This study explored how future physicians who are early on in their training conceptualize treatm... more This study explored how future physicians who are early on in their training conceptualize treatment adherence issues for a disease with a high societal stigma (e.g. HIV/AIDS) versus a disease with little to no societal stigma (e.g. diabetes). We surveyed 121 first and second year students enrolled in a BS/MD program. After observing a videotaped interview of a person with HIV/AIDS, students were asked to identify and resolve ethical dilemmas regarding treatment adherence, which were presented in the interview. This process was repeated for a videotaped interview of a person with diabetes. Students' responses to both interviews were compared. Analysis of qualitative comments indicated that students had difficulty identifying treatment adherence issues for high and low stigmatized diseases. Regarding the students' abilities to identify psychosocial factors and dilemmas for people with HIV, multiple concerns were identified, whereas most students had difficulty identifying psychosocial concerns for the person with diabetes. Most students had difficulty differentiating psychosocial dilemmas from ethical ones. Results suggest that premedical students have difficulty identifying and resolving psychosocial and ethical dilemmas for individuals with differently stigmatized diseases. Their ability to understand and resolve treatment adherence issues is limited. Despite the fact that most students knew someone with diabetes, they had more difficulty identifying psychosocial issues associated with diabetes compared to HIV. Findings support the need for education and training in psychosocial/ethical issues related to HIV and diabetes for students to help them better serve patient populations with diseases that bear low and high societal stigma.
International Journal of Critical Illness and Injury Science
Background: This study discerns surgeons' attitudes and practices in the determination of hea... more Background: This study discerns surgeons' attitudes and practices in the determination of heart valve replacement for patients with infectious endocarditis (IE) due to intravenous drug use (IVDU). We aimed to identify the factors contributing to surgeons' decision-making process for initial and recurrent surgical heart valves and the availability of institutional guidance. Methods: An IRB-approved, anonymous mixed-methods, open survey instrument was designed and validated with 24 questions. A convenience sample of cardiothoracic surgeons in the United States and globally resulted in a total of 220 study participants with 176 completing every question on the survey. Results: A cluster analysis revealed that although surgeons can be divided into subgroups based on their previous experience with valve replacements, these groups are not perfectly homogenous, and the number of identified clusters is dependent on technique used. Analysis of variance revealed the variables that most clearly divided the surgeons into subgroups were, in order of importance, years of practice, number of valve replacements, and geography. Conclusions: Our analysis showed heterogeneity among cardiothoracic surgeons regarding how they make clinical decisions regarding re-operative valve replacement related to IE-IVDU. Therefore, an opportunity exists for interprofessional teams to develop comprehensive guidelines to decrease variability in surgical decision-making regarding valve replacement associated with IE-IVDU.
Outcomes 1. Differentiate the content in diary and narrative 2. Locate study within the NIH ORBIT... more Outcomes 1. Differentiate the content in diary and narrative 2. Locate study within the NIH ORBIT model of behavioral trial development 3. Name at least 3 writing prompts for people who may not know how to begin writing a narrative while their child is in a pediatric ICU Original Research Background Parents of children in a pediatric ICU (PICU) have reported mental health symptoms 6 months after discharge. Writing is associated with positive health outcomes;however, studies with adult diaries focus on factual events, and pediatric data are limited. Research Objectives Quantify acceptability and feasibility of a narrative intervention and qualitatively examine written texts. Methods Prospective, proof-of-concept, 3-arm trial with legal guardians of children in the PICU of a 365-bed quaternary pediatric referral hospital. Randomly allocated participants received a blank composition book with encouragement to write (Arm 1), writing prompts (Arm 2), or at least one session (Arm 3) with narrative medicine coordinator (NMC). Feasibility was calculated as the ratio of books returned to distributed, number of books used, and ratio of completed to scheduled NMC meetings. Acceptability was measured with the Treatment Acceptability Questionnaire and the ratio of enrolled to approached persons. Descriptive statistics were calculated;between-group comparisons were made via Kruskal-Wallis tests. Thematic analysis identified emergent themes from independently coded texts. Results N = 20 participants enrolled in 6 months. Acceptability was high (49% enrollment;mean [SD] acceptability scores M = 24.8 [2.4]). Feasibility was good: 100% completed-to-scheduled Arm 3 sessions and 40% book return. There were significant between-group differences in journal use (chi-square = 8.7, df = 2, p = 0.013) (Arm 1, 25%;Arm 2, 80%;Arm 3, 100%). Texts revealed emotions (primarily “terrified,” “angry,” and “sad”) yet notably expressed more cognitive processes (wishing and advice giving). Conclusion The intervention was feasible and acceptable. Participants allocated to arms without the NMC appeared to produce texts with more disorganized thinking as well as lists and texts unrelated to the hospital or child's experience. Limitations include single-site, predominantly White female participants, and COVID-19 recruitment limitations. Implications for Research, Policy, or Practice Findings warrant proceeding to a controlled pilot trial. Parents appreciated and may benefit from guided narrative opportunities while their child is in a PICU.
At the global level, sufferers of mental illness encounter discrimination and bias, are devalued ... more At the global level, sufferers of mental illness encounter discrimination and bias, are devalued as persons, and are often disregarded by medical and scientific communities, especially when the illness is unidentifiable within a classification system or diagnostic category. Although there are shared experiences and stories among persons with mental illness, the concept of mental illness is defined and interpreted differently across cultures and contexts. Thus, a singly understood concept may not be fully achievable despite ongoing philosophical and scientific debates about the nature of mind and its relation to the body. However, the divide between eastern and western cultures may begin to shorten with a more holistic understanding of the subject of mental illnessthe embodied person. The gap between east and west is not simply filled with a universal medical model or a definition of mental illness, but a common understanding of the human condition and an appreciation of the illness narrative of the embodied person. This is but a brief examination into the complex concept of mental illness and the proposed need for a shared, holistic view of the subject of mental illness within and external to the medical milieu.
capacity do not have the right to remain in the hospital if there is no real medical reason to ju... more capacity do not have the right to remain in the hospital if there is no real medical reason to justify hospitalization after they have been offered several acceptable alternatives and they refuse based purely on personal preference, not wanting to be with invalid elders. Therefore, this patient should be informed that he will be discharged. In most settings, he will have a right to appeal his discharge decision, which means it will take a few days or more before a final discharge determination is reached and the patient is required to leave the hospital. An important practical strategy in a situation like this is to involve family, if they are available and the patient gives the team permission to contact them. Families can speak to their loved ones in ways that healthcare professionals cannot, which means they may influence their decisions in ways that leads to better outcomes. Though the care team should protect the patient from excessive coercion, family persuasion in this case c...
The treatment of patients with intravenous drug use (IVDU) has evolved to include a wide range of... more The treatment of patients with intravenous drug use (IVDU) has evolved to include a wide range of medications, psychiatric rehabilitation, and surgical interventions, especially for life-threatening complications such as infective endocarditis (IE). These interventions remain at the discretion of physicians, particularly surgeons, whose treatment decisions are influenced by several medical factors, unfortunately not without bias. The stigma associated with substance use disorder is prevalent, which leads to significant biases, even in the healthcare system. This bias is heightened when IVDU patients require repeat valve replacement surgeries for IE due to continued drug use. Patients who receive a valve replacement and continue to use illicit drugs intravenously often return to their medical providers, months to a few years later, with a reinfection of their bioprosthetic valve; such patients require additional surgeries which are at the center of many ethical discussions due to high mortality rates, for many complex medical and social reasons, associated with continuous chemical dependency after surgical interventions. This chapter examines the ethics of repeat heart valve replacement surgery for patients who are struggling with addiction. Considerations of justice, the fiduciary therapeutic relationship, and guiding ethical principles justify medically beneficial repeat heart valve replacement surgeries for IVDU patient populations.
Advances in Extracorporeal Membrane Oxygenation - Volume 3, 2019
Extracorporeal membrane oxygenation (ECMO) is an established therapy for the management of acute ... more Extracorporeal membrane oxygenation (ECMO) is an established therapy for the management of acute cardiopulmonary failure. A substantial concern when considering ECMO therapy is whether the patient will recover enough function to be weaned from support and survive to discharge. The concept of "a bridge to nowhere" is where a patient is supported on a therapy for which there is no hope for recovery and would, by definition, immediately die if support is discontinued-a somewhat unique concept in clinical medicine, but often considered when considering short-term mechanical support for acute heart and/or lung failure. Much like initiating mechanical ventilator support in patients who have no chance of meaningful recovery, there are concerns about embarking on or continuing with ECMO support in patients in whom recovery is unlikely. The purpose of this chapter is to review the ethical foundation and principles to support the clinical decision-making process when there are concerns regarding the initiation, continuation, or withdrawal of this highly invasive, resource-intensive life-support technology. Specific attention will be given to well-established principles of the ethical application of advanced life support and how to appropriately limit offering or continuing therapies for which meaningful outcomes are unlikely or further support is considered futile.
Pregnant, opioid-using women represent a challenge to healthcare providers attempting to engage t... more Pregnant, opioid-using women represent a challenge to healthcare providers attempting to engage them in prenatal and substance abuse services. Limited, primarily international research suggests that child welfare clients have mixed feelings about Child Protective Services (CPS) and that fear of CPS may present a barrier to care. Understanding how pregnant opioid-using women in substance abuse treatment perceive CPS may be useful in encouraging substance abuse treatment initiation. Participants were currently or recently (within past 12 months) pregnant women with current or recent (within past 12 months) abuse/dependence of pharmaceutical opioids at a drug treatment facility. Participants were recruited by treatment staff to participate in a comprehensive study across multiple domains. Data for this analysis were collected using semi-structured qualitative interviews. Transcribed data were thematically analyzed using in vivo and interpretive coding by three coders for purposes of in...
To examine barriers of advance care planning (ACP) experienced by care managers (CMs) through a m... more To examine barriers of advance care planning (ACP) experienced by care managers (CMs) through a mixed methods approach. A concurrent nested design was used to acquire a deeper understanding of ACP and to identify nuances between quantitative and qualitative data. Past quantitative studies on providers have identified barriers related to time, culture, knowledge, responsibility and availability of legal documents. These barriers, and accompanying attitudes and feelings, have been taken at face value without rich qualitative data to identify under what conditions and to what extent a barrier impacts care. A two-part multisite, mixed methods study was conducted using surveys and focus groups. Surveys were completed by 458 CMs at 10 Area Agencies on Aging and 62 participated in one of eight focus groups. Data were analysed using a concurrent nested design with individual data analysis and a merged data approach. There were three main distinctions between the quantitative and qualitative...
Using patient-reported experiences, this study: 1) quantitatively evaluated TTTS screening trends... more Using patient-reported experiences, this study: 1) quantitatively evaluated TTTS screening trends, 2) examined screening and diagnostic experiences using a mixed methods approach, and 3) determined gaps in clinical care experiences. This was a cross-sectional study. Data was collected using a self-report, retrospective survey. A triangulation design was used to validate quantitative survey data with thematically analyzed qualitative data. Participants were recruited through social media and national foundations and completed the survey online. Participants were 312 women who completed a TTTS pregnancy in the United States, representing the largest survey of participants who have experienced TTTS. Descriptive statistics and bivariate analyses were conducted. Multivariate logistic regression examined predictors of ultrasound frequency. Qualitative data were initially coded by hand and checked using qualitative software. The percentages of participants reporting guideline recommended s...
Not long after reading the target article by Cook and Hoas (2008)1. Cook, AF and Hoas, H. 2008. E... more Not long after reading the target article by Cook and Hoas (2008)1. Cook, AF and Hoas, H. 2008. Ethics and rural healthcare: What really happens? What might help?. American Journal of Bioethics , 8(4): 5256. [Taylor & Francis Online], [PubMed], [Web of Science ®] View ...
Background: A well-known phenomenon among U.S. medical students known as pimping, or the pedagogi... more Background: A well-known phenomenon among U.S. medical students known as pimping, or the pedagogical device of questioning students in the clinical setting, receives virtually no attention in medical literature. Purpose: Identifying 4th-year medical students' relevant knowledge and attitudes about pimping may help educators understand the range of beliefs about pimping and the role it plays in the socialization process into the medical community. Methods: Over a 2-month period, 11 fourth-year medical students at a Midwest medical school were asked 6 open-ended questions focusing on pimping as understood and experienced in the clinical setting. Investigators individually analyzed the interview data using qualitative methods to characterize students' experiences and recurring ideas and concepts. Results: All students noted the hierarchical nature of pimping, viewing it as a tool for attendings or residents to assess students' levels of knowledge. Although some students experienced malignant pimping, humiliated by incessant questioning or questions inappropriate to their level of training, all the students in the sample were positive about pimping and its effectiveness as a pedagogical tool. Investigators found that location within the clinical setting determines how students define and understand the motives for pimping. Conclusions: Understanding how students define and experience the pimping phenomenon prepares medical educators to scrutinize pimping as a pedagogical tool and to provide the most effective and encouraging environment for students.
In this essay we link the rationale for the medical humanities with radical hermeneutics, a move ... more In this essay we link the rationale for the medical humanities with radical hermeneutics, a move that infuses the medical humanities with incredulity and suspicion. This orientation is particularly important at this historical moment, when the evidence-based and competency blanket is threatening to overpower all aspects of medical education, including the medical humanities discourse itself. Radical hermeneutics works relentlessly against the final word on anything, and as such, it provides a critically provocative way of thinking about doctors, patients, illness, health, families, death--in short, the experience of being human. We use three literary examples to illustrate the complex, contradictory, perplexing, and disturbing questions related to a life in medicine: Rafael Campo's "Like a Prayer," Irvin Yalom's "Fat Lady," and Richard Selzer's "Brute."
This study explored how future physicians who are early on in their training conceptualize treatm... more This study explored how future physicians who are early on in their training conceptualize treatment adherence issues for a disease with a high societal stigma (e.g. HIV/AIDS) versus a disease with little to no societal stigma (e.g. diabetes). We surveyed 121 first and second year students enrolled in a BS/MD program. After observing a videotaped interview of a person with HIV/AIDS, students were asked to identify and resolve ethical dilemmas regarding treatment adherence, which were presented in the interview. This process was repeated for a videotaped interview of a person with diabetes. Students' responses to both interviews were compared. Analysis of qualitative comments indicated that students had difficulty identifying treatment adherence issues for high and low stigmatized diseases. Regarding the students' abilities to identify psychosocial factors and dilemmas for people with HIV, multiple concerns were identified, whereas most students had difficulty identifying psychosocial concerns for the person with diabetes. Most students had difficulty differentiating psychosocial dilemmas from ethical ones. Results suggest that premedical students have difficulty identifying and resolving psychosocial and ethical dilemmas for individuals with differently stigmatized diseases. Their ability to understand and resolve treatment adherence issues is limited. Despite the fact that most students knew someone with diabetes, they had more difficulty identifying psychosocial issues associated with diabetes compared to HIV. Findings support the need for education and training in psychosocial/ethical issues related to HIV and diabetes for students to help them better serve patient populations with diseases that bear low and high societal stigma.
International Journal of Critical Illness and Injury Science
Background: This study discerns surgeons' attitudes and practices in the determination of hea... more Background: This study discerns surgeons' attitudes and practices in the determination of heart valve replacement for patients with infectious endocarditis (IE) due to intravenous drug use (IVDU). We aimed to identify the factors contributing to surgeons' decision-making process for initial and recurrent surgical heart valves and the availability of institutional guidance. Methods: An IRB-approved, anonymous mixed-methods, open survey instrument was designed and validated with 24 questions. A convenience sample of cardiothoracic surgeons in the United States and globally resulted in a total of 220 study participants with 176 completing every question on the survey. Results: A cluster analysis revealed that although surgeons can be divided into subgroups based on their previous experience with valve replacements, these groups are not perfectly homogenous, and the number of identified clusters is dependent on technique used. Analysis of variance revealed the variables that most clearly divided the surgeons into subgroups were, in order of importance, years of practice, number of valve replacements, and geography. Conclusions: Our analysis showed heterogeneity among cardiothoracic surgeons regarding how they make clinical decisions regarding re-operative valve replacement related to IE-IVDU. Therefore, an opportunity exists for interprofessional teams to develop comprehensive guidelines to decrease variability in surgical decision-making regarding valve replacement associated with IE-IVDU.
Outcomes 1. Differentiate the content in diary and narrative 2. Locate study within the NIH ORBIT... more Outcomes 1. Differentiate the content in diary and narrative 2. Locate study within the NIH ORBIT model of behavioral trial development 3. Name at least 3 writing prompts for people who may not know how to begin writing a narrative while their child is in a pediatric ICU Original Research Background Parents of children in a pediatric ICU (PICU) have reported mental health symptoms 6 months after discharge. Writing is associated with positive health outcomes;however, studies with adult diaries focus on factual events, and pediatric data are limited. Research Objectives Quantify acceptability and feasibility of a narrative intervention and qualitatively examine written texts. Methods Prospective, proof-of-concept, 3-arm trial with legal guardians of children in the PICU of a 365-bed quaternary pediatric referral hospital. Randomly allocated participants received a blank composition book with encouragement to write (Arm 1), writing prompts (Arm 2), or at least one session (Arm 3) with narrative medicine coordinator (NMC). Feasibility was calculated as the ratio of books returned to distributed, number of books used, and ratio of completed to scheduled NMC meetings. Acceptability was measured with the Treatment Acceptability Questionnaire and the ratio of enrolled to approached persons. Descriptive statistics were calculated;between-group comparisons were made via Kruskal-Wallis tests. Thematic analysis identified emergent themes from independently coded texts. Results N = 20 participants enrolled in 6 months. Acceptability was high (49% enrollment;mean [SD] acceptability scores M = 24.8 [2.4]). Feasibility was good: 100% completed-to-scheduled Arm 3 sessions and 40% book return. There were significant between-group differences in journal use (chi-square = 8.7, df = 2, p = 0.013) (Arm 1, 25%;Arm 2, 80%;Arm 3, 100%). Texts revealed emotions (primarily “terrified,” “angry,” and “sad”) yet notably expressed more cognitive processes (wishing and advice giving). Conclusion The intervention was feasible and acceptable. Participants allocated to arms without the NMC appeared to produce texts with more disorganized thinking as well as lists and texts unrelated to the hospital or child's experience. Limitations include single-site, predominantly White female participants, and COVID-19 recruitment limitations. Implications for Research, Policy, or Practice Findings warrant proceeding to a controlled pilot trial. Parents appreciated and may benefit from guided narrative opportunities while their child is in a PICU.
At the global level, sufferers of mental illness encounter discrimination and bias, are devalued ... more At the global level, sufferers of mental illness encounter discrimination and bias, are devalued as persons, and are often disregarded by medical and scientific communities, especially when the illness is unidentifiable within a classification system or diagnostic category. Although there are shared experiences and stories among persons with mental illness, the concept of mental illness is defined and interpreted differently across cultures and contexts. Thus, a singly understood concept may not be fully achievable despite ongoing philosophical and scientific debates about the nature of mind and its relation to the body. However, the divide between eastern and western cultures may begin to shorten with a more holistic understanding of the subject of mental illnessthe embodied person. The gap between east and west is not simply filled with a universal medical model or a definition of mental illness, but a common understanding of the human condition and an appreciation of the illness narrative of the embodied person. This is but a brief examination into the complex concept of mental illness and the proposed need for a shared, holistic view of the subject of mental illness within and external to the medical milieu.
capacity do not have the right to remain in the hospital if there is no real medical reason to ju... more capacity do not have the right to remain in the hospital if there is no real medical reason to justify hospitalization after they have been offered several acceptable alternatives and they refuse based purely on personal preference, not wanting to be with invalid elders. Therefore, this patient should be informed that he will be discharged. In most settings, he will have a right to appeal his discharge decision, which means it will take a few days or more before a final discharge determination is reached and the patient is required to leave the hospital. An important practical strategy in a situation like this is to involve family, if they are available and the patient gives the team permission to contact them. Families can speak to their loved ones in ways that healthcare professionals cannot, which means they may influence their decisions in ways that leads to better outcomes. Though the care team should protect the patient from excessive coercion, family persuasion in this case c...
The treatment of patients with intravenous drug use (IVDU) has evolved to include a wide range of... more The treatment of patients with intravenous drug use (IVDU) has evolved to include a wide range of medications, psychiatric rehabilitation, and surgical interventions, especially for life-threatening complications such as infective endocarditis (IE). These interventions remain at the discretion of physicians, particularly surgeons, whose treatment decisions are influenced by several medical factors, unfortunately not without bias. The stigma associated with substance use disorder is prevalent, which leads to significant biases, even in the healthcare system. This bias is heightened when IVDU patients require repeat valve replacement surgeries for IE due to continued drug use. Patients who receive a valve replacement and continue to use illicit drugs intravenously often return to their medical providers, months to a few years later, with a reinfection of their bioprosthetic valve; such patients require additional surgeries which are at the center of many ethical discussions due to high mortality rates, for many complex medical and social reasons, associated with continuous chemical dependency after surgical interventions. This chapter examines the ethics of repeat heart valve replacement surgery for patients who are struggling with addiction. Considerations of justice, the fiduciary therapeutic relationship, and guiding ethical principles justify medically beneficial repeat heart valve replacement surgeries for IVDU patient populations.
Advances in Extracorporeal Membrane Oxygenation - Volume 3, 2019
Extracorporeal membrane oxygenation (ECMO) is an established therapy for the management of acute ... more Extracorporeal membrane oxygenation (ECMO) is an established therapy for the management of acute cardiopulmonary failure. A substantial concern when considering ECMO therapy is whether the patient will recover enough function to be weaned from support and survive to discharge. The concept of "a bridge to nowhere" is where a patient is supported on a therapy for which there is no hope for recovery and would, by definition, immediately die if support is discontinued-a somewhat unique concept in clinical medicine, but often considered when considering short-term mechanical support for acute heart and/or lung failure. Much like initiating mechanical ventilator support in patients who have no chance of meaningful recovery, there are concerns about embarking on or continuing with ECMO support in patients in whom recovery is unlikely. The purpose of this chapter is to review the ethical foundation and principles to support the clinical decision-making process when there are concerns regarding the initiation, continuation, or withdrawal of this highly invasive, resource-intensive life-support technology. Specific attention will be given to well-established principles of the ethical application of advanced life support and how to appropriately limit offering or continuing therapies for which meaningful outcomes are unlikely or further support is considered futile.
Pregnant, opioid-using women represent a challenge to healthcare providers attempting to engage t... more Pregnant, opioid-using women represent a challenge to healthcare providers attempting to engage them in prenatal and substance abuse services. Limited, primarily international research suggests that child welfare clients have mixed feelings about Child Protective Services (CPS) and that fear of CPS may present a barrier to care. Understanding how pregnant opioid-using women in substance abuse treatment perceive CPS may be useful in encouraging substance abuse treatment initiation. Participants were currently or recently (within past 12 months) pregnant women with current or recent (within past 12 months) abuse/dependence of pharmaceutical opioids at a drug treatment facility. Participants were recruited by treatment staff to participate in a comprehensive study across multiple domains. Data for this analysis were collected using semi-structured qualitative interviews. Transcribed data were thematically analyzed using in vivo and interpretive coding by three coders for purposes of in...
To examine barriers of advance care planning (ACP) experienced by care managers (CMs) through a m... more To examine barriers of advance care planning (ACP) experienced by care managers (CMs) through a mixed methods approach. A concurrent nested design was used to acquire a deeper understanding of ACP and to identify nuances between quantitative and qualitative data. Past quantitative studies on providers have identified barriers related to time, culture, knowledge, responsibility and availability of legal documents. These barriers, and accompanying attitudes and feelings, have been taken at face value without rich qualitative data to identify under what conditions and to what extent a barrier impacts care. A two-part multisite, mixed methods study was conducted using surveys and focus groups. Surveys were completed by 458 CMs at 10 Area Agencies on Aging and 62 participated in one of eight focus groups. Data were analysed using a concurrent nested design with individual data analysis and a merged data approach. There were three main distinctions between the quantitative and qualitative...
Using patient-reported experiences, this study: 1) quantitatively evaluated TTTS screening trends... more Using patient-reported experiences, this study: 1) quantitatively evaluated TTTS screening trends, 2) examined screening and diagnostic experiences using a mixed methods approach, and 3) determined gaps in clinical care experiences. This was a cross-sectional study. Data was collected using a self-report, retrospective survey. A triangulation design was used to validate quantitative survey data with thematically analyzed qualitative data. Participants were recruited through social media and national foundations and completed the survey online. Participants were 312 women who completed a TTTS pregnancy in the United States, representing the largest survey of participants who have experienced TTTS. Descriptive statistics and bivariate analyses were conducted. Multivariate logistic regression examined predictors of ultrasound frequency. Qualitative data were initially coded by hand and checked using qualitative software. The percentages of participants reporting guideline recommended s...
Not long after reading the target article by Cook and Hoas (2008)1. Cook, AF and Hoas, H. 2008. E... more Not long after reading the target article by Cook and Hoas (2008)1. Cook, AF and Hoas, H. 2008. Ethics and rural healthcare: What really happens? What might help?. American Journal of Bioethics , 8(4): 5256. [Taylor & Francis Online], [PubMed], [Web of Science ®] View ...
Background: A well-known phenomenon among U.S. medical students known as pimping, or the pedagogi... more Background: A well-known phenomenon among U.S. medical students known as pimping, or the pedagogical device of questioning students in the clinical setting, receives virtually no attention in medical literature. Purpose: Identifying 4th-year medical students' relevant knowledge and attitudes about pimping may help educators understand the range of beliefs about pimping and the role it plays in the socialization process into the medical community. Methods: Over a 2-month period, 11 fourth-year medical students at a Midwest medical school were asked 6 open-ended questions focusing on pimping as understood and experienced in the clinical setting. Investigators individually analyzed the interview data using qualitative methods to characterize students' experiences and recurring ideas and concepts. Results: All students noted the hierarchical nature of pimping, viewing it as a tool for attendings or residents to assess students' levels of knowledge. Although some students experienced malignant pimping, humiliated by incessant questioning or questions inappropriate to their level of training, all the students in the sample were positive about pimping and its effectiveness as a pedagogical tool. Investigators found that location within the clinical setting determines how students define and understand the motives for pimping. Conclusions: Understanding how students define and experience the pimping phenomenon prepares medical educators to scrutinize pimping as a pedagogical tool and to provide the most effective and encouraging environment for students.
In this essay we link the rationale for the medical humanities with radical hermeneutics, a move ... more In this essay we link the rationale for the medical humanities with radical hermeneutics, a move that infuses the medical humanities with incredulity and suspicion. This orientation is particularly important at this historical moment, when the evidence-based and competency blanket is threatening to overpower all aspects of medical education, including the medical humanities discourse itself. Radical hermeneutics works relentlessly against the final word on anything, and as such, it provides a critically provocative way of thinking about doctors, patients, illness, health, families, death--in short, the experience of being human. We use three literary examples to illustrate the complex, contradictory, perplexing, and disturbing questions related to a life in medicine: Rafael Campo's "Like a Prayer," Irvin Yalom's "Fat Lady," and Richard Selzer's "Brute."
Uploads
Papers by Julie Aultman