Maturity model for assessing the medical humanities: a Delphi study.

BACKGROUND: Becoming a first-level discipline in China means access to more educational resources. The development of medical humanities in China has been going on for more than 40 years, and some medical schools have set up master's and doctoral programs in medical humanities. The demand for medical humanities-related knowledge in China is also growing after COVID-19. However, medical humanities is only a second-level discipline and receives limited resources to meet the needs of society. This study aims to establish a system of indicators that can assess whether the medical humanities has a first-level discipline and provide a basis for its upgrading to a first-level. METHODS: A Delphi technique was used, with the panel of expert expressing their views in a series of two questionnaires. A coefficient of variation of less than 0.2 indicates expert agreement. RESULT: A total of 25 experts participated in this Delphi study. Consensus was reached on 11 first-grade indices and 48 s-grade indices. The authoritative coefficient(Cr) of the experts was 0.804, which indicates that the experts have a high level of reliability. CONCLUSION: This study provides a reliable foundation for the evaluation of medical humanities maturity.

Investigation of clinical medicine undergraduates' recognition of narrative medicine.

BACKGROUND: Narrative Medicine (NM), a contemporary medical concept proposed in the 21st century, emphasizes the use of narrative as a literary form in medicine. This study aims to explore the understanding about NM and willingness to learn NM among medical students in our hospital. METHODS: A questionnaire survey was conducted among 130 students at Xiangya Medical College of Central South University. RESULTS: The findings revealed that a small percentage of students (3.1%) were familiar with narrative medicine and its training methods. Knowledge about the treatment skills (77.7%) and core content (55.4%) of narrative medicine was limited among the students. Despite this, a majority (63.1%) expressed a lack of interest in further understanding and learning about narrative medicine. Surprisingly, the survey indicated that students possessed a high level of narrative literacy, even without formal training in narrative medicine. Additionally, over half of the surveyed students (61.5%) believed that narrative medicine could benefit their clinical practice. CONCLUSIONS: This study serves as a preliminary basis for the future development of narrative medicine education in China. It highlights the need to prioritize medical humanities education and provide medical students with more opportunities to access information on narrative medicine. By doing so, we can strive to enhance the visibility and promote the integration of narrative medicine into medical humanities education in China.

Disorienting or Transforming? Using the Arts and Humanities to Foster Social Advocacy.

Introduction: The arts and humanities (AH) have transformative potential in medical education. Research suggests that AH-based pedagogies may facilitate both personal and professional transformation in medical learners, which may then further enhance the teaching and learning of social advocacy skills. However, the potential for such curricula to advance social advocacy training remains under-explored. Therefore, we sought to identify how AH may facilitate transformative learning of social advocacy in medical education. Methods: Building upon previous research, we conducted a critical narrative review seeking examples from the literature on how AH may promote transformative learning of social advocacy in North American medical education. Through a search of seven databases and MedEdPORTAL, we identified 11 articles and conducted both descriptive and interpretative analyses of their relation to key tenets of transformative learning, including: disorientation/dissonance, critical reflection, and discourse/dialogue. Results: We found that AH are used in varied ways to foster transformative learning in social advocacy. However, most approaches emphasize their use to elicit disorientation and dissonance; there is less evidence in the literature regarding how they may be of potential utility when applied to disorienting dilemma, critical reflection, and discourse/dialogue. Discussion: The tremendous potential of AH to foster transformative learning in social advocacy is constrained due to minimal attention to critical reflection and dialogue. Future research must consider how novel approaches that draw from AH may be used for more robust engagement with transformative learning tenets in medical education.

Through the looking glass: qualitative study of critical care clinicians engaging in humanities.

PURPOSE: Critical care medicine is facing an epidemic of burnout and consequent attrition. Interventions are needed to re-establish the medical field as a place of professional growth, resilience, and personal well-being. Humanities facilitate creation, reflection, and meaning-making, holding the promise of personal and community transformation. This study aimed to explore how clinicians engage with a humanities program, and what role and impact do the humanities play in their individual and collective journey. METHODS: This is a qualitative study employing a phenomenological approach. Participants were faculty and trainees who participated in the program. Data consisted of (a) 60-h observations of humanities evenings, (b) more than 200 humanities artifacts brought by participants, and (c) 15 in-depth participant interviews. Data were analyzed inductively and reflectively by a team of researchers. RESULTS: Participants were motivated to engage with the humanities curriculum because of past experiences with art, identifying a desire to re-explore their creativity to make meaning from their clinical experiences and a wish to socialize with and understand their colleagues through a different lens. The evenings facilitated self-expression, and inspired and empowered participants to create art pieces and re-engage with art in their daily lives. More importantly, they found a community where they could be vulnerable and supported, where shared experiences were discussed, emotions were validated, and relationships were deepened between colleagues. CONCLUSIONS: Humanities may impact resilience and personal and community well-being by facilitating reflection and meaning-making of challenging clinical work and building bonds between colleagues.

Five ways to get a grip on teaching advocacy in medical education: the health humanities as a novel approach.

The advocate role is recognized as an intrinsic medical competency. Despite recent attention to pedagogical approaches, it is a role that remains poorly understood and difficult to teach. At the same time there is a growing body of evidence showing the necessity of incorporating humanities-based education into medical curricula. Here, we present five ways to use the humanities as a tool for teaching the advocate role including: decentre the physician as expert, develop engaged providers, engage learners in curricular decisions, value the humanities (and show it), and keep it practical.

Le rôle de défenseur des intérêts des patients est reconnu comme une compétence médicale à part entière. Malgré l'attention récente portée aux approches pédagogiques, ce rôle reste mal compris et difficile à enseigner. En parallèle, un nombre croissant de travaux démontrent la nécessité d'intégrer l'enseignement des sciences humaines dans les programmes d'études médicales. Nous présentons ici cinq façons d'utiliser les sciences humaines comme outil pour enseigner le rôle de défenseur des intérêts des patients, notamment : décentraliser le rôle d'expert du médecin, former des professionnels engagés, faire participer les apprenants aux décisions relatives au programme d'études, valoriser les sciences humaines (et le montrer), et rester pratique.

Exploring the experiences of Canadian medical students with a background in the arts and humanities.

Background: Arts and Humanities (A/H) training is a powerful strategy to help medical students develop key competencies which align with the CanMEDS roles that Canadian physicians are expected to embody. Students with backgrounds in A/H may enter medical school with the skills and dispositions that A/H training provides. This paper explores the varied experiences of medical students with prior A/H backgrounds, with an emphasis on how they navigate relationships with their student cohorts and participate in undergraduate medical training environments. Methods: Descriptive qualitative research methodology was used to conduct and analyze semi-structured interviews exploring the perspectives of Canadian medical students with either a A/H degree or training in A/H (n = 13). Domains such as identity, integration of interests, and challenges in maintaining A/H interests during medical training were explored. Results: Participants described their A/H identity as intertwined with their identity as medical trainees and described their sense of interconnection between the disciplines. Challenges included imposter syndrome and difficulties in relating with peers from science backgrounds. Participants described returning to their A/H interests as a tool for wellness amidst medical training. Conclusions: Medical students with a background in A/H training describe this background as offering both affordances and challenges for their sense of identity, belonging, and wellness. These students offer an untapped resource: they come with dispositions of value to medicine, and they perceive a positive, hidden A/H curriculum that supports their maintenance of these dispositions during training. Understanding more about these hidden treasures could help foster the development of well-rounded and humanistic physicians in the entire medical class.

Contexte: Une formation en arts et sciences humaines (A/SH) est une stratégie efficace pour aider les étudiants en médecine à développer des compétences clés qui s'harmonisent aux rôles CanMEDS que les médecins canadiens sont censés incarner. Les étudiants ayant un bagage en A/SH peuvent entrer à la faculté de médecine dotés des compétences et des dispositions qu'une formation en A/SH apporte. Cet article explore les expériences diverses vécues par des étudiants en médecine ayant déjà un bagage en A/SH, en mettant l'accent sur la façon dont ils entretiennent des relations au sein de leurs cohortes d'étudiants et s'intègrent dans des contextes de formation médicale de premier cycle. Méthodes: Une méthodologie de recherche qualitative descriptive a été utilisée pour mener et analyser des entretiens semi-structurés explorant les points de vue d'étudiants en médecine canadiens ayant soit un diplôme en A/SH ou une formation en A/SH (n=13). Des domaines tels que l'identité, la conciliation des champs d'intérêt et les défis liés au maintien de ceux liés aux A/SH pendant la formation médicale ont été explorés. Résultats: Les participants ont décrit leur identité A/SH comme étant intimement liée à celle de médecin en formation et ont décrit leur sentiment d'interconnexion entre les disciplines. Parmi les défis à relever figurent le syndrome de l'imposteur et les difficultés à nouer des relations avec des pairs ayant un bagage scientifique. Les participants ont décrit le fait de revenir à leurs champs d'intérêt liés aux A/SH comme étant un outil de bien-être au courant de la formation médicale. Conclusions: Les étudiants en médecine qui ont un bagage en A/SH le décrivent comme offrant à la fois des possibilités et des défis pour leur sentiment d'identité, d'appartenance et de bien-être. Ces étudiants constituent une ressource inexploitée : ils ont des dispositions recherchées en médecine et ils ont l'impression de profiter d'un curriculum caché A/H positif qui les aide à conserver ces dispositions au cours de leur formation. Mieux comprendre ces trésors cachés pourrait contribuer à favoriser le développement de médecins compétents et humanistes au sein de leur cohorte.

How Inpatient Psychiatric Units Can Be Both Safe and Therapeutic.

Inpatient psychiatric units should be therapeutic environments that support dignity and recovery. When adverse outcomes (eg, self-harm, violence) happen in these settings, clinicians and administrators can face litigation and other pressures to prioritize risk management over supporting patients' access to personal belongings, exercise equipment, and private spaces. This article describes these downward pressures toward sparser, controlling environments in inpatient psychiatric settings as a safety funnel and suggests strategies for balancing safety, humanity, and recovery in these contexts.

Role of public health professionals in the climate and ecological crisis: a qualitative study.

BACKGROUND: The climate and ecological emergency is the single biggest health threat facing humanity, yet it is not clear to what extent the public health workforce have been involved in work on this topic. This research aimed to establish what public health consultants working in local authorities in England perceive their role to be, whether the climate crisis is seen as a core component of public health and to identify barriers to action. METHODS: Semi-structured interviews were undertaken with a purposive sample (n=11) of local authority public health consultants in England. Participants were recruited via public health organisations, social media or snowballing. Thematic content analysis was used to identify codes and themes. RESULTS: Public health professionals have started work on climate change but reported being unclear about their role and feeling isolated working on this topic. Barriers to action included shortage of financial resources, communication tools and capacity, limited sharing of best practice, lack of local expertise and conflict between the need for action on climate change and other urgent issues. CONCLUSION: We highlight the need to urgently address existing barriers to enable this important part of the public health workforce to play their role in tackling the climate and ecological crisis.

Climate-driven invasion and incipient warnings of kelp ecosystem collapse.

Climate change is progressively redistributing species towards the Earth's poles, indicating widespread potential for ecosystem collapse. Detecting early-warning-signals and enacting adaptation measures is therefore a key imperative for humanity. However, detecting early-warning signals has remained elusive and has focused on exceptionally high-frequency and/ or long-term time-series, which are generally unattainable for most ecosystems that are under-sampled and already impacted by warming. Here, we show that a catastrophic phase-shift in kelp ecosystems, caused by range-extension of an overgrazing sea urchin, also propagates poleward. Critically, we show that incipient spatial-pattern-formations of kelp overgrazing are detectable well-in-advance of collapse along temperate reefs in the ocean warming hotspot of south-eastern Australia. Demonstrating poleward progression of collapse over 15 years, these early-warning 'incipient barrens' are now widespread along 500 km of coast with projections indicating that half of all kelp beds within this range-extension region will collapse by ~2030. Overgrazing was positively associated with deep boulder-reefs, yet negatively associated with predatory lobsters and subordinate abalone competitors, which have both been intensively fished. Climate-driven collapse of ecosystems is occurring; however, by looking equatorward, space-for-time substitutions can enable practical detection of early-warning spatial-pattern-formations, allowing local climate adaptation measures to be enacted in advance.

Efficient pneumonia detection using Vision Transformers on chest X-rays.

Pneumonia is a widespread and acute respiratory infection that impacts people of all ages. Early detection and treatment of pneumonia are essential for avoiding complications and enhancing clinical results. We can reduce mortality, improve healthcare efficiency, and contribute to the global battle against a disease that has plagued humanity for centuries by devising and deploying effective detection methods. Detecting pneumonia is not only a medical necessity but also a humanitarian imperative and a technological frontier. Chest X-rays are a frequently used imaging modality for diagnosing pneumonia. This paper examines in detail a cutting-edge method for detecting pneumonia implemented on the Vision Transformer (ViT) architecture on a public dataset of chest X-rays available on Kaggle. To acquire global context and spatial relationships from chest X-ray images, the proposed framework deploys the ViT model, which integrates self-attention mechanisms and transformer architecture. According to our experimentation with the proposed Vision Transformer-based framework, it achieves a higher accuracy of 97.61%, sensitivity of 95%, and specificity of 98% in detecting pneumonia from chest X-rays. The ViT model is preferable for capturing global context, comprehending spatial relationships, and processing images that have different resolutions. The framework establishes its efficacy as a robust pneumonia detection solution by surpassing convolutional neural network (CNN) based architectures.

What Might It Mean to Embrace Emancipatory Pedagogy in Medical Education?

An emerging and important goal of professional health training and education is to develop a workforce that is equipped to address patients' social and structural determinants of health and to contribute to health equity. However, current medical education does not adequately achieve this vision. Emancipatory teaching, as described by scholars such as Paulo Freire and bell hooks, equips students with tools to identify and challenge oppressive systems. It helps students achieve freedom for themselves, thereby contributing to more emancipatory and humanistic patient care. Changing teaching in this way would help reverse implicit curricular values that tend to enshrine hierarchy and oppression. Humanities and bioethics scholars working within health professional schools thus should promote a more critical, emancipatory pedagogy in their institutions.

Laing and Rogers in London: An unfortunate meeting or something else?

BACKGROUND: In the summer of 1978 a large 1-day event was scheduled to take place in the Grand Ballroom at the Hilton Hotel in Park Lane, London between the psychotherapists Carl R. Rogers (1902-1987), and his associates, and Ronald D. Laing (1927-1989) and his group. From among all the eyewitness accounts of that meeting, I have found only the testimonies of Maureen O'Hara, Ian Cunningham, Charles Elliot, and Emmy van Deurzen. According to O'Hara, Laing behaved in a rude, impolite, and aggressive way toward his American colleague Rogers. For his part, Cunningham says that Rogers came over as he had expected: a genuinely nice, caring, humane person. Laing, though, was even more impressive in person than in his books. Similarly, Elliot observes that Laing and Rogers held a genuine encounter, one in which both sat like two real mutually respecting persons who asked each other questions, while the perspective of van Deurzen is more in line with that of O'Hara than that of Elliot. AIMS: Taking into account the different versions given on the Laing-Rogers event, I will analyze whether this encounter was only an unfortunate meeting or something else. METHODS: Narrative review; combining eyewitness accounts with the few sources found in the literature on this topic. RESULTS/CONCLUSIONS: As I will show here, all these accounts taken jointly paint a picture of Laing as a brilliant clinician and as a terrible man. Without exculpating Laing for committing all sorts of mischief, I will offer a tentative account of his behavior sustained by his own psychic dynamics. In doing so, I will attempt to explain why Laing reacted in so censurable a way, going beyond Thomas S. Szasz's (1920-2012) condemnation in his essay on antipsychiatry, which gives credence only to O'Hara's version without quoting more sources or posing more questions.