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Clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties are associated with eating disorder symptoms in clinical samples. The aim of the current study was to test a model including clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties to understand eating disorder symptoms in an adolescent community sample. Adolescents (N = 446, M age = 16.25 years, SD = 1.64; 74.2% female) completed measures of clinical perfectionism, self-esteem, mood intolerance, interpersonal difficulties, and eating disorder symptoms. Path analysis indicated clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties were all directly associated with symptoms of eating disorders, and that clinical perfectionism was indirectly associated with eating disorders through self-esteem, mood intolerance, and interpersonal difficulties. The results indicate the cognitive-behavioural model of eating disorders can be applied to adolescents in the community with symptoms of eating disorders. Directional causality between constructs should be established to understand whether increased clinical perfectionism, and reduced self-esteem, mood intolerance, and interpersonal difficulties are vulnerabilities to the development and maintenance of eating disorders.
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Many outpatient physicians and patients feel that current scheduling systems do not afford enough time for direct patient-physician interaction, leaving patients feeling unheard and physicians feeling demoralized. This dissatisfaction degrades patients' trust in the health care system and contributes to workforce moral injury and burnout. In the hopes of understanding the roots of this time stress and helping to guide future decisions about how to organize physicians' time, this article describes changes in the organization of U.S. outpatient physicians' time, starting from care at home in the late 19th century. It discusses the origins of the appointment system, which was invented to be highly personalized, with assistants adjusting appointment durations to accommodate clinical activities, specific patient needs, and individual physician proclivities. The article then describes how centralization of appointment scheduling became more common as U.S. medicine became increasingly consolidated into larger and larger groups and health systems. This distanced schedulers from the people and care they were organizing and necessitated standardized appointment durations, which did not accommodate individual patient and physician needs. With the rise of managerialism, schedulers became increasingly accountable to administrators rather than patients and physicians. Whereas early appointment systems depended on personal connection between schedulers and the physicians and patients they supported, today's schedulers have few such interactions. The widespread shift to centralized scheduling and standardized time slots has contributed to misalignment among time allocation, patient care, and health care workforce well-being and is likely exacerbating ongoing tensions among patients, physicians, and administrators.
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Assistência Ambulatorial , Agendamento de Consultas , Humanos , Assistência Ambulatorial/organização & administração , Estados UnidosRESUMO
BACKGROUND: Medical humanities courses that incorporate the visual arts traditionally require in-person instruction and visits to museums. The COVID-19 pandemic afforded medical educators a unique opportunity to implement and evaluate virtual visual arts programming. METHODS: A two-week, 7-module visual arts and medicine elective course for third and fourth-year medical students was conducted virtually in the Spring of 2021. The course included traditional didactic components as well as a range of hands-on creative art activities including painting, graphic medicine, photovoice, and Kintsugi (Japanese craft). Digital tools including Canvas, Google Jamboard, and Zoom facilitated student engagement. Student feedback was collected through anonymous post-course surveys. RESULTS: We successfully conducted a virtual visual arts and medicine elective which integrated hands-on creative art activities. Most students "strongly agreed" that remote instruction was sufficient to meet course objectives. However, all students also "agreed" that in-person instruction may promote more in-depth engagement with the visual arts. The hands-on creative art activities were appreciated by all students. CONCLUSION: Visual arts-based medical humanities courses can be delivered virtually and can include hands-on creative art activities such as painting. Future visual arts and medicine courses may benefit from incorporating a range of pedagogical methodologies, digital tools, control groups, and pre-/post-course assessments.
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COVID-19 , Estudantes de Medicina , Currículo , Ciências Humanas/educação , Humanos , PandemiasRESUMO
OBJECTIVE: Using the Emotional Cascade Model as a theoretical framework, this study tested whether the relationship between perfectionism and non-suicidal self-injury (NSSI) operates through rumination and negative affect. Additionally, we tested whether the associations between perfectionism and both rumination and negative affect are moderated by attention control. METHODS: Using a correlational cross-sectional design, adults aged 18-25 with (N = 197) and without (N = 271) a history of NSSI completed measures of perfectionism, rumination, negative affect, attention control, and NSSI. RESULTS: Perfectionism was directly associated with increased odds of NSSI, and indirectly associated with odds of NSSI through rumination and negative affect. The relationship between perfectionism and rumination was moderated by attention focusing, such that the relationship was stronger for individuals who were higher in attention focusing. CONCLUSION: Integrating perfectionism and attention with existing models of NSSI may improve understanding of the factors contributing to NSSI and offers insights into future clinical directions.
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Perfeccionismo , Comportamento Autodestrutivo , Adolescente , Adulto , Atenção , Estudos Transversais , Emoções , Humanos , Comportamento Autodestrutivo/psicologia , Adulto JovemRESUMO
Victor C. Vaughan (1851-1929) was a noted medical educator, microbiologist, and active proponent for the idea of eugenics. Vaughan spent his career at the University of Michigan, where he served as Medical School Dean for many years. He lectured widely on the importance of "race betterment" and actively supported passage of state legislation that led to over 3,000 sterilizations in the state of Michigan. After his death, Vaughan's name was applied to student organizations, endowed chairs, buildings, and more. This paper considers how the use of Vaughan's name not only reflected Vaughan's support of eugenics but also gendered and racialized ideas about what it means to be a physician. We conclude that the use of any name from the past carries meanings about what our values are in the present and that, if there was ever a moment to celebrate the life of Victor Vaughan, that moment has passed.
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Bereavement is commonly experienced by students in higher education and is associated with negative health and academic consequences. We conducted a systematic review of the literature to identify how grief affects students in higher education and the types of support they seek and/or find beneficial. A search of Health Collection, Medline, CINAHL Plus, Web of Science, Taylor and Francis online, ProQuest, and Open Grey resulted in 30 articles that met inclusion criteria. A narrative synthesis resulted in 11 themes focused on the university experience following bereavement (six themes) and supports following bereavement (five themes). Our review highlights how grief symptoms can have a negative impact on bereaved students' academic and social experiences. These difficulties are exacerbated by barriers to accessing grief supports, and unhelpful responses from staff and peers. Students' grief is often disenfranchised and so students learn to avoid grief related emotions, communications, and support-seeking.
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Burnout in medicine is a substantial problem with adverse consequences for both physicians and the patients who they treat. In our efforts to combat burnout, we must consider every tool at our disposal, since a complex problem requires a multifaceted approach. Recognizing that many physicians derive meaning from spirituality and religion, attempts to improve physician and trainee wellness should acknowledge the importance of religion and spirituality for self-care more than has heretofore been the case.
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Esgotamento Profissional , Médicos , Esgotamento Profissional/prevenção & controle , Humanos , Religião , EspiritualidadeRESUMO
The coronavirus disease 2019 pandemic led to some of the most drastic changes in clinical care delivery ever seen in the United States. Almost overnight, providers of prenatal care adopted virtual visits and reduced visit schedules. These changes stood in stark contrast to the 12 to 14 in-person prenatal visit schedule that had been previously recommended for almost a century. As maternity care providers consider what prenatal care delivery changes we should maintain following the acute pandemic, we may gain insight from understanding the evolution of prenatal care delivery guidelines. In this paper, we start by sketching out the relatively unstructured beginnings of prenatal care in the 19th century. Most medical care fell within the domain of laypeople, and childbirth was a central feature of female domestic culture. We explore how early discoveries about "toxemia" created the groundwork for future prenatal care interventions, including screening of urine and blood pressure-which in turn created a need for routine prenatal care visits. We then discuss the organization of the medical profession, including the field of obstetrics and gynecology. In the early 20th century, new data increasingly revealed high rates of both infant and maternal mortalities, leading to a greater emphasis on prenatal care. These discoveries culminated in the first codification of a prenatal visit schedule in 1930 by the Children's Bureau. Surprisingly, this schedule remained essentially unchanged for almost a century. Through the founding of the American College of Obstetricians and Gynecologists, significant technological advancements in laboratory testing and ultrasonography, and calls of the National Institutes of Health Task Force for changes in prenatal care delivery in 1989, prenatal care recommendations continued to be the same as they had been in 1930-monthly visits until 28 weeks' gestation, bimonthly visits until 36 weeks' gestation, and weekly visits until delivery. However, coronavirus disease 2019 forced us to change, to reconsider both the need for in-person visits and frequency of visits. Currently, as we transition from the acute pandemic, we should consider how to use what we have learned in this unprecedented time to shape future prenatal care. Lessons from a century of prenatal care provide valuable insights to inform the next generation of prenatal care delivery.
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Atenção à Saúde/normas , Guias de Prática Clínica como Assunto , Cuidado Pré-Natal/normas , Atenção à Saúde/tendências , Feminino , Humanos , Gravidez , Cuidado Pré-Natal/tendências , Estados UnidosRESUMO
The potentiation of neural activity in lateral prefrontal regions via transcranial direct current stimulation (tDCS) can reduce patterns of biased attention for threat and may facilitate intentional emotion regulation. The current study sought to determine whether left dorsolateral prefrontal cortex tDCS, in combination with intentional down-regulation of emotional responses would reduce negative appraisals of aversive content during emotional regulation (assessed during online tDCS), reduce patterns of biased attention and attention bias variability (assessed offline), and attenuate spontaneous (uninstructed) emotional reactivity to negative content (assessed offline) above tDCS or intentional down-regulation of emotions in isolation. Healthy participants (n = 116) were allocated to one of four experimental conditions involving either active or sham tDCS, combined with an either a down-regulate or maintain emotion regulation task. Attention bias/bias variability was assessed with an attentional probe task, and emotional reactivity was assessed in a negative video viewing task. tDCS did not affect the appraisals of negative stimuli during emotion regulation, and there were no effects on attention bias/bias variability. However, tDCS did attenuate emotional reactivity. Those receiving active stimulation showed smaller elevations in negative mood in response to viewing aversive video content compared with sham. The present findings are consistent with the potential of left frontal tDCS to attenuate negative emotional reactions to aversive content but provide no support for tDCS enhancement of emotion regulation, nor its impact on attention bias or attention bias variability.
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Viés de Atenção , Regulação Emocional , Estimulação Transcraniana por Corrente Contínua , Emoções , Humanos , Córtex Pré-FrontalRESUMO
The professional autonomy of physicians often requires they take responsibility for life and death decisions, but they must also find ways to avoid bearing the full weight of such decisions. We conducted in-person, semi-structured interviews with neonatologists (n = 20) in four waves between 1978 and 2017 in a single Midwestern U.S. city. Using open coding analysis, we found over time that neonatologists described changes in their sense of professional autonomy and responsibility for decisions with life and death consequences. Through the early 1990s, as neonatology consolidated as a profession, physicians simultaneously enjoyed high levels of professional discretion and responsibility and were often constrained by bioethics and the law. By 2010s, high involvement of parents and collaboration with multiple subspecialties diffused the burden felt by individual practitioners, but neonatology's professional autonomy was correlatively diminished. Decision-making in the NICU over four decades reveal a complex relationship between the professional autonomy of neonatologist and the burden they bear, with some instances of ceding autonomy as a protective measure and other situations of unwelcomed erosion of professional autonomy that neonatologists see as complicating provision of care.
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Neonatologia , Médicos , Tomada de Decisões , Humanos , Neonatologistas , Autonomia Profissional , Pesquisa QualitativaRESUMO
BACKGROUND: Arts exposure is associated with positive psychological constructs. To date, no randomized, controlled studies have integrated art into clinical medical education or measured its effects on positive psychological constructs or educational outcomes. In this study, we assessed the possibility and potential benefits of integrating visual arts education into a required internal medicine (IM) clinical clerkship. METHODS: We conducted a controlled trial in an academic healthcare system with an affiliated art museum. IM students were assigned to one of three interventions: museum-based arts (n = 11), hospital-based arts (n = 10), or hospital-based conventional education (n = 13). Arts groups explored empathy, resilience, and compassion in works of art during facilitator-guided discussions. We assessed pre- and post-intervention measures of empathy, mindfulness, tolerance of ambiguity, and grit and tracked National Board of Medical Examiners IM shelf exam performance to capture changes in educational outcomes. Focus group discussions with participants in the arts-based interventions were performed at the study's conclusion. RESULTS: Arts education was successfully integrated into a busy clinical clerkship in both hospital and art museum settings. Focus group participants reported increased implicit bias cognizance and time for reflection, but no significant differences in psychometric or educational outcomes were identified. While most students felt positively toward the experience; some experienced distress from missed clinical time. CONCLUSIONS: This pilot study demonstrates the feasibility of integrating visual arts education into the clerkship. Although observable quantitative differences in measures of positive psychological constructs and educational outcomes were not found, qualitative assessment suggested benefits as well as the feasibility of bringing fine arts instruction into the clinical space. A larger, multi-center study is warranted.
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Arte , Estágio Clínico , Educação Médica , Empatia , Humanos , Projetos PilotoRESUMO
The construct of perfectionism has been argued to consist of two factors, perfectionistic concerns and perfectionistic strivings. Though perfectionistic concerns are consistently associated with adverse outcomes, the evidence for perfectionistic strivings is mixed. Item cross-loadings of the two-factor model of perfectionism raise questions about whether the two factors assess both common and distinct aspects of perfectionism. The present study aimed to clarify the structure of the Frost Multidimensional Perfectionism Scale and the Clinical Perfectionism Scale, by comparing single-factor, two-factor, and bifactor models in a community sample (N = 397). Findings provided greater support for the bifactor model, relative to the two-factor or one-factor models, for the Frost Multidimensional Perfectionism Scale and the Clinical Perfectionism Scale. In each bifactor model, the general factor was positively associated with symptoms of depression, anxiety, and stress, while the perfectionistic strivings group factor was negatively associated with depression. Results suggest the bifactor model best represents the structure of perfectionism and provide additional support for the use of a general factor score in clinical treatment and research examining perfectionism.
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Ansiedade/psicologia , Depressão/psicologia , Perfeccionismo , Estresse Psicológico/psicologia , Adolescente , Adulto , Idoso , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Angústia Psicológica , Psicometria , Inquéritos e Questionários , Adulto JovemRESUMO
Fiberoptic endoscopy was developed at the University of Michigan in the 1950s by gastroenterology fellow Basil Hirschowitz and 2 physicists. Previous methods to visualize the gastrointestinal lumen used rigid instruments that relied on rudimentary optical systems. They were limited in reach and caused patients considerable discomfort. Fiberoptic technology dramatically changed endoscopic practice. The fiberoptic endoscope, or fiberscope, was a flexible instrument that allowed direct inspection of the gastrointestinal lumen. Although many practicing endoscopists initially resisted its adoption, the fiberscope ultimately held sway. Studying the period from the fiberscope's first introduction in the late 1950s to its more widespread acceptance in the late 1960s may help us understand how a new technology makes its way into routine clinical practice.
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Endoscopia Gastrointestinal/história , Tecnologia de Fibra Óptica/história , Endoscopia Gastrointestinal/instrumentação , Tecnologia de Fibra Óptica/instrumentação , História do Século XX , Estados UnidosRESUMO
American cultural diplomacy played a key role in the institutionalization of Brazilian cardiology. In 1942, Frank Wilson, an internationally recognized pioneer in electrocardiography, made an extended wartime visit to Rio de Janeiro and São Paulo. The visit was sponsored by the United States Department of State as part of Roosevelt's Good Neighbor Policy and brought Wilson together with a group of physicians who would establish the specialty of cardiology in Brazil. This US cultural and diplomatic initiative strengthened an academic network that was already evolving and would eventually prove to be of benefit to both sides. Latin American physicians began in the 1920s to visit Wilson's laboratory at the University of Michigan, where they established the relationships on which Wilson would build. While affiliation with the "Wilson school" advanced the cause of Brazilian cardiologists who sought to establish themselves as specialists, cooperation with Latin American physicians benefitted Wilson in his pursuit of wider recognition for his innovations in the use of electrocardiography (ECG). Wilson's identity as a scientific ambassador to Latin America helped in legitimating his approach to the clinical application of the ECG. A close examination of Wilson's relationship to Brazilian cardiology demonstrates the role played by science and medicine as a part of wartime cultural diplomacy, as well as the dynamics of the transnational circulation of scientific knowledge and practices.
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Cardiologia/história , Diplomacia , Eletrocardiografia , Medicina , Guerra , Brasil , História do Século XX , Humanos , Estados UnidosRESUMO
Western medicine has long been dominated by a faith in the value of science and a belief in the power of technology. I study the history of how technology came to be seen as useful by focusing on one of the most dramatic new tools ever discovered: the X-ray machine. I use a statistically valid sampling of case records from 1900-1925 at the Pennsylvania Hospital to ask why and when physicians at these hospitals came to see X-rays as useful for patient care. Soon after the X-ray's 1895 invention there was seemingly worldwide agreement that it could be used to diagnose common conditions such as fractures and foreign bodies. However, it was only several decades later, after the underlying structure of the hospital changed due to importation of technologies from business, that X-ray images became seen as part of routine patient care.