Use of a Graphic Memoir to Enhance Clinicians' Understanding of and Empathy for Patients with Parkinson Disease.

CONTEXT: Parkinson disease (PD) can be physically, emotionally, and financially burdensome. Understanding its impact from the patient's perspective is an important way to sensitize clinicians to the challenges of living with PD. OBJECTIVE: To evaluate whether a book-length graphic memoir (an illness story in comic form) can help clinicians appreciate PD from the patient's perspective. DESIGN: A convergent mixed-methods study of clinicians working in a multidisciplinary movement disorders clinic. Participants read My Degeneration and completed preintervention and post-intervention questionnaires. They also attended a book group discussion. Quantitative findings were compared before and after the intervention, and qualitative data were analyzed for themes. MAIN OUTCOME MEASURES: Clinicians': 1) confidence in understanding patients' experiences with PD, 2) knowledge about PD, and 3) empathy toward patients and families. RESULTS: After reading the book, participants' confidence in understanding patients' experiences with PD increased significantly in the areas of stigma and disease impact on patients and families. Clinical knowledge was unchanged. Qualitative analysis revealed 3 main themes: 1) the book provides a meaningful way for clinicians to learn about the experience of living with PD; 2) the medium of comics engages clinicians in ways different from other mediums; and 3) benefits of the book may extend beyond the clinical team. CONCLUSION: Clinicians who read My Degeneration gained insight into the psychosocial effects of PD on patients and their loved ones. The book helped facilitate deeper understanding of patients' experiences living with PD and fostered greater empathy and self-reflection.

A Collaborative Response to Provocative Comments in a Medical School.

This article was migrated. The article was marked as recommended. In 2018, anonymous online provocative comments were submitted to student leaders of a Syrian Refugee Initiative (SRI) at the Penn State College of Medicine. This triggered a series of actions with students and medical school leaders aimed at identifying the person who submitted the comments, trying to understand mutual perspectives, and managing the impact of the event on the student body. We describe the history of our college's commitment to humanism and how the SRI was a direct outgrowth of that culture. Voices of the student leaders who were directly impacted by the provocative comments and educational leaders who worked to resolve the crisis are presented. We also describe a collaborative process that involved engaging cybersecurity experts to identify the perpetrator, and share how the students and educational leaders were able to develop trust despite initial skepticism by students over the leadership's avowed commitment to taking the hate speech seriously. While the perpetrator was never identified and opportunities for improvement were identified along the way, by including student leaders in the process, students and administrators were able to develop trust and reach reasonable closure on this disturbing event. Take home messages are presented to guide other institutions in navigating instances of provocative comments or speech.

Graphic Pathographies and the Ethical Practice of Person-Centered Medicine.

Graphic medicine is a swiftly growing movement that explores, theoretically and practically, the use of comics in medical education and patient care. At the heart of graphic medicine are graphic pathographies, stories of illness conveyed in comic form. These stories are helpful tools for health care professionals who seek new insight into the personal, lived experience of illness and for patients who want to learn more about their disease from others who have actually experienced it. Featuring excerpts from five graphic pathographies, this essay illustrates how the medium can be used to educate patients and enhance empathy in health care professionals, particularly with regard to informed consent and end-of-life issues.

Team Investment and Longitudinal Relationships: An Innovative Global Health Education Model.

PROBLEM: Increasing student interest in global health has resulted in medical schools offering more global health opportunities. However, concerns have been raised, particularly about one-time, short-term experiences, including lack of follow-through for students and perpetuation of unintentional messages of global health heroism, neocolonialism, and disregard for existing systems and communities of care. Medical schools must develop global health programs that address these issues. APPROACH: The Global Health Scholars Program (GHSP) was created in 2008-2009 at Penn State College of Medicine. This four-year program is based on values of team investment and longitudinal relationships and uses the service-learning framework of preparation, service, and reflection. Teams of approximately five students, with faculty oversight, participate in two separate monthlong trips abroad to the same host community in years 1 and 4, and in campus- and Web-based activities in years 2 and 3. OUTCOMES: As of December 2016, 191 students have been accepted into the GHSP. Since inception, applications have grown by 475% and program sites have expanded from one to seven sites on four continents. The response from students has been positive, but logistical challenges persist in sustaining team investment and maintaining longitudinal relationships between student teams and host communities. NEXT STEPS: Formal methods of assessment should be used to compare the GHSP model with more traditional approaches to global health education. Other medical schools with similar aims can adapt the GHSP model to expand their global health programming.

Medical Student Perceptions of Their Education About Suffering.

BACKGROUND AND OBJECTIVES: To explore student perceptions of their medical school teaching and learning about human suffering and to elicit student recommendations for better approaches to teaching about suffering. METHODS: Qualitative study involving focus groups of students from each class at two US medical schools. RESULTS: Students reported that teaching about human suffering was variable, rarely explicit, and occurred primarily in the pre-clinical curriculum. In the clinical curriculum, addressing patient suffering was neither overtly valued nor evaluated by attending physicians. Students perceived little or no explicit educational attention to the suffering of patients and their families, with the exceptions of specific rotations and attendings. They described little or no teaching of clinical skills to identify and manage suffering and desired such training. Students learned about the clinical management of suffering primarily by ad hoc observation of role models. Some also noted that exposure to patient suffering and the demands of medical education contributed to their own suffering. Students recommended intentional, integrated and longitudinal teaching about suffering, with regular reinforcement and evaluation, across the medical school curriculum. CONCLUSIONS: Students perceived teaching about human suffering as insufficient at the institutions studied and desired to learn clinical skills to identify and help patients manage suffering. Medical educators should explicitly address patient suffering and create longitudinal curricula with improved clinical teaching, faculty role modeling, and student evaluation.

Optimal Frequency of Psychosocial Distress Screening in Radiation Oncology.

PURPOSE: To accurately hypothesize the optimal frequency of psychosocial distress screening in patients undergoing radiation therapy using exploratory modeling of prospective data. MATERIALS AND METHODS: Between October 2010 and May 2011, 71 RT patients underwent daily screening with the Distress Thermometer. Prevalences of Distress Thermometer scores ≥ 4 were recorded. Optimal screening frequency was evaluated by planned post hoc comparison of prevalence rates and required screening events estimated by numerical modeling, consisting of data point omission to mimic weekly, every-other-week, monthly, and one-time screening intervals. Dependence on clinical variables and chronologic trends were assessed as secondary end points. RESULTS: A total of 2,028 daily screening events identified that 37% of patients reported distress at least once during the course of treatment. Weekly, every-other-week, monthly, and one-time screening models estimated distress prevalences of 32%, 31%, 23%, and 17%, respectively, but required only 21%, 12%, 7%, and 4% of the assessments required for daily screening. No clinical parameter significantly predicted distress in univariable analysis, but "alone" living situation trended toward significance (P = .06). Physician-reported grade 3 toxicity predicted distress with 98% specificity, but only 19% sensitivity. CONCLUSION: Thirty-seven percent of radiation oncology patients reported distress at least once during treatment. Screening at every-other-week intervals optimized efficiency and frequency, identifying nearly 90% of distressed patients with 12% of the screening events compared with daily screening.

Humanities mini-course curricula for midcareer health professionals at the Penn State Milton S. Hershey Medical Center.

The field of medical humanities has traditionally focused on medical students and, more recently, on premedical undergraduates. Comparatively little formal humanities pedagogy has been dedicated to midcareer health professionals. To address this lack, the Department of Humanities at the Pennsylvania State University College of Medicine and the Milton S. Hershey Medical Center designed eight annual humanities mini-courses for faculty and staff throughout the college and medical center.These mini-courses fell into four categories: reading, reflection, and discussion; creative expression; technology; and ethics. They were geared toward midcareer health professionals who were seeking new intellectual and creative stimulation and variety in daily routine. They also provided humanities faculty the opportunity to devote attention to topics that capitalize on their professional training and that interest them personally.Participants indicated a high degree of satisfaction with the mini-courses for four principal reasons: (1) learning the tools and methodologies of a new discipline or domain other than biomedicine, (2) using their minds and training in uncustomary ways, (3) forming new alliances with colleagues (which served to lessen the sense of professional isolation), and (4) enjoying a respite from the stressful flow of the workday. Humanities faculty facilitators provided more mixed responses but agreed that conducting the mini-courses had been a positive overall experience.Although this article provides a foundational framework for the development of a humanities mini-course series, the authors encourage others to replicate these curricula in other medical settings as an important step toward a robust pedagogy designed for midcareer health care professionals.