Rethinking research in the medical humanities: a scoping review and narrative synthesis of quantitative outcome studies.

OBJECTIVES: The rise of medical humanities teaching in medical education has introduced pressure to prove efficacy and utility. Review articles on the available evidence have been criticised for poor methodology and unwarranted conclusions. To support a more nuanced discussion of how the medical humanities work, we conducted a scoping review of quantitative studies of medical humanities teaching. METHODS: Using a search strategy involving MEDLINE, EMBASE and ERIC, and hand searching, our scoping review located 11 045 articles that referred to the use of medical humanities teaching in medical education. Of these, 62 studies using quantitative evaluation methods were selected for review. Three iterations of analysis were performed: descriptive, conceptual, and discursive. RESULTS: Descriptive analysis revealed that the medical humanities as a whole cannot be easily systematised based on simple descriptive categories. Conceptual analysis supported the development of a conceptual framework in which the foci of the arts and humanities in medical education can be mapped alongside their related epistemic functions for teaching and learning. Within the framework, art functioned as expertise, as dialogue or as a means of expression and transformation. In the discursive analysis, we found three main ways in which the relationship between the arts and humanities and medicine was constructed as, respectively, intrinsic, additive and curative. CONCLUSIONS: This review offers a nuanced framework of how different types of medical humanities work. The epistemological assumptions and discursive positioning of medical humanities teaching frame the forms of outcomes research that are considered relevant to curriculum decision making, and shed light on why dominant review methodologies make some functions of medical humanities teaching visible and render others invisible. We recommend the use of this framework to improve the rigor and relevance of future explorations of the efficacy and utility of medical humanities teaching.

A model of engagement in reflective writing-based portfolios: Interactions between points of vulnerability and acts of adaptability.

BACKGROUND: Portfolios are widely used for meeting new accreditation standards in the age of competency-based medicine. However, the method of learning through portfolio has been suggested to be vulnerable. AIM: The aim of this study was to explore conditions affecting the experience of teaching and learning from the perspective of both students and mentors in a reflective writing-based portfolio initiative. METHOD: Using mixed-methods rooted in grounded theory, 139 students and 13 mentors completed questionnaires, 23 students participated in four focus groups and 9 mentors in individual interviews. RESULTS: The overarching theme in our data was student-mentor engagement. Our results confirm previous literature describing portfolio as a vulnerable method of learning, extend this concept by identifying and categorizing specific points of vulnerability, and contribute new knowledge regarding acts of adaptability, which serve to strengthen the student-mentor relationship. CONCLUSION: Engagement is central to the success of portfolio and is shaped by a dynamic interaction between points of vulnerability and acts of adaptability. We propose a model of engagement in portfolio that can be used for faculty development to optimize student-mentor engagement.

A confirmed case of toxic shock syndrome associated with the use of a menstrual cup.

Menstrual cups have been reported to be an acceptable substitute for tampons. These flexible cups have also been reported to provide a sustainable solution to menstrual management, with modest cost savings and no significant health risk. The present article documents the first case of toxic shock syndrome associated with the use of a menstrual cup in a woman 37 years of age, using a menstrual cup for the first time. Toxic shock syndrome and the literature on menstrual cups is reviewed and a possible mechanism for the development of toxic shock syndrome in the patient is described.

Les coupes menstruelles sont considérées comme un substitut acceptable des tampons. Ces coupes flexibles sont également considérées comme une solution durable pour gérer les menstruations, entraînant de modestes économies, sans risque important pour la santé.Le présent article rend compte du premier cas de syndrome du choc toxique chez une femme de 37 ans, qui utilisait une coupe menstruelle pour la première fois. Les chercheurs analysent le syndrome du choc toxique et les publications sur les coupes menstruelles et décrivent un mécanisme possible d'apparition du syndrome du choc toxique chez la patiente.

Considerations in the use of reflective writing for student assessment: issues of reliability and validity.

CONTEXT: Reflective writing is a popular tool to support the growth of reflective capacity in undergraduate medical learners. Its popularity stems from research suggesting that reflective capacity may lead to improvements in skills such as empathy, communication, collaboration and professionalism. This has led to assumptions that reflective writing can also serve as a tool for student assessment. However, evidence to support the reliability and validity of reflective writing as a meaningful assessment strategy is lacking. METHODS: Using a published instrument for measuring 'reflective capacity' (the Reflection Evaluation for Learners' Enhanced Competencies Tool [REFLECT]), four trained raters independently scored four samples of writing from each of 107 undergraduate medical students to determine the reliability of reflective writing scores. REFLECT scores were then correlated with scores on a Year 4 objective structured clinical examination (OSCE) and Year 2 multiple-choice question (MCQ) examinations to examine, respectively, convergent and divergent validity. RESULTS: Across four writing samples, four-rater Cronbach's α-values ranged from 0.72 to 0.82, demonstrating reasonable inter-rater reliability with four raters using the REFLECT rubric. However, inter-sample reliability was fairly low (four-sample Cronbach's α = 0.54, single-sample intraclass correlation coefficient: 0.23), which suggests that performance on one reflective writing sample was not strongly indicative of performance on the next. Approximately 14 writing samples are required to achieve reasonable inter-sample reliability. The study found weak, non-significant correlations between reflective writing scores and both OSCE global scores (r = 0.13) and MCQ examination scores (r = 0.10), demonstrating a lack of relationship between reflective writing and these measures of performance. CONCLUSIONS: Our findings suggest that to draw meaningful conclusions about reflective capacity as a stable construct in individuals requires 14 writing samples per student, each assessed by four or five raters. This calls into question the feasibility and utility of using reflective writing rigorously as an assessment tool in undergraduate medical education.

Narrative medicine as a means of training medical students toward residency competencies.

OBJECTIVE: This study sought to explore the perceived influence of narrative medicine training on clinical skill development of fourth-year medical students, focusing on competencies mandated by ACGME and the RCPSC in areas of communication, collaboration, and professionalism. METHODS: Using grounded-theory, three methods of data collection were used to query twelve medical students participating in a one-month narrative medicine elective regarding the process of training and the influence on clinical skills. Iterative thematic analysis and data triangulation occurred. RESULTS: Response rate was 91% (survey), 50% (focus group) and 25% (follow-up). Five major findings emerged. Students perceive that they: develop and improve specific communication skills; enhance their capacity to collaborate, empathize, and be patient-centered; develop personally and professionally through reflection. They report that the pedagogical approach used in narrative training is critical to its dividends but misunderstood and perceived as counter-culture. CONCLUSION/PRACTICE IMPLICATIONS: Participating medical students reported that they perceived narrative medicine to be an important, effective, but counter-culture means of enhancing communication, collaboration, and professional development. The authors contend that these skills are integral to medical practice, consistent with core competencies mandated by the ACGME/RCPSC, and difficult to teach. Future research must explore sequelae of training on actual clinical performance.