Medicine and Health Sciences Commons^™

Compassionate Practice: A Review And Framework For Integrating Medical Humanities Into Pre-Medical And Medical Curricula, Megan E. Mccoy

University Honors Theses

The article presents the findings of a comprehensive narrative literature review aimed at addressing the question: What are the current frameworks of the medical humanities discipline in terms of purpose, methodology, curriculum, and student learning outcomes? Thematic analysis and qualitative coding highlighted key themes and areas of concern, including the purpose of medical humanities, methodology, current curriculum, and student outcomes. Recommendations are provided to address disagreements within the discipline, proposing a conceptual framework and definition for medical humanities, alongside advocating for a mixed-method approach as the primary methodology. Curriculum guidelines emphasize the importance of a quality integrated curriculum focusing on …

Assessment Of Breastfeeding Education In Medical Training, Saranya Madan, Abigail Kuplicki

Medical Student Research Symposium

In 2019, the Academy of Breastfeeding Medicine issued a revised set of educational objectives for medical trainees at various stages of education. In this statement, objectives for medical school were broken down into preclinical and clinical training objectives. In this project, our goal is to assess the degree to which medical training at Wayne State University School of Medicine is addressing these aims.

The assessment of breastfeeding education is accomplished by surveying medical students at various stages of training (M1-M4) and eliciting their level of confidence in and understanding of the topics outlined in the objectives by the Academy of …

About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski

Electronic Thesis and Dissertation Repository

This study explored how healthcare providers engage in advance care planning and end-of-life care conversations. The research explored what shapes their understanding and the extent to which concepts from thanatology they intuitively bring in, explicitly bring in, and maybe fail to recognize. To achieve this, constructivist grounded theory (CGT) methodology guided the design, data collection, analysis, and interpretation of the findings, which allowed for iteration across interviews and analysis with existing theories and data in the literature. The CGT design encouraged further engagement with the literature in an ongoing iterative fashion as well as with the analysis of the data. …

Unmasking Structural Racism In U.S. Medical Education: Advancing Equity For Underrepresented Medical Students, Daryl O. Traylor, Eboni E. Anderson, Destiney Kirby, Asia Nichole Hodges, Brianna Clark, Stephen Sinatra Jr.

Journal of Social, Behavioral, and Health Sciences

The COVID pandemic cast a harsh light on the structural and systemic health inequalities that exist in American society and in U.S. medical education. Black and Brown communities were disproportionately affected, and the pandemic highlighted the need for a diverse physician and healthcare workforce. Both the lack of equitable, high-quality healthcare in underrepresented communities and the obstacles that students who are underrepresented in medicine (URiM) experience in medical school are direct consequences of the structural racism that flourishes in U.S. medical schools and healthcare institutions. In this article, we explain structural racism and how it has manifested itself in medical …

Healthcare Disparities In The Lgbtqia+ Community: A Scoping Review Of Community Vs Provider Experiences, Uttara Hardikar, Alisha Vincent, Venkateswar Venkataman, Millicent Channell

Rowan-Virtua Research Day

Background: It is well-established that healthcare disparities exist in the LGBTQIA+ community. The divide is a growing concern exacerbated by recent changes in the healthcare and sociopolitical climate. To eliminate this divide and find ways to deliver better outcomes to the LGBTQIA+ is a dire need. This report analyzes the possible reasons from the community as well as the providers perspective, with a goal to find best practices that could be implemented in both components.

Methods: A scoping literature review was carried out as described below to collect perspectives from both sides: patients as well as providers.

Results: From patient …

Changing Internal Medicine Residents’ Perspectives On Social Determinants Of Health, Timsal Ghani, Diana Vargas, Yvette Wang

Rowan-Virtua Research Day

Social determinants of health (SDOH)

- conditions in which people are born, live, learn, work, play and worship

- affect wide range of health, functioning and quality of life

SDOH play enormous roles in health and well being

- annual US deaths attributable to SDOH equivalent to the number due to lung cancer

- place of birth, race and income all have strong influence on health outcomes

- place of birth is more strongly associated with life expectancy than race or genetics

There is growing awareness of importance of social factors in improving overall population health and wellbeing

- highlighted …

Implementing Best Practices For Co-Prescribing Naloxone In Your Agency: A Guide For Healthcare Professions, Michael Anyanwu, Emmanuel Asenso Jr., Ahmad Hussein, Jessica Baaklini, Michael Sunderhauf

Rowan-Virtua Research Day

From April 2020 to April 2021, it has been recorded that there have been 75,673 opioid overdose-related deaths in the United States. This number is up almost 20,000 more from the last period that deaths were recorded, coming in at 56,064 from April 2019 to April 2020. The use of naloxone, has been proven to save the lives of overdose patients on opioids by reversing its effects. It has already shown significant reduction in opioid overdose related mortality. Pharmacists are now able to prescribe naloxone with opioid prescriptions without a script from a doctor. EMS units are active in communities …

Addressing Health Disparities And Cultural Competency In Reproductive Health Through Active Learning In The University Of Puerto Rico, School Of Medicine, Ines E. Garcia-Garcia, Kary M. Bouet Md, Lourdes Garcia-Fragoso, Juan Rivera-Gonzalez

Journal of Health Disparities Research and Practice

Introduction: Lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights which impact reproductive health. Previous pregnancy, induced abortion, and hormonal contraceptive use are common among women who report sex with women, regardless of self-identification as lesbian. LGBTQ have higher risk of smoking, use illicit drugs or have alcohol related problems. Methods: A faculty development training addressed methods and skills for teaching cultural competence and eliminate health disparities. Faculty facilitated a small group active learning activity, including a vignette and a reflective self-evaluation, for medical students …

Slovenia: Cardiovascular Disease, Natalia Pinto

Global Public Health

Though the rates of mortality due to cardiovascular diseases in Slovenia have decreased, this is still the leading cause of death in the country. Cardiovascular disease is the leading cause of death in Europe in general as well. Various forms of heart disease have the highest rate of death within the country as a whole. As Slovenia continues to educate its population on how to prevent and be cautious when dealing with this disease, the people of Slovenia will suffer less from cardiovascular diseases.This report will discuss the challenges of Cardiovascular disease in Slovenia, the frequency of the disease and …

Ace’S Contextualization For Healthcare Workers, Nektarios Konstantinopoulos

Family Medicine Clerkship Student Projects

There is a well-established causative relationship between Adverse Childhood Experiences (ACE’s) and pathology. Despite strong supporting evidence, some healthcare workers are unaware of how deep this relationship is. I conducted an educational session surrounding ACEs targeting healthcare workers in an attempt to contextualize the relationship between ACE’s and consequent disease.

Clinical Public Health Integration In Medical School Curriculum: Transitioning Medical Student Training From Medical Problems To Health Solutions, Ashtin Jeney, Bridget C. Huysman, Jamie Majdi, Kent Aje, Madeline Taskier, David K. Popiel, Lawrence R. Deyton, Karla Bartholomew

GW Research Days 2016 - 2020

The current chronic disease burden, growing health disparities, and evolution of our healthcare system require that medical students be equipped with basic public health education to effectively manage patients, navigate the healthcare system, and advocate for health(1,2,3,4,5,6). The Institute of Medicine and the AAMC emphasize the need for physicians to be trained in public health(1,8). The inaugural year of the revised curriculum at The George Washington University School of Medicine and Health Sciences (GW SMHS) represented a first step at the institution to integrate clinical public health into medical education. As part of this process, the Clinical Public Health (CLiPH) …

Practice Management Guidelines For The Diagnosis And Management Of Injury In The Pregnant Patient: The East Practice Management Guidelines Work Group, Robert Barraco, William Chiu, Thomas Clancy, John Como, James Ebert, L Hess, William Hoff, Michele Holevar, J Quirk, Bruce J Simon, Patrice Weiss

Robert D Barraco MD, MPH

Trauma during pregnancy has presented very unique challenges over the centuries. From the first report of Ambrose Pare of a gunshot wound to the uterus in the 1600s to the present, there have existed controversies and inconsistencies in diagnosis, management, prognostics, and outcome. Anxiety is heightened by the addition of another, smaller patient. Trauma affects 7% of all pregnancies and requires admission in 4 of 1000 pregnancies. The incidence increases with advancing gestational age. Just over half of trauma during pregnancy occurs in the third trimester. Motor vehicle crashes comprise 50% of these traumas, and falls and assaults account for …

Assessing Multicultural Knowledge, Attitudes, Skills And Comfort: Medical Education For A Changing World, Seth Vanzant

Master of Public Health Program Student Publications

Objectives: To assess the knowledge, skills, comfort and attitudes pertaining to cultural competency of first and fourth year medical students at Wright State University’s Boonshoft School of Medicine in Dayton, Ohio.

Study Design: The Cross Cultural Competency Questionnaire (CCCQ) was distributed to first and fourth year medical students. The CCCQ provided demographic information, as well as the students’ perceptions of their cross cultural knowledge, skills, comfort and attitudes. IBM’s Statistical Package for the Social Sciences (SPSS) was used to analyze the data, in an attempt to identify potential predictive factors for higher levels of cultural competency among entry level students, …

The Disavowed Curriculum: Understanding Student's Reasoning In Professionally Challenging Situations, Shiphra Ginsburg, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

CONTEXT: Understanding students' perceptions of and responses to lapses in professionalism is important to shaping students' professional development. OBJECTIVE: Utilize realistic, standardized professional dilemmas to obtain insight into students' reasoning and motivations in "real time." DESIGN: Qualitative study using 5 videotaped scenarios (each depicting a student placed in a situation which requires action in response to a professional dilemma) and individual interviews, in which students were questioned about what they would do next and why. SETTING: University of Toronto. PARTICIPANTS: Eighteen fourth-year medical students; participation voluntary and anonymous. MAIN OUTCOME MEASURE: A model to explain students' reasoning in the face …

Techne Or Artful Science And The Genre Of Case Presentations In Healthcare Settings, Catherine Schryer, Lorelei Lingard, Marlee Spafford

Lorelei Lingard

This paper presents a qualitative study that investigated the role of case presentations in the socialization of medical and optometry students. Using the debate from classical rhetoric around the term techne (art or science), we observed that genre theory helps explain the way case presentations mediate the development of professional identity through the interaction of certain knowledge (techne 1), “savvy” knowledge (techne 2), and ethical reflection (phronesis). We noted that these mediated scenes of learning are necessary but problematic because they can lead students to yearn for certainty and to exclude outsiders (other healthcare providers, patients). Finally, our research challenges …

Look Who’S Talking: Teaching And Learning Using The Genre Of Medical Case Presentations, Marlee Spafford, Catherine Schryer, Marcellina Mian, Lorelei Lingard

Lorelei Lingard

In a pediatric teaching hospital, the authors examined 16 novice medical case presentations that were classified as instances of a hybrid apprenticeship genre. In contrast to strict school and workplace genres, an apprenticeship genre results from the sometimes competing activity systems of student education and patient care. The authors examined these novice case presentations for the amount and patterns of time devoted to student learning and expert teaching, the difficulties created for participants, the sometimes misunderstood implicit messages delivered by experts, and the opportunities to address educational objectives. This study offers professional communication researchers a model that combines quantitative and …

What Do We Mean By "Relevance"? A Clinical And Rhetorical Definition With Implications For Teaching And Learning The Case-Presentation Format, Lorelei Lingard, R. Haber

Lorelei Lingard

No abstract provided.

Tensions Influencing Operating Room Team Function: Does Institutional Context Make A Difference?, Lorelei Lingard, Stacey Garwood, Dan Poenaru

Lorelei Lingard

BACKGROUND: A recent study of operating room (OR) team communication in a large, urban hospital described recurrent tension catalysts and a preliminary theory of team members' interpretive processes. To determine to what extent these findings were transferable to other institutional contexts, we conducted a validation study in 2 small, academic hospitals in a mid-size city. METHODS: Eight focus groups and 8 interviews were conducted with 6 general surgeons, 22 OR nurses, 5 anaesthesiologists and 10 trainees. Observations of 10 surgeons and their team members were conducted over 4 months. Data were analysed by applying thematic codes derived from previous research …

'Talking The Talk': School And Workplace Genre Tension In Clerkship Case Presentations, Lorelei Lingard, C. Schryer, K. Garwood, M. Spafford

Lorelei Lingard

BACKGROUND: Socialisation into a community involves learning sanctioned ways of talking. This study investigates the case presentation genre as a site of socialisation into the clinical community of practice. METHODS: Sixteen oral case presentations and the teaching exchanges surrounding them (involving 11 students and 10 faculty members) were observed by paired researchers during inpatient paediatric medicine rounds. A total of 21 in-depth interviews were conducted with 11 students and 10 faculty. Both data sets were audio-recorded, transcribed and analysed for emergent themes and rhetorical strategies. RESULTS: Students emphasised case presentation as a school genre and described the ideal presentation as …

A Qualitative Study Examining Tensions In Interdoctor Telephone Consultations, Anupma Wadhwa, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor-patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain. METHODS: Data …

What Healthcare Students Do With What They Don't Know: The Socializing Power Of 'Uncertainty' In The Case Presentation, Marlee Spafford, Catherine Schryer, Lorelei Lingard, Patricia Hrynchak

Lorelei Lingard

Healthcare students learn to manage clinical uncertainty amid the tensions that emerge between clinical omniscience and the 'truth for now' realities of the knowledge explosion in healthcare. The case presentation provides a portal to viewing the practitioner's ability to manage uncertainty. We examined the communicative features of uncertainty in 31 novice optometry case presentations and considered how these features contributed to the development of professional identity in optometry students. We also reflected on how these features compared with our earlier study of medical students' case presentations. Optometry students, like their counterparts in medicine, displayed a novice rhetoric of uncertainty that …

Forming Professional Identities On The Health Care Team: Discursive Constructions Of The 'Other' In The Operating Room, Lorelei Lingard, R. Reznick, I. Devito, S. Espin

Lorelei Lingard

BACKGROUND: Inter-professional health care teams represent the nucleus of both patient care and the clinical education of novices. Both activities depend upon the'talk' that team members use to interact with one another. This study explored team members' interpretations of tense team communications in the operating room (OR). METHODS: The study was conducted using 52 team members divided into 14 focus groups. Team members comprised 13 surgeons, 19 nurses, nine anaesthetists and 11 trainees. Both uni-disciplinary (n = 11) and multi-disciplinary (n = 3) formats were employed. All groups discussed three communication scenarios, derived from prior ethnographic research. Discussions were audio-recorded …

Junior Faculty Experiences With Informal Mentoring, Karen Leslie, Lorelei Lingard, Sarah Whyte

Lorelei Lingard

Mentoring is one way in which new faculty can acquire the skills needed for a successful academic career. Little is known about how informal mentoring is operationalized in an academic setting. This study had two main objectives: (1) to determine if junior faculty identify as having an informal mentor(s) and to describe their informal mentoring relationships; and (2) to identify the areas in which these faculty seek career assistance and advice. The study employed a grounded theory approach. Subjects were recruited from the clinical teaching faculty and were 3-7 years into their first faculty position. Theoretical sampling was employed in …

Tensions In The Field: Teaching Standards Of Practice In Optometry Case Presentations, Marlee Spafford, Lorelei Lingard, Catherine Schryer, Patricia Hrynchak

Lorelei Lingard

PURPOSE: Professional identity formation and its relationship to case presentations were studied in an optometry school's onsite clinic. METHODS: Eight optometry students and six faculty optometrists were audio-recorded during 31 oral case presentations and the teaching exchanges related to them. Using convenience sampling, interviews were audio-recorded of four of the students and four of the optometrists from the field observations. After transcribing these audio-recordings, the research team members applied a grounded theory method to identify, test, and revise emergent themes. The theme reported herein pertains to communicating standards of practice. RESULTS: Faculty optometrists demonstrated three ways of communicating standards of …

Clinical Oversight: Conceptualizing The Relationship Between Supervision And Safety, Tara Kennedy, Lorelei Lingard, G. Baker, Lisa Kitchen, Glenn Regehr

Lorelei Lingard

BACKGROUND: Concern about the link between clinical supervision and safe, quality health care has led to widespread increases in the supervision of medical trainees. The effects of increased supervision on patient care and trainee education are not known, primarily because the current multifacted and poorly operationalized concept of clinical supervision limits the potential for evaluation.

OBJECTIVE: To develop a conceptual model of clinical supervision to inform and guide policy and research.

DESIGN, SETTING, AND PARTICIPANTS: Observational fieldwork and interviews were conducted in the Emergency Department and General Internal Medicine in-patient teaching wards of two academic health sciences centers associated with …

Teaching The Balancing Act: Integrating Patient And Professional Agendas In Optometry, Marlee Spafford, Lorelei Lingard, Catherine Schryer, Patricia Hrynchak

Lorelei Lingard

PURPOSE: We observed novice case presentations to identify the opportunities optometry students have to learn about balancing patient and professional agendas. METHODS: Eight optometry students and 6 faculty optometrists were audio-recorded during 31 case presentations. Four students and 4 optometrists from the field observations were interviewed. We analyzed the data using a grounded theory method. RESULTS: Students encountered patient and professional agendas that were both compatible (these instances typically involved appointment purpose and treatment options) and incompatible (these instances typically involved patient consent and 'guideline adherence). CONCLUSIONS: Ideally through explicit instruction, optometrists facilitated the student's ability to negotiate these tensions …

Team Communications In The Operating Room: Talk Patterns, Sites Of Tension, And Implications For Novices, Lorelei Lingard, Richard Reznick, Sherry Espin, Glenn Regehr, Isabella Devito

Lorelei Lingard

PURPOSE: Although the communication that occurs within health care teams is important to both team function and the socialization of novices, the nature of team communication and its educational influence are not well documented. This study explored the nature of communications among operating room (OR) team members from surgery, nursing, and anesthesia to identify common communicative patterns, sites of tension, and their impact on novices.

METHOD: Paired researchers observed 128 hours of OR interactions during 35 procedures from four surgical divisions at one teaching hospital. Brief, unstructured interviews were conducted following each observation. Field notes were independently read by each …

Exploring The Gap Between Knowledge And Behavior: A Qualitative Study Of Clinician Action Following An Educational Intervention, Tara Kennedy, Glenn Regehr, Jay Rosenfield, S. Roberts, Lorelei Lingard

Lorelei Lingard

PURPOSE: Many medical education interventions improve clinicians' knowledge but fail to change behavior. The authors exposed this knowledge-behavior gap through standardized clinical interactions, thus allowing in-depth exploration of the contributing factors. METHOD: A typical evidence-based educational intervention in one clinical domain (early signs of autism) was administered to family medicine residents at the University of Toronto in 2001-02, and change in knowledge was assessed through a multiple-choice test. Six to eight weeks later, participants' relevant knowledge was documented, and their clinical behavior was observed during four interactions with standardized patients. Factors producing a knowledge-behavior discrepancy were then explored using semistructured …

Progressive Independence In Clinical Training: A Tradition Worth Defending?, Tara Kennedy, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Progressive independence is a traditional premise of clinical training. Recently, issues such as managed care, work hours limitation, and patient safety have begun to impact the degree of autonomy afforded to clinical trainees. This article reviews empirical evidence and theory pertaining to the role of progressive autonomy in clinical learning. METHOD: A computerized literature search was performed using Medline, PsycINFO, Social Sciences Citation Index, and Educational Resources Information Center. This article presents a synthetic review of relevant empirical and theoretical concepts from the domains of medicine, psychology, education, kinesiology, and sociology. RESULTS: The clinical psychology and medical education literatures …

Experience And Influence Of Residents' Involvement In Selection Process For Pediatric Residency Program, S. Katz, S. Mehta, Lorelei Lingard, S. Tallett

Lorelei Lingard

No abstract provided.