The creation of an integrated basic science curriculum is a major goal in medical education. Howe... more The creation of an integrated basic science curriculum is a major goal in medical education. However, there is little consensus on how this can be effectively accomplished. One route is to utilize clinical problems that integrate multiple disciplines. This study describes an approach to utilize a large group case-based discussion (CBD) integrating ethics and medical genetics that has been administered to two consecutive classes. In this CBD, first-year medical students were provided the opportunity to apply and transfer knowledge to a novel clinical scenario utilizing content previously covered in two courses (“Genes, Molecules and Cells” and “Ethical Foundations in Medicine”) that run concurrently. Students were presented with preimplantation genetic diagnosis results for an X-linked disorder and asked to decipher embryo genotypes and make group recommendations on which embryo(s) they would transfer to achieve a “healthy” pregnancy. In addition to genotype considerations, students were asked to consider the three fundamental ethical principles in healthcare and shared medical decision-making when making their embryo transfer recommendations. This study reports the details of the integrated activity, facilitator feedback, and discusses modifications made to the activity to improve integration and knowledge transfer. Furthermore, this study reports positive feedback from students for this integrated discipline CBD and a significant improvement in learning outcomes following the intervention.
Traumatic brain injury (TBI) survivors typically exhibit significant learning and memory deficits... more Traumatic brain injury (TBI) survivors typically exhibit significant learning and memory deficits and also frequently demonstrate hyperactivation during functional magnetic resonance imaging (fMRI) tasks involving working memory encoding and maintenance. However, it remains unclear whether the hyperactivation observed during such working memory tasks is also present during long-term memory encoding. The preliminary experiments presented here were designed to examine this question. In Experiment 1, 7 healthy controls (HC) and 7 patients with moderate to severe TBI encoded ecologically relevant object location associations (OLA) while undergoing fMRI and then completed a memory test outside of the fMRI environment. fMRI data analysis included only the correctly encoded trials and revealed hyperactivation in the TBI relative to HC group in regions critical for OLA encoding, including bilateral dorsal and ventral visual processing areas, bilateral frontoparietal working memory network r...
Congenital heart care offers a unique lens to evaluate the importance of the practice of empathy ... more Congenital heart care offers a unique lens to evaluate the importance of the practice of empathy understood as respectful compassion. Beginning in utero, providers can interact with patients across the lifespan and at different stages in the experience of CHD. These multiple opportunities to connect with patients from diagnosis to correction and recovery allow the clinician to build rapport and trust of tremendous therapeutic and interpersonal value. Taking time to get to know the values, preferences, experiences, and stories of the patient and families and continuity of care are essential elements. The movement towards teaching virtue or character ethics in medicine came forward with the medical professionalism movement. There was an acknowledgment that as one entered medical school, one's identity transitioned towards a professional identity. A road one travelled to become a good doctor included the development of characteristics that good doctors have, including patience, compassion, trustworthiness, honour, duty, excellence, perceptiveness, humility, and accountability, for example. Often on the list of virtues is empathy, and indeed, empathy has become the pinnacle of virtues and the virtue that most caring, humanistic clinicians were said to hold. 1 While empathy is often touted as one of the primary virtues that should be instilled in medical professionals, attempts at a standard definition of empathy and how to tell if it is instilled or not bring forward a legion of challenges. Empathy has many definitions, from moral imagination (Aristotle) to emotional intelligence (Goleman). Empathy is commonly described as the ability to understand or share the feelings and experiences of others and a capacity to perceive another's experience. 2-4 Interestingly, neurologic evaluation has found similarity in excitation of brain areas related to observing another's emotions based on facial expression and when the observer experiences the same emotion through what are referred to as "mirror neurons." 4 However, feeling what a patient feels may not necessarily be what is needed to be a virtuous physician. First, there is an ethical issue regardless of the conceptual and empirical issues surrounding the claim that we can experience the same state as another. It seems to be less than humble to assert that one can indeed be in a position, especially over short durations of time, to honestly know what another is going through and what their experiences mean to them. Second, a mirror state is unnecessary for the kind of humanistic engagement that we believe is important for patients, families, and clinicians. That is not to say that emotion or shared understanding is unnecessary to realise or, worse, detrimental to the goals of medicine in the clinical encounter. As Osler reminds us, it is vital for clinicians to be composed for the sake of patients and to manage one's emotional states to be as transparent as possible in one's clinical judgment. 5 Yet the dictum to manage one's outward and inward emotional responses with patients and families is not the same as a moratorium on emotions. If we regard emotions as being a central part of the human experience, in advocating for humanism in medicine, we must acknowledge the emotional life of patients, families, and clinicians. Perhaps the definition we seek is that empathy is respectful compassion. To respect patients fully as human beings is to acknowledge and provide some space for their emotional life. For example, they may well be scared, hopeful, or angry in the face of a diagnosis. The ability of physicians to perceive such states and communicate in some way that they perceive them makes a positive impact on the clinical interaction because it helps build rapport. Through rapport, trust may be developed, and arguably, a necessary condition of any therapeutic relationship is trust. Marshaling one's ability to perceive the emotions of others, and to know how much space in the clinical encounter to give them, is therefore warranted as it is a means to the best possible outcomes. And it is also valuable because it is a way to respect patients as human beings, as having an inherent dignity. Educational interventions meant to develop empathy in medical students have attempted to realize humanism in medicine. But it is unclear what has been effective, not unsurprisingly, because it is difficult to determine what one can measure to see if empathy has waxed or waned, and indeed, what we mean definitionally by empathy is blurry: it is a tricky subject to teach and assess. Do we mean feeling what another feels? If so, what makes this state better for the goals of medicine than understanding that someone has specific emotional responses and that we ought to acknowledge this in some caring way? Interestingly, pediatricians, internists, and family medicine physicians scored among the highest relative to other subspecialties using a validated scale to assess physician empathy,
Frustration in meeting challenges associated with the healthcare system and social determinants o... more Frustration in meeting challenges associated with the healthcare system and social determinants of patients’ health have been cited as causes of moral distress leading to erosion of clinician empathy. Including non-traditional health professions like law on interprofessional teams offers advocacy services that address patients’ social needs and may facilitate health systems change, aiding clinicians’ ability to treat illness and enhance quality of life. By including lawyers as partners in health care, health professionals gain knowledge and potential allies that address non-medical influences impacting health, and prevent causes of their own moral distress and empathy erosion.
MedEdPORTAL® is the journal of teaching and learning resources published by the Association of Am... more MedEdPORTAL® is the journal of teaching and learning resources published by the Association of American Medical Colleges (AAMC) in partnership with the American Dental Education Association (ADEA).
Abstract Background: There has been a recent movement towards social accountability in medical sc... more Abstract Background: There has been a recent movement towards social accountability in medical schools, which includes integrating the social, economic, and cultural determinants of health into the curriculum. Medical schools and their guiding bodies have met this challenge of educating future physicians to provide effective care to diverse populations with varying response and successes. Because these topics have not been systematically taught in most medical school curricula, strategies are needed to teach them alongside clinical sciences. Aim and method: We provide 12 tips on how to teach social determinants of health and cultural competency to undergraduate medical students. These recommendations are based on a review of the literature and our experience in developing and delivering a longitudinal course over the last five years. Conclusion: Medical students must be taught to think critically about the social and cultural issues impacting health, and the intersection with the basic biology and clinical skills. Teaching social determinants of health in medicine requires keeping the material concrete and applicable. Educators must engage students in active learning strategies, reflection, and focus on how to make the material relevant to the clinical care of patients.
Percentage of Views Leading to Downloads: 13% MedEdPORTAL® is the journal of teaching and learnin... more Percentage of Views Leading to Downloads: 13% MedEdPORTAL® is the journal of teaching and learning resources published by the Association of American Medical Colleges (AAMC) in partnership with the American Dental Education Association (ADEA).
... Address for correspondence: Madeleine J. Sigman-Grant, PhD, RD, University of Nevada Reno, 80... more ... Address for correspondence: Madeleine J. Sigman-Grant, PhD, RD, University of Nevada Reno, 8050 Paradise Road, Las Vegas, NV 89123. ... relative to particular jurisdictionsfor example, the right to make someone else's health care decisions (as a health care proxy). ...
People make sense of their own identities and experiences, including illness, in a narrative cont... more People make sense of their own identities and experiences, including illness, in a narrative context. We see and understand our lives through the stories we tell and hear about ourselves and others. Through the faculty of the imagination, we can stand in the shoes of others to understand different points of view and experiences. Indeed, sometimes ethical failures are failures of imagination. Representing and reading stories of illness can develop the moral imagination of students and providers. Through the study of literature, we can cultivate the capacity to empathize with others and can create ethical possibilities for shared decision-making.
Soulevant la question de la preseance pre-phenomenale de l'Autre sur le Meme dans le cadre et... more Soulevant la question de la preseance pre-phenomenale de l'Autre sur le Meme dans le cadre ethique de l'absence de topos chez Levinas, l'A. montre qu'il y a affinite entre la definition de l'interiorite comme anteriorite chez Levinas et la definition de l'etre comme essence chez Heidegger. Examinant les notions d'obsession et persecution, sensibilite et responsabilite, l'A. denonce le danger terroriste et totalitariste que peut representer l'enormite de l'absolument autre sans le contrepoids du meme
Academic medicine : journal of the Association of American Medical Colleges, Jan 7, 2017
While there are more women in leadership positions in academic medicine now than ever before in o... more While there are more women in leadership positions in academic medicine now than ever before in our history, evidence from recent surveys of women and from graduating medical students demonstrates that sexual harassment continues in our institutions. Our ability to change the culture is hampered by fear of reporting episodes of harassment, which is largely due to fear of retaliation. We describe some efforts in scientific societies that are addressing this and working to establish safe environments at national meetings. We must also work at the level of each institution to make it safe for individuals to come forward, to provide training for victims and for bystanders, and to abolish "locker room" talk that is demeaning to women.
The creation of an integrated basic science curriculum is a major goal in medical education. Howe... more The creation of an integrated basic science curriculum is a major goal in medical education. However, there is little consensus on how this can be effectively accomplished. One route is to utilize clinical problems that integrate multiple disciplines. This study describes an approach to utilize a large group case-based discussion (CBD) integrating ethics and medical genetics that has been administered to two consecutive classes. In this CBD, first-year medical students were provided the opportunity to apply and transfer knowledge to a novel clinical scenario utilizing content previously covered in two courses (“Genes, Molecules and Cells” and “Ethical Foundations in Medicine”) that run concurrently. Students were presented with preimplantation genetic diagnosis results for an X-linked disorder and asked to decipher embryo genotypes and make group recommendations on which embryo(s) they would transfer to achieve a “healthy” pregnancy. In addition to genotype considerations, students were asked to consider the three fundamental ethical principles in healthcare and shared medical decision-making when making their embryo transfer recommendations. This study reports the details of the integrated activity, facilitator feedback, and discusses modifications made to the activity to improve integration and knowledge transfer. Furthermore, this study reports positive feedback from students for this integrated discipline CBD and a significant improvement in learning outcomes following the intervention.
Traumatic brain injury (TBI) survivors typically exhibit significant learning and memory deficits... more Traumatic brain injury (TBI) survivors typically exhibit significant learning and memory deficits and also frequently demonstrate hyperactivation during functional magnetic resonance imaging (fMRI) tasks involving working memory encoding and maintenance. However, it remains unclear whether the hyperactivation observed during such working memory tasks is also present during long-term memory encoding. The preliminary experiments presented here were designed to examine this question. In Experiment 1, 7 healthy controls (HC) and 7 patients with moderate to severe TBI encoded ecologically relevant object location associations (OLA) while undergoing fMRI and then completed a memory test outside of the fMRI environment. fMRI data analysis included only the correctly encoded trials and revealed hyperactivation in the TBI relative to HC group in regions critical for OLA encoding, including bilateral dorsal and ventral visual processing areas, bilateral frontoparietal working memory network r...
Congenital heart care offers a unique lens to evaluate the importance of the practice of empathy ... more Congenital heart care offers a unique lens to evaluate the importance of the practice of empathy understood as respectful compassion. Beginning in utero, providers can interact with patients across the lifespan and at different stages in the experience of CHD. These multiple opportunities to connect with patients from diagnosis to correction and recovery allow the clinician to build rapport and trust of tremendous therapeutic and interpersonal value. Taking time to get to know the values, preferences, experiences, and stories of the patient and families and continuity of care are essential elements. The movement towards teaching virtue or character ethics in medicine came forward with the medical professionalism movement. There was an acknowledgment that as one entered medical school, one's identity transitioned towards a professional identity. A road one travelled to become a good doctor included the development of characteristics that good doctors have, including patience, compassion, trustworthiness, honour, duty, excellence, perceptiveness, humility, and accountability, for example. Often on the list of virtues is empathy, and indeed, empathy has become the pinnacle of virtues and the virtue that most caring, humanistic clinicians were said to hold. 1 While empathy is often touted as one of the primary virtues that should be instilled in medical professionals, attempts at a standard definition of empathy and how to tell if it is instilled or not bring forward a legion of challenges. Empathy has many definitions, from moral imagination (Aristotle) to emotional intelligence (Goleman). Empathy is commonly described as the ability to understand or share the feelings and experiences of others and a capacity to perceive another's experience. 2-4 Interestingly, neurologic evaluation has found similarity in excitation of brain areas related to observing another's emotions based on facial expression and when the observer experiences the same emotion through what are referred to as "mirror neurons." 4 However, feeling what a patient feels may not necessarily be what is needed to be a virtuous physician. First, there is an ethical issue regardless of the conceptual and empirical issues surrounding the claim that we can experience the same state as another. It seems to be less than humble to assert that one can indeed be in a position, especially over short durations of time, to honestly know what another is going through and what their experiences mean to them. Second, a mirror state is unnecessary for the kind of humanistic engagement that we believe is important for patients, families, and clinicians. That is not to say that emotion or shared understanding is unnecessary to realise or, worse, detrimental to the goals of medicine in the clinical encounter. As Osler reminds us, it is vital for clinicians to be composed for the sake of patients and to manage one's emotional states to be as transparent as possible in one's clinical judgment. 5 Yet the dictum to manage one's outward and inward emotional responses with patients and families is not the same as a moratorium on emotions. If we regard emotions as being a central part of the human experience, in advocating for humanism in medicine, we must acknowledge the emotional life of patients, families, and clinicians. Perhaps the definition we seek is that empathy is respectful compassion. To respect patients fully as human beings is to acknowledge and provide some space for their emotional life. For example, they may well be scared, hopeful, or angry in the face of a diagnosis. The ability of physicians to perceive such states and communicate in some way that they perceive them makes a positive impact on the clinical interaction because it helps build rapport. Through rapport, trust may be developed, and arguably, a necessary condition of any therapeutic relationship is trust. Marshaling one's ability to perceive the emotions of others, and to know how much space in the clinical encounter to give them, is therefore warranted as it is a means to the best possible outcomes. And it is also valuable because it is a way to respect patients as human beings, as having an inherent dignity. Educational interventions meant to develop empathy in medical students have attempted to realize humanism in medicine. But it is unclear what has been effective, not unsurprisingly, because it is difficult to determine what one can measure to see if empathy has waxed or waned, and indeed, what we mean definitionally by empathy is blurry: it is a tricky subject to teach and assess. Do we mean feeling what another feels? If so, what makes this state better for the goals of medicine than understanding that someone has specific emotional responses and that we ought to acknowledge this in some caring way? Interestingly, pediatricians, internists, and family medicine physicians scored among the highest relative to other subspecialties using a validated scale to assess physician empathy,
Frustration in meeting challenges associated with the healthcare system and social determinants o... more Frustration in meeting challenges associated with the healthcare system and social determinants of patients’ health have been cited as causes of moral distress leading to erosion of clinician empathy. Including non-traditional health professions like law on interprofessional teams offers advocacy services that address patients’ social needs and may facilitate health systems change, aiding clinicians’ ability to treat illness and enhance quality of life. By including lawyers as partners in health care, health professionals gain knowledge and potential allies that address non-medical influences impacting health, and prevent causes of their own moral distress and empathy erosion.
MedEdPORTAL® is the journal of teaching and learning resources published by the Association of Am... more MedEdPORTAL® is the journal of teaching and learning resources published by the Association of American Medical Colleges (AAMC) in partnership with the American Dental Education Association (ADEA).
Abstract Background: There has been a recent movement towards social accountability in medical sc... more Abstract Background: There has been a recent movement towards social accountability in medical schools, which includes integrating the social, economic, and cultural determinants of health into the curriculum. Medical schools and their guiding bodies have met this challenge of educating future physicians to provide effective care to diverse populations with varying response and successes. Because these topics have not been systematically taught in most medical school curricula, strategies are needed to teach them alongside clinical sciences. Aim and method: We provide 12 tips on how to teach social determinants of health and cultural competency to undergraduate medical students. These recommendations are based on a review of the literature and our experience in developing and delivering a longitudinal course over the last five years. Conclusion: Medical students must be taught to think critically about the social and cultural issues impacting health, and the intersection with the basic biology and clinical skills. Teaching social determinants of health in medicine requires keeping the material concrete and applicable. Educators must engage students in active learning strategies, reflection, and focus on how to make the material relevant to the clinical care of patients.
Percentage of Views Leading to Downloads: 13% MedEdPORTAL® is the journal of teaching and learnin... more Percentage of Views Leading to Downloads: 13% MedEdPORTAL® is the journal of teaching and learning resources published by the Association of American Medical Colleges (AAMC) in partnership with the American Dental Education Association (ADEA).
... Address for correspondence: Madeleine J. Sigman-Grant, PhD, RD, University of Nevada Reno, 80... more ... Address for correspondence: Madeleine J. Sigman-Grant, PhD, RD, University of Nevada Reno, 8050 Paradise Road, Las Vegas, NV 89123. ... relative to particular jurisdictionsfor example, the right to make someone else's health care decisions (as a health care proxy). ...
People make sense of their own identities and experiences, including illness, in a narrative cont... more People make sense of their own identities and experiences, including illness, in a narrative context. We see and understand our lives through the stories we tell and hear about ourselves and others. Through the faculty of the imagination, we can stand in the shoes of others to understand different points of view and experiences. Indeed, sometimes ethical failures are failures of imagination. Representing and reading stories of illness can develop the moral imagination of students and providers. Through the study of literature, we can cultivate the capacity to empathize with others and can create ethical possibilities for shared decision-making.
Soulevant la question de la preseance pre-phenomenale de l'Autre sur le Meme dans le cadre et... more Soulevant la question de la preseance pre-phenomenale de l'Autre sur le Meme dans le cadre ethique de l'absence de topos chez Levinas, l'A. montre qu'il y a affinite entre la definition de l'interiorite comme anteriorite chez Levinas et la definition de l'etre comme essence chez Heidegger. Examinant les notions d'obsession et persecution, sensibilite et responsabilite, l'A. denonce le danger terroriste et totalitariste que peut representer l'enormite de l'absolument autre sans le contrepoids du meme
Academic medicine : journal of the Association of American Medical Colleges, Jan 7, 2017
While there are more women in leadership positions in academic medicine now than ever before in o... more While there are more women in leadership positions in academic medicine now than ever before in our history, evidence from recent surveys of women and from graduating medical students demonstrates that sexual harassment continues in our institutions. Our ability to change the culture is hampered by fear of reporting episodes of harassment, which is largely due to fear of retaliation. We describe some efforts in scientific societies that are addressing this and working to establish safe environments at national meetings. We must also work at the level of each institution to make it safe for individuals to come forward, to provide training for victims and for bystanders, and to abolish "locker room" talk that is demeaning to women.
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Papers by Marin Gillis