Delese Wear

Insurgent multiculturalism: rethinking how and why we teach culture in medical education.

The author proposes a theoretical orientation for cultural competency that reorganizes common curricular responses to the study of culture in medical education. What has come to be known in medical education as cultural competency is theoretically truncated and may actually work against what educators hope to achieve. Using Girouxs concept of insurgent multiculturalism, she suggests that the critical study of culture might be a bridge to certain aspects of professional development. Insurgent multiculturalism moves inquiry away from a focus on nondominant groups to a study of how unequal distributions of power allow some groups but not others to acquire and keep resources, including the rituals, policies, attitudes, and protocols of medical institutions. This approach includes not only the doctor–patient relationship but also the social causes of inequalities and dominance. Linked to professional development efforts, insurgent multiculturalism can provide students with more opportunities to look at their biases, challenge their assumptions, know people beyond labels, confront the effects of power and privilege, and develop a far greater capacity for compassion and respect.

Making Fun of Patients: Medical Students' Perceptions and Use of Derogatory and Cynical Humor in Clinical Settings

Purpose It has long been known that medical students become more cynical as they move through their training, and at times even exhibit “ethical erosion.” This study examines one dimension of this phenomenon: how medical students perceive and use derogatory and cynical humor directed at patients. Method The authors conducted five voluntary focus groups over a three-month period with 58 third- and fourth-year medical students at the Northeastern Ohio Universities College of Medicine in 2005. After transcribing the taped interviews, the authors analyzed the data using qualitative methods and identified themes found across groups. Results The categories that emerged from the data were (1) categories of patients who are objects of humor, including those deemed “fair game” due to obesity or other conditions perceived as preventable or self-inflicted; (2) locations for humor; (3) the “humor game,” including student, resident, and faculty interaction and initiation of humor; (4) not-funny humor; and (5) motives for humor, including coping and stress relief. Conclusions The authors offer recommendations for addressing the use of derogatory humor directed at patients that include a more critical, open discussion of these attitudes and behaviors with medical students, residents, and attending physicians, and more vigorous attention to faculty development for residents.

Can compassion be taught? Let's ask our students.

BackgroundMedical educators act on the belief that students benefit from formal and informal educational experiences that foster virtues such as compassion, altruism, and respect for patients.ObjectiveThe purpose of this study is to examine fourth year medical students’ perspectives on how, where, and by whom they believe the virtues associated with good physicianhood have been taught to them.DesignFourth year students were assigned a two- to three-page essay that asked them to reflect on how their medical education had “fostered and hindered” their conceptions of compassion, altruism, and respect for patients.ParticipantsAll 112 students completed this assignment, and 52 (46%) gave us permission to use their essays for this study.ApproachAn inductive, qualitative approach was used to develop themes derived from students’ essays.ResultsStudents’ thoughts were organized around the idea of influences in three areas to which they consistently referred. Foundational influences included parents and “formative years,” religious faith, and other experiences preceding medical school. Preclinical education influences comprised formal classroom experiences (both positive and negative effects). Clinical education influences included role modeling (both positive and negative) and the clinical environment (notable for emphasis on efficiency and conflicting cues). Students’ essays drew most heavily on the effects of role modeling.DiscussionMedical students arrive at our doors as thoughtful, compassionate people. Positive role models and activities to promote critical self-reflection may help nurture these attitudes.

Reflection in/and Writing: Pedagogy and Practice in Medical Education

During the past decade, “reflection” and “reflective writing” have become familiar terms and practices in medical education. The authors of this article argue that the use of the terms requires more thoughtfulness and precision, particularly because medical educators ask students to do so much reflection and reflective writing. First, the authors discuss John Dewey’s thoughts on the elements of reflection. Then the authors turn the discussion to composition studies in an effort to form a more robust conception of reflective writing. In particular, they examine what the discipline of composition studies refers to as the writing process. Next, they offer two approaches to teaching composition: the expressivist orientation and the critical/cultural studies orientation. The authors examine the vigorous debate over how to respond to reflective writing, and, finally, they offer a set of recommendations for incorporating reflection and reflective writing into the medical curriculum.

Hidden in Plain Sight: The Formal, Informal, and Hidden Curricula of a Psychiatry Clerkship

Purpose To examine perceptions of the formal, informal, and hidden curricula in psychiatry as they are observed and experienced by (1) attending physicians who have teaching responsibilities for residents and medical students, (2) residents who are taught by those same physicians and who have teaching responsibilities for medical students, and (3) medical students who are taught by attendings and residents during their psychiatry rotation. Method From June to November 2007, the authors conducted focus groups with attendings, residents, and students in one midwestern academic setting. The sessions were audiotaped, transcribed, and analyzed for themes surrounding the formal, informal, and hidden curricula. Results All three groups offered a similar belief that the knowledge, skills, and values of the formal curriculum focused on building relationships. Similarly, all three suggested that elements of the informal and hidden curricula were expressed primarily as the values arising from attendings’ role modeling, as the nature and amount of time attendings spend with patients, and as attendings’ advice arising from experience and intuition versus “textbook learning.” Whereas students and residents offered negative values arising from the informal and hidden curricula, attendings did not, offering instead the more positive values they intended to encourage through the informal and hidden curricula. Conclusions The process described here has great potential in local settings across all disciplines. Asking teachers and learners in any setting to think about how they experience the educational environment and what sense they make of all curricular efforts can provide a reality check for educators and a values check for learners as they critically reflect on the meanings of what they are learning.

The limits of narrative : medical student resistance to confronting inequality and oppression in literature and beyond

Introduction  Upon designing and implementing a literature course on family values for Year 4 medical students, we found that while the supposed benefits of literary inquiry were to lead students to a deeper understanding of difficult issues such as illness and violence in the family, many of our students were unable to engage critically with the course material. This, we believe, was a result of their resistance to confronting issues such as inequality and oppression. This paper is an attempt to theorise student resistance to difficult, unruly subjects they encounter in a literature class, particularly those surrounding race, gender, social class and sexual identity.

Derogatory and cynical humour directed towards patients: views of residents and attending doctors

Context  A study of medical students’ perspectives on derogatory and cynical humour was published in 2006. The current study examines residents’ and attending doctors’ perspectives on the same phenomenon in three clinical departments of psychiatry, internal medicine and surgery.

Literary inquiry and professional development in medicine: against abstractions

The professional development discourse currently circulating in academic medicine owes much to the work of the American Board of Internal Medicine (ABIM) and their Project Professionalism.They identify the elements of altruism, duty, excellence, honor and integrity, accountability, and respect for others as forming the basis of professional development. While an admirable effort, Project Professionalism remains primarily an abstract set of attitudes and behaviors with a number of vignettes that are of limited use to medical educators attempting to foster the development of professionalism in medical students. This paper outlines an approach to professional development grounded in medical narratives written by physicians, including memoirs, essays, and poetry, that may help students grapple with the challenges of medicine that involve those very elements put forth by ABIM. An argument is made that literature may be a superior medium for engagement with these elements because of its ability to evoke discomfort and vulnerability in ways the case report does not.

Retheorizing Sexual Harassment in Medical Education: Women Students' Perceptions at Five U.S. Medical Schools

Abstract Background: The literature consistently reports that sexual harassment occurs with regularity in medical education, mostly in clinical settings, and most of it goes unreported. Reasons for nonreporting include the fear of retaliation, a reluctance to be viewed as a victim, a fear that one is being “too sensitive,” and the belief that nothing will be done. Purpose: We wanted to examine with greater concentration the stories women students tell about sexual harassment, including what they count as sexual harassment, for more or different clues to their persistent nonreporting. Methods: We used focus groups to interview 30 women students at 5 U.S. medical schools. We used systematic inductive guidelines to analyze the transcribed data, linking to and building new theoretical frameworks to provide an interpretive understanding of the lived experiences of the women in our study. Results: Consistent with previous literature, most of the students interviewed had either witnessed or observed sexual harassment. We selected 2 theoretical lenses heretofore not used to explain responses to sexual harassment: 3rd-wave feminist theory to think about how current women students conceive sexual harassment and personality theory to explain beliefs about nonreporting. Conclusions: Medical educators need new ways to understand how contemporary women students define and respond to sexual harassment.

The Medical Humanities: Toward a Renewed Praxis

In this essay, I explore medical humanities practice in the United States with descriptions offered by fifteen faculty members who participated in an electronic survey. The questions posed focused on the desirability of a core humanities curriculum in medical education; on the knowledge, skills, and values that are found in such a curriculum; and on who should teach medical humanities and make curriculum decisions regarding content and placement. I conclude with a call for a renewed interdisciplinarity in the medical humanities and a move away from the territorial aspects of disciplinary knowledge and methods sometimes found in medical humanities practice.