Grace Under Pressure: a mixed methods impact assessment of a verbatim theatre intervention to improve healthcare workplace culture.

BACKGROUND: Healthcare workplace mistreatment has been documented globally. Poor workplace behaviour, ranging from incivility to bullying and harassment, is common in healthcare, and contributes significantly to adverse events in healthcare, poor mental health among healthcare workers, and to attrition in the healthcare workforce, particularly in junior years. Poor workplace behaviour is often normalised, and is difficult to address. Verbatim theatre, a form of research informed theatre in which plays are created from informants' exact words only, is particularly suited to facilitating workplace culture change by raising awareness about issues that are difficult to discuss. The objective of this study was to assess the impact of the verbatim theatre play 'Grace Under Pressure' on workplace culture in NSW hospitals. METHODS: The intervention was conducted in 13 hospitals from 8 Local Health Districts (LHDs) in NSW, Australia, in October and November 2019, with aggregated impact across all sites measured by a bespoke survey ('Pam McLean Centre (PMC) survey') at the conclusion of the intervention. This study was conducted in 3 Local Health Districts (one urban, one regional, one remote), with data collection conducted in November-December 2019 and December 2020. The study design was a mixed methods assessment of the play's impact using (1) validated baseline measures of psychosocial risk, analysed descriptively, (2) overall findings from the PMC survey above, analysed descriptively, (3) interviews conducted within a month of the intervention, analysed thematically and (4) interviews conducted one year later, analysed thematically. RESULTS: Half (51.5%) of the respondents (n = 149) to the baseline survey had scores indicating high risk of job strain and depressive symptoms. Of 478 respondents to the PMC survey (response rate 57%), 93% found the play important, 92% recommended others see the play, 89% considered that it stimulated thinking about workplace behaviour, and 85% that it made discussing these issues easier. Thematic analysis of interviews within one month (n = 21) showed that the play raised awareness about poor workplace behaviour and motivated behaviour change. Interviews conducted one year later (n = 6) attributed improved workplace culture to the intervention due to improved awareness, discussion and capacity to respond to challenging issues. CONCLUSIONS: Verbatim theatre is effective in raising awareness about difficult workplace behaviour in ways that motivate behaviour change, and hence can be effective in catalysing real improvements in healthcare workplace culture. Creative approaches are recommended for addressing similarly complex challenges in healthcare workforce retention.

"It's Not Literally True, But You Get the Gist:" How nuanced understandings of truth encourage people to condone and spread misinformation.

People have a more-nuanced view of misinformation than the binary distinction between "fake news" and "real news" implies. We distinguish between the truth of a statement's verbatim details (i.e., the specific, literal information) and its gist (i.e., the general, overarching meaning), and suggest that people tolerate and intentionally spread misinformation in part because they believe its gist. That is, even when they recognize a claim as literally false, they may judge it as morally acceptable to spread because they believe it is true "in spirit." Prior knowledge, partisanship, and imagination increase belief in the gist. We argue that partisan conflict about the morality of spreading misinformation hinges on disagreements not only about facts but also about gists.

A conceptual-perceptual distinctiveness processing account of the superior recognition memory of pictures over environmental sounds.

Researchers have proposed a coarser or gist-based representation for sounds, whereas a more verbatim-based representation is retrieved from long-term memory to account for higher recognition performance for pictures. This study examined the mechanism for the recognition advantage for pictures. In Experiment 1A, pictures and sounds were presented in separate trials in a mixed list during the study phase and participants showed in a yes-no test, a higher proportion of correct responses for targets, exemplar foils categorically related to the target, and novel foils for pictures compared with sounds. In Experiment 1B, the picture recognition advantage was replicated in a two-alternative forced-choice test for the novel and exemplar foil conditions. For Experiment 2A, even when verbal labels (i.e., written labels) were presented for sounds during the study phase, a recognition advantage for pictures was shown for both targets and exemplar foils. Experiment 2B showed that the presence of written labels for sounds, during both the study and test phases did not eliminate the advantage of recognition of pictures in terms of correct rejection of exemplar foils. Finally, in two additional experiments, we examined whether the degree of similarity within pictures and sounds could account for the recognition advantage of pictures. The mean similarity rating for pictures was higher than the mean similarity rating for sounds in the exemplar test condition, whereas mean similarity rating for sounds was higher than pictures in the novel test condition. These results pose a challenge for some versions of distinctiveness accounts of the picture superiority effect. We propose a conceptual-perceptual distinctiveness processing account of recognition memory for pictures and sounds.

The Acceptable Text Similarity Level in Manuscripts Submitted to Scientific Journals.

Plagiarism is among commonly identified scientific misconducts in submitted manuscripts. Some journals routinely check the level of text similarity in the submitted manuscripts at the time of submission and reject the submission on the fly if the text similarity score exceeds a set cut-off value (e.g., 20%). Herein, I present a manuscript with 32% text similarity, yet without any instances of text plagiarism. This underlines the fact that text similarity is not necessarily tantamount to text plagiarism. Every instance of text similarity should be examined with scrutiny by a trained person in the editorial office. A high text similarity score does not always imply plagiarism; a low score, on the other hand, does not guarantee absence of plagiarism. There is no cut-off for text similarity to imply text plagiarism.

Integration of the Verbatim Exercise into a Hospice and Palliative Medicine Fellowship.

One of the more challenging aspects of specialty level training in any medical fellowship is learning to communicate mindfully and effectively with patients and families in the face of serious illness. For the past five years, our accredited Hospice and Palliative Medicine (HPM) fellowship program has been integrating the "verbatim"-an exercise with a long and integral history in the training of health care chaplains. Verbatims are word-for-word accounts of a clinician's encounter with a patient and/or the patient's family. The verbatim serves as a formative educational exercise offering a method to hone one's clinical skills and competencies, while providing a unique space to practice self-awareness and self-reflection. Although sometimes difficult and intense for the fellow, we have found this to be a helpful exercise in improving the fellow's ability to make meaningful connections with patients and leading to improved outcomes of communication episodes. This potential growth in self-awareness supports both resiliency and mindfulness, which are essential skills for longevity and reduction of burnout risk in the field of HPM. The verbatim invites all participants to reflect on their own participation in facilitating whole person care to patients and families. Out of the six HPM milestone metrics for fellowship training, the verbatim exercise supports achievement in at least three of the milestones. We present survey data over the past five years of our fellowship in support of the utility of this exercise and for consideration to include this exercise in a palliative medicine fellowship. We offer additional suggestions for further study of this formative tool. This article delineates the verbatim technique and its specific integration into our accredited ACGME Hospice and Palliative Medicine fellowship training program.

Understanding and preferences regarding risk communication during pregnancy: a survey to facilitate provider communication with patients.

BACKGROUND: Clear communication of medical risk helps to ensure proper patient understanding of healthcare options and supports informed decision-making. Communication involving visual and written risk typically conveys risk more effectively than conversations alone between a patient and a clinician. However, perception of risk is context-dependent, and the efficacy of and preferences for commonly-used risk communication formats are not well-understood during pregnancy, which is a time of complex decision-making. We sought to address this knowledge gap. OBJECTIVE: This study aimed to assess pregnant and recently pregnant people's understanding and preferences for different risk communication formats. STUDY DESIGN: We conducted an open online REDCap survey of pregnant and recently pregnant people over a 1-month period in 2022. Study participants were aged 16 to 49 years, pregnant or recently pregnant, and able to provide informed consent in English. Data collected included demographics, measurements of accuracy of understanding including both gist accuracy (general understanding) and verbatim accuracy (numeric quantification), and preferences for risk communication formats including icon arrays, pie charts, bar graphs, and text. Descriptive analyses of the proportion of correctly answered questions were calculated. RESULTS: A total of 247 participants completed ≥1 item on accuracy and risk communication preferences, and 230 provided complete responses. Gist (general) understanding was accurate between 74% and 89% of the time for most graphical formats. Verbatim understanding (exact numeric quantification) was approximately 90% accurate for most formats. Respondents preferred that figures be used over circles to display risk in icon arrays, both for themselves and for infants, although figures generated more worry. However, participants substantially preferred pie charts over bar graphs (59%-70% vs 19%-25%). Respondents preferred risk to be expressed with a lower denominator of 200 rather than a higher denominator of 1000 (79% vs 13%, although the lower denominator generated more worry), and in terms of chance of survival rather than chance of death (50% vs 33%). CONCLUSION: In a survey of pregnant and recently pregnant people, most respondents preferred pie charts over other graph formats, and lower rather than higher denominators in text. Presentations of survival rather than death estimates were also preferred. Approximately 75% to 90% of respondents accurately understood risk presented with visual and written communication. For the remaining participants, for whom accurate understanding was challenging, new strategies need to be developed.

Terms used by physicians when deciding to withhold treatment for older patients not having received palliative care in an acute geriatric care unit.

PURPOSE: There are no guidelines or consensus statements on the terms to be used when discussing withholding of treatment for patients in acute geriatric care units and who have not received palliative care. The objective of the present study was to analyze the terms used in medical records to refer to the withholding of treatment for patients who died in an acute geriatric care unit and did not receive palliative care. METHODS: We conducted an ambispective multicentre cohort study based on the DAMAGE study. Data on 53 patients who died in the acute geriatric care unit and who had not received palliative care were extracted from medical records. The verbatims referring to the withholding of treatment were analyzed in terms of keywords and then key concepts, as defined by several reviewers in a consensus-based approach. RESULTS: The mean age of the patients was 86.4 years, 34.1% were male. Terms referring to the withholding of treatment were found for 25 of the 53 patients (47.2%). Most of the decisions on the withholding of treatment were recorded in the week following admission to the acute geriatric care unit. Our analysis of the terms identified 11 key concepts: treatment limitation, no resuscitation, withholding diagnostic procedures, justification of care, ethical considerations, disease progression, uncertainty, the patient's wishes, the family's wishes, patient's comfort, and collegiality. The terms used to describe key concepts varied markedly from one physician to another. CONCLUSION: Decisions about the withholding of treatment are frequently noted in the medical records of patients who die in the acute geriatric care unit without having received palliative care. The broad variety of key concepts and differences in the choice of words highlight the need for standardized terms.

Emotional Nuance Enhances Verbatim Retention of Written Materials.

Recent studies have demonstrated that details of verbal material are retained in memory. Further, converging evidence points to a memory-enhancing effect of emotion such that memory for emotional events is stronger than memory for neutral events. Building upon this work, it appears likely that verbatim sentence forms will be remembered better when tinged with emotional nuance. Most previous studies have focused on single words. The current study examines the role of emotional nuance in the verbatim retention of longer sentences in written material. In this study, participants silently read transcriptions of spontaneous narratives, half of which had been delivered within a context of emotional expression and the other half with neutral expression. Transcripts were taken from selected narratives that received the highest, most extreme ratings, neutral or emotional. Participants identified written excerpts in a yes/no recognition test. Results revealed that participants' verbatim memory was significantly greater for excerpts from emotionally nuanced narratives than from neutral narratives. It is concluded that the narratives, pre-rated as emotional or neutral, drove this effect of emotion on verbatim retention. These findings expand a growing body of evidence for a role of emotion in memory, and lend support to episodic theories of language and the constructionist account.

Interactions and implications of Fuzzy-Trace theory for risk taking behaviors in bipolar disorder.

BACKGROUND: According to Fuzzy-Trace Theory (FTT), qualitative, bottom-line, "gist" reasoning leads to less risk taking and more mature decision-making, less easily swayed by emotions than quantitative, detail-oriented, "verbatim" reasoning. In Bipolar disorder deleterious risky behaviors are common. Prior research confirmed the relationships posited between FTT and risk taking. We aim to understand whether FTT acts upon risk taking in the manner proposed in the FTT framework, namely, that (a) gist "values" mediate the role of "categorical gist". Furthermore, the roles of mania and impulsivity, cited as factors for risk-taking, remain to be clarified. In this study, we investigate if (b) manic symptoms and impulsivity moderate these relationships. METHODS: Participants (N = 105) completed an online survey including demographics, clinical variables, symptomatology, FTT, risk taking and risk perception. RESULTS: Mediational models indicated that (a) Gist Values mediated Categorical Gist's effect on risk taking, as expected by the FTT framework. (b) Impulsivity moderates risk taking, but manic-type symptomatology does not. LIMITATIONS: Voluntary, self-report surveys may have low participant motivation and limit the diagnostic validity and the inpatient generalizability of the results. CONCLUSIONS: The results move beyond a focus on mood-related aspects of Bipolar disorder and confirm the importance of understanding reasoning processes like FTT in combination with impulsivity, as potential behavioral factors of risk taking in Bipolar disorder. The clarifications on FTT's functioning as a mechanism prescribe possible openings for more efficacious reduction of risky behaviors through behavioral interventions focusing on value creation.

Cold Water Immersion After a Handball Training Session: The Relationship Between Physical Data and Sensorial Experience.

The aim of this study was to examine the relationship between the physiological data from subjects and their reported sensory experiences during two types of recovery methods following a handball training session. Female handball players (average age: 21.4 ± 1.3 years; weight: 59.2 ± 3.3 kg; height: 158 ± 3 cm; body mass index, 23.4 ± 2.0 kg.m-2) carried out an athletic training session (rating of perceived exertion RPE: 14.70 ± 0.89) with either a passive recovery (PR) period or cold water immersion (CWI) for 14 min) (cross-over design). Physiological data were collected during the recovery period: CWI had a greater effect than PR on heart rate (HR; bpm), the higher frequencies (HF) of heart rate variability (HRV: 46.44 ± 21.50 vs. 24.12 ± 17.62), delayed onset muscle soreness (DOMS: 1.37 ± 0.51 vs. 2.12 ± 1.25), and various reported emotional sensations. Spectrum HRV analysis showed a significant increase in HF during CWI. Sensorial experiences during the recovery periods were gathered from verbatim reports 24 h later. Players' comments about CWI revealed a congruence between the physiological data and sensorial reports. They used words such as: "thermal shock," "regeneration," "resourcefulness," "dynamism," and "disappearance of pain" to describe their sensations. In conclusion, this study demonstrated the link between physiological and experiential data during CWI and we propose that action of the parasympathetic system on the autonomic nervous system can, at least in part, explain the observed correlations between the corporeal data measured and the sensorial experiences reported.

Long-Lasting Verbatim Memory for the Words of Books After a Single Reading Without Any Learning Intention.

The present study reveals an intriguing ability of our human memory: when reading a book once without any intention of learning, we store long-lasting verbatim memories of the words written in the book without being aware of it. Participants read a book chapter consisting of 32 pages (3,772 words) once without knowing that their memory would be tested later. In memory tests immediately after reading and 1 week after reading, they were asked to remember exactly which word was written at a specific position in the book chapter. Only memory for words was tested that were theme-unrelated and non-central. To measure memory, a two-alternative forced choice recognition test was used where a page was shown either as read before or with the replacement of one single word by a synonym. For each response, participants indicated whether the response was based on phenomenal memory experience (recollection or familiarity) or guessing. In the immediate test, participants claimed to have phenomenal memory experience for about a quarter of the tested positions, truly remembering the word in about half of cases. In the 1-week-delayed test, phenomenal memory experience was nearly entirely absent and completely uninformative. When claiming to have no phenomenal memory experience, participants still truly remembered the word for about 10% of the tested positions in both the immediate test and the 1-week-delayed test, without any forgetting. These findings demonstrate that we store more from read texts in memory than commonly believed.

Verbatim Theater: Prompting Reflection and Discussion about Healthcare Culture as a Means of Promoting Culture Change.

Problem: The mistreatment of medical and nursing students and junior health professionals has been reported internationally in research and the media. Mistreatment can be embedded and normalized in hierarchical healthcare workplaces, limiting the effectiveness of policies and reporting tools to generate change; as a result, some of those who experience mistreatment later perpetuate it. We used a novel, creative approach, verbatim theater, to highlight the complexity of healthcare workplaces, encourage critical reflection, and support long-term culture change. Intervention: Verbatim theater is a theater-for-change documentary genre in which a playscript is devised using only the words spoken by informants. In 2017, 30 healthcare students and health professionals were recruited and interviewed about their experience of work and training by the multidisciplinary Sydney Arts and Health Collective using semi-structured interviews. Interview transcripts became the primary material from which the script for the verbatim theater play 'Grace Under Pressure' was developed. The performing arts have previously been used to develop the communication skills of health professional students; this esthetic expression of the real-life effects of healthcare workplace culture on trainees and students was implemented to stimulate consciousness of, and dialogue about, workplace mistreatment in healthcare work and training. Context: The play premiered at a major Sydney theater in October 2017, attended by the lay public and student and practicing health professionals. In November 2017, three focus groups were held with a sample of audience members comprising healthcare professionals and students. These focus groups explored the impact of the play on reflection and discussion of healthcare culture and/or promoting culture change in the health workplace. We analyzed the focus group data using theoretical thematic analysis, informed by Turner's theory of the relation between 'social' and 'esthetic' drama to understand the impact of the play on its audience. Impact: Focus group members recognized aspects of their personal experience of professionalism, training, and workplace culture in the play, Grace Under Pressure. They reported that the play's use of real-life stories and authentic language facilitated their critical reflection. Participants constructed some learning as 'revelation,' in which the play enabled them to gain significant new insight into the culture of health care and opened up discussions with colleagues. As a result, participants suggested possible remedies for unhealthy aspects of the culture, including systemic issues of bullying and harassment. A small number of participants critiqued aspects of the play they believed did not adequately reflect their experience, with some believing that the play over-emphasized workplace mistreatment. Lessons Learned: Verbatim theater is a potent method for making personal experiences of healthcare workplace and training culture more visible to lay and health professional audiences. In line with Turner's theory, the play's use of real-life stories and authentic language enabled recognition of systemic challenges in healthcare workplaces by training and practicing health professionals in the audience. Verbatim theater provides a means to promote awareness and discussion of difficult social issues and potential means of addressing them.

To illuminate and motivate: A fuzzy-trace model of the spread of information online.

We propose, and test, a model of online media platform users' decisions to act on, and share, received information. Specifically, we focus on how mental representations of message content drive its spread. Our model is based on Fuzzy-Trace Theory (FTT), a leading theory of decision under risk. Per FTT, online content is mentally represented in two ways: verbatim (objective, but decontextualized, facts), and gist (subjective, but meaningful, interpretation). Although encoded in parallel, gist tends to drive behaviors more strongly than verbatim representations for most individuals. Our model uses factors derived from FTT to make predictions regarding which content is more likely to be shared, namely: a) different levels of mental representation, b) the motivational content of a message, c) difficulty of information processing (e.g., the ease with which a given message may be comprehended and, therefore, its gist extracted), and d) social values.

Replication, Registration, and Scientific Creativity.

The bureaucratization of psychological science exacts intellectual costs that go beyond the sheer amount of time that is drained away from creative scientific activity. Additional administrative hurdles are now being generated in an attempt to ensure the replicability of psychological effects. A cognitive analysis of those hurdles shows that impairment of scientific creativity is a foreseeable consequence, owing to their frequent verbatim-processing focus and the negative emotional context in which they are embedded. We consider whether it is possible to enhance replicability without increasing bureaucratic obstacles and to enhance scientific creativity in the presence of such obstacles.

The Cardiac Rehabilitation Psychodynamic Group Intervention (CR-PGI): An Explorative Study.

Objective: An explorative study focusing on the process of a Cardiac Rehabilitation Psychodynamic Group Intervention (CR-PGI) addressed to myocardial infarction (MI) patients is discussed. The study aimed at analyzing whether the treatment based on CR-PGI serves as a communicational context within which MI patients are enabled to explore new interpretations of their post-infarction condition. Methods: The intervention, divided into 12 weekly one-hour group sessions, was addressed to MI patients recruited within a Public Hospital of southern Italy. Each session was audio-recorded and lexical correspondence analysis (LCA) was applied to the verbatim transcripts, in order to provide a map of the evolution of the communication exchange occurring over the 12 sessions. Results: The findings showed that the discourses associated to the first eight sessions differed from the discourses of the last four sessions. Two main transitions occurred. The first concerns the response to the infarction, first interpreted as a process of affective elaboration and afterwards as practical management of the functional aspects associated with the condition of MI patients. The second concerns the nature of the change and contrasts a lifestyle-oriented model with a social role approach, which refers to social, legal, and medical practices related to the acknowledgment of being an MI patient. Conclusion: The findings offer preliminary support to the capacity of CR-PGI to work as a context where new meanings for the biographical rupture of the MI can be explored. Consistently with the rationale of the model, the intervention seems to have promoted the emergence of new ways of feeling and understanding one's condition.

Examination of Spiritual Needs in Hurricane Sandy Disaster Recovery Through Clinical Pastoral Education Verbatims.

Objectives Spiritual support is an essential component to disaster response and recovery. The goals of this study were to (a) provide a qualitative examination of spiritual needs of recipients of disaster relief after Hurricane Sandy, as observed by spiritual care interns in "verbatims"; (b) demonstrate the feasibility of conducting research with providers of disaster spiritual care. Methods The study was accomplished through analysis (including codebook development and transcript coding) of written pastoral reports-aka "verbatims" ( n = 18)-as well as audio-recorded, transcribed seminars ( n = 23). Clinical Pastoral Education verbatims offer qualitative data in the form of confidential, anonymous reports of what the students do in the field. Results Analysis of coded transcripts yielded several themes and subthemes as results. Significance of Results Major themes include: (a) the feasibility of research for CPE students as subject; (b) the discussion of magnitude of the storm and aftermath, as a spiritual need in disaster;

False memory for orthographically versus semantically similar words in adolescents with dyslexia: a fuzzy-trace theory perspective.

The presented research was conducted in order to investigate the connections between developmental dyslexia and the functioning of verbatim and gist memory traces-assumed in the fuzzy-trace theory. The participants were 71 high school students (33 with dyslexia and 38 without learning difficulties). The modified procedure and multinomial model of Stahl and Klauer (simplified conjoint recognition model) was used to collect and analyze data. Results showed statistically significant differences in four of the model parameters: (a) the probability of verbatim trace recollection upon presentation of orthographically similar stimulus was higher in the control than dyslexia group, (b) the probability of verbatim trace recollection upon presentation of semantically similar stimulus was higher in the control than dyslexia group, (c) the probability of gist trace retrieval upon presentation of semantically similar stimulus was higher in the dyslexia than control group, and (d) the probability of gist trace retrieval upon target stimulus presentation (in the semantic condition) was higher in the control than dyslexia group. The obtained results suggest differences of memory functioning in terms of verbatim and gist trace retrieval between people with and without dyslexia on specific, elementary cognitive processes postulated by the fuzzy-trace theory. These can indicate new approaches in the education of persons with developmental dyslexia, focused on specific impairments and the strengths of their memory functioning.

Hearing voices: Comparing two methods for analysis of focus group data.

AIM: This paper compares two qualitative approaches used to thematically analyse data obtained from focus groups conducted with critical care nurses from Australia. BACKGROUND: Focus groups are an effective mechanism to generate understanding and gain insight into the research participants' world. Traditional verbatim transcription of participants' recorded words necessitates significant investment of time and resources. An alternative approach under reported in the literature is to directly analyse the audio recordings. To identify the effectiveness of the audio recording only approach, the study aimed to independently compare two qualitative methods of data analysis, namely the traditional transcribed method with the audio recording method. METHODS: The study to revise the specialist critical care competency standards included focus groups conducted in each state in Australia (n=12) facilitated by experienced researchers. Two of the research team analysed transcribed focus group data and two team members were blinded to the transcription process and directly analysed audio recordings from the focus groups. A process of thematic analysis used independently by the two teams was used to identify themes. RESULTS: When the findings were compared, the themes generated using each technique were consistent and there were no different themes or subthemes identified. The two techniques appeared to be comparable. Overarching key themes were consistent with the approach. CONCLUSION: The direct analysis method appears to have advantages. It is cost effective, trustworthy and possibly a superior alternative when used with focus group data. However, the audio only method requires experienced researchers who understand the context and if combining the two approaches takes time to do.

Understanding Partnerships With Patients/Clients in a Team Context Through Verbatim Theater.

Introduction: Patient partnership has come to the forefront in health care practice and education, influencing professional programs and interprofessional education curricula. While students conceptually understand the idea of partnering with the patient, the practice of doing so is more challenging. Innovative ways to teach this health care approach may be effective in enabling students to apply their learning and promote enhanced patient partnerships. This resource provides an arts-based approach for exploring notions of partnerships with patients in a team context with interprofessional collaboration. Method: This 2-hour resource features a verbatim reader's theater script and accompanying discussion questions for a small-group reading and debrief activity. The voice of individuals with lived experience is elevated to enhance student learning and connection to the topic. Quotations were taken from interviews with individuals who had experience with the health care system and from health care providers. Results: The script and accompanying small-group discussion questions have been used in the interprofessional education curriculum with approximately 1,100 health profession students. Student response has been positive, indicating a new appreciation for thinking about partnering with patients. Discussion: Although the script has been used in the context of interprofessional education, it has the potential to be used as part of uniprofessional teaching and in practice environments, since understanding the nature of partnerships between practitioners and patients transcends all settings.