Through the looking glass: qualitative study of critical care clinicians engaging in humanities.

PURPOSE: Critical care medicine is facing an epidemic of burnout and consequent attrition. Interventions are needed to re-establish the medical field as a place of professional growth, resilience, and personal well-being. Humanities facilitate creation, reflection, and meaning-making, holding the promise of personal and community transformation. This study aimed to explore how clinicians engage with a humanities program, and what role and impact do the humanities play in their individual and collective journey. METHODS: This is a qualitative study employing a phenomenological approach. Participants were faculty and trainees who participated in the program. Data consisted of (a) 60-h observations of humanities evenings, (b) more than 200 humanities artifacts brought by participants, and (c) 15 in-depth participant interviews. Data were analyzed inductively and reflectively by a team of researchers. RESULTS: Participants were motivated to engage with the humanities curriculum because of past experiences with art, identifying a desire to re-explore their creativity to make meaning from their clinical experiences and a wish to socialize with and understand their colleagues through a different lens. The evenings facilitated self-expression, and inspired and empowered participants to create art pieces and re-engage with art in their daily lives. More importantly, they found a community where they could be vulnerable and supported, where shared experiences were discussed, emotions were validated, and relationships were deepened between colleagues. CONCLUSIONS: Humanities may impact resilience and personal and community well-being by facilitating reflection and meaning-making of challenging clinical work and building bonds between colleagues.

Being and Becoming: Narrative Records of Pediatric Critical Care Clinicians.

Medical humanities initiatives have been integrated in our Pediatric Critical Care program to help clinicians make meaning of key experiences in their professional and personal journeys. In particular, narrative medicine and clinicians' writings illuminate and commemorate these journeys and increase our understanding of our profession in its full complexity. In this piece, we provide an example of a medical humanities curriculum and a selection of pieces written by several participants in it. These pieces form a collective narrative, portraying aspects of our individual and collective biography.

Who am I? Narratives as a window to transformative moments in critical care.

Critical care clinicians practice a liminal medicine at the border between life and death, witnessing suffering and tragedy which cannot fail to impact the clinicians themselves. Clinicians' professional identity is predicated upon their iterative efforts to articulate and contextualize these experiences, while a failure to do so may lead to burnout. This journey of self-discovery is illuminated by clinician narratives which capture key moments in building their professional identity. We analyzed a collection of narratives by critical care clinicians to determine which experiences most profoundly impacted their professional identity formation. After surveying 30 critical care journals, we identified one journal that published 84 clinician narratives since 2013; these constituted our data source. A clinician educator, an art historian, and an anthropologist analyzed these pieces using a narrative analysis technique identifying major themes and subthemes. Once the research team agreed on a thematic structure, a clinician-ethicist and a trainee read all the pieces for analytic validation. The main theme that emerged across all these pieces was the experience of existing at the heart of the dynamic tension between life and death. We identified three further sub-themes: the experience of bridging the existential divide between dissimilar worlds and contexts, fulfilling divergent roles, and the concurrent experience of feeling dissonant emotions. Our study constitutes a novel exploration of transformative clinical experiences within Critical Care, introducing a methodology that equips medical educators in Critical Care and beyond to better understand and support clinicians in their professional identity formation. As clinician burnout soars amidst increasing stressors on our healthcare systems, a healthy professional identity formation is an invaluable asset for personal growth and moral resilience. Our study paves the way for post-graduate and continuing education interventions that foster mindful personal growth within the medical subspecialties.

Prevalence of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among Korean College Women / 신경정신의학

OBJECT: More than 75% of women have been reported to experience premenstrual symptoms and three to eight percent of them suffer from premenstrual dysphoric disorder(PMDD). But little is known about prevalence of premenstrual syndrome(PMS) and PMDD among Korean women. The purpose of this study was to investigate the prevalence of PMDD and PMS in Korean women who attended universities at the time of survey. METHODS: One thousand four hundred and nineteen subjects were randomly selected with cluster sampling method among four women's university in Seoul. We measured the severity of premenstrual symptoms using six-point rating scale developed by the authors on the basis of the research criteria for PMDD in DSM-IV. Premenstrual worsening of symptoms was defined as increase in symptom scores of more than 75% from follicular to luteal phase score. And also, we compared characteristic symptoms, eating behaviors, and functional impairments between PMS and PMDD. RESULT: After excluding inadequate data according to our exclusion criteria, 873 of 1419 subjects(61.5%) were included in the estimation of the prevalence of PMS and PMDD. Each prevalence rate of PMS and PMDD was found to be 83.3% and 5.0% on the basis of 75% change method respectively. The most frequent symptom was physical symptoms such as headache or breast tenderness(56.4%) in PMS and 'felt irritable'(95.5%) in PMDD. Of the 44 subjects with PMDD, 39(88.6%) reported to have experienced the impairment in work or school at least once per month because of premenstrual symptoms. CONCLUSION: Our results indicate that prevalence and symptoms of PMDD in Korean university women are similar to those in western culture. The finding that mood symptoms were more frequent and severe in PMDD than in PMS implies that the former may be a disordered condition to be distinguished from the latter physiologic one.