By Medical Students, for Medical Students: A Narrative Medicine Antiracism Program.

Objectives: Medical schools have sought to incorporate concepts of race and racism in their curricula to facilitate students' abilities to grapple with healthcare disparities in the United States; however, these efforts frequently fail to address implicit bias or equip students with cultural humility, reflective capacity, and interpersonal skills required to navigate racialized systems in healthcare. The purpose of this study was to develop and evaluate an antiracism narrative medicine (NM) program designed by and for preclinical medical students. Method: Preclinical medical students at a single center were eligible to participate from June-July 2021. Program evaluation included a postprogram qualitative interview and electronic survey. The semistructured interview included questions about program experience, lessons learned, and perspectives on antiracism curricula in medical education. Interviews were qualitatively analyzed using open and axial coding. Survey data were analyzed with descriptive statistics. Results: A total of 30 students registered. All (100%) respondents reported "somewhat true" or "very true" in the postprogram survey when asked about their ability to reflect on their own racial identity, racial identity of others, and influence of their racial identity on their future role as a healthcare worker through the program. Qualitative analysis revealed 3 themes: (1) curricular engagement; (2) racism and antiracism in medicine; and (3) group experience. Subthemes included: meaningful theoretical content; multimodal works and unique perspectives; race, identity, and intersectionality; deeper diversity, equity, and inclusion engagement; reconstructive visions; future oriented work; close reading and writing build confidence in discomfort; community and support system; and authentic space among peer learners. Conclusion: This virtual, peer-facilitated antiracism NM program provided an engaging and challenging experience for participants. Postprogram interviews revealed the program deepened students' understanding of racism, promoted self-reflection and community building, and propagated reconstructive visions for continuing antiracism work.

A New Construct in Undergraduate Medical Education Health Humanities Outcomes: Humanistic Practice.

Proposed educational outcomes for the health humanities in medical education range from empathy to visual thinking skills to social accountability. This lack of widely agreed-upon high-level curricular goals limits humanities educators' ability to design purposeful curricula toward clear, common ends and threatens justifications for scarce curricular time. We propose a novel approach to the hoped-for outcomes of health humanities training in medical schools, which has the potential to encompass traditional health humanities knowledge, skills, and behaviors while also being concrete and measurable: humanistic practice. Humanistic practice, adapted from the concept of ethical sensitivity, is an intentional process of applying humanities knowledge and skills to a clinical scenario by 1) noticing that the scenario requires humanities knowledge or skills, 2) informing one's clinical and interpersonal strategy and behavior with humanities knowledge or skills, 3) reflecting on the effectiveness of the strategy and behavior, and 4) reorienting to develop new approaches for future practice. The construct of humanistic practice may help address some of the foundational problems in health humanities outcomes research since it transcends the traditional diverse content domains in the health humanities, can link patient and provider experiences, and may bridge the divide among the additive, curative, and intrinsic epistemic positions of humanities to medical education.

Nurturing Empathy through Arts, Literature, and Role Play for Postgraduate Trainees of Ophthalmology.

Background and Purpose: Empathy is essential in patient-centered compassionate health care. Lack of formal training, workload, patient factors, and digitalization have been attributed to its regression. Empathy can be nurtured by educational interventions. A structured empathy education module for postgraduate trainees is not available in India. The aim for this research was to develop, deliver, and evaluate one for ophthalmology postgraduate trainees. Methodology: This interventional study was conducted in the tertiary ophthalmology department of Western India during 2022-2023. Four workshops comprising of interactive lectures, literature, creative arts, and role plays were delivered with trained facilitators. Data from surveys for trainee self-assessment, patient perception of trainee empathy, pre-post knowledge test, and trainee and facilitator feedback were collected and analyzed. Results: Seventy-nine ophthalmology postgraduate trainees participated in this intervention. Excessive workload and lack of training were shared as the barriers to empathetic care. Trainees showed improved knowledge, skills, and attitude in empathy after the workshops. The facilitators and trainees were satisfied with the learning goals, execution, utility, feasibility, and relevance of the workshops. Ninety-three percent trainees want this module to be a part of postgraduate curriculum. Conclusion: This study substantiates the use of structured interactive training for cultivating empathy in postgraduate trainees. Barriers against empathy were identified and can be mitigated by restorative measures. Literature, arts, and role plays are the effective education tools for empathy.

Playing well with others: lessons from theatre for the health professions about collaboration, creativity and community.

Despite collaboration among different professions being recognized as fundamentally important to contemporary and future healthcare practice, the concept is woefully undertheorized. This has implications for how health professions educators might best introduce students to interprofessional collaboration and support their transition into interprofessional, collaborative workplaces. To address this, we engage in a conceptual analysis of published collaborative, interprofessional practices and conceptual understandings in theatre, as a highly collaborative art form and industry, to advance thinking in the health professions, specifically to inform interprofessional education. Our analysis advances a conceptualization of collaboration that takes place within a work culture of creativity and community, that includes four modes of collaboration, or the ways theatre practitioners collaborate, by: (1) paying attention to and traversing roles and hierarchies; (2) engaging in reciprocal listening and challenging of others; (3) developing trust and communication, and; (4) navigating uncertainty, risk and failure. We conclude by inviting those working in the health professions to consider what might be gleaned from our conceptualization, where the embodied and human-centred aspects of working together are attended to alongside structural and organizational aspects.

Health Humanistic Education for Medical Students Based on "Health China" Strategy / 中国医学伦理学

Based on "Health China" strategy, health humanities education of medical students should be strengthened. The health humanistic education treats all medical students as the object, and infiltrates the humanities into the whole process of health education of medical students in an all-round way, so as to improve health literacy and promote health. Following the strategic deployment of "Health China" and guided by "Health China 2030" Planning Outline, health humanistic education should establish the era orientation of "health first", "people’s health as the center" and "joint construction and sharing", adapt the needs of medical humanistic reform from "disease-centered" to "health-centered", cultivate medical talents with benevolence and skill to meet the needs of a better life, train general practitioners to ensure people’s health in an all-round and all-cycles.

The art of equity: critical health humanities in practice.

BACKGROUND: The American Association of Medical Colleges has called for incorporation of the health humanities into medical education, and many medical schools now offer formal programs or content in this field. However, there is growing recognition among educators that we must expand beyond empathy and wellness and apply the health humanities to questions of social justice - that is, critical health humanities. In this paper we demonstrate how this burgeoning field offers us tools for integrating social justice into medical education, utilizing the frameworks of critical consciousness and structural competency. PRACTICE OF HEALTH HUMANITIES: Critical health humanities can be applied at multiple levels of learners, and in a variety of contexts. We are two physician-writers who have developed several educational programs that demonstrate this. We taught a seminar that introduced first-year and second-year undergraduates to concepts such as social determinants of health, intergenerational trauma, intersectionality, resilience, and cross-cultural care through works of fiction, poetry, film, podcasts, stand-up comedy, and more. Through creative projects and empathic reflection, students engaged with the complexities of structural forces that create and maintain health disparities. Medical students in their clinical years can engage in critical health humanities learning experiences as well. We teach several multidisciplinary electives that address social (in)justice in medicine, as well as mentor fourth-year students engaged in independent electives that foster critical awareness around health equity and ethics. Beyond the classroom, we have actively engaged in critical health humanities practices through story slams, literary journal clubs, conference presentations, and Grand Rounds. Through these activities we have included learners at GME and CME levels. These examples also demonstrate how community engagement and multidisciplinary partnerships can contribute to the practice of critical health humanities. CONCLUSION: In this paper, we explore the growing field of critical health humanities and its potential for teaching health equity through narrative practices. We provide concrete examples of educational activities that incorporate critical consciousness and structural competency - frameworks we have found useful for conceptualizing critical health humanities as a pedagogical practice. We also discuss the strengths and challenges of this work and suggest future directions.

The Use of Shells of Marine Molluscs in Spanish Ethnomedicine: A Historical Approach and Present and Future Perspectives.

Since ancient times, the shells of marine molluscs have been used as a therapeutic and/or prophylactic resource. In Spain, they were part of practical guides for doctors or pharmacists until the 19th century. In general, seashells were prepared by dissolving in vinegar and were part of plasters or powders used as toothpaste, or to treat dyspepsia, heartburn and leprosy. Thus, the nacre or mother-of-pearl of various molluscs was regularly used in the Royal Colleges of Surgery and in hospitals during the times of the Cortes of Cadiz, as a medicine in galenic preparations based on powders. In contemporary Spanish ethnomedicine, seashells, with a high symbolic value, have been used as an amulet to prevent cracks in the breasts and promote their development during lactation, to avoid teething pain in young children, to eliminate stains on the face or to cure erysipelas. But, as in other countries, products derived from seashells have also been empirically applied. The two resources used traditionally have been the cuttlebone, the internal shell of cuttlefish and the nacre obtained from the external shells of some species. Cuttlebone, dried and pulverised, has been applied externally to cure corneal leukoma and in dental hygiene. In the case of nacre, a distinction must be made between chemical and physical remedies. Certain seashells, macerated in lemon juice, were used in coastal areas to remove spots on the face during postpartum. However, the most common practice in Spain mainland was to dissolve mother-of-pearl buttons in lemon juice (or vinegar). The substance thus obtained has been used to treat different dermatological conditions of the face (chloasma, acne), as well as to eliminate freckles. For the extraction of foreign bodies in the eyes, a very widespread traditional remedy has been to introduce small mother-of-pearl buttons under the lid. These popular remedies and practices are compared with those collected in classic works of medicine throughout history, and data on the pharmacological activity and pharmaceutical applications of the products used are provided. The use of cuttlebone powders is supported by different works on anti-inflammatory, immune-modulatory and/or wound healing properties. Nacre powder has been used in traditional medicines to treat palpitations, convulsions or epilepsy. As sedation and a tranquilisation agent, nacre is an interesting source for further drug development. Likewise, nacre is a biomaterial for orthopaedic and other tissue bioengineering applications. This article is a historical, cultural and anthropological view that can open new epistemological paths in marine-derived product research.

Creating Alignment: How the Humanities Can Help Heal Physicians and Patients.

The medical humanities, an umbrella term for the fields of ethics, social science, and fine arts, are increasingly recognized as an important component of medical education. Since the Flexner report, the primacy of science and evidence-based medicine has replaced subjectivity and nuance. While this has been critical for standardization of care and patient safety, an exclusive emphasis on science in undergraduate medical education can devalue more humanistic pursuits. Modern medicine is now plagued with burnout, pandemics, and societal ills that permeate into medicine. Addressing these requires a thoughtful, holistic approach where we extend our sights beyond strict evidence-based medicine.

Developing and validating the Sexual Health Literacy Scale in an Iranian adult sample.

The literature has shown that sexual health literacy has limited applicability in many developing countries. The present study, therefore, aimed to develop and examine the validity and reliability of the Sexual Health Literacy Scale (SHLS) among a sample of 595 Iranian university students. The first analysis yielded themes obtained from a qualitative content analysis of the 118-item SHLS scale. Concepts were extracted using the method of latent content analysis (Bengtsson, NursingPlus Open 2:8-16, 2016). 327 initial codes were extracted and main categories (Elo and Kyngäs, J Adv Nurs. 62 (1): 107-115, 2007) or themes (Graneheim and Lundman, Nurse Education Today 24: 105-112, 2004) obtained consisting of the information source, individual barriers, understanding and application, capacity and motivation, damage, skills, sexual rights, and socio-cultural barriers. In the second analysis, the 595 students were randomly split into two groups. An exploratory factor analysis was conducted on the themes derived and quantified in Phase 1. 6 Factors were obtained and found to be consistent in both groups. Criterion-related validity of sexual health literacy was determined by stepwise multiple regression to predict marital satisfaction. The reliability of SHLS was also investigated. The third analysis examined the fit of the 6 factors obtained from the 595 students in the original sample to a new sample of 221 university students using cross-validation via confirmatory factor analysis. We developed and validated a six-factor structure of the Sexual Health Literacy Scale 106 (SHLS-106): factor 1, Sexual Skills; factor 2, Individual Socio-cultural Barriers; factor 3, Sexual Vulnerability; factor 4, Resources to Access Sexual Information; factor 5, Understanding and Application; factor 6, Capacity and Motivation. SHLS-106 shows good test-retest reliability and criterion, incremental and convergent validities. This is the first study to examine the validity and reliability of the Sexual Health Literacy Scale in an Iranian sample. Considering the acceptable validity and reliability of this instrument, the psychometric properties of SHLS-106 need to be further investigated in diverse, more extended samples to clarify the extent of application of this scale in different settings. SHLS-106 can effectively examine sexual health literacy, a dynamic scale in nature influenced by the individual, healthcare system, contextual, and social factors in different cultures.

Active and Assisted Living, a Practice for the Ageing Population and People with Cognitive Disabilities: An Architectural Perspective.

The current digital revolution is causing a paradigm shift encompassing all environments in which human beings conduct their daily activities. Technology is starting to govern the world, gradually modifying not only individual and social behaviour, but also ways of living. The necessary adaptation to new information and communication technologies forces societies to rethink both public and private spaces, in which evolution is slower than rapid social transformation. As part of this change, the concept of Active Assisted Living (AAL) has developed. Assisted spaces can be designed to provide older adults, carers, or people who have cognitive disabilities, such as Alzheimer's disease or other dementias, with a healthier, safer, and more comfortable life, while also affording them greater personal autonomy. AAL aims to improve people's quality of life and allow them to remain in their own homes for as long as possible, not in residences. This study conducted a critical review about AAL from an architectural point of view. The research adopted a qualitative approach in which we collected the studies during the last twenty years, then used descriptive, narrative and critical analysis methods. Based on these, this paper aims to explain this new technological paradigm, its characteristics, its main development trends, and its implementation limitations. The results obtained show how the development of AAL will be in the next ten years, and how this concept, and its application, can influence architecture and provide the bases for further research into the design of buildings and cities.

Framing of female medical personnel during the COVID-19 pandemic: a case study of the Chinese official media.

This paper analyzes the media frames adopted by the official WeChat and Sina Weibo accounts of the People's Daily between January 1 and December 31, 2020, for reports about female medical personnel involved in pandemic prevention and control. Although the number of female medical personnel involved in pandemic prevention and control far exceeded that of their male counterparts, the extent of media reports on the former was far less than that of the latter. The human interest frame about female medical personnel was mainly applied, while the use of the action frame was less frequent, which highlighted the gender identity and family role of these women but weakened their professional identity. This was not conducive to praising the contributions of female medical personnel in fighting the pandemic. The media frames of reporting medical personnel in WeChat and Sina Weibo accounts of the People's Daily are not always the same. After Wuhan's lockdown ended on April 8, the proportion of the human interest frame of the report text of female medical personnel decreased, and the proportion of the action frame increased, while the proportion of the human interest frame of the report text of male medical personnel increased and the proportion of the action frame decreased. Previous studies mainly analyzed the use of the media frames of female news personalities, but few studies focused on whether women had the possibility of breaking away from the gender media frames. This study shows that some female medical personnel with exceptional professional competence are likely to transcend the gender media frames and receive similar coverage to that of male medical professionals, like Li Lanjuan and Chen Wei.

Cognitive and emotional factors related to COVID-19 among high-risk ethnically diverse adults at the onset of the New York City outbreak: A cross-sectional survey.

A cross-sectional survey was conducted among high-risk, racially/ethnically diverse adults at the point in time when New York City (NYC) became the COVID-19 pandemic's global epicenter. The study objective was to assess the threat and coping appraisals (cognitive factors known to correspond with people's willingness to adopt behaviorally focused interventions) and levels of distress, anxiety, and intolerance for uncertainty (emotional factors). Survey respondents were recruited in April 2020 using an online survey with unpaid recruitment on the GetHealthyHeights.org community-oriented website. We also recruited participants that engaged in previous research studies to gain survey responses from community members at higher risk for COVID-19 complications due to comorbidities compared to the general population. Analysis was performed to test for differences in survey responses by comorbidities, age, race, ethnicity, and employment status. Results show that the devastating effects of the pandemic appear to have uniquely impacted minority respondents, who reported significantly higher levels of anxiety and were significantly more likely to report having little control over whether they will get COVID-19 compared with White/non-Hispanic respondents. Minority respondents also had significantly higher mean scores on the behaviorally focused dimension of the intolerance of uncertainty (IU) scale, which measures avoidance and paralysis in the face of uncertainty. In multivariate analysis, IU predicted anxiety levels, and this association was not mediated by cognitive factors (threat and coping appraisals). By conducting this survey early in the pandemic, our study uniquely evaluated cognitive and emotional factors among a racially/ethnically diverse group of NYC residents during the height of the COVID-19 pandemic. Our findings suggest the need to acknowledge the disparities that appear to exist in pandemic response and for culturally tailored messaging and interventions. Few studies have reported differences by race and ethnicity during pandemic exposure. Therefore, further research on factors that may influence pandemic response among minority populations is needed.

Well-being of artisanal fishing communities and children's engagement in fisheries amidst the COVID-19 pandemic: a case in Aklan, Philippines.

This study describes and explains the multifaceted effects of the COVID-19 pandemic on the socio-economic and psychosocial well-being of the artisanal fishing communities in Central Philippines. The state of child labour and their education amidst the COVID-19 lockdown were also explored. Four hundred artisanal fishing households, with 792 children, from the 10 coastal municipalities in Aklan province were surveyed in May-December 2020 through face-to-face household interviews. The COVID-19 pandemic worsened poverty in these highly vulnerable fishing communities primarily through severe disruptions in their fishing and marine tourism-related livelihoods. The proportion of households living below the Philippine poverty threshold of PHP12,030 (USD232.7) monthly for a family of five members increased from 78% pre-COVID to 91% peri-COVID. This economic impoverishment was more pronounced in larger families with limited income, as in the survey sites, where 41% of the households have more than five family members. Furthermore, 57% of the surveyed households believed that learning difficulty increased by 81% among children due to the blended online education modality. Amidst increased impoverishment, child labour intensified, and children stopped schooling. A significant decline in happiness index peri-COVID was also observed in the study sites indicating extreme socio-economic challenges. Contrary to expectations, however, interpersonal relations in most households improved, underscoring women's stabilising and nurturing role. This latter phenomenon signifies that cooperative and nurturing actor relationships can be generated even in a crisis. Policies that mainstreamed local communities' reproductive health, family planning, and programmes that diversify socio-economic, environmental, and technological assets must be renewed and promoted. The goal is to holistically improve human well-being by increasing or sustaining stocks of these assets to promote resilience and sustainability amidst crisis and complexity.

Correction: Assessing the significance of first place and online third places in supporting Malaysian seniors' well-being during the pandemic.

[This corrects the article DOI: 10.1057/s41599-023-01655-5.].

Medical Humanism in the Posthuman Era: A Critical Examination of its Past, Present, and Future.

This paper explores the historical and contemporary significance of medical humanism and its potential value in medical education. Medical humanities emerged as a response to the issues arising from science-driven modern medicine, most notably the marginalization of the individual in medical practice. Medical humanism has evolved to become a guiding ideology in shaping the theory and practice of medical humanities. However, the COVID-19 pandemic has brought about significant changes in medical humanities, challenging the foundations of humanism beyond medical humanism. The rise of posthumanism raises fundamental questions about humanism itself. The climate crisis, driven by human greed and capitalism's exploitation of nature, has led to the emergence of viruses that transcend species boundaries. The overflow of severely ill patients has highlighted the classic medical ethics problem of "who should be saved first" in Korea, and medical humanism is facing a crisis. Various marginalized groups have also pointed out the biases inherent in medical humanism. With this rapidly changing environment in mind, this paper examines the past and present of medical humanism in order to identify the underlying ideology of medical humanism and its future potential in medical education. This paper assumes that there are two axes of humanism: human-centeredness and anthropocentrism. Medical humanism has historically developed along the axis of human-centeredness rather than anthropocentrism, emphasizing the academic inquiry into human nature and conditions, as well as the moral element of humanity. Furthermore, this paper discusses the challenges that medical humanism faces from post-human centeredness and post-anthropocentrism, as well as the recent discourse on posthumanism. Finally, the implications of this shift in medical humanism for the education of the history of medicine are briefly explored.

The impact of perceived risk of online takeout packaging and the moderating role of educational level.

With the rapid development of e-commerce and the impact of COVID-19, online takeout has become the first choice of more and more consumers. Previous research has indicated that food packaging is of great significance to marketing performance, yet very little is known about the mechanisms through which food packaging pollution risk affects online takeout consumption. This study proposes an expanded model of the Theory of Planned Behavior (TPB) by incorporating the Concept of Perceived Risk (CPR) to analyze the mechanism of consumers' packaging pollution risk perception (PPRP) on their purchasing intention toward online takeout. Online survey was performed to collect data from 336 valid respondents in China, which was analyzed using structural equation modeling. The research findings verify the effectiveness of the TPB in the context of Chinese online takeout. Notably, the PPRP of online takeout was found to have a significant negative impact on consumers' attitudes, subjective norms, and perceived behavioral control (PBC). It was also confirmed that consumers' attitudes, subjective norms, and PBC regarding online takeout partially mediate the negative relationship between PPRP and purchase intention. In addition, the findings corroborate the granular nuances among three groups concerning consumers' education level. The results do not only provide suggestions to the online takeout industry but also contribute theoretical value and practical significance for the improvement of sustainable food consumption.

How nursing students' risk perception affected their professional commitment during the COVID-19 pandemic: the mediating effects of negative emotions and moderating effects of psychological capital.

Nurses play a pivotal role in the delivery of medical services. Professional commitment is crucial for nursing professionals' long-term, healthy, and sustainable development. However, nursing students' professional commitment levels are currently unsatisfactory in China, especially given that the COVID-19 pandemic has posed unprecedented challenges to the profession. Therefore, studies investigating the professional commitment levels of nursing students and the underlying influencing factors are urgently required. This study explored how nursing students' risk perceptions, negative emotions, and psychological capital affected their professional commitment during the COVID-19 pandemic. A cross-sectional study was conducted among nursing students using risk perception, professional commitment, negative emotions, and psychological capital scales. An analysis of 1142 Chinese nursing students suggested that nursing students' risk perception positively impacted professional commitment and that negative emotions mediated this association. Importantly, psychological capital moderates the mediating effect of negative emotions and can buffer the negative emotions caused by risk perception. This study demonstrated that effective intervention strategies should be implemented in multiple dimensions such as education, individual, public and society to improve the professional commitment of nursing students.

Assessing the significance of first place and online third places in supporting Malaysian seniors' well-being during the pandemic.

The enforced lockdowns and social distancing measures associated with COVID-19 may have influenced older adults' preferences towards their homes and neighborhoods as well as social spaces. One objective of this research is to determine whether home and neighborhood environments ("first place") affect how satisfied older adults are with their lives during the epidemic. This study also examined the extent to which social spaces that exist in the virtual world ("online third places") affect older adults' life satisfaction when they would have to practice risk-averse behaviors in times of pandemic. To collect data, this study analyzed the responses of 500 active older adults and conducted in-depth interviews with seven older adults who served as neighborhood leaders in Klang Valley, Malaysia. The study found that there is a direct relationship between older adults' satisfaction with their current housing and their overall life satisfaction during the pandemic. Similarly, having a quality neighborhood nearby increases the likelihood of living a satisfied life during the pandemic. Most online third parties, with the exception of instant messaging apps, do not appear to provide older adults with an adequate platform to interact with their friends, participate in social networking, and join communities for emotional support during the pandemic. The findings and recommendations of this study would be very useful in developing effective interventions to promote aging in place during the coronavirus outbreak.

Stages of organizational development and employee assistance programs in Taiwan.

Employee assistance programs (EAPs) provide work, living, and health services to help employees overcome personal and organizational obstacles that affect their productivity. Most businesses in Taiwan are small or medium-sized, and their scale, stage of development, and resources affect their implementation of EAPs. This study explored EAPs and related measures that organizations can implement in each stage of their development. The results may serve as a reference for human resources personnel in planning EAPs, specifically in identifying appropriate measures to implement for each developmental stage of their organizations. The modified Delphi method and fuzzy analytic hierarchy process were used to organize and analyze key EAP measures and their weights during the creation, guidance, authorization, coordination, and collaboration stages of organizational development. Data analysis revealed that in all five stages of organizational development, work-related EAP measures are the most crucial. As an organization transitions from the creation to collaboration stages, the work dimension is neglected in favor of the health dimension. In the authorization stage, the organization begins to provide a wider range of services in the living dimension. The results and other information regarding EAP service models indicate that in each developmental stage, an organization should adopt a different EAP service model that suits its resources, organizational structure, implementation of EAP measures, and other factors.

Short communication: Birth Shock!

Birth Shock! is an AHRC-funded (AH/K003364/1) engagement-focused project exploring and enhancing the impact and reach of The Birth Project (AH/V000926/1). This study is particularly concerned with the role the arts can play in the perinatal period, especially in supporting the wellbeing of new mothers. In particular, we wished to assess the role of a suite of films exploring this subject with trainee and health-professional audiences.