'I had to Educate Myself': A thematic analysis of online stillbirth stories to improve obstetric care.

OBJECTIVE: To examine which met and unmet needs are discussed in stillbirth stories shared on YouTube with the aim to improve obstetric care. DESIGN: Inductive thematic analysis of 19 English-language stillbirth stories uploaded to YouTube. SETTING: Online setting, YouTube video content. SAMPLE: Women who experienced stillbirth and shared a video on YouTube talking about their experience. METHODS: We conducted a thorough textual reading of the transcripts following Braun and Clarke's guidelines for thematic analysis. MAIN OUTCOME MEASURES: Codes were developed and grouped into themes. RESULTS: Although some women actively used their birth videos to call out shortcomings in their care, most others used their platform for other purposes such as destigmatisation, awareness and support, and rather unintentionally provided insight into their met and unmet needs. When analysing their birth stories, three major themes emerged: choice and decision-making, education and information, and behaviour of healthcare providers. CONCLUSIONS: This study demonstrates the value of birth stories in research. We identified three major opportunities for improvement of obstetric care: being provided with options and being able to make choices in the decision-making process are clearly valued, but there are some caveats: women and other childbearing individuals need timely and continuous information, and more attention is needed for emotional intelligence training of healthcare providers.

The employment of art therapy to develop empathy and foster wellbeing for junior doctors in a palliative medicine rotation - a qualitative exploratory study on acceptability.

BACKGROUND: The interdisciplinary realm of medical humanities explores narratives and experiences that can enhance medical education for physicians through perspective-taking and reflective practice. However, there is a gap in comprehension regarding its appropriateness at the postgraduate level, especially when utilising art therapists as faculty. This study aims to assess the acceptability of an innovative art therapy-focused educational initiative among junior doctors during a palliative care rotation, with the goal of cultivating empathy and promoting well-being. METHODS: A qualitative research project was conducted at the Division of Supportive and Palliative Care (DSPC) in the National Cancer Centre Singapore (NCCS). The study involved the recruitment of junior doctors who had successfully completed a three-month palliative care rotation program, spanning from January 2020 to April 2021. In a single small-group session lasting 1.5 h, with 3 to 4 participants each time, the individuals participated in activities such as collage making, group reflection, and sharing of artistic creations. These sessions were facilitated by an accredited art therapist and a clinical psychologist, focusing on themes related to empathy and wellbeing. To assess the acceptability of the program, two individual interviews were conducted three months apart with each participant. An independent research assistant utilised a semi-structured question guide that considered affective attitude, burden, perceived effectiveness, coherence, and self-efficacy. Thematic analysis of the transcribed data was then employed to scrutinise the participants' experiences. RESULTS: A total of 20 individual interviews were completed with 11 participants. The three themes identified were lack of pre-existing knowledge of the humanities, promotors, and barriers to program acceptability. CONCLUSIONS: The participants have mixed perceptions of the program's acceptability. While all completed the program in its entirety, the acceptability of the program is impeded by wider systemic factors such as service and manpower needs. It is vital to address these structural limitations as failing to do so risks skewing current ambivalence towards outright rejection of future endeavours to integrate humanities programs into medical education.

Twelve tips for maximizing the potential of reflective writing in medical education.

Reflective writing (RW) is a popular tool in medical education, but it is being used in ways that fail to maximize its potential. Literature in the field focuses on why RW is used - that is to develop, assess, and remediate learner competencies - but less so on how to use it effectively. The emerging literature on how to integrate RW in medical education is haphazard, scattered and, at times, reductionist. We need a synthesis to translate this literature into cohesive strategies for medical educators using RW in a variety of contexts. These 12 tips offer guidelines for the principles and practices of using RW in medical education. This synthesis aims to support more strategic and meaningful integration of RW in medical education.

Cultivating compassion in medicine: a toolkit for medical students to improve self-kindness and enhance clinical care.

BACKGROUND: Compassionate care lies at the foundation of good patient care and is a quality that patients and providers continue to value in the fast-paced setting of contemporary medicine. Compassion is often discussed superficially in medical school curricula, but the practical aspect of learning this skill is often not taught using a formal framework. In the present work, the authors present an 8-session curriculum with a mindfulness-based approach to compassion that addresses this need. It is hypothesized that students in this curriculum will improve in their levels of compassion based on validated scales. METHODS: The curriculum was delivered to fourth-year medical students at Renaissance School of Medicine at Stony Brook University who had just completed their clerkship year. It was developed as a customizable set of modules that could be delivered in various ways. The students were taught with evidence-based cognitive exercises followed by group discussions and written reflections based on compassion-focused thematic questions. All students completed a pre- and post-Self-Compassion Scale, Compassion Scale, and Toronto Mindfulness Scale. Students in this course were compared with students in different courses about non-clinical topics delivered at the same time. Wilcoxon Signed Rank tests and Mann Whitney U tests were used to assess potential associations between pre- and post-survey responses for the validated scales and subscales. RESULTS: 17 fourth-year medical students completed pre- and post-course tests, 11 participated in the compassion curriculum while 6 participated from the other courses. Before any of the courses began, all students performed similarly on the pre-test across all scales. The students in the compassion curriculum demonstrated a significant increase in their total Self-Compassion score by 8.7 [95% CI 4.3 to 13.2] points (p = 0.008), total Compassion score by 6.0 [95% CI 1.4 to 10.6] points (p = 0.012), and the curiosity component of the Toronto Mindfulness Scale by 4.4 [95% CI 1.0 to 7.7] points (p = 0.012). There was no statistically significant difference between pre- and post-tests among the non-compassion curriculum students in the aforementioned scales (p = 0.461, p = 0.144, p = 0.785, respectively). CONCLUSIONS: Our results indicate that the students in our course developed an enhanced ability to engage in self-compassion, to understand the shared human experience, and to be motivated to act to alleviate suffering. Regardless of a program's existing compassion education, this customizable model allows for easy integration into a medical student's crowded curriculum. Furthermore, although teaching compassion early and often in a clinician's training is desirable, our study that targeted fourth-year medical students suggests an additional benefit of rekindling the loss of compassion well described in a medical student's clinical years.

Opinions of Polish postgraduate nursing students on medical humanization courses in relation to age, years of service, and nursing specialty.

BACKGROUND: The Polish educational system for nurses has undergone a substantial transformation over the past two decades, with the introduction of a mandatory university education that encompasses humanization in medicine. Consequently, nurses who had been licensed to practice before the implementation of the reform returned to universities to pursue master's degrees alongside their younger colleagues who had only recently obtained bachelor's degrees. This distinctive learning environment, in which nurses of varying ages and years of practice study together, offers an opportunity to gain insight into their perspectives on the educational process. Accordingly, the present study aims to examine the opinions of Polish postgraduate nursing students at one university regarding medical humanization courses, focusing on the extent to which these opinions are shaped by age, years of service, and specialty of nursing care. METHODS: From February to June 2023, an anonymous survey was conducted on the university's online platform, involving 89 out of 169 participants in the master's degree nursing program. The newly designed questionnaire comprised 15 primary questions and 11 metric questions. RESULTS: The study population consisted of registered nurses with a mean age of 35 years (ranging from 22 to 54 years). The majority of participants were women (97.8%). The analysis revealed that older students (Spearman's rho 0.480, p < 0.001) and those with more years of professional experience (Spearman's rho 0.377, p < 0.001) perceived humanizing classes as a vital component of nurse training and work. Younger and less experienced students did not share this perspective. Specialization status was also identified as a differentiating factor (Chi² = 10.830, p < 0.05). However, other characteristics, including the number of positions held during the survey, the type of position, the primary employer, and the nature of work (shift or non-shift), did not exhibit statistically significant differentiation among participants. CONCLUSIONS: This study found age- and work-experience-related differences in nursing students' opinions toward courses teaching humanization in health care. The results suggest that changing the teaching format and involving older and more experienced students in sharing experiences with younger and less experienced students could potentially improve the implementation of learned skills in clinical practice.

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.

What Does It Mean to Be Human Today?

With the progress of artificial intelligence, the digitalization of the lifeworld, and the reduction of the mind to neuronal processes, the human being appears more and more as a product of data and algorithms. Thus, we conceive ourselves "in the image of our machines," and conversely, we elevate our machines and our brains to new subjects. At the same time, demands for an enhancement of human nature culminate in transhumanist visions of taking human evolution to a new stage. Against this self-reification of the human being, the present book defends a humanism of embodiment: our corporeality, vitality, and embodied freedom are the foundations of a self-determined existence, which uses the new technologies only as means instead of submitting to them. The book offers an array of interventions directed against a reductionist naturalism in various areas of science and society. As an alternative, it offers an embodied and enactive account of the human person: we are neither pure minds nor brains, but primarily embodied, living beings in relation with others. This general concept is applied to issues such as artificial intelligence (AI), transhumanism and enhancement, virtual reality, neuroscience, embodied freedom, psychiatry, and finally to the accelerating dynamics of current society which lead to an increasing disembodiment of our everyday life. The book thus applies cutting-edge concepts of embodiment and enactivism to current scientific, technological, and cultural tendencies that will crucially influence our society's development in the twenty-first century.

Pandemic Forms.

Narrative structures, though invisible to the naked eye, guide our understanding of pandemics. Like curves and graphs, we can plot them, identify their patterns and organizing principles. These structures act upon our understanding of social and biological events just as much as the rhythms of viral replication and mutation. They order not only themselves but also social and health outcomes. This essay uses narrative precision to expand beyond Charles Rosenberg's influential dramaturgic model and develops new pandemic forms, scaled from the level of an individual line break to the multi-part series: Arc, a form of sequence. Cycle, a form of repetition. Sequel, a form of elongation. Caesura, a form of break. It investigates the potentialities and limitations of these forms, how they intersect, collide, and contradict, and how analysis of these interactions contributes to a deeper understanding of pandemics, their effects, and the diverse perspectives defining their structures. In doing so, it prototypes how literary methods offer conceptual frameworks for pandemic historiography and how a transdisciplinary, medical humanities analysis produces novel understandings at the intersection of health, culture, and society.

Staff disability data in UK higher education: Evidence from EDI reports.

OBJECTIVES: To explore how higher education institutions (HEIs) make transparent the data they collect on staff disability, and how this relates to existing equality, diversity and inclusion (EDI) charters. DESIGN: Descriptive cross-sector quantitative study based on UK HEIs. SETTING: Higher education sector in the UK. PARTICIPANTS: 162 HEIs across the UK with information extracted from the Higher Education Statistics Agency (HESA), each institution's website and Advance HE. PRIMARY AND SECONDARY OUTCOME MEASURES: Availability of a publicly available EDI report. Type of information on staff disability identified within the EDI report and level of detail, the latter derived from the number of different types of information provided in the report. Athena SWAN and Disability Confident award level for each HEI were used as a proxy for the sector's commitment to EDI. RESULTS: Under a quarter of HEIs do not have an open EDI report online. The majority of Athena SWAN award holders make their EDI reports publicly available, which is similar by Disability Confident status. Russell Group universities are more likely to have a publicly available report. Regionally, EDI report availability is lowest in London. The level of detail with regards to staff disability varies, with more than half of institutions providing 'little detail' and just under a third 'some detail'. Athena SWAN award holders and Disability Confident members are twice as likely to provide 'some detail' than those which do not hold an award. CONCLUSIONS: Challenges remain to obtain a clear picture of staff with disabilities within higher education. The lack of both uniformity and transparency in EDI reporting with respect to disability hinders the ability to quantify staff with disabilities within higher education, develop meaningful interventions and address inequities more widely.

Interdisciplinary co-teaching as a sustainable model for health humanities pedagogy.

Academics and students from marginalised identities encounter challenges and barriers at all levels of participation in the settler colonial university, in both practices of teaching and learning. While this observation holds true for courses in the health humanities, their unique interdisciplinary position and context creates space for challenging dominant norms in society and in academia. In this paper, we describe our experiences as two black and queer graduate students developing and co-teaching an online interdisciplinary course, 'Race and Medicine'. The idea for co-teaching originated as a means of ensuring continuity and sustainability in the course (AvB was expecting her first child and contending with the possibility of unplanned preterm birth) and emerged into what we suggest, in line with the transformative pedagogical theory of bell hooks, was a micro-scale transgressive learning community. We argue that our co-teaching partnership facilitated practices of revealing, mitigating and disrupting oppressive structures in the white heteropatriarchal academy, in addition to offering unique learning opportunities for students. The intersections of difference and similarity between our disciplinary, professional and social identities transformed and enhanced the types of conversations and learning activities we held with the class and were a feature of the course which was rated highly in evaluations. We conclude by suggesting co-teaching as a possible model of sustainable pedagogy for the health humanities, one that is especially valuable for racialised graduate students who are developing professional identities as instructors and exploring careers in the health humanities. In addition to facilitating interdisciplinary student learning, co-teaching and the subsequent formation of micro-scale transgressive learning communities challenges the dominant power structures of the academy by making space for teaching and learning in the contexts of solidarity, care and sustainability.

On the art of audio description: Naomi Kawase's Radiance.

Audio description improves access to visual culture for people who are unable to fully participate in it due to visual impairments. Because of this direct benefit to disabled people, it is usually defined as an accommodation or inclusion service. Rather than adopting this view, we see disability as a creative force, arguing that it can engender a new dimension of art: audio description as a form of cinematic ekphrasis. This claim is made by drawing on the 2017 movie Radiance, by Japanese director Naomi Kawase. This movie puts audio description in the spotlight and stimulates discussion on this underdeveloped and under-recognised art. Radiance is structured around the process of making the audio description, thus offering good insight into the artistry and main challenges of this process. Between the words of this meditation on the art of audio description, Kawase also challenges the dominant ocular normative narrative on blindness as a deficiency and provokes a discussion on the contribution that blindness-with its different, still culturally unexplored modes of perception-could make to the interpretation of visual arts. Radiance can thus be treated as an artful argument for the greater recognition of disabled people's right to participate in cultural life.

Eugenics and genetic screening in television medical dramas.

Medical dramas offer unique insights into the way popular media makes sense of genetic technology and the ethics of its applications. In this paper we evaluate the contrasting depictions in television medical dramas of reproductive genetic screening and eugenics-two medical themes that some commentators see as closely related. By conducting a content analysis of 32 episodes of doctor shows featuring eugenic and/or genetic screening themes, we put the medical drama landscape in conversation with bioethics scholarship and mark a significant divergence between the two. While the academic literature has been parsing the possible relationship between genetic screening and eugenics for over 50 years, doctor shows tend to champion genetic screening as a powerful tool for promoting individual reproductive choice and criticise eugenics as a socially unjust infringement of reproductive freedom. In doing so, medical dramas mark a subtle but important moral distinction between the population-level implications of eugenics and the highly personal, emotional impact of genetic screening.

Contention and collaboration: the tenuous encounter of modern Ayurveda and Western medicine in the twentieth and twenty-first centuries.

Complementary medicine systems are ascending to rapid popularity as the twenty-first century progresses. Often adapted from ancient systems of healing such as Ayurveda, these modern alternative medical movements reappraise millennia-old health traditions that found their inception at the confluence of religious philosophy and herbal healing. Naturally, contemporary global economic forces and a desire to market traditional medicine products in an enticing fashion have characterised how historic traditional medicine systems are presented in the modern context. By establishing a vision of complementary medicine born from ancient traditions, it becomes clear how traditional methods of healing can contend with Western biomedicine-the prevailing standard of care around the globe. The claims made by both sides parry along a line of scientific validity, efficacy and regulatory purview. India, the birthplace of Ayurveda and an epicentre of contemporary medical education, is a prime arena to study the friction between biomedicine and traditional medicine. In this piece, I focus on the modernisation of Ayurveda and how it has found conflict with allopathic medicine. I posit that Ayurveda has re-emerged since the early twentieth century as a key tenet of Indian modernity: and in doing so has found contention with Western medicine. I furthermore argue that despite existing discord, the two medical traditions are not inherently antithetical. They can be synergistic, so long as healthcare delivery and education recognise the limits of each and focus on coaction rather than contradiction.

"This will keep me happy for weeks": care objects, affect and graphic medicine.

Looking beyond anthropocentric care relationships reveals nuanced levels of interdependence among human and non-human entities. Attention to these heterogeneous inter-relationships illuminates the subtle and visceral affective intensities among diverse participants, including humans, objects and the environment, among others. The interdisciplinary field of graphic medicine foregrounds these entanglements through comic affordances, challenging the predominant notion that care belongs only at the scale of human beings. This article analyses selected sections from graphic medical narratives such as Brian Fies's Mom's Cancer, Sarah Leavitt's Tangles and Joyce Farmer's Special Exits to illustrate how objects become a source of care for humans during illness, thus becoming care objects. Furthermore, using the affordances of comics, this essay examines, how the selected sections of the abovementioned graphic narratives portray the often unnoticed/overlooked affective entanglement between the sufferers and objects. In doing so, this article underscores the inter-relatedness between humans and non-human entities within the context of caregiving.

Chronic challenges: picturing chronic disease by the World Health Organization.

Chronic diseases are among the leading causes of mortality in the world, the subject of major regional and international efforts to tackle shared risk factors, implement prevention and control measures and set national targets as part of the drive towards universal health coverage. Yet there is a growing conviction that chronic diseases suffer an image problem. It has been suggested that the terminology 'dulls the senses' to the problems, and in an age where the mass media affords unprecedented opportunities to inform and persuade people to care about their health and that of others, chronic disease representation remains a contested and much debated issue.This article investigates how WHO created and disseminated visual narratives to raise popular consciousness and build a visual vocabulary around chronic disease in the second half of the 20th century. It examines the measures taken to conceptualise, photograph and publicise chronic diseases, and considers who had control over their representation. In focussing predominantly on cancer, diabetes and cardiovascular disease, it reveals different narratives; the power of scientific and technological progress; individual and community action for health; promising utopian and parallel dystopian visions. It embeds these in a production context which reveals an intricate picturing process involving overcoming challenges of representation. It uses this historical background to discuss issues relating to how chronic disease and chronic pain have been narrated visually, such as the ideas of emotional response, moral failure, how people navigate the 'risk society' and ultimately the concerns regarding the intentional and unintentional influence that the media can have on the image of disease given to society.

Bearing witness poetically in a pandemic: documenting suffering and care in conditions of physical isolation and uncertainty.

The COVID-19 crisis is still affecting millions of people worldwide. However, government and mass media attention to the continuing loss of life, severe illness and prolonged effects of COVID-19 has subsided, rendering the suffering of those who have become ill or disabled, or who have lost loved ones to the disease, largely hidden from view. In this article, we employ autoethnographic poetic inquiry from the perspective of a mother/carer whose young adult daughter became critically ill and hospitalised after becoming infected while the mother herself was isolating at home due to her own COVID-19 diagnosis. The first author created a poem from notes she had made in a journal from telephone conversations and messages with the healthcare providers caring for her daughter. The second author responded to the poem, identifying the feelings and meanings it surfaced. Together, the authors draw on scholarship discussing concepts of uncertainty, liminality, moral distress, bearing witness and illness narratives to reflect on how autoethnographic poetic inquiry can document and make visible COVID-19-related suffering.

Neurodiversity and disability: what is at stake?

Neurodiversity has come hugely to the fore in recent years in a variety of contexts, and is now subject to academic debate, activist discussion, and increasingly embedded in a range of institutional and corporate settings in the Global North, from workplaces to early years education, from psychotherapy to mainstream political discourses. The term has gained traction in Medical Humanities, as well as debate within bioethics, philosophy of psychology, and of law. Institutionally, it is now relied on in therapeutic practice, autism service provision, as well as in higher education, in particular. In this conceptual article we examine what is at stake in these usages and the implications in need of scrutiny. We resituate neurodiversity in relation to questions of disability by examining the deployment of neurology as the basis for identity, rights and benefits. The emergence of the term and the understandings to which it gives rise, we argue, leave out urgent questions of what is at stake for disabled people in a political climate of increasing harshness and ableism.

Between medicine, humanities and the law: compiling a living archive of assisted dying.

Stories about personal experiences of assisted dying, a term comprising both instances when a lethal substance is administered by a physician or by the patient themselves, are frequently cited in law-making processes. These experiences of healthcare systems and the laws governing end-of-life procedures thereby interactively influence the future of medicine at the deathbed. With more countries legalising some form of assisted dying or opening political debate about the issue, addressing how these personal stories shape public opinions and social institutions is timely. In this current controversy, we question how medical humanities researchers are to make sense of the role of these stories in law-making, and critically reflect on a digital archive that seeks to make these interconnections visible. At the methodological level, the reciprocal interactions in assisted dying between medicine, law and the arts urges us to reconsider the conceptual foundations of interdisciplinary research in the medical humanities.

From othering to belonging: a framework for DEI history-telling and strategising.

The medical profession in the USA is-and has long been-a segregated workforce. Currently, just 5.0% of all US physicians are black. Understanding the origins and mechanisms of this disparity is essential to creating a future where black healing and healers are supported by our medical system. In pursuit of this future, this article offers 'othering' and 'belonging' as frames of analysis and intervention for diversity and equity initiatives.Building on previous historical studies of racism in medicine, this project reveals how the figure of the 'American physician' was created through exclusionary/othering tactics. In part 1, we analyse antebellum historical sources to demonstrate the role of medicine in creating and promulgating racial categories and hierarchies. Next, in part 2, we explore the historical conditions that produced the American physician as a significant professional identity by analysing texts by the American Medical Association and affiliated state medical societies. Then, we turn towards solutions in part 3. To redress inequities produced by othering, particularly the continued exclusion of black people from the medical profession, we argue that medical leaders should cultivate a professional culture of belonging. As we will explain, belonging goes beyond tolerating and respecting difference; it entails shared culture, equal rights and inclusive structures.

Sociocultural aspects of the medicalisation of infertility: a comparative reading of two illness narratives.

This paper is a comparative reading of variations in the medicalisation of infertility caused by sociocultural aspects, in two illness narratives by patients: Elizabeth Katkin's Conceivability (2018), a story of navigating a fertility industry with polycystic ovarian syndrome and antiphospholipid syndrome in America and Rohini Rajagopal's What's a Lemon Squeezer Doing in My Vagina (2021), a discussion from India of a growing awareness of medicalisation in treatment of unexplained infertility. For this purpose, it first charts scholarship on illness narratives and medicalisation, noting a historical association. Following this, it shows how infertility, a physiological symptom of reproductive incapacity or failure to show clinical pregnancy, is generally medicalised. This paper reads the texts as showing hitherto unaddressed sociocultural aspects of infertility's medicalisation. At the same time, drawing from existing sociological and anthropological scholarship, it shows how a reading of sociocultural aspects in medicalised infertility nuances understanding of it's medicalisation. This comparative reading attends to sociocultural values and norms within the texts, including pronatalism, fetal personhood, kinship organisation, purity/pollution, individual reliance, sacred duty and so forth. It draws from scholarship on embodiment, rhetorical strategies and the language of medicine. It also shows how a patient's non-medicalised, affective history of 'deep' sickness caused by the biographical disruption of infertility is not that of a 'poor historian'. In laying out the particularisation of such sociocultural values and norms across America and India, medicalisation's migration from its origins to the margins reveals subjectivised, stratified reproduction in infertility illness narratives. This paper is part of a turn in scholarship away from understanding the medicalisation of infertility as naturalised and decontextualised.