Analogies and metaphors in clinical medicine

The use of metaphors by service users with diverse long-term conditions: a secondary qualitative data analysis

Long-term conditions and accompanied co-morbidities now affect about a quarter of the UK population. Enabling patients and caregivers to communicate their experience of illness in their own words is vital to developing a shared understanding of the condition and its impact on patients' and caregivers' lives and in delivering person-centred care. Studies of patient language show how metaphors provide insight into the physical and emotional world of the patient, but such studies are often limited by their focus on a single illness. The authors of this study undertook a secondary qualitative data analysis of 25 interviews, comparing the metaphors used by patients and parents of patients with five longterm conditions. Analysis shows how similar metaphors can be used in empowering and disempowering ways as patients strive to accept illness in their daily lives and how metaphor use depends on the manifestation, diagnosis, and treatment of individual conditions. The study concludes with implications for how metaphorical expressions can be attended to by healthcare professionals as part of shared care planning.

On the use and abuse of metaphors in assessment

This paper is motivated by a desire to advance assessment in the health professions through encouraging the judicious and productive use of metaphors. Through five specific examples (pixels, driving lesson/test, jury deliberations, signal processing, and assessment as a toolbox), we interrogate how metaphors are being used in assessment to consider what value they add to understanding and implementation of assessment practices. By unpacking these metaphors in action, we probe each metaphor's rationale and function, the gains each metaphor makes, and explore the unintended meanings they may carry. In summarizing common uses of metaphors, we elucidate how there may be both advantages and/or disadvantages. Metaphors can play important roles in simplifying, complexifying, communicating, translating, encouraging reflection, and convincing. They may be powerfully rhetorical, leading to intended consequences, actions, and other pragmatic outcomes. Although metaphors can be extremely helpful, they do not constitute thorough critique, justified evidence or argumentation. We argue that although metaphors have utility, they must be carefully considered if they are to serve assessment needs in intended ways. We should pay attention to how metaphors may be misinterpreted, what they ignore or unintentionally signal, and perhaps mitigate against this with anticipated corrections or nuanced qualifications. Failure to do so may lead to implementing practices that miss underlying and relevant complexities for assessment science and practice. Using metaphors requires careful attention with respect to their role, contributions, benefits and limitations. We highlight the value that comes from critiquing metaphors, and demonstrate the care required to ensure their continued utility.

Effectiveness of an analogy-containing video project to reinforce pharmacy students' learning of kidney physiology

BACKGROUND AND PURPOSE

Kidney physiology is one of the most difficult topics covered in health professions education. This study examined the effectiveness of an analogy-containing video project to reinforce pharmacy students' knowledge of kidney physiology.

EDUCATIONAL ACTIVITY AND SETTING

Students were assigned in groups to create a video that used analogy to explain kidney physiology processes. Survey responses, a rubric, and an objective test were used to assess the project's effectiveness.

FINDINGS

Students generated various analogies, such as making tea or coffee, cars and roads, and the college application process to explain kidney physiology. Most of the submitted videos successfully met all criteria in the rubric. All students believed that the project was effective, to varying degrees, in reinforcing their knowledge. Weak to moderate positive correlations were found between time spent on the project and perceived effectiveness of use of analogy to accomplish most of the learning objectives investigated. Students reported that the project engaged both lower- and higher-order cognitive skills. Quiz score analysis showed higher average scores of students on physiology-related questions compared to non-physiology items. Notably, this improvement was most marked for bottom-performing students. About 60% of students recommended the use of videos as a class assignment, but only 50% believed that they should be used as an alternative to quizzes.

SUMMARY

An analogy-containing video project effectively reinforced student learning of kidney physiology. Further studies are needed to verify the effectiveness of this technique compared to other didactic and learning approaches.

A Spoonful of Eponyms Helps the Pathology Go Down: Using Food Eponyms and Visual Mnemonics in Preclinical Pathology Education

Food eponymophilia in medicine describes a phenomenon by which diseases or pathologies are named for food items, such as "oat cell carcinoma" or "coffee bean nucleus." Some argue that these metaphors enrich medical education by providing familiar analogies to communicate pathology that is otherwise difficult to describe. Others argue that these metaphors are esoteric, burdensome, culturally irrelevant, and outdated. Few studies have ever focused on the use of metaphors in medical education, and even fewer have focused particularly on pathology or food eponyms. We aim to investigate the use of food eponyms in undergraduate medical education, particularly in pathology education, at the University of Central Florida College of Medicine. We used an interactive learning module to objectively assess whether or not students learn and retain pathology knowledge better using food eponyms, and a post-module survey to assess student perception of the use of these visual mnemonics within pathology educational activities. Results suggest that students not only learn and retain pathology knowledge through this type of activity, but that they also find these eponyms and mnemonics useful as they prepare for their USMLE step 1 exam, clinical clerkship, and future practice. This study is the first of its kind to investigate the usefulness of food eponymophilia in medical education and suggests that students empirically benefit from the use of these memory aids and find this form of learning enjoyable. Preclinical pathology education should make use of these tools in an effort to make pathology as palatable as possible.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01474-w.

Replacing a Veterinary Physiology Endocrinology Lecture with a Blended Learning Approach Using an Everyday Analogy

Understanding scientific concepts and processes is critical for veterinary education. This article outlines the impact of blended learning and the use of an analogy on student understanding of the hypothalamic-pituitary-target gland axis over a three-year period. The first-year veterinary physiology course at our institution was modified to incorporate a blended learning approach. An analogy centered around a fast-food restaurant was introduced via an animated video to explain key concepts using an online module. Students completed the module on their own time and class time was optional for asking questions or obtaining clarification as needed. Learning was assessed using the same set of multiple-choice exam questions (MCQs). As hypothesized, students using the online module performed equally well (significantly better for those in the lower quartile) on three summative MCQs to those who received the same information delivered by traditional lecture. Student feedback identified positive aspects regarding blended learning using the analogy, including dynamic visuals, ability to work at their own time and pace, and ease of repeating information. Students cited lack of discipline and poor time management as obstacles to completing the module. Changing the anatomy and physiology of the hypothalamus and pituitary gland from static images and text to an animated video significantly improved student's preference for the blended learning approach. Blended learning and the analogy was preferred by 47% of students over the traditional lecture format (21% preferred traditional lecture and 32% were indifferent) and it was more effective in helping students master this important physiological concept.

A metaphor for epidemiology: The sea of person time

Metaphors have had an important role to play in the theory and practice of epidemiology. Some well-known examples include "black boxes," the "web of causation," "shoe-leather epidemiology," the "ivory tower" and the ubiquitous "gold standard." Metaphors like these do not replace methods or principles but rather like memes can spark a creative response and thoughtful reflection. In this paper, I bring to the attention of epidemiologists a metaphor that originated forty years ago in a paper describing and explaining measures of disease incidence. The authors wrote about a "sea of population time" to represent how incident disease events-specifically, incidence density measures- occur in the two-dimensional space of person-time. A "sea of population time" or "sea of person time" seems ideally suited as a metaphor for creative and thoughtful development in epidemiology. The vast and varied characteristics of oceans provide a plethora of ideas that can potentially help us to think more deeply about the role and responsibilities of epidemiologists. As an example, consider the notion that epidemiologists' journey across this sea in their methodologically-laden and concept-heavy fishing boats searching for the causes of disease. At the same time, epidemiologists live in the sea itself subject to and thus at risk of all the same diseases that affect human populations. Storms on this imaginary sea could sink our boats causing us to rethink conceptual and methodological frameworks. Here I provide in lyric form examples that explore what might exist behind the sea of person time and on its shores.

Safety net, gateway, market, sport, and war: Exploring how emergency physicians conceptualize and ascribe meaning to emergency care

BACKGROUND

Metaphorical expressions and conceptualisations are widely used in medical discourse to convey complex and abstract concepts. Our study uses a novel way to examine the spontaneous use of metaphors by emergency physicians as they articulate their experiences of practicing emergency care. These co-constructions shed light on the values and beliefs that shape their emergency care practice.

METHODS

We invited 25 Taiwanese emergency physicians to participate in one-to-one semi-structured interviews.

RESULTS

Drawing on social constructionism theory, systematic metaphor analysis method and Metaphor Identification Procedure (MIP) we identified metaphorical linguistic expressions in their talk, grouping them into five-overarching conceptual metaphors. We argue that these metaphors underpin emergency physicians' experiences of practicing emergency medical care: Safety Net, Gateway, Market, War, and Sport.

DISCUSSION

The Safety Net, Gateway, and Market conceptualisations highlight physician-patient relationships and the social mission, resource allocation, and consumerism aspects of emergency care practice. The Sport and War conceptualisations highlight the physician-physician relationship and the demanding, team-based nature of emergency care practice.

CONCLUSION

We propose that the choice of metaphorical conceptualisation deployed by emergency physicians has implications on their embodiment of professional identities. This discussion of using metaphors to study professional identities contributes to the literature concerned with finding creative and innovative ways to research identities. Future studies may utilize metaphors to gain a comprehensive understanding of physicians' professional identities in other specialties.

Mit den Augen Susan Sontags: Metaphern im Umgang mit COVID-19

In der Erfahrung, Kommunikation und Bewältigung von Krankheit spielen Metaphern eine wichtige Rolle: Als Denkkonzepte spiegeln sie zugrundeliegende Haltungen gegenüber den durch sie beschriebenen Vorgängen wider. Susan Sontag hat mit ihrem Essay „Illness as Metaphor“ nachhaltig die moralisch kritischen Implikationen einer unreflektierten Metaphernverwendung im Umgang mit Erkrankung aufgezeigt, indem sie deren stigmatisierende und hierin zusätzlich belastende Wirkung für Erkrankte reflektiert.

In der gegenwärtigen Situation der Covid-19-Pandemie trifft ein bisher unbekanntes Virus mit der Macht und Dynamik der Globalisierung auf die hierauf nicht vorbereiteten spätmodernen Gegenwartsgesellschaften, die nun nach Erklärung und Sinnzuschreibung suchen. Auch hier fungieren Metaphern als Denkkonzepte und Vehikel von Interpretation. Im Rückgriff auf die Perspektive Susan Sontags und ihren Appell für einen entmystifizierten Umgang mit Krankheit geht dieser Beitrag folgenden Fragen nach: Welche Bilder werden in der Berichterstattung über CoV‑2 vermittelt? Welche Einstellung gegenüber Gesundheit und Krankheit wird mit den Metaphern transportiert, und welche Lebenshaltung liegt dieser zugrunde? Welche Einsichten für einen gesunden Umgang mit Covid-19 und Krankheit generell ergeben sich, wenn man die Pandemie aus ihren Metaphern und zugrundliegenden Denkkonzepten herausschält?

Using Autobiography a Pedagogical tool in Pharmacology: Traversing the Un-explored

This article was migrated. The article was marked as recommended. In today's era, medical teaching is becoming increasingly complex and challenging. Out of all subjects in the medical curriculum, Pharmacology is one of the major disciplines undergoing constant development and advancement. A strong foundation of pharmacological knowledge is needed to help students improve upon their understanding and thereby manage clinical conditions in a more effective manner. Unfortunately, Pharmacology is perceived as a dry and volatile subject by medical students. This calls for a need to explore various pedagogical tools at medical schools, so as to best identify methods effective for active learning. Efforts need to be directed towards the objective of making Pharmacology teaching interesting and learner-centered by formulating creative and innovative teaching-learning modules in and outside the classrooms. Learner-centered teaching can foster students' interest in the subject and contribute to knowledge acquisition as well as future application. In context to this, the current piece explores and addresses the application of "Autobiography of drugs" as one of the pedagogical tools in the subject of Pharmacology.

Employing imaginative rationality: using metaphor when discussing death

The prevalence of metaphors in medicine is widely acknowledged. In a qualitative study exploring expectations of longevity, we observed repeated recourse to the imaginative rationality provided by metaphors to express perspectives on longevity and death. Bafflement, acceptance, uncertainty and distress were conveyed through metaphors, providing valuable insight into the internal healthcare frameworks of participants. Skilful use of imaginative rationality in the healthcare setting may illuminate the elusive and often eschewed topic of death in a way that fosters clarity and new understandings, and pave the way towards a better life, and death for patients. By becoming aware of the nuances contained within patients'-as well as their own-metaphors, clinicians may enhance patients' overall healthcare experience and avert unintended miscommunication.

Seizure metaphors in children with epilepsy: A study based on a multiple-choice self-report questionnaire

The advantages of metaphorical representation are pointed out in many fields of clinical research (e.g. cancer, HIV, psychogenic nonepileptic seizures). This study aimed at offering a novel contribution showing how children with epilepsy describe the symptomatology of their seizure experiences by means of particular kinds of cognitive metaphors. Twenty-three children with idiopathic generalized epilepsy and thirty-one healthy children were recruited for this study and interviewed with a multiple-choice questionnaire asking them to describe their epileptic seizures by means of suitable metaphors. A psychologist blinded to medical diagnosis assessed and categorized all metaphors. By considering the 89 metaphors produced by the children with epilepsy and the 147 ones by the healthy controls, Agent/Force was the primary metaphor assessed by children with epilepsy, followed by Event/Situation as the second preference. Moreover, comparing the results of the control group with those of the subjects with epilepsy, it was found that controls were oriented towards selecting exogenous forces, while subjects with epilepsy tended to select endogenous forces. In particular, children with epilepsy showed a peculiar preference for an endogenous force resembling the waggle metaphor, which is similar to the effect of a quake's shaking (earthquake or seaquake). The metaphors identified by this research are a useful resource to better understand the seizure experiences of patients with epilepsy, helping to improve clinical treatment.

Exploring first grade medical students' professional identity using metaphors: implications for medical curricula

BACKGROUND

Although professional identity development is an important concept in medical education, the process has not been well-investigated from a student perspective.

PURPOSE

This study examines the metaphorical images formulated by first grade medical students in Turkey to describe physicians in the context of establishing a professional identity, along with its limitations.

METHOD

Participants (N=148) completed the prompt: A physician is like _____ because _____ to indicate their conceptualizations of physician. The data were analyzed both qualitatively and quantitatively.

RESULTS

Altogether, 71 well-articulated metaphorical images were identified - comprising six conceptual themes.

CONCLUSIONS

While subject to some limitations, the use of metaphors to formulate and describe professional identities can be helpful in reflecting the personal beliefs and values of matriculants to medical school, as well as providing some guidance and feedback to curriculum development efforts.

Harnessing Complex Emergent Metaphors for Effective Communication in Palliative Care

Terminally ill patients can have unexpected, enigmatic, and profound cognitive shifts that significantly alter their perception of themselves, thereby eliminating their fear of death and dying. However, there are no systematic studies into these remarkable yet ineffable transcendence experiences. They therefore remain easily overlooked or viewed as isolated anomalies and therefore excluded from quality-of-life patient considerations. We use a multimodal methodology for identifying the prevalence and thematic properties of complex emergent metaphors patients use to report these experiences. Although previous research has pioneered the importance of understanding conventional or primary metaphors at the end of life, our findings indicate the considerable potential of more complex metaphors for reducing barriers to effective communication in palliative care.