Aaron Michelfelder

Integrative Medicine and Gastrointestinal Disease

Common disorders of the gastrointestinal (GI) tract account for about 50 million visits per year to physicians trained in traditional allopathic or osteopathic medicine. Sometimes patients turn to more alternative treatments because standard medical therapy is either not producing the most desired result or may have side effects, or patients may see complementary or alternative therapies as more natural. In the United States, the overall expenditure for complementary and alternative medicine (CAM) is in the tens of billions of dollars per year. Because physicians need to be aware of the latest evidence for different complementary and alternative therapies used for gastrointestinal disorders, this article focuses on the most common and most studied CAM therapies for selected common gastrointestinal disorders.

I Will Never Let That Be OK Again: Student Reflections on Competent Spiritual Care for Dying Patients

Purpose To examine medical students’ reflections on the spiritual care of a patient who has died so as to understand how students experienced this significant event and how they or their teams addressed patients’ spiritual needs. Method In 2010–2011, the authors gave third-year students at Loyola University Chicago Stritch School of Medicine an essay assignment, prompting them to reflect on the experience of the death of one of their patients. The authors analyzed the content of the essays using an iterative, multistep process. Three authors independently coded the essays for themes based on the competencies (developed by Puchalski and colleagues and reflected in the essay prompt) of communication, compassionate presence, patient care, and personal and professional development. The authors reached consensus through discussion. Results A salient theme in the students’ writings was awareness of their personal and professional development. Students reported being aware that they were becoming desensitized to the human dimension of care, and particularly to dying patients and their families. Students wished to learn to contain their emotions to better serve their patients, and they articulated a commitment to addressing patient and family needs. Students identified systemic fragmentation of patient care as a barrier to meeting patient needs and as a facilitator of provider desensitization. Conclusions Written student reflections are a rich source of data regarding the spiritual care of dying patients and their families. They provide insight into the personal and professional development of medical students and suggest that medical schools should support students’ formation.

Physician, Know Thyself: The Role of Reflection in Bioethics and Professionalism Education

Reflection in medical education is becoming more widespread. Drawing on our Jesuit Catholic heritage, the Loyola University Chicago Stritch School of Medicine incorporates reflection in its formal curriculum and co–curricular programs. The aim of this type of reflection is to help students in their formation as they learn to step back and analyze their experiences in medical education and their impact on the student. Although reflection is incorporated through all four years of our undergraduate medical curriculum, this essay will focus on three areas where bioethics faculty and medical educators have purposefully integrated reflection in the medical school, specifically within our bioethics education and professional development efforts: 1) in our three–year longitudinal clinical skills course Patient Centered Medicine (PCM), 2) in our co–curricular Bioethics and Professionalism Honors Program, and 3) in our newly created Physician’s Vocation Program (PVP).

Pre-operative guided imagery in female pelvic medicine and reconstructive surgery: a randomized trial

Introduction and hypothesisThe purpose was to determine if pre-operative guided imagery (GIM) would help women to feel more prepared, less anxious, and have higher satisfaction scores 6xa0weeks after surgery compared with routine care.MethodsEligible women planning to undergo pelvic floor surgery were enrolled and randomized. The GIM group received an institution-specific CD that uses GIM to detail day of surgery (DOS) events and expectations. Participants were asked to listen to the CD once daily during the week before surgery. At three time points (surgical consent visit, DOS, and 6-weeks post-operatively), we measured anxiety using the State and Trait Anxiety Inventory for Adults (STADI), in addition to preparedness for surgery and overall satisfaction (ten-point Likert scales). Data were analyzed in SPSS 23 using two-tailed t tests.ResultsA total of 38 out of 44 (86%) enrolled participants completed the study (GIM: 18, control: 20). The GIM self-reported compliance rate was 72%, with an average use of 4.8 times (rangexa0=xa03–8 times). Women in the GIM group reported a significant increase from baseline in preparedness for surgery on both DOS and 6xa0weeks post-operatively (7.32xa0±xa01.81 vs 9.11xa0±xa01.13, pxa0=xa00.001) and (7.32xa0±xa01.81 vs 9.22xa0±xa00.81, pxa0=xa00.001) respectively; a change that was not seen in the control group. Satisfaction was high in both the GIM and the control group (9.55xa0±xa00.85 and 9.05xa0±xa01.70, pxa0=xa00.263). In all patients, anxiety increased from baseline to DOS and dropped at 6xa0weeks post-operatively, and was not significantly different in the two groups.ConclusionsGuided imagery improved patient preparedness for pelvic floor surgery with an overnight stay on their DOS and 6xa0weeks post-operatively.