... Development Workshop Sarah Stone University of Massachusetts Medical School Community Faculty... more ... Development Workshop Sarah Stone University of Massachusetts Medical School Community Faculty Development Center Department of Internal Medicine Worcester, Massachusetts, USA (Now deceased) Kathleen Mazor ...
I entered the examination room to find one of my scheduled patients waiting. I am often amazed at... more I entered the examination room to find one of my scheduled patients waiting. I am often amazed at what patients bring with them when they visit their doctor. Not just what, but who. And not just who, but why. She had brought her large bag of medical problems. In the bag was the breast cancer of 11 years, seemingly an old problem, but always present and early to come out of the bag. There was the recurrent lymphedema of one arm with intermittent cellulitis. There were the chronic headaches. There were the perplexing hot flashes. Cervical spondylosis, hypercholesterolemia, the positive PPD, the stroke of several years back (no residual deficit, but that didn't allow it to be discarded), and her periodic depressive episodes were all there, waiting to be taken out as necessary. Somewhere in the depths of the bag were the lining of her maxillary sinus as well as
Explore-the Journal of Science and Healing, Nov 1, 2014
Background: The integration of complementary medicine is gradually becoming an accepted part of s... more Background: The integration of complementary medicine is gradually becoming an accepted part of standard care for patients with cancer. In our integrative oncology program, we have encountered difficulties in recruiting Arab patients. In order to understand the special needs of this population, we conducted interviews among Arab practitioners of complementary and traditional medicine (CTM). The characteristics of practitioners and their views regarding the therapeutic process were examined. Methods: Semi-structured qualitative interviews were administered to 27 Arab practitioners of CTM whose clientele was comprised primarily of Arab cancer patients. Conventional content analysis of the transcribed interviews and field notes was performed in order to identify key themes. Result: Three groups of CTM practice were identified: Folkherbal medicine (n ¼ 9), complementary medicine (CM; n ¼ 14), and religious healing (n ¼ 4). Seven factors were identified in the practitioner accounts: the duration and scheduling of treatment sessions, the language of communication, the presence of family members, the appearance of the practitioner, the definition of treatment goals, the discussion of behavioral and lifestyle changes, and finally, the use of tangible elements in treatment. Conclusions: The study of Arab CTM practitioner recommendations may help facilitate a culture-sensitive encounter with Arab patients with cancer. This approach may also have implications for other ethno-culturally unique populations.
tO 7 AM). No other major changes took place over this time period that would seem to affect physi... more tO 7 AM). No other major changes took place over this time period that would seem to affect physician assessment of wellness. Results: Postimplementation wellness scores for the group were compared with the preimplementation scores using a single-tailed t test and an ~ of P<.05. A significant improvement in overall wellness was noted by these standards. Only 1 of the 20 questions had a less well score on the posttemplate survey, and this difference did not attain statistical significance. Five questions independently showed significant improvement in wellness regarding improved sleep habits and more positive work attitudes. Of interest, the majority of the group opposed the template before its commencement; however, after 6 months this view had altered signtficantly (P<.05). Conclusion: Scheduling and wellness issues are of primary importance to the specmlty of emergency medicine. This study indicates that overall wellness may be improved by a physiologically friendly schedule even if this is not recognized by physicians before implementation.
ObjectivesInterprofessional (IP) collaboration and effective teamwork remain variable in healthca... more ObjectivesInterprofessional (IP) collaboration and effective teamwork remain variable in healthcare organisations. IP bias, assumptions and conflicts limit the capacity of healthcare teams to leverage the expertise of their members to meet growing complexities of patient needs and optimise healthcare outcomes. We aimed to understand how a longitudinal faculty development programme, designed to optimise IP learning, influenced its participants in their IP roles.DesignIn this qualitative study, using a constructivist grounded theory approach, we analysed participants’ anonymous narrative responses to open-ended questions about specific knowledge, insights and skills acquired during our IP longitudinal faculty development programme and applications of this learning to teaching and practice.SettingFive university-based academic health centres across the USA.ParticipantsIP faculty/clinician leaders from at least three different professions completed small group-based faculty development ...
Presents a poem relating the experiences of shopping and social distancing during the COVID-19 pa... more Presents a poem relating the experiences of shopping and social distancing during the COVID-19 pandemic (PsycInfo Database Record (c) 2021 APA, all rights reserved)
In this episode, Dr. Dave Hatem discusses the moment when his perspective on the neurological exa... more In this episode, Dr. Dave Hatem discusses the moment when his perspective on the neurological exam changes with hosts Qiuwei Yang and Dr. Hugh Silk. Recorded February 2020.
Reflection is critical to experiential, lifelong, self-directed learning. The practice of medicin... more Reflection is critical to experiential, lifelong, self-directed learning. The practice of medicine is characterized by complexity, uncertainty, emotional intensity, values conflicts, and ethical challenges. It has been proposed that the capacity to reflect masterfully is required to work effectively in such complex settings. Many physicians eventually master this capacity, most struggle somewhere along the way, and some manifest significant trouble reflecting accurately and efficiently enough to achieve clinical competence. In this chapter, the author reviews conceptual models highlighting the critical nature of reflection and demonstrates through case examples that reflective capacity can be enhanced through structured writing exercises. While narrative exercises have value for most physicians, students who will benefit most from a narrative-based remediation strategy are those who lack insight into their own problems and deficits, especially those who are insensitive to the perspectives of others and or who hold unexamined biases and attitudes that negatively impact clinical competence.
Teaching and assessment of communication and interpersonal skills, one of the American Council fo... more Teaching and assessment of communication and interpersonal skills, one of the American Council for Graduate Medical Education-designated core competencies, is an important but difficult task in the training of physicians. Assessment of trainees offers an opportunity to provide explicit feedback on their skills and encourages learning. This article describes a pilot study in which clinician-educators affiliated with the geriatrics training programs at Beth Israel Deaconess Medical Center and Boston University Medical Center designed and piloted a novel Objective Structured Clinical Examination (OSCE) to assess the communication and interpersonal skills of medical, dental, and geriatric psychiatry fellows. The OSCE consisted of three stations where geriatricians and standardized patients evaluated candidates using specifically designed checklists and an abbreviated version of the Master Interview Rating Scale. Communication skills were assessed through performance of specific ''real life'' clinical tasks, such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills were assessed through the effect of the communication between doctor and standardized patient on fostering trust, relieving anxiety, and establishing a therapeutic relationship. This pilot study demonstrated that the OSCE format of assessment provides a valid means of evaluating the communication and interpersonal skills of interdisciplinary geriatric trainees and provides a valuable forum for formative assessment and feedback. Given that geriatricians and non geriatricians involved in elder care both need communication and interpersonal skills, this novel OSCE can be used for assessment of these skills in trainees in diverse healthcare subspecialties.
BACKGROUND: Learning environments overtly or implicitly address patient-centered values and have ... more BACKGROUND: Learning environments overtly or implicitly address patient-centered values and have been the focus of research for more than 40 years, often in studies about the ''hidden curriculum.'' However, many of these studies occurred at single medical schools and used time-intensive ethnographic methods. This field of inquiry lacks survey methods and information about how learning environments differ across medical schools.
Background: Folk medicine knowledge and practices of Egypt were mainly found in Ebers papyrus dat... more Background: Folk medicine knowledge and practices of Egypt were mainly found in Ebers papyrus dated to ca.1500 BC as medical scrolls contained about 700 magical formulas and folk remedies and suggested high integration of medical treatments with religion. Other sources of folk medicine were brought from different nationalities by those who came and lived in Egypt and through exchanging commercial activities with foreign merchants. From the records, the plant kingdom appears to be the main origin for material(s) used in folk medicine. In this respect, Queen Hatchepsoot was the first to cultivate plants for medicinal use in the Temple gardens of Karnak. At the present time, flora of plants which are used in folk medicine in Egypt are distributed in following phyto-geographical regions: the Libyan desert on the western side of the Nile, the Arabian Desert including Sinai, the Northern Mediterranean coast belt which belongs to the "Mediterranean Province", the Nile-Valley and the Delta and the St. Katherine Protectorate in Sinai. The popularity of folk medicine had greatly increased until present days in Egypt that can be regarded as market-driven opportunities of health belief practices originating from inherited folk traditions. For example, honey was used by the Pharos in mummification of the kings and is taken today, on basis of religious beliefs, to be as a full pharmacy. It is widely used in folk medicine for smoothing skin, healing diabetic foot and increasing energy. In the Sahara, from the tradition of those who inhabit the Oases in Egypt, the processed date is used to cure rheumatic fever, teeth protection, anemia and skin healing. Fenugreek "helba" whose seeds were found in Tutankhamun's tomb, is believed to transcend the body; it was used as aphrodisiac and its oil was believed to turn an old man into a young one. The seeds of this plant are a part of Egyptian society tradition, "as a must" to be taken to increase mother's milk production. Materials and methods: While ancient Egyptians probably depended on repeated experimented medical recipes, today researchers are applying folk medicine scientifically in clinical studies. Plant scientists aim to establish methods to increase the metabolites from which active constituents originate in plant tissues to statistically significant levels via physiological treatments. In addition to morphological measurements, plant pigments, phenolics, alkaloids, terpenoids and glycosides are estimated using spectrophotometer, GLC and/or HPLC. For example, anethole was found to highly accumulate in fennel in response to a pyrimidine derivative substance and methionine as seed treatment. In parallel, histochemical tests using light-stainreaction technique under the epifluorescent microscope enable detecting and localizing certain chemical formulas relevant to their possible role in medical purposes for a given plant. Results and discussion: From records of ancient Egypt, medication and its practices performed in the temples by priest physicians, who gained power and authority over the commons. In the present time, folk medicine and its practices are domi
To evaluate the effectiveness of a teaching method that uses 3-dimensional (3D) silicone-based pr... more To evaluate the effectiveness of a teaching method that uses 3-dimensional (3D) silicone-based prosthetic mimics of common serious lesions and eruptions and to compare learning outcomes with those achieved through the conventional method of lectures with 2-dimensional (2D) images.
In Reply to Ventres and McAuliffe: We agree with Drs. Ventres and McAuliffe that systemic change ... more In Reply to Ventres and McAuliffe: We agree with Drs. Ventres and McAuliffe that systemic change in medical education and practice is necessary to address the challenges of "power, prestige, and profit" that can work against institutional and organizational compassion and collaboration. The triple C "compassionate, collaborative care" is a necessary starting point to achieving systemic changes. The following We are concerned that the "triple P" factors have not yet been explicitly acknowledged and will thus continue to work against the development of compassionate organizational learning and service environments. We suggest that those interested in promoting more humanistic health care explore how power, prestige, and profit both add to and detract from progressive initiatives that support organizational professionalism. 6 We encourage them to address these "triple P" factors as an unambiguous step toward transparency and efficacy on their paths to reforming medical education and practice.
Our lives are made up of stories. Stories have a direction and draw the reader into the mystery o... more Our lives are made up of stories. Stories have a direction and draw the reader into the mystery of what will happen next. Some of our earliest memories are of stories told to us at the end of the day by parents and loved ones. The practice of medicine is lived in stories: "I was well until. .. ." "It all started when I was doing. .. ." are common openings of the medical encounter. But stories do more than facilitate conversation. Narrative probes the depths of medical experience [1], and allows for greater understanding of our patients [2], our work, and ourselves [3]. Stories, for the writer, and often for the reader, can be the work of meaning, and even creation [4-7]. This allows for great possibilities. "To do its work, writing creates and recreates the past in the present moment. It reaches into the shadows and pulls what cannot be seen or spoken onto the page where it is open to discussion and revision. .. . As writers write to represent, to understand, to integrate experience, they are free to try out alternatives, to see both experience and themselves as they are, as they were, as they might be [8]". In this way, writing and narrative can be seen as an act of being, paying attention and capturing details of the present moment. Writing narrative is, simultaneously, an act of observing, of becoming, of predicting, and of making choices about how one might act differently or rewrite the story, our part or that of others. Yet stories have an uncertain place in the world of medicine. There is an increasing push toward evidence-based thinking. The anecdote is disparaged as "soft" in contrast with "hard" clinical data. But as details of disease are pursued, there are details of a life that may be left behind [9]. The language of biomedical disease conflicts with the details of patient illness [10,11]. More recently there have been calls for moving beyond "taking" a history from the
... Development Workshop Sarah Stone University of Massachusetts Medical School Community Faculty... more ... Development Workshop Sarah Stone University of Massachusetts Medical School Community Faculty Development Center Department of Internal Medicine Worcester, Massachusetts, USA (Now deceased) Kathleen Mazor ...
I entered the examination room to find one of my scheduled patients waiting. I am often amazed at... more I entered the examination room to find one of my scheduled patients waiting. I am often amazed at what patients bring with them when they visit their doctor. Not just what, but who. And not just who, but why. She had brought her large bag of medical problems. In the bag was the breast cancer of 11 years, seemingly an old problem, but always present and early to come out of the bag. There was the recurrent lymphedema of one arm with intermittent cellulitis. There were the chronic headaches. There were the perplexing hot flashes. Cervical spondylosis, hypercholesterolemia, the positive PPD, the stroke of several years back (no residual deficit, but that didn't allow it to be discarded), and her periodic depressive episodes were all there, waiting to be taken out as necessary. Somewhere in the depths of the bag were the lining of her maxillary sinus as well as
Explore-the Journal of Science and Healing, Nov 1, 2014
Background: The integration of complementary medicine is gradually becoming an accepted part of s... more Background: The integration of complementary medicine is gradually becoming an accepted part of standard care for patients with cancer. In our integrative oncology program, we have encountered difficulties in recruiting Arab patients. In order to understand the special needs of this population, we conducted interviews among Arab practitioners of complementary and traditional medicine (CTM). The characteristics of practitioners and their views regarding the therapeutic process were examined. Methods: Semi-structured qualitative interviews were administered to 27 Arab practitioners of CTM whose clientele was comprised primarily of Arab cancer patients. Conventional content analysis of the transcribed interviews and field notes was performed in order to identify key themes. Result: Three groups of CTM practice were identified: Folkherbal medicine (n ¼ 9), complementary medicine (CM; n ¼ 14), and religious healing (n ¼ 4). Seven factors were identified in the practitioner accounts: the duration and scheduling of treatment sessions, the language of communication, the presence of family members, the appearance of the practitioner, the definition of treatment goals, the discussion of behavioral and lifestyle changes, and finally, the use of tangible elements in treatment. Conclusions: The study of Arab CTM practitioner recommendations may help facilitate a culture-sensitive encounter with Arab patients with cancer. This approach may also have implications for other ethno-culturally unique populations.
tO 7 AM). No other major changes took place over this time period that would seem to affect physi... more tO 7 AM). No other major changes took place over this time period that would seem to affect physician assessment of wellness. Results: Postimplementation wellness scores for the group were compared with the preimplementation scores using a single-tailed t test and an ~ of P<.05. A significant improvement in overall wellness was noted by these standards. Only 1 of the 20 questions had a less well score on the posttemplate survey, and this difference did not attain statistical significance. Five questions independently showed significant improvement in wellness regarding improved sleep habits and more positive work attitudes. Of interest, the majority of the group opposed the template before its commencement; however, after 6 months this view had altered signtficantly (P<.05). Conclusion: Scheduling and wellness issues are of primary importance to the specmlty of emergency medicine. This study indicates that overall wellness may be improved by a physiologically friendly schedule even if this is not recognized by physicians before implementation.
ObjectivesInterprofessional (IP) collaboration and effective teamwork remain variable in healthca... more ObjectivesInterprofessional (IP) collaboration and effective teamwork remain variable in healthcare organisations. IP bias, assumptions and conflicts limit the capacity of healthcare teams to leverage the expertise of their members to meet growing complexities of patient needs and optimise healthcare outcomes. We aimed to understand how a longitudinal faculty development programme, designed to optimise IP learning, influenced its participants in their IP roles.DesignIn this qualitative study, using a constructivist grounded theory approach, we analysed participants’ anonymous narrative responses to open-ended questions about specific knowledge, insights and skills acquired during our IP longitudinal faculty development programme and applications of this learning to teaching and practice.SettingFive university-based academic health centres across the USA.ParticipantsIP faculty/clinician leaders from at least three different professions completed small group-based faculty development ...
Presents a poem relating the experiences of shopping and social distancing during the COVID-19 pa... more Presents a poem relating the experiences of shopping and social distancing during the COVID-19 pandemic (PsycInfo Database Record (c) 2021 APA, all rights reserved)
In this episode, Dr. Dave Hatem discusses the moment when his perspective on the neurological exa... more In this episode, Dr. Dave Hatem discusses the moment when his perspective on the neurological exam changes with hosts Qiuwei Yang and Dr. Hugh Silk. Recorded February 2020.
Reflection is critical to experiential, lifelong, self-directed learning. The practice of medicin... more Reflection is critical to experiential, lifelong, self-directed learning. The practice of medicine is characterized by complexity, uncertainty, emotional intensity, values conflicts, and ethical challenges. It has been proposed that the capacity to reflect masterfully is required to work effectively in such complex settings. Many physicians eventually master this capacity, most struggle somewhere along the way, and some manifest significant trouble reflecting accurately and efficiently enough to achieve clinical competence. In this chapter, the author reviews conceptual models highlighting the critical nature of reflection and demonstrates through case examples that reflective capacity can be enhanced through structured writing exercises. While narrative exercises have value for most physicians, students who will benefit most from a narrative-based remediation strategy are those who lack insight into their own problems and deficits, especially those who are insensitive to the perspectives of others and or who hold unexamined biases and attitudes that negatively impact clinical competence.
Teaching and assessment of communication and interpersonal skills, one of the American Council fo... more Teaching and assessment of communication and interpersonal skills, one of the American Council for Graduate Medical Education-designated core competencies, is an important but difficult task in the training of physicians. Assessment of trainees offers an opportunity to provide explicit feedback on their skills and encourages learning. This article describes a pilot study in which clinician-educators affiliated with the geriatrics training programs at Beth Israel Deaconess Medical Center and Boston University Medical Center designed and piloted a novel Objective Structured Clinical Examination (OSCE) to assess the communication and interpersonal skills of medical, dental, and geriatric psychiatry fellows. The OSCE consisted of three stations where geriatricians and standardized patients evaluated candidates using specifically designed checklists and an abbreviated version of the Master Interview Rating Scale. Communication skills were assessed through performance of specific ''real life'' clinical tasks, such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills were assessed through the effect of the communication between doctor and standardized patient on fostering trust, relieving anxiety, and establishing a therapeutic relationship. This pilot study demonstrated that the OSCE format of assessment provides a valid means of evaluating the communication and interpersonal skills of interdisciplinary geriatric trainees and provides a valuable forum for formative assessment and feedback. Given that geriatricians and non geriatricians involved in elder care both need communication and interpersonal skills, this novel OSCE can be used for assessment of these skills in trainees in diverse healthcare subspecialties.
BACKGROUND: Learning environments overtly or implicitly address patient-centered values and have ... more BACKGROUND: Learning environments overtly or implicitly address patient-centered values and have been the focus of research for more than 40 years, often in studies about the ''hidden curriculum.'' However, many of these studies occurred at single medical schools and used time-intensive ethnographic methods. This field of inquiry lacks survey methods and information about how learning environments differ across medical schools.
Background: Folk medicine knowledge and practices of Egypt were mainly found in Ebers papyrus dat... more Background: Folk medicine knowledge and practices of Egypt were mainly found in Ebers papyrus dated to ca.1500 BC as medical scrolls contained about 700 magical formulas and folk remedies and suggested high integration of medical treatments with religion. Other sources of folk medicine were brought from different nationalities by those who came and lived in Egypt and through exchanging commercial activities with foreign merchants. From the records, the plant kingdom appears to be the main origin for material(s) used in folk medicine. In this respect, Queen Hatchepsoot was the first to cultivate plants for medicinal use in the Temple gardens of Karnak. At the present time, flora of plants which are used in folk medicine in Egypt are distributed in following phyto-geographical regions: the Libyan desert on the western side of the Nile, the Arabian Desert including Sinai, the Northern Mediterranean coast belt which belongs to the "Mediterranean Province", the Nile-Valley and the Delta and the St. Katherine Protectorate in Sinai. The popularity of folk medicine had greatly increased until present days in Egypt that can be regarded as market-driven opportunities of health belief practices originating from inherited folk traditions. For example, honey was used by the Pharos in mummification of the kings and is taken today, on basis of religious beliefs, to be as a full pharmacy. It is widely used in folk medicine for smoothing skin, healing diabetic foot and increasing energy. In the Sahara, from the tradition of those who inhabit the Oases in Egypt, the processed date is used to cure rheumatic fever, teeth protection, anemia and skin healing. Fenugreek "helba" whose seeds were found in Tutankhamun's tomb, is believed to transcend the body; it was used as aphrodisiac and its oil was believed to turn an old man into a young one. The seeds of this plant are a part of Egyptian society tradition, "as a must" to be taken to increase mother's milk production. Materials and methods: While ancient Egyptians probably depended on repeated experimented medical recipes, today researchers are applying folk medicine scientifically in clinical studies. Plant scientists aim to establish methods to increase the metabolites from which active constituents originate in plant tissues to statistically significant levels via physiological treatments. In addition to morphological measurements, plant pigments, phenolics, alkaloids, terpenoids and glycosides are estimated using spectrophotometer, GLC and/or HPLC. For example, anethole was found to highly accumulate in fennel in response to a pyrimidine derivative substance and methionine as seed treatment. In parallel, histochemical tests using light-stainreaction technique under the epifluorescent microscope enable detecting and localizing certain chemical formulas relevant to their possible role in medical purposes for a given plant. Results and discussion: From records of ancient Egypt, medication and its practices performed in the temples by priest physicians, who gained power and authority over the commons. In the present time, folk medicine and its practices are domi
To evaluate the effectiveness of a teaching method that uses 3-dimensional (3D) silicone-based pr... more To evaluate the effectiveness of a teaching method that uses 3-dimensional (3D) silicone-based prosthetic mimics of common serious lesions and eruptions and to compare learning outcomes with those achieved through the conventional method of lectures with 2-dimensional (2D) images.
In Reply to Ventres and McAuliffe: We agree with Drs. Ventres and McAuliffe that systemic change ... more In Reply to Ventres and McAuliffe: We agree with Drs. Ventres and McAuliffe that systemic change in medical education and practice is necessary to address the challenges of "power, prestige, and profit" that can work against institutional and organizational compassion and collaboration. The triple C "compassionate, collaborative care" is a necessary starting point to achieving systemic changes. The following We are concerned that the "triple P" factors have not yet been explicitly acknowledged and will thus continue to work against the development of compassionate organizational learning and service environments. We suggest that those interested in promoting more humanistic health care explore how power, prestige, and profit both add to and detract from progressive initiatives that support organizational professionalism. 6 We encourage them to address these "triple P" factors as an unambiguous step toward transparency and efficacy on their paths to reforming medical education and practice.
Our lives are made up of stories. Stories have a direction and draw the reader into the mystery o... more Our lives are made up of stories. Stories have a direction and draw the reader into the mystery of what will happen next. Some of our earliest memories are of stories told to us at the end of the day by parents and loved ones. The practice of medicine is lived in stories: "I was well until. .. ." "It all started when I was doing. .. ." are common openings of the medical encounter. But stories do more than facilitate conversation. Narrative probes the depths of medical experience [1], and allows for greater understanding of our patients [2], our work, and ourselves [3]. Stories, for the writer, and often for the reader, can be the work of meaning, and even creation [4-7]. This allows for great possibilities. "To do its work, writing creates and recreates the past in the present moment. It reaches into the shadows and pulls what cannot be seen or spoken onto the page where it is open to discussion and revision. .. . As writers write to represent, to understand, to integrate experience, they are free to try out alternatives, to see both experience and themselves as they are, as they were, as they might be [8]". In this way, writing and narrative can be seen as an act of being, paying attention and capturing details of the present moment. Writing narrative is, simultaneously, an act of observing, of becoming, of predicting, and of making choices about how one might act differently or rewrite the story, our part or that of others. Yet stories have an uncertain place in the world of medicine. There is an increasing push toward evidence-based thinking. The anecdote is disparaged as "soft" in contrast with "hard" clinical data. But as details of disease are pursued, there are details of a life that may be left behind [9]. The language of biomedical disease conflicts with the details of patient illness [10,11]. More recently there have been calls for moving beyond "taking" a history from the
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