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.

Functional realism: a defense of narrative medicine.

In this paper we (1) define and describe the practice of narrative medicine, (2) reveal the need for narrative medicine by exposing the presuppositions that give rise to its discounting, including a reductive empiricism and a strict dichotomy between scientific fact and narrative value, (3) show evidence of the effects of education in narrative competence in the medical clinic, and (4) present Peircean realism as the proper conceptual model for our argument that the medical school curriculum committees should give space to the employment of the scientific and literary knowledge in medical practice. On account of our argument, we contend that the medical community should tend to latitude and openness with regard to the tools we use to resolve medical problems. These tools include both biomedical and narrative knowledge.

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.

Locus of control and metabolic control of diabetes: a meta-analysis.

PURPOSE: The purpose of this meta-analysis was to investigate whether locus of control (LOC) for internal LOC, powerful others, or chance is correlated with how well people control diabetes (measured by H1C). METHODS: The literature search included Medline, CINAHL, PsychINFO, PsychArticles, Health Source, Academic Search Elite, EMBASE, Current Contents, and BIOsis databases, which yielded 296 articles. Selection criteria for inclusion were adult participants with diabetes mellitus, use of glycosylated hemoglobin (H1C) as a measure of glycemic control, measurement of a locus-of control scale, and a Pearson correlation (r) value. Seventeen articles met all inclusion criteria. The R package "metacor," was used to perform a random effects meta-analysis and estimate correlation coefficients between the 3 LOC measurements and H1C. RESULTS: The strength of subjects ascribing an internal LOC (across 13 studies) was uncorrelated with H1C (r = -0.0099; 95% confidence interval [CI], -0.1092, 0.0893). A LOC ascribed to powerful others LOC (across 9 studies) was similarly uncorrelated with H1C (r = 0.0928; 95% CI, -0.0136, 0.1993). Ascribing LOC to chance (across 9 studies) was also uncorrelated with H1C (r = 0.0926; 95% CI, -0.0398, 0.2250). CONCLUSIONS: This meta-analysis of 17 studies found no correlation between the control of diabetes and LOC. At best, there may be a weak correlation between powerful others and chance LOC with the metabolic control of diabetes. The use of LOC as a means of designing diabetes care can be discarded as this random effects meta-analysis found no significant correlation with effectiveness of diabetes control in adult patients.

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.

The logic of diagnosis: Peirce, literary narrative, and the history of present illness.

This essay presents a theoretical construct upon which to base a working--"pragmatic"--definition of the History of Present Illness (HPI). The major thesis of this essay is that analysis of both the logic of hypothesis formation and literary narrative--especially detective stories--facilitates understanding of the diagnostic process. The essay examines three elements necessary to a successful development of a patient's HPI: the logic of hypothesis formation, based upon the work of the philosopher-logician, Charles Sanders Peirce; the organization of knowledge in relation to structures of narrative; and the feedback necessary to the successful physician-interviewer. It concludes with a systematic description of the design of hypothesis formation within diagnoses.

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.