Lois LaCivita Nixon

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.

The challenge of promoting professionalism through medical ethics and humanities education.

Given recent emphasis on professionalism training in medical schools by accrediting organizations, medical ethics and humanities educators need to develop a comprehensive understanding of this emphasis. To achieve this, the Project to Rebalance and Integrate Medical Education (PRIME) II Workshop (May 2011) enlisted representatives of the three major accreditation organizations to join with a national expert panel of medical educators in ethics, history, literature, and the visual arts. PRIME II faculty engaged in a dialogue on the future of professionalism in medical education. The authors present three overarching themes that resulted from the PRIME II discussions: transformation, question everything, and unity of vision and purpose.The first theme highlights that education toward professionalism requires transformational change, whereby medical ethics and humanities educators would make explicit the centrality of professionalism to the formation of physicians. The second theme emphasizes that the flourishing of professionalism must be based on first addressing the dysfunctional aspects of the current system of health care delivery and financing that undermine the goals of medical education. The third theme focuses on how ethics and humanities educators must have unity of vision and purpose in order to collaborate and identify how their disciplines advance professionalism. These themes should help shape discussions of the future of medical ethics and humanities teaching.The authors argue that improvement of the ethics and humanities-based knowledge, skills, and conduct that fosters professionalism should enhance patient care and be evaluated for its distinctive contributions to educational processes aimed at producing this outcome.

Medical professionalism: what the study of literature can contribute to the conversation

Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the meaning of “professionalism” itself (as well as its virtues), thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism.

Anticipating deep autumn: a widening lens

Medicine has become one of the most powerful influences of the twentieth century, and currently dominates how we approach and think about another powerful phenomenon: the aging of the world’s population. Our reliance on the medical model, with its focus on pathology, physiology, and biomedical interventions, makes it difficult for aging men and women and those in the health care field who care for them to seek alternative ways to attach meaning to the process of growing old. This article explores the role of the humanities as an alternative to the biomedical model which can enlarge our abilities to see the multidimensional aspects of aging. Age related writings and visual images by Kenyon, Neel, Olds, Valadon, and Hemingway are discussed to illustrate how fictive representations can and do serve as a moral impetus or stimulus for meaningful reflection about life stages that have not yet been experienced.

Beyond medical futility: a proposed taxonomy ofultra vires acts in medicine

When is a physician’s act non-medical, and how might such non-medical acts be classified? One approach, analogous to the substantive due process inquiry employed by American courts weighing the constitutionality of legislative acts, would involve consideration of the following questions: 1) Is a legitimate medical goal being pursued? 2) Are the means being employed legitimately medical? 3) Are the goals and means appropriately related? Accordingly, a physician acts medically when employing legitimate and appropriate medical means in pursuit of a legitimate medical goal. In contrast, when the goals pursued or means employed are not legitimately medical, or when the two are not appropriately related, the act ismedically ultra vires (“beyond the powers”)—that is, an act beyond the physician’s power or authority—and consequently non-medical.Medically ultra vires acts may be further sub-classified depending upon which prong of the above trident is defective. Where the goal of the act, though achievable, is not legitimately medical, the act ismedically ultra vires because of goal illegitimacy, ormedically ultra fines (“beyond the ends”). Where the means employed are not legitimately medical, the act ismedically ultra vires because of means illegitimacy, ormedically ultra modos (“beyond the means”). Where the means and goals are not appropriately related, the act ismedically ultra vires because of means-goals disjunction, ormedically ultra nexus (“beyond the connection”). Medical futility (where the medical goal in question, albeit legitimate, cannot be achieved by the act under consideration) represents the paradigmatic example of the latter.

“Home Burial” and “Dead Baby”: Poetic Perspectives in Medical Education:

This article illustrates the use and value of literature in increasing ones sensitivity and compassion in areas extending beyond the prescribed boundaries of medical training and practice. “Home Burial” by Robert Frost and “Dead Baby” by William Carlos Williams portray in different ways the anguish and despair of parents after a childs death. If anatomy, biochemistry, and micro-biology prepare health care providers for the clinical dimensions of their work, these poems attend to other attributes of good care giving.