Vannatta J

Meeting the Family: Promoting Humanism in Gross Anatomy

Background: Human dissection commonly occurs early in the undergraduate medical school curriculum, thus presenting an immediate opportunity for educators to teach and encourage humanistic qualities of respect, empathy, and compassion. Purpose: The purpose of this study was to measure the impact of the Donor Luncheon, a unique program in which medical students meet the families of the anatomical donor prior to dissection in the anatomy course at the University of Oklahoma College of Medicine. Methods: Students were randomized into groups of 8 to attend the luncheon and either met with family of the donor or attended the luncheon with no donor family present. A questionnaire measured students’ attitudes at 2 weeks, 6 weeks, and at the conclusion of the anatomy course. Results: Factor analysis revealed 5 scales. Analysis revealed statistically significant differences across time for Donor as Person, Dissection Process, and Donor as Patient and statistically significant differences between groups for Donor as Person and Donor as Patient. Conclusions: These results suggest that this program can provide students with the opportunity to maintain more humanistic attitudes at the beginning of their medical education career.

Enhancing humanism through gross anatomy: a pre-course intervention.

Context and setting At the University of Oklahoma College of Medicine, we designed a luncheon where the families of anatomy donors are invited to meet the students who will dissect the bodies of their relatives before the anatomy course begins. The luncheon was specifically designed so that the families of donors lunched with and became acquainted with the very students assigned to dissect their family member. Why the idea was necessary It is well documented that a certain dark humour is associated with gross anatomy classes in medical schools. We felt that meeting the families of donors and hearing their life narratives before beginning dissection would increase the level of professionalism in the anatomy laboratory. We also felt it would increase student empathy for the diseased donor’s suffering during life as the students went about the dissection. What was done A freshman class of medical students was randomised into groups of students who participated in the donor luncheon experience and students who did not. Families of donors to the anatomy programme were invited to a luncheon sponsored by the College of Medicine. They were asked to bring pictures and the life stories of the donors to share with the students. This luncheon took place during orientation in Year 1 of medical school. The idea was to personalise the donor so that the first patient the students encountered would have a name, a life story and thus a psychosocial history. We hypothesised that the experience of meeting the donor’s family and learning the donor’s life story would create empathy for the donor and his or her family. It was also hypothesised that less dark humour and cadaver tricks would be used by students who met with the families of donors. The students and families became acquainted and the families shared stories about their donor members over lunch. Evaluation of results and impact Evaluation was carried out using questionnaires in order to compare the 2 groups of students. Those exposed to the families of anatomy donors were more likely to think about the donor’s family during the gross anatomy course (a measure of empathic understanding) and were less likely to quit thinking of the donor as a human being and detach from the process. Both these findings were statistically significant. Interestingly, the group exposed to donor families approached the gross anatomy experience more intellectually than emotionally, compared with the non-exposed group. One student who participated in a cadaver trick was exposed for this behaviour in a 360-degree professionalism evaluation used during the course. This behaviour was seen as unprofessional by fellow students. In summary, we believe our results affirm that a programme such as the anatomy donor luncheon offered at the University of Oklahoma College of Medicine provides an ideal opportunity to teach and encourage humanistic qualities of respect, empathy and compassion.

Functional Realism: A Defense of Narrative Medicine

In this paper we (1) define and describe the practice of narrative medicine, (2) reveal the need for narrative medicine by exposing the presuppositions that give rise to its discounting, including a reductive empiricism and a strict dichotomy between scientific fact and narrative value, (3) show evidence of the effects of education in narrative competence in the medical clinic, and (4) present Peircean realism as the proper conceptual model for our argument that the medical school curriculum committees should give space to the employment of the scientific and literary knowledge in medical practice. On account of our argument, we contend that the medical community should tend to latitude and openness with regard to the tools we use to resolve medical problems. These tools include both biomedical and narrative knowledge.

Providing context for a medical school basic science curriculum: The importance of the humanities

Abstract Introduction: To increase students’ understanding of what it means to be a physician and engage in the everyday practice of medicine, a humanities program was implemented into the preclinical curriculum of the medical school curriculum. The purpose of our study was to determine how medical students’ views of being a doctor evolved after participating in a required humanities course. Methods: Medical students completing a 16-clock hour humanities course from 10 courses were asked to respond to an open-ended reflection question regarding changes, if any, of their views of being a doctor. The constant comparative method was used for coding; triangulation and a variety of techniques were used to provide evidence of validity of the analysis. Results: A majority of first- and second-year medical students (rr = 70%) replied, resulting in 100 pages of text. A meta-theme of Contextualizing the Purpose of Medicine and three subthemes: the importance of Treating Patients Rather than a Disease, Understanding Observation Skills are Important, and Recognizing that Doctors are Fallible emerged from the data. Conclusions: Results suggest that requiring humanities as part of the required preclinical curriculum can have a positive influence on medical students and act as a bridge to contextualize the purpose of medicine.

The Chief Concern of Medicine: Narrative, Phronesis, and the History of Present Illness

This article proposes that the history and physical exam, which is the standard initial record for each patient, includes the category of “chief concern” to complement the category of “chief complaint.” Such inclusion would necessitate close attention to narrative features of the patients history of present illness, with particular attention to the “end” and “point” of the patients story and to the patients own sense of what constitutes health. Discernment of the ends of moral action is the key feature of Aristotles ethical category of phronesis or “practical reason,” the chief example of which is the seasoned, successful physician. To this end, the article advocates the inclusion of the study of narrative and narrative knowledge in the training and practices of physicians.

Senior medical students learn as simulated patients

Techniques of simulated patients, feedback and role play were combined to compare in a randomized, controlled design two methods of teaching interviewing skills to senior medical students. Over a six-month period senior medical students enrolled in the ambulatory medicine clerkship were entered into the study. Students were randomized into two groups. Group 1 (n = 20) students became simulated patients and were interviewed by two sophomore students, providing the sophomores with feedback on technique. Group 2 (n = 29) students practiced the interviewing skills in role play with faculty tutoring. Students in both groups performed before and after videotaped interviews with simulated patients. All video tapes were rated for technique, using the Arizona Clinical Interview Rating Scale. Results show statistically significant improvement in interview skills in each group, Group 1 (mean1 = 3.10, mean2 = 3.81, p = 0.0001) and Group 2 (mean1 = 3.04, mean2 = 3.66, p = 0.0001). There is no significant difference be...