. Her prolonged recovery eventually resulted in progression of her melanoma nearly 1 year later, while off therapy. Instead of discontinuing immunotherapy completely, she agreed to a re-challenge with ipilimumab. After one dose, her melanoma regressed and continues to show a sustained response nearly 1 year after treatment without any signs of relapse in her neuropathy. Guillain-Barré toxicity resulting from immune checkpoint inhibition poses a difficult challenge to an oncologist who is determining the next line of treatment for patients with unresectable metastatic melanoma that have progressed while off therapy and who have no targetable mutations. Our case raises the question of whether a re-challenge with a different class of immunotherapy agent is a reasonable option.