Transformation and Closure for Anatomical Donor Families that Meet Medical Students.

The University of Oklahoma College of Medicine has conducted an annual Anatomical Donor Luncheon where families of the anatomical donors met anatomy dissection groups of medical students. The luncheon presented an opportunity for donor family members to share the life story of their loved one with the medical students prior to the start of the anatomy course. This study was designed to understand the impact of the Anatomical Donor Luncheon on families of the donors. Seven families in two different focus groups were included to explore the reactions and attitudes of the donor families to meeting the medical students. Conversations were digitally recorded and transcribed. Qualitative analysis of textual data were coded by three investigators using the Constant Comparative Method. To provide evidence of validity, a form of member checking was utilized. For further triangulation, an analyst not involved in conducting the focus groups or analyzing the data, re-coded all data. This analyst used categories and themes identified by the original analysts, ensuring validity of the themes and any negative cases (data not supporting or contradictory of the established categories and themes). One meta-theme and three sub-themes were identified. The meta-theme was Donor Family Participants Experience Transformation and Closure, and sub-themes were Motivators for Participation, Optimal Venue Factors, and Optimal Medical Student-Anatomical Donor Family Interactions. Study findings indicated the Anatomical Donor Luncheon facilitated closure on the death of their loved one, and transformed their apprehension about the luncheon and body donation into an attitude of gratitude and appreciation.

Providing context for a medical school basic science curriculum: The importance of the humanities.

INTRODUCTION: To increase students' understanding of what it means to be a physician and engage in the everyday practice of medicine, a humanities program was implemented into the preclinical curriculum of the medical school curriculum. The purpose of our study was to determine how medical students' views of being a doctor evolved after participating in a required humanities course. METHODS: Medical students completing a 16-clock hour humanities course from 10 courses were asked to respond to an open-ended reflection question regarding changes, if any, of their views of being a doctor. The constant comparative method was used for coding; triangulation and a variety of techniques were used to provide evidence of validity of the analysis. RESULTS: A majority of first- and second-year medical students (rr = 70%) replied, resulting in 100 pages of text. A meta-theme of Contextualizing the Purpose of Medicine and three subthemes: the importance of Treating Patients Rather than a Disease, Understanding Observation Skills are Important, and Recognizing that Doctors are Fallible emerged from the data. CONCLUSIONS: Results suggest that requiring humanities as part of the required preclinical curriculum can have a positive influence on medical students and act as a bridge to contextualize the purpose of medicine.

Changing the culture of a medical school by orienting students and faculty toward community medicine.

Oklahoma's health status has been ranked among the worst in the country. In 1972, the University of Oklahoma established the Tulsa branch of its College of Medicine (COM) to expand the physician workforce for northeastern Oklahoma and to provide care for the uninsured patients of the area. In 2008, the Tulsa branch launched a distinct educational track, the University of Oklahoma COM's School of Community Medicine (SCM), to prepare providers equipped and committed to addressing prevalent health disparities.The authors describe the Tulsa branch's Summer Institute (SI), a signature program of the SCM, and how it is part of SCM's process of institutional transformation to align its education, service, and research missions toward improving the health status of the entire region. The SI is a weeklong, prematriculation immersion experience in community medicine. It brings entering medical and physician assistant students together with students and faculty from other disciplines to develop a shared culture of community medicine. The SI uses an unconventional curriculum, based on Scharmer's Theory U, which emphasizes appreciative inquiry, critical thinking, and collaborative problem solving. Also, the curriculum includes Professional Meaning conversations, small-group sessions to facilitate the integration of students' observations into their professional identities and commitments. Development of prototypes of a better health care system enables participants to learn by doing and to bring community medicine to life.The authors describe these and other curricular elements of the SI, present early evaluation data, and discuss the curriculum's incremental evolution. A longitudinal outcomes evaluation is under way.

Obstetrics and gynecology clerkship for males and females: similar curriculum, different outcomes?

OBJECTIVE: To determine if performance differences exist between male and female students on a 6-week obstetrics and gynecology (Ob/Gyn) clerkship and to evaluate potential variables that might underlie any observed variations. STUDY DESIGN: Final clerkship grades and component scores (clinical evaluations, objective structured clinical examination [OSCE], oral examination, and National Board of Medical Examiners [NBME] subject examination) from July 2007 to June 2010 were matched by student and analyzed by gender. Basic science grade point average (GPA) and initial United States Medical Licensing Exam (USMLE) Step 1 scores were used to establish students' baseline medical knowledge. On a post-clerkship questionnaire, a subset of students reported the numbers of procedures they performed during the clerkship; students also completed online pre- and post-clerkship questionnaires reflecting their self-assessed confidence in women's health clinical skills. RESULTS: Scores were analyzed for 136 women and 220 men. Final clerkship grades were significantly higher for females than for males (89.05 vs. 87.34, p=0.0004, η(2)=0.08). Specifically, females outscored males on the OSCE, oral, and NBME subject examination portions of the clerkship but not clinical evaluations. Males reported completing fewer breast examinations (p=0.001, η(2)=0.14). Pre-clerkship, males were significantly less confident than females in women's health clinical skills (p<0.01) but reached similar levels upon completion of the clerkship. No gender differences were detected for basic science GPA and USMLE Step 1 scores. CONCLUSION: Student gender is associated with final grades on an Ob/Gyn clerkship. Further research regarding these differences should be explored.

Taking bioethics personally.

This narrative symposium examines the relationship of bioethics practice to personal experiences of illness. A call for stories was developed by Tod Chambers, the symposium editor, and editorial staff and was sent to several commonly used bioethics listservs and posted on the Narrative Inquiry in Bioethics website. The call asked authors to relate a personal story of being ill or caring for a person who is ill, and to describe how this affected how they think about bioethical questions and the practice of medicine. Eighteen individuals were invited to submit full stories based on review of their proposals. Twelve stories are published in this symposium, and six supplemental stories are published online only through Project MUSE. Authors explore themes of vulnerability, suffering, communication, voluntariness, cultural barriers, and flaws in local healthcare systems through stories about their own illnesses or about caring for children, partners, parents and grandparents. Commentary articles by Arthur Frank, Bradley Lewis, and Carol Taylor follow the collection of personal narratives.

A teaching oath: a commitment to medical students' learning and development.

BACKGROUND: There are several oaths and affirmations that are integrated into the academic customs of the health sciences, such as the Hippocratic Oath and the Ethical Affirmation for Scientists. What current oaths do not communicate is that teaching and learning are the foundation of the professions. SUMMARY: We articulated an oath to punctuate the important role of teaching and to emphasize that educating students is not a marginal responsibility but an important duty. The goal of this oath is to include all educators who contribute to teaching medical students, including basic science and clinical faculty, residents, nurses, and healthcare providers. This oath is also designed to be concise, allowing for a public declaration during ceremonies that call attention to teaching and learning. CONCLUSIONS: Publically declaring the Teaching Oath is an opportunity to clarify the highest standards of teaching and to energize educators to fulfill the promise of a dynamic learning community.

Perspective: Guidelines for reporting team-based learning activities in the medical and health sciences education literature.

Medical and health sciences educators are increasingly employing team-based learning (TBL) in their teaching activities. TBL is a comprehensive strategy for developing and using self-managed learning teams that has created a fertile area for medical education scholarship. However, because this method can be implemented in a variety of ways, published reports about TBL may be difficult to understand, critique, replicate, or compare unless authors fully describe their interventions.The authors of this article offer a conceptual model and propose a set of guidelines for standardizing the way that the results of TBL implementations are reported and critiqued. They identify and articulate the seven core design elements that underlie the TBL method and relate them to educational principles that maximize student engagement and learning within teams. The guidelines underscore important principles relevant to many forms of small-group learning. The authors suggest that following these guidelines when writing articles about TBL implementations should help standardize descriptive information in the medical and health sciences education literature about the essential aspects of TBL activities and allow authors and reviewers to successfully replicate TBL implementations and draw meaningful conclusions about observed outcomes.

Meeting the family: promoting humanism in gross anatomy.

BACKGROUND: Human dissection commonly occurs early in the undergraduate medical school curriculum, thus presenting an immediate opportunity for educators to teach and encourage humanistic qualities of respect, empathy, and compassion. PURPOSE: The purpose of this study was to measure the impact of the Donor Luncheon, a unique program in which medical students meet the families of the anatomical donor prior to dissection in the anatomy course at the University of Oklahoma College of Medicine. METHODS: Students were randomized into groups of 8 to attend the luncheon and either met with family of the donor or attended the luncheon with no donor family present. A questionnaire measured students' attitudes at 2 weeks, 6 weeks, and at the conclusion of the anatomy course. RESULTS: Factor analysis revealed 5 scales. Analysis revealed statistically significant differences across time for Donor as Person, Dissection Process, and Donor as Patient and statistically significant differences between groups for Donor as Person and Donor as Patient. CONCLUSIONS: These results suggest that this program can provide students with the opportunity to maintain more humanistic attitudes at the beginning of their medical education career.

Part seven: The role of narrative in the everyday practice of medicine developing narrative competence.

It has been the thesis of this symposium that medicine is a narrative enterprise. We have presented our case that the work in is largely narrative. If that is true, then one of the goals of medical education should be to create methods of improving the narrative competencies in learners and practitioners of medicine. This final paper will explore the field of Narrative Medicine and briefly discuss methods currently in use in American Medical Education and conclude with the experience at the University of Oklahoma College of Medicine over the past ten years.

Helping medical students understand postpartum psychosis through the prism of "The Yellow Wallpaper" by Charlotte Perkins Gilman.

OBJECTIVE: We assessed the use of literature to illustrate a postpartum depression lecture. METHODS: Medical students and faculty facilitators were surveyed after small group discussions. RESULTS: Students' ratings and comments were positive, and faculty comments were neutral to positive. CONCLUSION: Students valued this teaching method, while faculty observations reflected challenges of assessing literature's contributions to medical education in improving empathy and treatment outcome.