The Ontology of Oncology: Navigating Cyborgs and Assemblages Through Cancer Treatment.

Through narrative, the subjective experience of illness offers a corrective to biomedicine's interpretive grip. Narrative is both process and product and illness narratives, in particular, are examples of embodied research. This ecopathography - drawing upon embodied experiences of treatment and recovery from late stage Non-Hodgkin's lymphoma - enlists Haraway's cyborg and Lupton's digital assemblage in an effort to make broader claims about patient care in the United States, and specifically, the role of technology in healthcare and in the construction of patient identity. A surgically implanted port (facilitating blood draws and the delivery of chemotherapy) and the patient portal (representing the results of those blood draws as well as a medium for communication) provide a foundation for how cyborgian assemblages both assist and trouble the cancer experience. At stake is the fluidity and ambiguity of boundaries (human/machine, human/animal, and physical/virtual) and the management of those boundaries with regard to patient care.

Defining Moments: A Nurse's Touch.

In most cultures, touch is the sense we most strongly associate with healing. In this essay, I describe the different ways touch was incorporated into my cancer treatment as well as wonder how touch in the clinical setting might remain changed as the result of COVID-19. More specifically, I narrate my clinical relationship with my oncology nurses and the role of instrumental and empathic touch over the course of six months of treatment and two years of follow-up. Touch in the nurse-patient relationship is necessary, multi-faceted, complicated, and, in the face of a pandemic, amended.

The Difficult Case Consultation: An intervention for interprofessional health communication.

An interprofessional group of healthcare practitioners sought a new approach to the early detection, prevention, and resolution of "difficult cases" in the inpatient care context. An action research project addressed this need by developing a narrative re-framing tool that helped reveal entrenched assumptions regarding the root causes of difficult cases in the hospital. The intervention method that emerged from the project - the Difficult Case Consultation (DCC) - is a theoretically-grounded process that helps teams to analyze and address complex communication problems in interprofessional healthcare contexts. Collaborative processes grounded in theory have proven to be the most successful when seeking to optimize healthcare team communication. The article describes the collaborative development of the DCC, presents two cases illustrating the process, and describes systemic factors that exacerbated the emergence of difficult cases in the inpatient context.

Mad Men as health communication: health-related themes in the hit AMC television series.

As a popular contemporary text, the appeal of cable television's Mad Men (AMC) lies in its capacity to highlight the differences between 1960s sensibilities and 21st-century assumptions. Viewers can enjoy a sense of superiority by recognizing the "folly" of the beliefs and actions of the characters with the benefit of historic hindsight, as well as noting the evolution of technology, philosophy, and human rights. Health-related scenes and themes in the series are a particularly interesting focus for analysis. We employ Burke's four master tropes as an analytical lens and argue that the dominant dramatic technique of irony, particularly in the form that we call strategic anachronism-derived from an audience's enjoyment of historical hindsight-highlights the racism, sexism, homophobia, and overall conservatism of the early 1960s while simultaneously serving to obfuscate the ways in which we still have much to critique in the delivery of contemporary health care and other body politics.

The radar graph: the development of an educational tool to demonstrate resident competency.

BACKGROUND: Despite the movement toward competency-based assessment by accrediting bodies in recent years, there is no consensus on how to best assess medical competence. Direct observation is a useful tool. At the same time, a comprehensive assessment system based on direct observation has been difficult to develop. INTERVENTION: We developed a system that translates data obtained from checklists of observed behaviors completed during educational activities, including direct observation of clinical care, into a graphic tool (the "radar graph") usable for both formative and summative assessment. Using unique, observable behaviors to evaluate levels of competency on the Dreyfus scale, we assessed resident performance in 6 learning sites within our residency. Data are represented on a radar graph, which residents and faculty used to recognize both strengths and areas for growth to guide educational planning for the individual learner. RESULTS: Initial data show that the radar graphs have construct validity because the development process accurately reflects the desired construct, assessors were adequately trained, and the radar graphs demonstrated resident growth over time. A form completion rate of 90% for >1500 disseminated assessments suggests the feasibility of our process. CONCLUSIONS: The radar graph is a promising tool for use in resident feedback and competency assessment. Further research is needed to determine the full utility of the radar graphs, including a better understanding of the tool's reliability and construct validity.

Generating developmentally appropriate competency assessment at a family medicine residency.

BACKGROUND AND OBJECTIVES: Ten years after the Accreditation Council for Graduate Medical Education's (ACGME) mandate that residency programs evaluate learners' competency, research is needed to guide efforts to meet this challenge. During an innovative residency redesign, the authors developed a process to effectively measure "competence." This particular family medicine residency admits six residents per class year and is sponsored by an academic community hospital. Our objective was to generate developmentally appropriate observable behaviors that assess competencies. METHODS: Eight steps guided the development of this assessment system: (1) Generate residency-specific competencies, (2) Define residency-specific competencies, (3) Identify principles of assessment, (4) Compose and analyze narratives of excellence within each competency, (5) Distill standard statements from narratives and organize into Dreyfus levels of competence, (6) Derive observable behaviors from standard statements to directly correlate behaviors and competency levels, (7) Design assessment tools (based on observable behaviors) for six residency learning sites, and (8) Translate assessment tools for ACGME competencies. RESULTS: The results of this process include an assessment system that (1) features six tools used with strategic frequency throughout the academic year and (2) generates global assessment of residents' performance in both ACGME and residency-specific competencies. CONCLUSIONS: Narrative reflection was an effective method to tie observable behaviors to competencies. The process was time intensive; however, greater efficiency and enthusiasm is expected in the use of these assessment tools, with greater confidence in the program's capacity to assess training outcomes. Future research should include comparison of these tools with those of other programs.

Transforming emergency medicine through narrative: qualitative action research at a community hospital.

Emergency departments struggle daily to save lives in an environment characterized by staff shortages, limited resources, and an expanding patient population. This qualitative action research study focused on the nature of communication in an urban emergency room (ER) and the organizing practices employed by staff to cope with these environmental changes, highlighting disconnects between current practices and traditional models of emergent care. A narrative description of the ER culture served as an impetus for practical improvements at this site, providing staff with both a unique perspective and a useful tool for improving their emergency care practices.