Orit Cohen Castel

The use of abstract paintings and narratives to foster reflective capacity in medical educators: a multinational faculty development workshop

Reflective capacity is integral to core healthcare professional practice competencies. Reflection plays a central role in teacher education as reflecting on teaching behaviours with critical analysis can potentially improve teaching practice. The humanities including narrative and the visual arts can serve as a valuable tool for fostering reflection. We conducted a multinational faculty development workshop aiming to enhance reflective capacity in medical educators by using a combination of abstract paintings and narratives. Twenty-three family physicians or physicians-in-training from 10 countries participated in the workshop. Qualitative assessment of the workshop showed that the combined use of art and narrative was well received and perceived as contributing to the reflective exercise. Participants generally felt that viewing abstract paintings had facilitated a valuable mood transformation and prepared them emotionally for the reflective writing. Our analysis found that the following themes emerged from participants’ responses: (1) narratives from different countries are similar; (2) the use of art helped access feelings; (3) viewing abstract paintings facilitated next steps; (4) writing reflective narratives promoted examination of educational challenges, compassion for self and other, and building an action plan; and (5) sharing of narrative was helpful for fostering active listening and appreciating multiple perspectives. Future research might include comparing outcomes for a group participating in arts–narrative-based workshops with those of a control group using only reflective narrative or in combination with figurative art, and implementing a combination of qualitative and quantitative methods of assessment.

The effect of low back pain on work absenteeism among soldiers on active service.

Study Design. A prospective longitudinal study. Objective. To identify factors that influence absenteeism among soldiers with acute low back pain (ALBP). Summary of Background Data. Recommendations for the treatment of low back pain include continuing physical activity. Ninety-seven percent of patients return to work within 1 month. Methods. This was a prospective longitudinal study using a questionnaire to assess morbidity from ALBP and the job being carried out by the soldier at the time of referral to the army clinic and 6 weeks later. Potential associations were investigated between prolonged absenteeism and variables including disease indexes, use of healthcare services, the soldiers army job, and their satisfaction with it. Results. The study population consisted of 160 soldiers with uncomplicated ALBP. Eighty-six percent of the participants returned to their job within 6 weeks. The rates of improvement in pain, the mental functioning under pain, satisfaction with jobs, and having combat status were higher among soldiers who returned to their jobs as compared with those who did not. Those who did not return to their jobs had higher rates of utilization of healthcare services. Conclusion. Nondisease factors are associated with the duration of absenteeism among soldiers with ALBP. Absenteeism is directly related to use of healthcare services.

Family physicians' perceptions, beliefs, and attitudes regarding information sharing with prostate cancer patients throughout the course of the disease

ObjectivesThis study aimed to describe family physicians’ perceptions regarding the concerns of men with prostate cancer as well as their beliefs and attitudes toward information sharing and decision making with prostate cancer patients throughout the course of their disease.Materials and methodsA questionnaire (44 items) was mailed to 780 board-certified family physicians registered in the 2003 computerized database of Clalit Health Services, Israel’s largest health maintenance organization.ResultsThree hundred eighty-two (50%) physicians completed the questionnaires. Overall, respondents believed that patients have substantial concerns throughout the cancer trajectory and that the most troubling issue is the fear of disease progression. There were no significant differences in the amount of information physicians were willing to share with patients throughout the course of the disease. Sixty-four percent of respondents stated that they would tailor the information to the patients’ wishes and characteristics. Seventy percent felt competent at breaking bad news and 74% would discuss emotions with patients. Fifty-five percent of respondents preferred that patients be autonomous in their decision making.ConclusionsFamily physicians in Israel are aware of patients’ concerns and recognize the importance of sharing information with prostate cancer patients. Further studies are needed to examine the practice of these attitudes and to verify whether they are compatible with patients’ expectations in the relevant cultural and ethnic context.

A shift to ambulatory medical education in Israel

Background:  The Council for Higher Education in Israel published an extensive report in 2007, calling for a significant increase of undergraduate medical education in Israel in ambulatory care settings. The objective of this article is to propose an action plan aimed at shifting undergraduate medical education in Israel towards ambulatory education.

Patient’s Utilization of Primary Care: A Profile of Clinical and Administrative Reasons for Visits in Israel

Background: Data on patients’ utilization of health services in primary care is relevant to planning healthcare. Data may be collected by numerous methods, but obtaining a true picture of content of care has practical difficulties. Objectives: To describe patient’s reasons for visits to primary care physicians (PCPs) as presented by the patient; and to examine the effect of patient-, doctor- and clinic-related variables on the reasons for the visit. Methods: Visits to PCPs were observed by peer doctors during 2014, at primary care clinics in Israel. Data were collected on characteristics of physicians, patients, clinics, type of visit, and reasons for visit. Results: Eleven physicians from 7 clinics participated in the study. Data were gathered from 327 visits. Patients visited for a wide variety of reasons. The most common acute complaints were upper respiratory symptoms, gastrointestinal, skin symptoms, and back and neck problems. The most common chronic complaints were hypertension and diabetes. Patients presented with administrative requests in 36% of visits; 15% were for solely administrative issues. A total of 26.6% of visits included requests for blood tests or discussion of tests. Patients initiated preventive medicine issues in 5% of visits. Visits for chronic problems were directly correlated with patient age and the extent of acquaintance with the physician. Gender-associated differences were also found: women were more likely to visit for a new medical problem than men, while men were more likely to visit for known or chronic problems. Conclusions: Patients visit their PCP for a wide variety of reasons, often during the same visit. Patients refer for administrative requests in about a third of visits. They initiate preventive care infrequently (1 out of 20 visits). To further characterize patient utilization of primary care, a broader study needs to be performed.