Empathy and shame through critical phenomenology: The limits and possibilities of affective work and the case of COVID-19 vaccinations.

This paper begins by developing the critical phenomenologies of shame and empathy. It rejects that empathy is the supposed antidote to shame, and rather demonstrates the ways in which they function in parallel. The author contends that both shame and indeed empathy risk objectifying and fetishizing the other who is being shamed or empathized with. This argument and phenomenology about the relationship between shame and empathy is then applied and further developed through a case study of COVID-19 vaccinations. The author explores whether empathy and shame ever "work" to increase vaccine uptake, and ultimately argues that both affects do and do not depending on the structures of power informing the specific context.

Glimpsing Death Through Zoom.

This personal essay brings readers into what it is like to experience a patient's death for the first time as a medical student, but with a topical twist: this experience happens over Zoom. The author is part of the 2023 cohort of medical school graduates who will have spent at least half of medical school online. Most people think of virtual medical education as a loss, but this essay is about how "Zoom medical school" actually allowed one student to experience a "good death" very unlike the deaths typically witnessed in hospitals. The essay details and reflects upon the experience of shadowing a palliative care physician's Zoom appointments with a patient, Mrs. K, over the weeks leading up to her death from cancer, surrounded by children and grandchildren at home. In contrast, the author weaves in the story of her own grandfather who died last year from COVID-19, intubated alone in an ICU all the way in Tehran, Iran. The essay concludes that medicine is not just about preventing death, but about making a good death possible-and that a good death is embedded in the communities that brought meaning to one's life in the first place.

The prism model: advancing a theory of practice for arts and humanities in medical education.

INTRODUCTION: The arts and humanities have transformative potential for medical education. Realizing this potential requires an understanding of what arts and humanities teaching is and what it aims to do. A 2016 review of exclusively quantitative studies mapped three discursive positions (art as intrinsic to, additive to or curative for medicine) and three epistemic functions (art for mastering skills, perspective taking, and personal growth and activism). A more inclusive sample might offer new insights into the position and function of arts and humanities teaching in medical education. METHODS: Informed by this 2016 framework, we conducted discursive and conceptual analyses of 769 citations from a database created in a recent scoping review. We also analyzed the 15 stakeholder interviews from this review for recurring themes. These three analyses were iteratively compared and combined to produce a model representing the complex relationship among discursive functions and learning domains. RESULTS: The literature largely positioned arts and humanities as additive to medicine and focused on the functions of mastering skills and perspective taking. Stakeholders emphasized the intrinsic value of arts and humanities and advocated their utility for social critique and change. We offer a refined theory of practice-the Prism Model of four functions (mastering skills, perspective taking, personal insight and social advocacy)-to support more strategic use of arts and humanities in medical education across all learning domains. DISCUSSION: The Prism Model encourages greater pedagogical flexibility and critical reflection in arts and humanities teaching, offering a foundation for achieving its transformative potential.

How Are the Arts and Humanities Used in Medical Education? Results of a Scoping Review.

PURPOSE: Although focused reviews have characterized subsets of the literature on the arts and humanities in medical education, a large-scale overview of the field is needed to inform efforts to strengthen these approaches in medicine. METHOD: The authors conducted a scoping review in 2019 to identify how the arts and humanities are used to educate physicians and interprofessional learners across the medical education continuum in Canada and the United States. A search strategy involving 7 databases identified 21,985 citations. Five reviewers independently screened the titles and abstracts. Full-text screening followed (n = 4,649). Of these, 769 records met the inclusion criteria. The authors performed descriptive and statistical analyses and conducted semistructured interviews with 15 stakeholders. RESULTS: The literature is dominated by conceptual works (n = 294) that critically engaged with arts and humanities approaches or generally called for their use in medical education, followed by program descriptions (n = 255). The literary arts (n = 197) were most common. Less than a third of records explicitly engaged theory as a strong component (n = 230). Of descriptive and empirical records (n = 424), more than half concerned undergraduate medical education (n = 245). There were gaps in the literature on interprofessional education, program evaluation, and learner assessment. Programming was most often taught by medical faculty who published their initiatives (n = 236). Absent were voices of contributing artists, docents, and other arts and humanities practitioners from outside medicine. Stakeholders confirmed that these findings resonated with their experiences. CONCLUSIONS: This literature is characterized by brief, episodic installments, privileging a biomedical orientation and largely lacking a theoretical frame to weave the installments into a larger story that accumulates over time and across subfields. These findings should inform efforts to promote, integrate, and study uses of the arts and humanities in medical education.

Bringing narratives from physicians, patients and caregivers together: a scoping review of published research.

Patients and family caregivers tell different stories about their illness and care experiences than their physicians do. Better understanding of the relationships among these narratives could offer insight into intersections and disconnections in patient, caregiver and physician perceptions of illness and care. Such understanding could support enhanced patient-centred care in medical education and practice. Narrative writing is increasingly common among physicians, patients and caregivers and uniquely positioned to reveal matters of concern to these groups. We conducted a scoping review to identify literature in which first-person narratives from more than one group (physicians, patients and/or caregivers) were considered as 'data'. A search strategy involving nine databases located 6337 citations. Two reviewers independently screened titles and abstracts. Full-text screening followed (n=82), along with handsearching of grey literature and bibliographies. Of these, 22 met inclusion criteria. Most pieces analysed narratives by patients and caregivers (n=13), followed by patients, caregivers and physicians (n=7) and patients and physicians (n=2). Only nine pieces compared perspectives among any of these groups. The rest combined narratives for analysis, largely patient and caregiver stories (n=12). Most of the 22 papers used descriptive content analysis to derive themes. Themes of humanity, identity, agency and communication intersect between groups but often manifest in unique ways. What is absent, however, is a more interpretive narrative analysis of structure, orientation and characterisation within these narratives, which may reveal even more than their content. This scoping review offers a cautionary tale of lost potential. Many narratives are gathered and analysed but usually only thematically and rarely comparatively. We call for researchers to explore the potential of comparative analysis and the power of narrative inquiry in the field. Comparative narrative analysis may enrich understanding of how differences between perspectives come to be and what they mean for the experience of illness and care.