The human kindness curriculum: An innovative preclinical initiative to highlight kindness and empathy in medicine.

Background: Prior studies have shown a marked drop in empathy among students during their third (clinical) year of medical school. Curricula developed to address this problem have varied greatly in content and have not always been subjected to validated measures of impact. Methods: In 2015, we initiated a Human Kindness (HK) curriculum for the initial 2 years of medical school. This mandatory 12-h curriculum (6 h/year) included an innovative series of lectures and patient interactions with regard to compassion and empathy in the clinical setting. Both quantitative (Jefferson Scale of Empathy [JSE]) and qualitative data were collected prospectively to evaluate the impact of the HK curriculum. Results: In the initial Pilot Year, neither 1st (Group 1) nor 2nd (Group 2) year medical students showed pre-post changes in JSE scores. Substantial changes were made to the curriculum based on faculty and student evaluations. In the following Implementation Year, both the new 1st (Group 3) and the now 2nd year (Group 4) students, who previously experienced the Pilot Year, showed significant improvements in post-course JSE scores; this improvement remained valid across subanalyses of gender, age, and student career focus (e.g., internal medicine, surgery, etc.). Despite the disappointingly flat initial Pilot Year JSE scores, the 3rd year students (Group 2) who experienced only the Pilot Year of the curriculum (i.e., 2nd year students at the time of the Pilot Year) had subsequent JSE scores that did not show the typical decline associated with the clinical years. Students generally evaluated the HK curriculum positively and rated it as being important to their medical education and development as a physician. Discussion: A required preclinical curriculum focused on HK resulted in significant improvements in medical student empathy; this improvement was maintained during the 1st clinical year of training.

A Case Report of Scrupulosity Presenting as Catatonia in a Patient With Both OCD and OCPD.

We present the case of a woman in her 40s with a history of hypothyroidism, a differential diagnosis of major depressive disorder with psychotic features versus bipolar I disorder, catatonia, and anorexia nervosa. The patient was admitted to the hospital for poor oral intake, mutism, and social withdrawal. Administration of lorazepam successfully treated these presenting symptoms. However, on subsequent days, she was found to be reading the Bible almost constantly during waking hours, at the expense of engaging in treatment or interacting with others. The patient's history and presentation supported the idea that her hyper-religiosity stemmed not from bipolar disorder or psychosis, as previously thought, but rather from a subtype of obsessive-compulsive disorder referred to as scrupulosity. This report summarizes the characteristics of scrupulosity and discusses this potentially deceptive mimic of more commonly seen conditions.

The University of California Crisis Standards of Care: Public Reasoning for Socially Responsible Medicine.

During the Covid-19 pandemic, the University of California convened the University of California Critical Care Bioethics Working Group, a team of twenty individuals tasked with developing a set of triage procedures. This article highlights several crucial components of the UC procedures and describes the reasoning behind them. The recommendations and the reasoning in the UC protocol are distinctive because of the emphasis the working group placed on grounding its decisions on the public's preferences for triage protocols. To highlight the distinctiveness of the recommendations and reasoning, this article contrasts the UC procedures with the triage procedures known as the "Pittsburgh framework." Among the specific topics discussed are age discrimination, disability discrimination, the prioritization of critical workers for scarce resources, and triage priority for pregnant patients.

Ethical considerations and patient safety concerns for cancelling non-urgent surgeries during the COVID-19 pandemic: a review.

At the time of writing of this article, there have been over 110 million cases and 2.4 million deaths worldwide since the start of the Coronavirus Disease 2019 (COVID-19) pandemic, postponing millions of non-urgent surgeries. Existing literature explores the complexities of rationing medical care. However, implications of non-urgent surgery postponement during the COVID-19 pandemic have not yet been analyzed within the context of the four pillars of medical ethics. The objective of this review is to discuss the ethics of elective surgery cancellation during the COVID-19 pandemic in relation to beneficence, non-maleficence, justice, and autonomy. This review hypothesizes that a more equitable decision-making algorithm can be formulated by analyzing the ethical dilemmas of elective surgical care during the pandemic through the lens of these four pillars. This paper's analysis shows that non-urgent surgeries treat conditions that can become urgent if left untreated. Postponement of these surgeries can cause cumulative harm downstream. An improved algorithm can address these issues of beneficence by weighing local pandemic stressors within predictive algorithms to appropriately increase surgeries. Additionally, the potential harms of performing non-urgent surgeries extend beyond the patient. Non-maleficence is maintained through using enhanced screening protocols and modifying surgical techniques to reduce risks to patients and clinicians. This model proposes a system to transfer patients from areas of high to low burden, addressing the challenge of justice by considering facility burden rather than value judgments concerning the nature of a particular surgery, such as cosmetic surgeries. Autonomy can be respected by giving patients the option to cancel or postpone non-urgent surgeries. However, in the context of limited resources in a global pandemic, autonomy is not absolute. Non-urgent surgeries can ethically be postponed in opposition to the patient's preference. The proposed algorithm attempts to uphold the four principles of medical ethics in rationing non-urgent surgical care by building upon existing decision models, using additional measures of resource burden and surgical safety to increase health care access and decrease long-term harm as much as possible. The next global health crisis will undoubtedly present its own unique challenges. This model may serve as a comprehensive starting point in determining future guidelines for non-urgent surgical care.

Same behavior, different provider: American medical students' attitudes toward reporting risky behaviors committed by doctors, nurses, and classmates.

The bioethics literature lacks findings about medical students' attitudes toward reporting risky behaviors that can cause error or reduce the perceived quality of health care. A survey was administered to 159 medical students to assess their likelihood to directly approach and to report various providers-a physician, nurse, or medical student-for three behaviors (poor hand hygiene, intoxication, or disrespect of patients). For the same behavior, medical students were significantly more likely to approach a classmate, followed by a nurse and then a doctor (p < .0001), to ask for behavioral modification. Across all three health care provider types, medical students were most likely to report intoxication (p < .0001). Medical students' willingness to approach or report a provider for a risky or unprofessional behavior is influenced by the type of health care provider in question. Medical schools should implement patient safety curricula that alleviate fears about reporting superiors and create anonymous reporting systems to improve reporting rates.

Attribution of cause by patients with depression, anxiety, and alexithymia.

This study evaluated the relationship between the personality construct of alexithymia and the attribution of depression to biological, psychological, sociocultural, and external stress. When alexithymia was considered as a continuous variable, there was a significant correlation between a higher score on the Toronto Alexithymia Scale and a greater belief in psychological causes for their psychiatric disorder. The other factors also had positive but nonsignificant correlations with alexithymia. When alexithymia was categorically partitioned and controlled for depressed mood, alexithymic subjects more frequently endorsed all four factors to be causal for their psychiatric illness. This appears to contradict earlier assumptions that alexithymic patients tend to be less psychologically minded than those without this psychological trait.