Medical Education Empowered by Theater (MEET)

Exploring Untested Feasibilities: Critical Pedagogy's Approach to Addressing Abuse and Oppression in Medical Education

Abuse and oppression in medical education persists. Particularly when transitioning to practice, students and residents face dissonance between what they perceive as the ideals of patient care and reality. They witness, and eventually take part in, joking about fellow students and patients, discriminating against minorities, and imposing unbearable workload to subordinates, to mention some practices that have been normalized as the reality of medical training, beyond any possibility of change. We suggest that Critical Pedagogy, an educational movement rooted in Brazil that aims to empower learners and educators as full citizens, can help medical education reinstitute hope for a more humanistic culture by testing new realistic transformative actions, i.e., untested feasibilities, to promote change. We use vignettes based on real situations of oppression to present three concepts of Critical Pedagogy contextualized to medical education: (a) critical consciousness as praxis; (b) pedagogy with learners; and (c) education as a democratic relationship between individuals. The vignettes explore how each one of these concepts can support educators and learners to break chains of injustice and oppression. Perceiving disagreements as opportunities for change, legitimizing the perspectives and values of all engaged in analyzing reality, is needed to nurture critical consciousness. Critical Pedagogy understands education as a partnership of trust between learners and educators and seeks a pedagogy that is built with learners, not on them. Finally, we present suggestions for individual- and systems-level actions that can translate these principles of Critical Pedagogy into a praxis of untested feasibilities for medical education.

An evidence-informed pedagogical approach to support professional identity formation in medical students: AMEE Guide No. 171

There is a long and impressive scholarly history evidencing why it is important to address professional identity formation (PIF) in medical curricula. In this AMEE Guide, the authors present an evidence-informed pedagogical approach to assist educators in developing educational practices to foster a healthy PIF in medical students. The authors first describe the theoretical framework that underpin this approach. At the core of this framework is the recognition that, for a healthy PIF, students need to become aware that they have the autonomy, but also responsibility, to form their professional identity in a way that fits both their personality and their (future) professional role. In other words, students need to learn to navigate the interplay between socialization and subjectification. Next, the authors outline the six-step structure of their pedagogical approach, designed to help students: (1) undergo a PIF-related experience, (2) observe their responses to the experience, (3) externalize their reflections, (4) share their reflections, (5) broaden their perspective, and (6) explore their freedom of choice through experimentation. The authors also describe six conducive conditions to facilitate the implementation of the pedagogical approach. These conditions include (1) creating a setting that enables students to slow down, (2) adopting a longitudinal approach, (3) making it part of the formal curriculum, (4) refraining from grading, (5) establishing an interdisciplinary expert team, and (6) providing teacher training. The authors conclude that the theoretical framework leads to a coherent and consistent pedagogical approach that, when implemented according to the conducive conditions, enables students to gradually internalize the reflective process and help them to cultivate a reflective attitude towards their PIF.

Perception and reaction of undergraduate critical disability studies students to six short films depicting neuro-advancements

Advancements in neurosciences and neurotechnologies pose various ethical and social challenges, warranting public/stakeholder engagement. Art, such as short films, can expose audiences to the social aspects of neuro-advancements. The 2019 BIO·FICTION Film Festival, for instance, examined how neurotechnologies shape society, the human body, and mind. Students are one important group of stakeholders, as they are expected to be critical thinkers and change agents. The lived reality of disabled people is impacted by neuro-advancements in many ways. Critical disability studies students are therefore key stakeholders, as their programs and courses encourage them to identify and address social challenges faced by disabled individuals. Therefore, they need to be able to evaluate the social impacts of neuro-advancements. Few studies exist that ascertain the views of critical disability studies students on the social impact of neuro-advancements. Our study sought to amplify the voices of critical disability studies students by analyzing the responses of 89 undergraduates from three courses to six top films from the BIO·FICTION festival. Conducted asynchronously due to COVID restrictions, students watched the films independently and responded to four guiding questions about: a) general thoughts about the films, b) their perceived impact on those watching, c) implications for their anticipated careers involving disabled people, and d) the social impact of neuro-advancements on disabled people. Our findings indicated that the topical (non-)fictional short films effectively prompted students to reflect on the social aspects of neuro-advancements and were well received. However, responses also indicated a need for follow-up discussions - virtual or in-person - to address questions about film content and deepen the discussion and class engagement. Such discussion setups could also inform film festivals aiming to raise awareness about the societal implications of emerging technologies.

Effectiveness of educational theater on nursing assistants' empathy in long-term care facility: A mixed methods study

Empathy plays a critical role in the care provided by nursing assistants (NAs) in long-term care (LTC) settings, directly influencing resident satisfaction and well-being. This mixed methods study evaluates the effectiveness of educational theater (ET) in enhancing empathy among 86 NAs in northern Taiwan. Quantitative assessments using pre- and post-intervention questionnaires showed no statistically significant improvements in empathy scores, but the ET group reported higher satisfaction compared to those receiving traditional lectures. Educational level and prior training significantly influenced pre-test empathy scores, favoring those with higher education or empathy-related training. Qualitative analysis of reflective writings and a focus group interview identified key themes: behavior recognition, understanding residents' perspectives, empathy development, and conflict resolution skill enhancement. These findings highlight ET's potential to enhance empathy-related learning for NAs, advocating for tailored empathy education in LTC settings.

When I say … improvisation

The art of improvisation is linked to the art of living to argue that learning improvisation is crucial to medical education; it connects expectation with intentional action geared toward engaging together.

Theatre of the Oppressed to Teach Medical Students About Power, Lived Experience, and Health Equity

BACKGROUND

A difficult challenge in health equity training is conducting honest and safe discussions about differences in lived experience based on social identity, and how racism and other systems of oppression impact health care.

OBJECTIVE

To evaluate a Theatre of the Oppressed workshop for medical students that examines systems of oppression as related to lived health care experiences.

DESIGN

Mixed-methods cross-sectional survey and interviews.

PARTICIPANTS

Forty randomly assigned early first-year medical students.

INTERVENTIONS

A 90-min virtual workshop with three clinical scenes created by students where a character is being discriminated against or oppressed. During performance, students can stop scene, replace oppressed character, and role play how they would address harm, marginalization, and power imbalance. Participants discuss what they have witnessed and experienced.

MAIN MEASURES/APPROACH

Likert-scale questions assessing workshop's impact. Open-ended survey questions and interviews about workshop.

KEY RESULTS

Thirty-one (78%) of 40 participants completed the survey. Fifty-three percent were female. Thirty-seven percent were White, 33% Asian American, 15% Black, 11% Latinx, and 4% multiracial. Ninety percent thought this training could help them take better care of patients with lived experiences different from their own. Most agreed or strongly agreed the workshop helped them develop listening (23, 77%) and observation (26, 84%) skills. Twelve (39%) students felt stressed, while 29 (94%) felt safe. Twenty-five (81%) students agreed or strongly agreed there were meaningful discussions about systemic inequities. Students reported the workshop helped them step into others' shoes, understand intersectional experiences of multiple identities, and discuss navigating and addressing bias, discrimination, social drivers of health, hierarchy, power structures, and systems of oppression. Some thought it was difficult to have open discussions because of fear of being poorly perceived by peers.

CONCLUSIONS

Theatre of the Oppressed enabled medical students to engage in meaningful discussions about racism and other systems of oppression.

Adopting a pedagogy of connection for medical education

In this article, we propose developing a "pedagogy of connection" based on the history and evolution of medical education in Brazil. This pedagogy emerged from the intersection of the healthcare and higher educational systems, both dedicated to the principles of social justice and universal access, in response to the country's efforts to address the enduring impacts of slavery and social inequality. Following the "Sanitary Reformation" movement-a foundational moment for Brazil's healthcare and medical education systems-Brazil established the Unified Public Healthcare System (Sistema Único de Saúde - SUS). SUS is founded on principles of universality, integrality, equity, community participation, political and administrative decentralisation, hierarchisation and regionalisation. Aligned with these core principles and inspired by critical pedagogy, Brazilian medical education has evolved with a profound commitment to social justice, critical consciousness, professional presence and compassion. This evolution has given rise to a "pedagogy of connection," which imbues medical education with a sense of purpose and joy, preparing future medical professionals to address the challenges of our ever-evolving society and healthcare systems. The connections fostered by this pedagogy occur in complementary dimensions: (a) healthcare system and society, (b) community, (c) profession, (d) patients, and (e) ourselves. This innovative pedagogy enhances medical education discourse and practice by emphasising the development of a professional identity grounded in social justice and patient-centred care, which remain challenges for current medical education systems. As the global medical education community embraces decolonisation, this pedagogy offers a framework that can be adapted and enriched in various contexts worldwide, fostering opportunities for mutual learning from diverse educational systems in a dialogical and democratic manner.

Pedagogies of discomfort and disruption: A meta-narrative review of emotions and equity-related pedagogy

INTRODUCTION

Discussions about equity in professional education can evoke a range of complex emotions. Approaches to emotionally challenging pedagogies may vary across professions. Comparative explorations of these approaches may yield fresh insights that could enhance our teaching and learning strategies within health professions education. Therefore, the authors sought to explore how the professional contexts of medicine, nursing and teacher education approach the role of emotions in equity-related pedagogy.

METHODS

A meta-narrative approach was utilised to synthesise existing research on the relationship between emotions and equity-related pedagogy in three different professions. Six databases were searched using key terms yielding 3102 titles. After screening, 58 articles were selected for extraction. Through coding and analysis, the authors sought to gain a deeper understanding of why emotions are relevant to equity-related pedagogy in each profession, and how each profession grapples with emotional dissonance.

RESULTS

There were both contrasting and complimentary meta-narratives about emotions and equity-related learning in medicine, nursing and teacher education. All three professions viewed emotions as relevant and essential for equity-related learning. Medicine and nursing sought to make emotions accessible and explicit, while foregrounding the need for learners to build skills to understand and address emotions such as critical reflection and dialogue. Meta-narratives in teacher education were similar to medicine and nursing; however, teacher education further emphasised the role of emotions in fostering community, trust and empathy.

DISCUSSION

Existing meta-narratives regarding emotions and equity-related pedagogy in health professions suggest that medicine and nursing have acknowledged the intrinsic role that emotions play in equity-related learning yet lag behind teacher education in considering the role of emotions as a socio-cultural connector and mediator.

The association between empathy and artistic practice: a cross-sectional study with medical students

BACKGROUND

Empathy is essential to medical practice, and efforts to cultivate it often include incorporating liberal arts into medical curricula to promote it. However, the association between empathy and engagement in artistic practice beyond the medical curricula remains unclear. This study aims to assess the association between medical students´ empathy and their engagement in artistic activities.

METHODS

Students enrolled at 11 Portuguese medical schools were invited to participate in an online survey. The survey included questions about their artistic practice, and the Interpersonal Reactivity Index (IRI) to measure empathy.

RESULTS

A total of 450 medical students completed the survey. 158 students (35%) were actively engaged in the arts, 118 of which practiced music (75%). Participants involved in artistic activities demonstrated significantly higher scores in the Fantasy subscale compared to their peers. Participants engaged in multiple artistic activities scored significantly higher in overall IRI, as well as in Empathic Concern and Fantasy subscales, compared to those practicing only one artistic activity. Participants who began their artistic practice earlier tended to achieve higher scores in overall IRI and on the Empathic Concern subscale.

CONCLUSIONS

The present study highlights a significant positive association between artistic practice and empathy levels among medical students. Further research is recommended to clarify this association, potentially informing revisions to medical school curricula.

Assessing Cultural Intelligence in PharmD Education Through Art

OBJECTIVE

This study, conducted in collaboration with the University of North Carolina (UNC)-Chapel Hill's Ackland Art Museum, assessed student experiences in a facilitated visual art experience designed to foster cultural intelligence among 143 first-year Doctor of Pharmacy students at the UNC Eshelman School of Pharmacy.

METHODS

A post-event survey was used to collect data on student perceptions of this experience and its implications. Quantitative items were analyzed using descriptive statistics. Qualitative items were deductively coded using the 4 domains of the Cultural Intelligence Framework: cultural awareness, cultural knowledge, cultural practice, and cultural desire. A convergent parallel mixed-methods approach was used to gain a deeper understanding of the data.

RESULTS

Of the 143 students who completed the survey (response rate = 99%), nearly all agreed (n = 60, 42%) or strongly agreed (n = 70, 49%) that the art experience was valuable. Students indicated that it increased their confidence in having open dialogue concerning equity, inclusivity, and race, expanded their perspectives about the implications of inequities, and provided knowledge they can apply in their careers as health science professionals. Findings revealed students' acknowledgment of their own backgrounds, enhanced understanding of bias and historical contexts, recognition of relevance to pharmacy practice, and expressed a desire for further cultural understanding.

CONCLUSION

This research underscores the potential of visual art and museum partnerships in fostering positive perceptions and beliefs about cultural intelligence among aspiring pharmacists.

When Play Reveals the Ache: Introducing Co-constructive Patient Simulation for Narrative Practitioners in Medical Education

Despite the ubiquity of healthcare simulation and the humanities in medical education, the two domains of learning remain unintegrated. The stories suffused within healthcare simulation have thus remained unshaped by the developments of narrative medicine and the health humanities. Healthcare simulation, in turn, has yet to utilize concepts like co-construction and narrative competence to enrich learners' understanding of patient experience alongside their clinical competencies. To create a conceptual bridge between these two fields (including narrative-based inquiry more broadly), we redescribe narrative competence via Ronald Heifetz's distinction of "technical" and "adaptive" challenges outlined in his adaptive leadership model. Heifetz, we argue, enriches learners' self-understanding of the unique demands of cultivating narrative competence, which can be both elucidated on the page and tested within the charged yet supportive simulation environment. We introduce Co-constructive Patient Simulation (CCPS) to demonstrate how working with simulated patients can support narrative work by drawing on the clinical vicissitudes of learners in the formulation and enactment of case studies. The three movements of CCPS-resensing, retelling, and retooling-told through learner experiences, describe the affinities and divergences between narrative medicine's sequence of attention, representation, and affiliation; Montello's three forms of narrative competence (departure, performance, change), and Heifetz's three steps (observe, interpret, and intervene) of adaptive leadership.

Redefining the Role of Medical Affairs Professionals as Innovators and Leaders in Industry-Led Medical Education

Medical affairs professionals are pivotal players at the intersection of medical innovation and practice in the pharmaceutical industry. They are uniquely positioned to translate complex medical knowledge into actionable insights for internal and external stakeholders. Industry-led continuing medical education (CME) programs, guided by these professionals, hold the potential to markedly improve clinicians' application of evidence-based medicine (EBM) in clinical settings, thereby elevating patient care outcomes. However, current CME techniques often overlook the integration of diverse disciplines such as educational theories, cognitive psychology, information mastery, and implementation science, which are important for effective real-time decision-making in patient care. This gap in integrating implementation science is vital, as it is key in ensuring that medical innovations are not just developed but also effectively implemented and efficiently utilized in clinical settings. In this opinion article, we aim to highlight the crucial yet often underrecognized role of medical affairs professionals in shaping robust and practical CME programs within the industry. We explore emerging trends and approaches in medical education and CME based on the principles of adult education. Additionally, we explore how medical affairs professionals can effectively drive the adoption of EBM in clinical practice. This exploration aims to provide insights into enhancing CME programs, with medical affairs professionals at the forefront of innovation and leadership in bridging gaps in clinical practice.

Co-Constructive Patient Simulation as an Experiential Tool for Continuing Professional Development in Healthcare

In this commentary, we examine how to use the recently developed educational method called Co-constructive Patient Simulation (CCPS) to improve continuous professional development in healthcare. CCPS invites learners to participate in the creation of meaningful simulated scenarios while fostering reflection-in/on/for-action and community-building. By participating in the creation of the simulated scenarios, learners guarantee that the challenges addressed by the learning activities are aligned with their developmental stages and needs. Additionally, as learners may invite supervisors to take the "hot seat" during the simulation session, the CCPS approach allows learners to witness how supervisors would handle situations perceived as challenging. This exchange of roles creates an opportunity for camaraderie, as supervisors expose themselves and assume a vulnerable position. This camaraderie facilitates educational bonding and community building. As a result, in this participatory and co-creative approach to simulation, experts become the facilitators of a learner-centred activity, which increases motivation and allows tailored and contextualised learning. This co-constructive approach to simulation adds to the repertoire of more traditional CPD strategies by fostering spontaneity and authenticity. It integrates learning opportunities in clinical practice, amplifies learner's critical reflection and autonomy, and harnesses real-life challenges to offer meaningful solutions to lifelong learning. The democratic environment optimised by experts joining the activity and sharing their vulnerabilities with trainees further catalyzes the creation of a community for teaching, learning, and shared development.

What affects you? A conversation analysis of exploring emotions during reflection sessions in Dutch general practitioner training

Introduction

In Dutch training for general practitioners (GPs), reflection on professional practice is key to their training. Such reflection is considered beneficial for professional development, especially when it entails discussing the emotional dimension of practice experiences. In the GP context, invitations to share the emotional side of things, such as "how did that make you feel?" are considered functional; yet, they are also sometimes viewed by participants as 'grilling', 'just too much' or 'too intimate'. Put shortly, putting emotions on the table is institutionally embedded in the GP reflection context, but not always straightforward. Thus, we ask: 'how do teachers and GP residents invite talk about emotions in educational reflection sessions?'.

Methods

In this study, we explored the Dutch phrase 'raken, geraakt worden' (being affected) as one interactional practice used to initiate emotion talk. We conducted a conversation analytic collection study of instances of this phenomenon based on 40 video recordings of hour-long 'reflection sessions' at the Dutch GP specialty training. During these sessions, approximately ten GPs in training discuss recent experiences from medical practice under supervision of one or two teachers.

Results

We found that participants orientated to the relevance of 'being affected' as a topic for discussion. Variations of the form 'what affects you now?' may contribute to putting emotions on the table; they can project a stepwise exploration of the emotional dimension of an experience. The 'what affects you now', often done in interrogative format doing a noticing, in combination with a request, is a powerful tool to instigate transformative sequences. The form is less effective to put emotions on the table when the topic shift it initiates is not grounded in previously presented personal stakes or displayed emotion.

Discussion

The study's findings show how detailed interactional analysis of one sequentially structured practice can benefit education and contribute to theory on emotions and reflection. The mobilizing power of 'what affects you' can serve institutional purposes by doing topical work in relation to educational aims, while its power can also be deflated when prior talk does not project the relevance of unpacking the emotional dimension of an experience. Its interactional workings may translate to other helping contexts as well.

Drama Training as a Tool to Teach Medical Trainees Communication Skills: A Scoping Review

PURPOSE

Recognizing the similarities between the skills an actor needs and those required of a physician in clinical communication, medical educators have begun to create drama-based interventions to teach communication skills. The purpose of this scoping review was to summarize existing educational interventions that use drama training to teach medical trainees communication skills.

METHOD

The authors searched PubMed, CINAHL Plus, Embase, ERIC, and Web of Science Core Collection multiple times beginning in March 2020 through March 2022. Articles were included if they (1) described components of an educational intervention, (2) used an active intervention based on drama training, (3) stated a curricular goal of improving learners' communication skills, and (4) included medical trainee learners. Data extracted included the details of the targeted learners and educational interventions, assessment tools, and outcomes. The quality of each study was assessed.

RESULTS

Thirty articles met the inclusion criteria. Twenty-five (83%) articles included acting and improvisation exercises, 9 (30%) used some or all of the conventions of forum theater, and 3 (10%) used dramatic performance. The interventions included undergraduate, graduate, and continuing medical education learners. Most were elective and involved a member of the theatrical community. Although low overall study quality (average MERSQI score was 8.5) limited the strength of the evidence, of the 8 articles that evaluated learners' knowledge, skills, and/or behaviors, the majority showed an initial improvement in communication skills post-intervention.

CONCLUSIONS

This review is the first, to the authors' knowledge, to focus on the curricular goal of improving communication skills and to include a broader scope (beyond medical improv) of drama trainings. While the included articles represent a diverse group of interventions, generally they reported an outcome of improved communication skills in their learners. More high-quality studies are needed to determine best practices and the generalizability of drama-based initiatives.

CHATogether: a novel digital program to promote Asian American Pacific Islander mental health in response to the COVID-19 pandemic

BACKGROUND

In response to the COVID-19 pandemic and the associated rise in anti-Asian hate crimes, we developed the Compassionate Home, Action Together program, (CHATogether) to support the mental health of the Asian American and Pacific Islander (AAPI) community. CHATogether is a culturally informed and virtually delivered support program that harnesses the talents of AAPI teens, young adults, parents, and mental health professionals who share a commitment to serve their local communities.

METHODS

Our objective was to identify the active components, optimal utilization, potential benefits, and pertinent limitations of the CHATogether program during the 3 years since its inception in 2019. By that time, the program had developed six distinct component arms: interactive theater, mental health education, research, peer support and community outreach, collaboration, and AAPI mentorship. To work towards this objective, we conducted a qualitative study using thematic analysis and an inductive approach based on grounded theory (GT), in which we analyzed anonymized transcripts of four focus groups, comprised of 20 program participants (11 females; 9 males).

RESULTS

We developed a model of two overarching domains, each with three underlying themes: I. Individual stressors: (1) Family conflict; (2) Cultural identity; and (3) Pandemic impact; and II. Collective stressors: (1) Stigma related to mental health and illness; (2) Pandemic uncertainty; and (3) Xenophobia and societal polarization. Strengths of the CHATogether program include its role as a conduit toward AAPI connectedness and pride as well as purpose in building community. Through support and mentorship, the program cultivates a unique platform that promotes healing and resiliency in response to pandemic stressors and beyond.

CONCLUSIONS

CHATogether creates a safe space for the AAPI community. Through its methods of storytelling and encouraging creativity, CHATogether facilitates the discussion of challenging topics specific to the AAPI community. Given the national mental health crisis that is further being exacerbated by the COVID-19 pandemic, a digital prevention program such as CHATogether holds promise towards providing access to mental health resources and supporting early help-seeking behaviors for individuals in the AAPI community.

Acting to teach communication skills to nurses

BACKGROUND

Interpersonal and communication skills are core competencies for nursing students. Empathetic, patient-centred communication improves patient outcomes and the care experience. Nursing trainees have reported a lack of preparation and confidence in communication and interpersonal skills with patients and members of the health care team. Acting-based hands-on training may provide a novel approach to develop communication in nursing students.

APPROACH

The corresponding author worked as a professional actor before pursuing a medical career. He created an acting-based workshop, inspired by classic acting exercises taught in drama conservatories for decades, to develop core communication and interpersonal skills for health care professionals. The course creator and an instructor with no acting background each facilitated the workshops. The initiative was taught to over 200 preclinical baccalaureate freshmen and sophomore nursing students as part of their clinical skills courses at one institution.

EVALUATION

Participants were asked to rate their self-efficacy for skills developed in the workshop using a 5-point Likert scale. A 4 or 5 rating was considered agreement. Most participants agreed the workshop developed their skills of self-awareness, observation, teamwork, flexibility, nonverbal and verbal communication, trust, mindfulness, body language awareness, active listening, and sensitivity to emotions expressed by others.

IMPLICATIONS

An acting-based teaching intervention is efficacious in instilling core communication and interpersonal skills to preclinical nursing students based on participants' self-efficacy ratings. This innovative way to teaching communication provides students with an experiential environment conducive to learning. Similar ratings between sessions suggest that health professions educators with no formal acting training can successfully teach this course.

Reflective writing in the teaching of communication skills for medical students-A systematic review

OBJECTIVE

To analyse the use, assessment, and measured outcomes of reflective writing (RW) in teaching communication to medical students.

METHODS

Systematic search of seven electronic databases, focused on using RW in teaching communication skills. Three reviewers selected and prepared the synthesis of the studies. The synthesis was based on thematic analysis using Braun and Clarke's approach.

RESULTS

We identified 1325 studies, reviewed 101 full-text articles, and included 12 articles in the analysis. The four themes identified showed that RW is not a stand-alone practice. RW is blended with other teaching strategies. Through RW, students identified structural, emotional, and relational aspects and challenges of communication. Only a few studies found a positive correlation between reflective ability and communication skills CONCLUSION: RW can be integrated with various teaching methods, at all stages of learning, to stimulate discussion of interpersonal and intrapersonal topics. Through RW, students explore theirs and their patient's emotions, values, behaviours, and needs identifying challenges and practices relevant to communication.

PRACTICE IMPLICATIONS

RW can address different structural, relational, and emotional issues that are relevant to communication learning. Further educational development and high-quality empirical research on the use of RW and unique outcomes are needed to support communication skills learning.

Diversity, Equity, and Inclusion: Moving from Performance to Transformation Through the Arts and Humanities

Effective engagement on issues of diversity, equity, and inclusion (DEI) requires activities that promote deep introspection and group conversations that serve to complement and build upon formal DEI presentations. The arts and humanities by their nature allow for intentional and sustained reflection and have the potential to be transformative of thinking. We therefore propose that the next phase of institutional pro-equity/anti-racism efforts includes arts- and humanities-based initiatives to facilitate reflection and that serve to complement and build upon formal DEI didactic presentations, implicit bias workshops, and anti-racism training.

Teaching and Practicing Humanism and Empathy through Embodied Engagement

Concerns have been raised regarding medicine’s dehumanization of patients and providers and regarding the need to include, in the medical school curriculum, components that encourage the development of empathy and humanistic practice. This essay suggests that the development of humanistic practice requires attention to not only the cognitive and affective/emotive aspects of humanism, but also to the nurturing of intersubjectivity between the provider and the patient through strategies designed to promote embodied awareness. Several approaches to the development of embodied awareness are discussed, including puppetry pedagogy, drama, and virtual reality applications.

Co-constructive Patient Simulation: A Learner-Centered Method to Enhance Communication and Reflection Skills

INTRODUCTION

In simulation sessions using standardized patients (SPs), it is the instructors, rather than the learners, who traditionally identify learning goals. We describe co-constructive patient simulation (CCPS), an experiential method in which learners address self-identified goals.

METHODS

In CCPS, a designated learner creates a case script based on a challenging clinical encounter. The script is then shared with an actor who is experienced working as an SP in medical settings. An instructor with experience in the model is involved in creating, editing, and practicing role play of the case. After co-creation of the case, learners with no prior knowledge of the case (peers or a supervisor) interview the SP. The clinical encounter is followed by a group debriefing session.

RESULTS

We conducted 6 CCPS sessions with senior trainees in child and adolescent psychiatry. Topics that are difficult to openly talk about may be especially appropriate for the CCPS model-without overt guidance or solicitation, the scripts developed by learners for this series involved: medical errors and error disclosure; racial tensions, including overt racism; interprofessional conflict; transphobia; patient-on-provider violence; sexual health; and the sharing of vulnerability and personal imperfections in the clinical setting.

CONCLUSIONS

Co-constructive patient simulation provides an alternative multistage and multimodal approach to traditional SP simulation sessions that can adapt iteratively and in real time to new clinical vicissitudes and challenges This learner-centered model holds promise to enrich simulation-based education by fostering autonomous, meaningful, and relevant experiences that are in alignment with trainees' self-identified learning goals.

Using the health humanities to impart disability competencies to undergraduate medical students

BACKGROUND

Disability competencies were included, for the first time, in India's new undergraduate competency-based curriculum as a result of physician-led advocacy in 2019; the regulatory body also recommended the use of the humanities in medicine.

OBJECTIVE

To use tools from the health humanities to impart disability competencies and help students appreciate the social and human rights issues associated with disability.

METHODS

A module was developed and piloted in the foundation course on the new cohort of students. The tools included storytelling, visual art, poetry, narratives, and Forum Theatre; many facilitators were doctors and patients with disabilities. Learners were introduced to the concept of universal design through a field visit. Quantitative and open-ended feedback was taken from learners after module delivery; reflections were sought after four months.

RESULTS

The data revealed that the humanities tools used in the module had the potential to help learners explore struggle and oppression and to expose discriminatory attitudes. Learners were able to think beyond the hegemony of normalcy, and show an understanding of diversity, dignity, autonomy, disableism, social inclusion, equity, and universal design. They admitted to the misconceptions they carried and showed keenness to advocate for change.

CONCLUSION

This study piloted a novel disability competencies module using tools from the health humanities and found that learners were able to engage with and show an understanding of the social and human rights issues associated with disability. Conversations by, for, and with people with disabilities must be part of such interventions in developing and delivering disability courses.

Anatomy 3.0: Rediscovering Theatrum Anatomicum in the wake of Covid-19

The Covid-19 pandemic has challenged medical educators internationally to confront the challenges of adapting their present educational activities to a rapidly evolving digital world. In this article, the authors use anatomy education as proxy to reflect on and remap the past, present, and future of medical education in the face of these disruptions. Inspired by the historical Theatrum Anatomicum (Anatomy 1.0), the authors argue replacing current anatomy dissection laboratory (Anatomy 2.0) with a prototype anatomy studio (Anatomy 3.0). In this studio, anatomists are web-performers who not only collaborate with other foundational science educators to devise meaningful and interactive content but who also partner with actors, directors, web-designers, computer engineers, information technologists, and visual artists to master online interactions and processes in order to optimize students' engagement and learning. This anatomy studio also offers students opportunities to create their own online content and thus reposition themselves digitally, a step into developing a new competency of stage presence within medical education. So restructured, Anatomy 3.0 will prepare students with the skills to navigate an emergent era of tele and digital medicine as well as help to foreshadow forthcoming changes in medical education.

Shared Living Experiences by Physicians have a Positive Impact on Mental Health Attitudes and Stigma among Medical Students: A Mixed-Methods Study

INTRODUCTION

Medical culture can make trainees feel like there is neither room for mistakes, nor space for personal shortcomings in the makeup of physicians. A dearth of role models who can exemplify that it is acceptable to need support compounds barriers to help-seeking once students struggle. We conducted a mixed-methods study to assess the impact of physicians sharing their living experiences with medical students.

METHODS

Second-year medical students participated, through synchronized videoconferencing, in an intervention consisting of 3 physicians who shared personal histories of vulnerability (e.g. failure on high-stakes exams; immigration and acculturation stress; and personal psychopathology, including treatment and recovery), followed by facilitated, small-group discussions. For the quantitative component, students completed the Opening Minds to Stigma Scale for Health Care Providers (OMS-HC) before and after the intervention. For the qualitative component, we conducted focus groups to explore the study intervention. We analyzed anonymized transcripts using thematic analysis aided by NVivo software.

RESULTS

We invited all students in the class (n = 61, 46% women) to participate in the research component. Among the 53 participants (87% of the class), OMS-HC scores improved after the intervention (P = .002), driven by the Attitudes (P = .003) and Disclosure (P < .001) subscales. We conducted 4 focus groups, each with a median of 6 participants (range, 5-7). We identified, through iterative thematic analysis of focus group transcripts, active components before, during, and after the intervention, with unexpected vulnerability and unarmored mutuality as particularly salient.

CONCLUSIONS

Sharing histories of personal vulnerability by senior physicians can lessen stigmatized views of mental health and normalize help-seeking among medical students. Synchronous videoconferencing proved to be an effective delivery mechanism for the intervention in a 'virtual wellness' format. Candid sharing by physicians has the potential to enhance students' ability to recognize, address, and seek help for their own mental health needs.