Barret Michalec

Humanism, the Hidden Curriculum, and Educational Reform: A Scoping Review and Thematic Analysis.

Background Medical educators have used the hidden curriculum concept for over three decades to make visible the effects of tacit learning, including how culture, structures, and institutions influence professional identity formation. In response to calls to see more humanistic-oriented training in medicine, the authors examined how the hidden curriculum construct has been applied in the English language medical education literature with a particular (and centering) look at its use within literature pertaining to humanism. They also explored the ends to which the hidden curriculum construct has been used in educational reform efforts (at the individual, organizational, and/or systems levels) related to nurturing and/or increasing humanism in health care. Method The authors conducted a scoping review and thematic analysis that draws from the tradition of critical discourse analysis. They identified 1,887 texts in the literature search, of which 200 met inclusion criteria. Results The analysis documents a strong preoccupation with negative effects of the hidden curriculum, particularly the moral erosion of physicians and the perceived undermining of humanistic values in health care. A conflation between professionalism and humanism was noted. Proposals for reform largely target medical students and medical school faculty, with very little consideration for how organizations, institutions, and sociopolitical relations more broadly contribute to problematic behaviors. Conclusions The authors argue that there is a need to transcend conceptualizations of the hidden curriculum as antithetical to humanism and offer suggestions for future research that explores the necessity and value of humanism and the hidden curriculum in medical education and training.

THE RACE GAP IN SUPPORT GROUP PARTICIPATION BY BREAST CANCER SURVIVORS Real or Artifact

Addressing methodological weaknesses of previous research, this study assesses whether African American women are, in fact, less likely to participate in breast cancer support groups than are White women. Of the breast cancer survivors, 958 (26% African Americans, 73% Caucasian) completed interviews concerning demographic characteristics, other support networks, effects of illness on home and spiritual life, and support group participation. Contrary to previous research, no race difference was found in support group participation. This research suggests more effort needs to be paid to sampling techniques and other methodological factors to adequately reflect the experiences and needs of breast cancer survivors, specifically African American women.

The pursuit of medical knowledge and the potential consequences of the hidden curriculum.

This study explores how preclinical medical students experience particular elements of their training, specifically their pursuit for medical knowledge and how this may impact their attributes as well as their relations with those outside of the realm of medicine. Ten first-year and 10 second-year students of a US medical school were interviewed regarding their experiences with and perceptions of their medical training. The students reported a cognitive and emotional distance from non-medical students that appears to be accentuated not only by their strenuous academic responsibilities but also elements of the hidden curriculum nested within medical training. Furthermore, students discuss experiencing disapproval, mistrust, and negative judgment toward laypersons thereby suggesting that this distancing may lend to deleterious effects on students’ ability and willingness to connect with others. A Parsonian lens is utilized to examine the notion of a ‘Knowledge Gap’ as well as aspects of the hidden curriculum in medical education and their role in professionalizing medical students.

The (stalled) progress of interprofessional collaboration: the role of gender

Abstract Researchers have demonstrated that team-based, collaborative care improves patient outcomes and fosters safer, more effective health care. Despite such positive findings, interprofessional collaboration (IPC) has been somewhat stunted in its adoption. Utilizing a socio-historical lens and employing expectation states theory, we explore potential reasons behind IPC’s slow integration. More specifically, we argue that a primary mechanism hindering the achievement of the full promise of IPC stems not only from the rigid occupational status hierarchy nested within health care delivery, but also from the broader status differences between men and women – and how these societal-level disparities are exercised and perpetuated within health care delivery. For instance, we examine not only the historical differences in occupational status of the more “gendered” professions within health care delivery teams (e.g. medicine and nursing), but also the persistent under-representation of women in the physician workforce, especially in leadership positions. Doing so reveals how gender representation, or lack thereof, could potentially lead to ineffective, mismanaged and segmented interprofessional care. Implications and potential solutions are discussed.

Learning to cure, but learning to care?

Utilizing interviews with students and a key administrator, analyses of academic schedules, and observations of courses, labs, and small groups, this study examines if and how elements of the explicit preclinical curriculum may have deleterious effects on medical students’ humanitarian attributes, namely empathy. Findings from this case-study of a medical school in the United States suggest that the lack of frequent formal testing in the psycho-social aspects of patient care during the preclinical years, as well as a general reduction in curriculum hours devoted to teaching the social aspects of medicine, may serve as mechanisms behind the diminution of medical students’ levels of empathy and other positive attributes as found by previous research. Following the basic tenets of the Testing Effect and the assumption that assessment drives learning, it is argued that a feasible way to maintain and potentially cultivate these traits among medical students, without saturating an overwhelmed medical curriculum, would be to install periodic, formally graded exams into preclinical curriculums that evaluate empathy and the psycho-social aspects of care.

Can empathy, other personality attributes, and level of positive social influence in medical school identify potential leaders in medicine?

Purpose To test the hypotheses that medical students recognized by peers as the most positive social influencers would score (1) high on measures of engaging personality attributes that are conducive to relationship building (empathy, sociability, activity, self-esteem), and (2) low on disengaging personality attributes that are detrimental to interpersonal relationships (loneliness, neuroticism, aggression-hostility, impulsive sensation seeking). Method The study included 666 Jefferson Medical College students who graduated in 2011–2013. Students used a peer nomination instrument to identify classmates who had a positive influence on their professional and personal development. At matriculation, these students had completed a survey that included the Jefferson Scale of Empathy and Zuckerman–Kuhlman Personality Questionnaire short form and abridged versions of the Rosenberg Self-Esteem Scale and UCLA Loneliness Scale. In multivariate analyses of variance, the method of contrasted groups was used to compare the personality attributes of students nominated most frequently by their peers as positive influencers (top influencers [top 25% in their class distribution], n = 176) with those of students nominated least frequently (bottom influencers [bottom 25%], n = 171). Results The top influencers scored significantly higher on empathy, sociability, and activity and significantly lower on loneliness compared with the bottom influencers. However, the effect size estimates of the differences were moderate at best. Conclusions The research hypotheses were partially confirmed. Positive social influencers appear to possess personality attributes conducive to relationship building, which is an important feature of effective leadership. The findings have implications for identifying and training potential leaders in medicine.

Barriers to and Facilitators of Interprofessional-Interdepartmental Interventions Unearthing Departmental Culture

This study evaluates how emergency department (ED) and medical intensive care unit (MICU) providers interact in the setting of a quality improvement project designed to enhance transport/care for patients from the ED to the MICU. Focus groups were conducted with nurses, residents, physician assistants, and physicians from the ED and MICU at baseline and 6 months regarding their thoughts on and perspectives of the intervention and working with colleagues from another department. Data were then analyzed utilizing a multistep coding scheme that identified key barriers to and facilitators of the interprofessional-interdepartmental intervention. Analysis also showed, however, that variances in departmental culture play a significant role in the willingness and ability of providers to practice interdepartmental team-based care. It is argued that anticipating and acknowledging these differences and designing systems to address them prior to launch will be essential to the development and implementation of effective interdepartmental quality improvement interventions.

An Interdepartmental Care Model to Expedite Admission from the Emergency Department to the Medical ICU.

BACKGROUND Early evidence suggests that multidisciplinary programs designed to expedite transfer from the emergency department (ED) may decrease boarding times. However, few models exist that provide effective ways to improve the ED- to-ICU transition process. In 2012 Christiana Care Health System (Newark, Delaware) created and implemented an interdepartmental program designed to expedite the transition of care from the ED to the medical ICU (MICU). METHODS This quasi-experimental study compared ED length of stay (LOS), MICU LOS, and overall hospital LOS before and after the MICU Alert Team (MAT) intervention program. The MAT consisted of a MICU nurse and physician assistant, with oversight by a MICU attending physician. The ED triggered the MAT after patients were stabilized and determined to require MICU admission. Following bedside face-to-face hand off, the MAT providers then assumed responsibly of a patients care. If no MICU bed was available, the MAT cared for patients in the ED until they were transferred to the MICU. RESULTS ED LOS was reduced by 30% (2.6 hours) from baseline (p < .001). There were no significant differences in MICU LOS (p = .26), overall hospital LOS (p = .43), or mortality (p = .59). ED LOS was shortened (p < .001) at each increasing level of MICU bed availability (31% when 0 MICU beds available; 26% when 1 or more MICU beds available). Time series analysis identified a 1.5-hour drop in ED LOS (p = .02) for patients transferred from the MICU immediately following intervention implementation and was sustained over time. CONCLUSION Early outcomes demonstrate that the MAT intervention can reduce ED LOS for critically ill patients. Additional studies should determine optimal approaches to improve clinical outcomes.

A Handbook for the Study of Mental Health: Viewing Mental Health from the Complete State Paradigm

Sociological approaches to psychological well-being are fundamentally different. The distinctive emphasis of sociological approaches is on how processes such as life events, social conditions, social roles, social structures, and cultural systems of meaning affect states of mind. Many sociologists study how social conditions affect levels of mental health. Most research that takes place in clinical settings examines particular types of mental illnesses, such as schizophrenia, bipolar disorder, major depression, and obsessive-compulsive disorder. Emile Durkheims study, Suicide, is generally regarded as the first explicitly sociological study of mental health. Contemporary studies in the sociology of mental health confirm the importance of social integration as a fundamental cause of well-being. Social inequality relates not only to economic and work conditions but is also an aspect of all social institutions. Birth cohorts are another social influence that shapes mental health. Generational factors also affect general levels of well-being and distress.

Identifying potential engaging leaders within medical education: The role of positive influence on peers

Abstract Background: Previous research has paid little to no attention towards exploring methods of identifying existing medical student leaders. Aim: Focusing on the role of influence and employing the tenets of the engaging leadership model, this study examines demographic and academic performance-related differences of positive influencers and if students who have been peer-identified as positive influencers also demonstrate high levels of genuine concern for others. Methods: Three separate fourth-year classes were asked to designate classmates that had significant positive influences on their professional and personal development. The top 10% of those students receiving positive influence nominations were compared with the other students on demographics, academic performance, and genuine concern for others. Results: Besides age, no demographic differences were found between positive influencers and other students. High positive influencers were not found to have higher standardized exam scores but did receive significantly higher clinical clerkship ratings. High positive influencers were found to possess a higher degree of genuine concern for others. Conclusion: The findings lend support to (a) utilizing the engaging model to explore leaders and leadership within medical education, (b) this particular method of identifying existing medical student leaders, and (c) return the focus of leadership research to the power of influence.