Felicia Cohn

Interpreting Values Conflicts Experienced by Obstetrics-Gynecology Clerkship Students Using Reflective Writing

Purpose To examine students’ responses to reflective practice assignments used in medical ethics and professionalism education. The study goals include an examination of what reflective writing reveals about students’ personal and professional values, identification of the narrative typologies students use to tell stories of ethical dilemmas, and a determination of the usefulness of reflective writing in informing ethics/professionalism curricula assessment and development. Method This study employed a mixed-methods design generating both descriptive data and interpretive analysis. Students’ reflective writing assignments, guided by a series of six questions designed to elicit students’ perceptions of moral conflicts they have encountered and their personal and professional ethical values, were collected from three successive cohorts of third-year medical students (n = 299) from July 2002 to January 2006 during an obstetrics-gynecology clerkship at the University of California, Irvine, School of Medicine. Content, thematic, and global narrative analyses of students’ reflective writing were conducted, drawing on content analysis, grounded theory, and narrative methodologies. Results Values conflicts usually were patient centered (181; 60.5%) and student centered (172; 57.5%), without much regard for important contextual issues such as patients’ socioeconomic status, insurance coverage, or culture. Common personal values included religious beliefs (82; 27.4%), respect (72; 24.1%), and the Golden Rule (66; 22.1%); frequent professional values were respect (72; 25.1%), beneficence (71; 23.7%), nonmaleficence (69; 23.1%), and autonomy (65; 21.7%). Whereas 35.5% (106) claimed to have addressed conflicts, 23.4% (70) said they did nothing. Restitution narratives (113; 37.8%) dominated. Conclusions This analytic approach facilitated assessment of student values, conflict sources, and narrative types. Findings reveal aspects of the influence of the hidden curriculum and can inform strategies for effective implementation of bioethics/professionalism curricula.

Minding the Gap(s): Narrativity and Liminality in Medical Student Writing

Author(s): Jones, Therese; Cohn, Felicia; Shapiro, Johanna | Abstract: With the publication of The Wounded Storyteller, sociologist Arthur Frank made a major contribution to conceptualizing and classifying patient pathographies or stories of illness. The categories of illness narratives that he identified—restitution, chaos, quest, testimony— are now widely applied as interpretive frameworks for the patient experience of illness. Elsewhere Cohn and Shapiro, et al., argue that, at the deepest level, Frank’s categories are relevant to the human condition, to those narratives that emerge from suffering, powerlessness, and loss of control. Because medical students experience traumatic and transformative events in the course of their training, the stories they construct can also be understood and organized through similar conceptual categories.

Fixing broken bones and broken homes: domestic violence as a patient safety issue.

BACKGROUND Domestic violence (DV) is a significant problem in terms of both patient harm and cost. To better address this problem, the diagnosis and treatment of DV are considered within the emerging model of patient safety and medical error reduction. The case of a female patient who presents in the clinical setting following an incident of DV shows how medical errors can be analyzed as they are in medical cases not involving DV, such as when a person with abdominal pain is sent away from the emergency department with instructions to take an acid reducer and later suffers a burst appendix. ROOT CAUSE ANALYSIS A number of factors inhibit the correct diagnosis and treatment of DV victims seeking additional treatment. Physicians often fail to screen for DV, misidentify symptoms, or deny the possibility of underlying DV, and patients often hide the symptoms and refuse to admit the problem. However, human factor errors related to knowledge, cultural norms, and individual biases; organizational factors, including lack of training and reimbursement; and technology factors related to information accessibility appear to play significant roles. CONCLUSION Failure to diagnose or adequately address DV can be interpreted as medical errors. Addressing DV requires a systemic response, which might begin with integrating education and training about DV into the clinical setting, ensuring the use of existing screening tools, and providing adequate and appropriate reimbursement levels.

Growing pains: the debate begins.

A profession, field, discipline—the debate continues. In its adolescence, bioethics appears to be growing but has not quite figured out what it wants to be when it grows up. Baker (2005) calls for ...