Pamela Brett-MacLean

Commitment to change statements can predict actual change in practice

Introduction: Statements of commitment to change are advocated both to promote and to assess continuing education interventions. However, most studies of commitment to change have used self‐reported outcomes, and self‐reports may significantly overestimate actual performance. As part of an educational randomized controlled trial, this study documented changes that family physicians committed to make in their prescribing and then used third‐party data to examine actual changes. Method: Following participation in a continuing medical education program using interactive small groups, physicians were asked to identify changes that they planned to make in their practices. For prescribing changes related to four conditions, data from a provincial pharmacy registry were analyzed for 6‐month periods before and after the educational intervention. Results: A total of 207 physicians participated in the project, which involved monthly meetings of 30 peer learning groups. Ninety‐nine physicians received experimental case‐based educational modules ± personal prescribing feedback, and 91 of these indicated that they planned to make at least one change in practice. Of the 209 intended changes, 71% were directly related to the prescribing messages in the materials. Discussion: In three of four indicator conditions, physicians who expressed a commitment to change were significantly more likely to change their actual prescribing for the target medications in the following 6 months. The percentage of physicians who did change their prescribing varied significantly by condition. Further study of the process of translating commitment to change into real practice change is needed.

Tipping the iceberg? The state of arts and health in Canada

The field of arts and health is rapidly gaining momentum in Canada despite the challenges of integration across a vast geography, two official languages and multiple interdisciplinary cultures. Although the field is young, there is a solid foundation of innovative work and great enthusiasm on the part of diverse practitioners about the fields salience and impact. This article provides an overview of the arts and health in Canada and considers work that spans health policy, healthcare practice, individual and community health promotion, health professional education and arts-based health research. A final section offers reflections and recommendations on arts and health in Canada. We provide an online appendix through the journals website that refers the interested reader to Canadian programs, resources, networks and other materials on the arts and health.

Protocol for a systematic review of the use of narrative storytelling and visual-arts-based approaches as knowledge translation tools in healthcare

BackgroundThe arts are powerful, accessible forms of communication that have the potential to impart knowledge by attracting interest and developing meaningful connections. Knowledge translation aims to reduce the ‘evidence-practice’ gap by developing, implementing and evaluating strategies designed to enhance awareness and promote behavior change congruent with research evidence. Increasingly, innovative approaches such as narrative storytelling and other arts-based interventions are being investigated to bridge the growing gap between practice and research. This study is the first to systematically identify and synthesize current research on narrative storytelling and visual art to translate and disseminate health research.MethodsA health research librarian will develop and implement search strategies designed to identify relevant evidence. Studies will be included if they are primary research employing narrative storytelling and/or visual art as a knowledge translation strategy in healthcare. Two reviewers will independently perform study selection, quality assessment, and data extraction using standard forms. Disagreements will be resolved through discussion or third party adjudication. Data will be grouped and analyzed by research design, type of knowledge translation strategy (that is, a narrative or visual-arts-based approach), and target audience. An overall synthesis across all studies will be conducted.DiscussionThe findings from this research project will describe the ‘state of the science’ regarding the use of narrative storytelling and visual art as knowledge translation strategies. This systematic review will provide critical information for: (1) researchers conducting knowledge translation intervention studies; (2) nursing, medicine, and allied healthcare professionals; (3) healthcare consumers, including patients and families; and (4) decision makers and knowledge users who are charged to increase use of the latest research in healthcare settings.

Film as a means to introduce narrative reflective practice in medicine and dentistry: a beginning story presented in three parts

Over the past two years, the authors pilot‐tested a new film‐based module in the first year Patient‐Centred Course (PCC1) in the Faculty of Medicine & Dentistry at the University of Alberta. This paper describes the rationale for, and response to use of film and facilitated small group discussion as a means of introducing narrative reflective practice. Feedback from students and facilitators in 2008 and 2009 supported the use of film as a means of promoting narrative reflection. Suggestions for improvement, along with changes introduced in 2009, are described. For example, based on positive student feedback, we were allotted increased time in the PCC1 block which allowed us to incorporate full‐length film screenings. Separate small groups for medical and dental students were also introduced, which was viewed as a positive change by dental facilitators and students. Planned changes in 2010, and suggestions for inquiry in this area are described.

“My turbinado sugar”: Art-making, well-being and professional identity in medical education

Background: There is strong evidence supporting the personal and professional benefits for medical students of exposure to art. There is limited information on art-making in relation to medical education. Methods: We explored art-making within medical education by analysing 76 artist statements submitted with visual artwork by students, residents and practitioners to the 2010 and 2011 White Coat Warm Art exhibitions. We analysed the data using grounded theory strategies to identify how medical students and practitioners describe their engagement in artistic creation and how it impacts their personal and professional lives. Results: Our analysis yielded eight themes that illustrated instrumental, humanistic and advocacy-oriented implications of art-making: enhancing learning, escaping constraints, balancing life and work, surviving, expressing self-identity and discovering professional identity, bearing witness, healing self and others, and advocating change. Conclusions: Art-making can play a valuable role in medical education by providing a means of making sense of, and learning foundational information and concepts in medicine. Creative expression through artistic means also provides learners and practitioners a means of exploring their emerging sense of professional identity and clarifying their value commitments. In addition, the experience of art-making fosters well-being, empathy and commitment towards a better future for medicine.

At the precipice: a prospective exploration of medical students’ expectations of the pre-clerkship to clerkship transition

Medical learners face many challenging transitions. We prospectively explored students’ perceptions of their upcoming transition to clerkship and their future professional selves. In 2013, 160/165 end-of-second-year medical students wrote narrative reflections and 79/165 completed a questionnaire on their perceptions of their upcoming transition to clerkship. Narratives were separately analyzed by four authors and then discussed to identify a final thematic framework using parsimonious category construction. We identified two overarching themes: (1) “Looking back”: experiences which had helped students feel prepared for clerkship with subthemes focused on of patient care, shadowing, classroom teaching and the pre-clerkship years as foundational knowledge, (2) “Looking forward”: anticipating the clerkship experience and the journey of becoming a physician with subthemes focused on death and dying, hierarchy, work-life balance, interactions with patients, concerns about competency and career choice. Questionnaire data revealed incongruities around expectations of minimal exposure to death and dying, little need for independent study and limited direct patient responsibility. We confirmed that internal transformations are happening in contemplative time even before clerkship. By prospectively exploring pre-clerkship students’ perceptions of the transition to clerkship training we identified expectations and misconceptions that could be addressed with future curricular interventions. While students are aware of and anticipating their learning needs it is not as clear that they realise how much their future learning will depend on their own inner resources. We suggest that more attention be paid to professional identity formation and the development of the physician as a person during these critical transitions.

Exploring the Benefits of an Optional Theatre Module on Medical Student Well-Being

Background: Medical students struggle with varied stressors and developing adequate coping mechanisms is essential. Purpose: This study examined medical student perceptions of the well-being impact of a theatre-based course. Methods: Eighteen 1st-year medical students at the University of Alberta participated in 3 focus groups following the conclusion of a theatre-based module that was piloted in the first quarter of 2010. A semistructured protocol was used to guide the focus groups, which were audiotaped and transcribed. Along with general feedback, impact on personal development and student well-being were discussed. Thematic aspects of these discussions were qualitatively analyzed. Findings: During the focus groups, medical students identified three aspects of the theatre-based module that contributed to their sense of overall well-being. These included (a) fun/relaxation, (b) enhanced relationships with each other, and (c) personal growth/resilience. Conclusion: Our findings suggest that participating in an optional theatre module can enhance medical student well-being. Our analysis suggests the need to consider novel, humanities-based curriculum offerings in relation to personal development and well- being.

Text and context: involving faculty panelists as models for reflection in a film-based narrative reflective practice module in undergraduate medical education

In this paper, the authors reflect on their experience of engaging faculty members as members of reflective panels following the screening of films used as part of a longitudinal narrative reflective practice module in the pre-clinical, Patient-Centred Care course in first and second year at the University of Alberta. Having experienced both highly reflective and more didactic panelist approaches over the course of several years’ experience, the authors wonder about what medical students may be ‘reading between the lines’ when they experience curricula that is not always consistent with stated curriculum aims and intentions. The authors suggest the value of closely considering both the texts and contexts that comprise medical education, particularly in relation to how these may shape medical student socialization into the profession of medicine.