John Encandela

Social science and the study of pain since Zborowski: a need for a new agenda.

In 1969, anthropologist Mark Zborowski published People in Pain, in which he showed that pain is responded to by behaviors and attitudes learned by pain sufferers within the cultures in which they are socialized. Research for this work was accomplished at a time when a number of social scientists were deeply involved in inquiry about the relationship between the individual psyche and society, and were, therefore, interested in subjective experiences of individuals. For reasons discussed in this article, social researchers shifted their focus, in the late 1960s and throughout the 1970s, from the study of subjective experience to research pertaining to more objectively verifiable phenomena. Consequently, because pain is not easily measurable, relatively few studies illuminating the human experience of pain were performed by social scientists since Zborowski completed his work. This article provides an overview of the small but pertinent research that has been conducted since the late 1960s, and challenges social scientists to develop a new agenda for the study of pain experiences. This research may be especially timely now, when there seems to be renewed interest among social scientists to study subjective experiences.

Guiding principles for the development of global health education curricula in undergraduate medical education

Background: Global health education (GHE) at undergraduate medical institutions has expanded significantly over the last 30 years, but many questions remain regarding the best practices for the development and implementation of global health programs. Aim: To identify key themes essential to the development of GHE programs. Method: We discuss five themes relevant to GHE in the context of existing literature and practice. Results: The following themes are essential to the development of GHE programs: the definition and scope of GHE, student competencies in global health, the challenges and opportunities associated with inter-institutional relationships, principles for GHE student placements, and the evaluation of GHE programs. We place these themes in the context of current literature and practice, and provide practical guidance on how these themes might be successfully implemented by institutions seeking to develop or refine GHE programs. Conclusions: Institutions developing or evaluating GHE programs should focus on these themes as they build their global health curricula.

ORGANIZATIONAL FEATURES AFFECTING THE USE OF COERCION IN THE ADMINISTRATION OF PSYCHIATRIC CARE

Historically, the use of coercion in psychiatric hospital admissions, and research on such use, have reflected social circumstances that impact on psychiatric care. Currently, the social emphasis on cost-saving in the U.S. and corresponding shifts in the organization, financing, and management of psychiatric and mental health care, have begun to affect research on the use of coercion in psychiatric admissions. Such research has begun to incorporate hospital organizational dynamics which affect the use of coercion in these admissions. The authors propose that this emphasis should be expanded into a comprehensive research agenda that examines the most pertinent organizational features affecting the use of coercion in psychiatric hospital admissions.

Test anxiety and United States Medical Licensing Examination scores

Many medical students experience test anxiety, which may impair their performance in examinations. We examined the relationship between test anxiety and United States Medical Licensing Examination (USMLE) step‐1 scores and determined the effect of a test‐taking course on anxiety and USMLE scores.

Addiction and Chronic Pain: Training Addiction Psychiatrists

ObjectiveAddiction psychiatrists are increasingly asked to address chronic pain in patients with addiction. Because of historic “divisions of labor” between physicians who manage pain and addiction psychiatrists who manage addiction, limited guidance exists for preparing addiction psychiatry trainees to address this comorbidity.MethodsA 1-h focus group composed of five geographically well-distributed addiction psychiatry fellowship directors/faculty was conducted to explore existing curricula, identify themes, and build consensus regarding educational goals for addiction psychiatry fellows in the area of chronic pain management.ResultsDiscussion resulted in five broad categories of themes involving perceptions of the importance of chronic pain training for addiction psychiatrists; barriers to curriculum development (one notably being that the addiction psychiatrist’s role in managing chronic pain is poorly articulated); facilitators to such development; and potential curricular content and roles of addiction psychiatrists in relation to chronic pain training.ConclusionEducators in addiction psychiatry should clarify their role in the management of chronic pain and prioritize training in this area.

Characteristics of test anxiety among medical students and congruence of strategies to address it

Introduction Medical students may experience test anxiety associated with ‘high stakes’ exams, such as Step 1 of the United States Medical Licensing Examination. Methods We collected qualitative responses about test anxiety at three points in time from 93 second-year medical students engaged in studying for and taking Step 1. Results Causes of test anxiety as reported by students were related to negative self-talk during preparation for the exam. Effects of anxiety had to do with emotional well-being, cognitive functioning, and physical well-being. Strategies included socializing with others and a variety of cognitive and physical approaches. Comparison of individuals’ strategies with causes and effects showed some congruence, but substantial incongruence between the types of strategies chosen and the reported causes and effects of test anxiety. Discussion Students’ adoption of a ‘menu’ of strategies rather than one or two carefully selected strategies suggest inefficiencies that might be addressed by interventions, such as advisor-directed conversations with students and incorporating student self-assessment and strategies for managing anxiety within courses on test-taking. Such interventions are in need of further study. An annotated list of evidence-based strategies would be helpful to students and educators. Most important, test anxiety should be viewed by medical educators as a ‘real’ experience, and students would benefit from educator support.

An Innovative Use of Case Conference to Teach Future Educators in Addiction Psychiatry

Objective An innovative course was developed for fellows enrolled in the Yale School of Medicine Addiction Psychiatry program to educate them in key principles of adult learning, apply these principles in a case conference presentation, and to improve skills in providing and receiving feedback. Methods An initial training module on educational skills was followed by individual mentorship to prepare a case presentation. A feedback module provided space to learn and practice skills in feedback delivery. Results The program showed positive results and improved confidence levels of the participants in presenting and providing/receiving feedback. Conclusions Implementing a course designed to improve teaching and feedback skills is feasible in a 1-year Addiction Psychiatry fellowship.

A Neurology Clerkship Curriculum Using Video-Based Lectures and Just-in-Time Teaching (JiTT)

Introduction Just-in-time teaching is an educational strategy that involves tailoring in-session learning activities based on student performance in presession assessments. We implemented this strategy in a third-year neurology clerkship. Methods Linked to core neurology clerkship lectures, eight brief video-based lectures and knowledge assessments were developed. Students watched videos and completed multiple-choice questions, and results were provided to faculty, who were given the opportunity to adjust the in-person lecture accordingly. Feedback was obtained by surveys of students and faculty lecturers and from student focus groups and faculty. Student performance on the end-of-clerkship examination was analyzed. Results Between October 2016 and April 2017, 135 students participated in the curriculum, and 56 students (41.5%) responded to the surveys. Most students agreed or strongly agreed that the new curriculum enhanced their learning and promoted their sense of responsibility in learning the content. Faculty agreed that this pedagogy helped prepare students for class. Most students watched the entire video-based lecture, although there was a trend toward decreased audience retention with longer lectures. There were no significant changes in performance on the end-of-clerkship examination after implementation of just-in-time teaching. In focus groups, students emphasized the importance of tying just-in-time teaching activities to the lecture and providing video-based lectures well in advance of the lectures. Discussion Just-in-time teaching using video-based lectures is an acceptable and feasible method to augment learning during a neurology clinical clerkship. We believe this method could be used in other neurology clerkships with similar success.

Utilization and Effectiveness of a Peer Advocate Program for Medical Students

Considerable evidence exists that medical students experience mental and emotional distress, including depression, anxiety, and suicidal ideation, at higher rates than the general population [1–3]. In spite of increased awareness and programmatic interventions, there are known barriers to medical students’ access to resources, including: reticence to use support services out of fear of appearing unstable in a setting of pervasive stigma surrounding mental health, perceived lack of time to take advantage of resources, fear of an effect on their academic record, and fear of an unwanted intervention [1, 4, 5]. It has been demonstrated that having a peer support system in place may be an effective way to encourage students to reach out for help [6]. A perusal of websites gives evidence that medical schools encourage peer networks and mentoring as a support mechanism, but their actual use and effectiveness for medical students is under-reported in the literature. At Yale School of Medicine, we implemented the Peer Advocate (PA) program, which has helped medical students navigate a variety of challenges by helping to facilitate vetting strategies and brainstorming solutions. The PA program has worked to connect students with the appropriate university and community resources, depending on each student’s needs. In this case report, we provide details on both the implementation and student evaluation of the PA program’s effectiveness. Peer Advocate Program

Twelve tips for incorporating and teaching sexual and gender minority health in medical school curricula

Abstract The World Health Organization has identified many barriers to improving the health of lesbian, gay, bisexual, and transgender (LGBT) patients, including challenges to incorporating and teaching about healthcare for such patients, which we call “sexual and gender minority” (SGM) health content. These challenges include structural and logistical barriers to incorporating SGM health content into undergraduate medical curricula, as well as lack of support in identifying high-quality pedagogical methods for teaching this material. Here, we provide twelve tips for incorporating and teaching SGM health curricular content in undergraduate medical education, including resources and strategies to support individual educators. Based on our success in developing and implementing this content, we believe that our approach can be effectively used by individual educators aiming to incorporate SGM health curricular material into their teaching, and to support individuals or groups championing the inclusion of a SGM health topical sequence in medical curricula.