Love and breakup letter methodology: A new research technique for medical education.

In everyday life, feelings are important to us, influencing our decision-making and motivating our actions. This is equally true within medicine and medical education, where feelings influence key aspects such as clinical decision-making, empathy, resilience, professional identity, reflection, team dynamics, career choices and questions of prejudice and bias. Feelings are therefore legitimate targets in medical education research, but asking research participants to talk openly about feelings can be challenging for participants and researchers alike. Within the disciple of User Experience (UX)-a relatively new research discipline used in the world of technology-researchers also seek to understand their customer's feelings, which are central to aspects of brand loyalty and choice of software platforms. UX researchers have developed innovative ways to explore feelings, in particular through the use of Love and Breakup Methodology (LBM)-participants are asked to write love and breakup letters to the product or app under study, and the letters are then used to guide the focus group discussion that follows. Methods: In this article, we describe the theoretical underpinnings of LBM, including ontological considerations. We also consider how LBM can be successfully used in medical education research and outline how we have adapted it in our own research studies and programme evaluations. Conclusions: Love and breakup letters are creative ways of understanding participants' positive and negative emotions about the matter under study. LBM has been utilised extensively by UX researchers in technology, but has been little used in medical education. It has rich potential to enhance research approaches to aspects of medicine that are influenced by feelings, including empathy and resilience, team working and many other aspects of professional practice. Although principally a focus group research tool, it can be adapted to other approaches, including questionnaire surveys and individual interviews.

How medical school alters empathy: Student love and break up letters to empathy for patients.

INTRODUCTION: Medical education is committed to promoting empathic communication. Despite this, much research indicates that empathy actually decreases as students progress through medical school. In qualitative terms, relatively little is known about this changing student relationship with the concept of empathy for patients and how teaching affects it. This study explores that knowledge gap. METHODS: Adopting a constructivist paradigm, we utilised a research approach new to medical education: Love and Breakup Letter Methodology. A purposive sample of 20 medical students were asked to write love and break up letters to 'empathy for patients'. The letters were prompts for the focus group discussions that followed. Forty letters and three focus group discussions were thematically analysed. RESULTS: The three major themes were: art and artifice; empathic burden; and empathy as a virtue. Students were uncomfortable with the common practice of faking empathic statements, a problem exacerbated by the need to 'tick the empathy box' during examinations. Students evolved their own empathic style, progressing from rote empathic statements towards phrases which suited their individual communication practice. They also learned non-verbal empathy from positive clinician role-modelling. Students reported considerable empathic burden. Significant barriers to empathy were reported within the hidden curriculum, including negative role-modelling that socialises students into having less compassion for difficult patients. Students strongly associated empathy with virtue. CONCLUSIONS: Medical education should address the problem of inauthentic empathy, including faking empathic s in assessments. Educators should remember the value of non-verbal compassionate communication. The problems of empathic burden, negative role modelling and of finding empathy difficult for challenging patients may account for some of the empathy decline reported in quantitative research. Framing empathy as a virtue may help students utilise empathy more readily when faced with patients they perceive as challenging and may promote a more authentic empathic practice.

Immunohistochemistry Critical Assay Performance Controls (ICAPC) Reduce Interobserver Variability in the Interpretation of BRAFV600E Immunohistochemistry.

The utility of prognostic and predictive immunohistochemistry biomarkers in the context of cancer is plagued by inconsistent interpretation of results which can lead to poor rates of adoption or inappropriate use of novel therapeutic strategies. To monitor immunohistochemistry assay performance, a new on-slide control motif, Immunohistochemistry Critical Assay Performance Controls (ICAPC) was developed. We hypothesized that the use of these controls by the diagnosing pathologist to interpret BRAFV600E would result in reduced interobserver and intraobserver interpretation errors. A cross-sectional, sequentially obtained sample of surgical pathology cases stained for BRAFV600E was assembled from a single hospital in Vancouver, British Columbia. Half of the cases had normal on-slide controls and the remainder with ICAPC. Results from 6 independent and blinded readers were compared with each other and to the gold-standard pathologic diagnosis with the goal of demonstrating superior interrater agreement with ICAPC relative to standard on-slide controls. Cohen's κ was used to compute pair-wise reader agreements, whereas Fleiss' κ was used to compare to the gold standard. The implementation of ICAPC resulted in statistically significant improvements in the interobserver agreement of BRAF mutation status ascertained by BRAFV600E immunohistochemistry. Half of the readers demonstrated significant improvements in agreement with the gold-standard diagnosis with the addition of ICAPC. Across all readers, the mean increase in κ was 0.14 with a 95% confidence interval of 0.01-0.28 (P=0.04). This study demonstrates that the addition of ICAPC serves to significantly reduce interobserver variability in the assessment of BRAFV600E immunohistochemistry. As such, we recommend that this approach should be used as part of a comprehensive quality management strategy in the setting of histopathology.