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Chapter 9 explores the origins of healing authority and its experiential grounding. Sociological accounts of authority usually refer to institutional power. Many elementary systems of medicine connect healers’ own initiatory illness and affliction to their knowledge and power. This connection is explicit in the Greek myth of Asklepios and was taken up by others in terms of the archetype of the wounded-healer. This ethos of the wounded-healer reflects a relational structure present in the dynamics of the clinical encounter. Healers’ relationship to their own wounds not only conveys symbolic power but can evoke specific psychological and interpersonal dynamics that may contribute to the effectiveness of treatment. In this symbolic logic of healing, the healer’s own wounds become sources of wisdom when they are confronted rather than denied. The ways this attitude may be learned and embodied are illustrated by a series of dreams with images of wounding and healing during psychiatric training. This ethos has implications for understanding the epistemic authority of healers, the training of clinicians, and addressing basic issues in intercultural health care.
Motivational interviewing is a patient-centred communication approach designed to facilitate behavioural change by enhancing intrinsic motivation. Despite its widespread global utility, research on the training and applications of motivational interviewing among resident physicians in Oman remains untapped.
Aims
To examine the awareness, training experiences and clinical implementation of motivational interviewing among psychiatry and family medicine residents enrolled with the Oman Medical Specialty Board (OMSB).
Method
A qualitative study was conducted using semi-structured interviews and focus group discussions with 22 resident physicians from psychiatry and family medicine programmes. Data were analysed using thematic analysis to identify key themes regarding motivational interviewing training and its application in clinical settings.
Results
Three primary themes emerged: (a) residents’ understanding and application of motivational interviewing principles, (b) barriers to the integration of motivational interviewing into clinical practice, such as time constraints and insufficient training, and (c) the need for culturally adapted approaches to motivational interviewing tailored to Omani patients. Although participants appreciated the utility of motivational interviewing to improve patient engagement, they reported inconsistent training and limited opportunities to practise the technique in clinical settings.
Conclusions
The study highlights significant gaps in motivational interviewing training and practice within Oman’s residency programmes. It underscores the necessity for comprehensive, structured motivational interviewing curricula that are sensitive to the local context. Enhancing practical training opportunities may improve the integration of motivational interviewing into patient care, particularly in managing chronic diseases and addiction.
Neurosurgery is a demanding specialty, and a trainee’s exposure to its tenets is usually achieved through residency. Medical students only access neurosurgical knowledge via brief stints in clerkships/electives and often lack mentorship and early exposure. This study sought to investigate the varying expectations about neurosurgical training held by Canadian medical students, with the goal of determining the impact of early exposure through educational opportunities and mentorship in developing interest and familiarity in the field.
Methods:
A cross-sectional study across Canada was conducted where students were provided with a 35-point questionnaire pertaining to mentorship, educational opportunities and interests regarding neurosurgery through REDcap. Questions were open-ended, closed-ended (single choice) or five-point Likert scale (matrix format). Interest in pursuing neurosurgery was selected as the primary outcome of this study and was dichotomized into high or low interest. Predictors of interest were determined using multivariable logistic regressions.
Results:
A total of 136 students from 14 accredited Canadian medical schools responded to the study. Most (55.9%) had prior exposure, and the most commonly reported deterring factors were work–life balance (94.5%) and family (84.6%). Predictors of interest included participation in relevant case-based discussion (OR = 2.644, 95% CI [1.221–5.847], p = 0.015) and involvement in neurosurgical research encouraged by home institution (OR = 1.619, 95% CI [1.124–2.396], p = 0.012).
Discussion
Future efforts to improve student interest should focus on early exposure to the field such as developing pre-clerkship neurosurgical electives or medical student groups focused on neurosurgery.
To evaluate the experiences and perspectives of otolaryngology residents regarding current parental leave (PL) practices, incorporating insights from both male and female trainees to assess institutional policies and support mechanisms.
Methods
A 43-item anonymous survey was distributed to 125 ACGME-accredited otolaryngology residency programs, yielding responses from 105 residents (response rate: 29%). Data were analyzed using descriptive statistics and thematic analysis to evaluate perceptions of PL policies, barriers to leave, and postpartum support.
Results
Most respondents were female (57%) and married (77%), with an average age of 30 years. Only 26% were aware of the American Board of Otolaryngology’s 8-week PL policy. Female residents typically took 4-6 weeks of leave, while male residents took none. Concerns about program strain (29%) and lack of lactation support (60%) were significant barriers. Despite this, most respondents felt supported by co-residents and faculty.
Conclusion
Otolaryngology residents reported dissatisfaction with PL policies, inadequate lactation support, and poor awareness of institutional guidelines. Addressing these issues is critical to fostering a supportive environment for residents pursuing parenthood during training.
While nutrition plays a major role in health, medical students have generally not received adequate nutritional education, lack confidence in their nutritional knowledge and feel unqualified to offer nutrition advice to future patients. Culinary medicine programmes have been developed to address this gap and employ an active learning approach that integrates medical and nutritional learning with the acquisition of culinary competencies and skills. This study aimed to qualitatively evaluate the Université Laval culinary medicine course based on students’ experiences of the course structure, active learning approach and its influence on their lifestyle, clinical practice and future approach to nutrition as physicians.
Design:
Discussion groups were conducted. Thematic content analysis of discussion group data was performed.
Setting:
A first French-language culinary medicine course was developed and pilot tested at Université Laval. The curriculum of this course combined online training videos on medical and nutritional concepts, hands-on cooking sessions and the realisation of a collaborative project.
Participants:
Pre-clerkship medical students enrolled in the elective culinary medicine course at each pilot project semesters (fall 2022: n 12, winter 2023: n 12).
Results:
Students valued the course’s innovative active learning approach, noting improvements in their diet, nutrition and cooking knowledge, skills, self-efficacy and confidence. They also developed greater critical thinking regarding nutrition and recognised their role in collaborating with dietitians.
Conclusion:
The culinary medicine course demonstrated prospective benefits for medical students, potentially improving their personal and future patients’ health and the integration of nutrition into medical education and practice.
The second wave of Latin American social medicine overlaps with the turmoil of the Cold War as the region experienced processes of anti-communism, military coups, and state violence. A landmark in its history is the establishment of the Latin American Social Medicine Association (ALAMES) in 1984, which today represents the longest-standing transnational organization in the field regionally, exploring the social basis of population health from a leftist political tradition. The association’s account of its origin points to Juan Cesar Garcia and his team at the Pan-America Health Organization (PAHO) as centralizing figures that guided the second wave to new grounds of internationalism. According to the collective, Garcia and the PAHO’s Department of Human Resources helped connect a scattered group of leftist scholars throughout the region’s public universities into the so-called Latin American social medicine Network, enabling a fruitful exchange of ideas and principles that continue to this day.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Modern Lifestyle Medicine can trace its roots from ancient practices to modern applications. Ancient systems, including Ayurveda and traditional Chinese medicine emphasised nutrition, sleep, and stress management, while Greco-Roman and Middle Eastern traditions also recognised the importance of lifestyle in health. The term ‘Lifestyle Medicine’ emerged in the late twentieth century, reflecting a shift towards addressing long-term conditions through lifestyle changes rather than pharmaceuticals. There are challenges on multiple fronts. Firstly, the question of whether research bias is favouring pharmaceutical and surgical interventions over lifestyle changes. Secondly, socio-economic factors exacerbate health inequities, impacting the effectiveness of Lifestyle Medicine. Thirdly, there are education gaps, with healthcare workers lacking knowledge and skills for lifestyle interventions. Fourthly, providers face time constraints and financial incentives that prioritise medications or surgery. Lastly, regulatory issues arise, necessitating quality education and evidence-based practices to distinguish Lifestyle Medicine from alternative approaches.
Palliative care services are unavailable for the vast majority of children in Bhutan. Children’s palliative care has not been incorporated into training programs for health professions, leading to limited knowledge and awareness of how best to support children facing serious or life-threatening conditions.
Objectives
To describe the impact of the Project ECHO children’s palliative care course on participants’ knowledge, comfort, and attitudes and to evaluate the overall acceptability of an online training to support palliative care training in Bhutan.
Methods
Before-and-after surveys of program participants were conducted, assessing changes in knowledge, comfort, and attitudes. Participants’ overall experiences and acceptability of the learning program were assessed through an end-of-program survey.
Results
Participants were primarily nurses (49%) or physicians (34%). Most participants (68%) worked in pediatric and/or neonatal care. Participants’ knowledge of core palliative care concepts improved significantly between the beginning and end of the course. Participants’ comfort and attitudes toward palliative care also improved, with significance effect sizes in most domains (11/18). Satisfaction with the program was high, with 100% of participants agreeing that the training was applicable to their clinical practice. Although most participants (56%) identified a personal need for additional clinical training to support practice change.
Significance of results
Project ECHO can be used to deliver palliative care education, with improved palliative care knowledge, comfort, and attitudes among program participants. A short online training program can generate interest in palliative care, which can be leveraged to further develop palliative care services in settings where palliative care is currently unavailable.
This study aimed to describe medical students’ perceptions and experiences with health policy and advocacy training and practice and define motivations and barriers for engagement.
Methods:
This was a mixed-methods study of medical students from May to October 2022. Students were invited to participate in a web-based survey and optional follow-up phone interview. Surveys were analyzed using descriptive statistics. Phone interviews were audio-recorded, transcribed, and de-identified. Interviews were coded inductively using a coding dictionary. Themes were identified using thematic analysis.
Results:
35/580 survey responses (6% response rate) and 15 interviews were completed. 100% rated social factors as related to overall health. 65.7% of participants felt “very confident” or “extremely confident” in identifying social needs but only 11.4% felt “very confident” in addressing these needs. From interviews, six themes were identified: (1) participants recognized that involvement in health policy and/or advocacy is a duty of physicians; (2) participants acknowledged physicians’ voices as well respected; (3) participants were comfortable identifying social determinants of health but felt unprepared to address needs; (4) barriers to future involvement included intimidation, self-doubt, and skepticism of impact; (5) past exposures and awareness of advocacy topics motivated participants to engage in health policy and/or advocacy during medical school; and (6) participants identified areas where the training on these topics excelled and offered recommendations for improvement, including simulation, earlier integration, and teaching on health-related laws and policies.
Conclusions:
This study highlights the importance of involvement in health policy and advocacy among medical students and the need for enhanced education and exposure.
Test educational interventions to increase the quality of care in telemedicine.
Background:
Telemedicine (TM) has become an essential tool to practise medicine around the world. However, education to address clinical skills in TM remains an area of need globally across the health professions. We aim to evaluate the impact of a pilot online learning platform (OLP) and standardized coaching programme on the quality of medical student TM clinical skills.
Methods:
A randomized pilot study was conducted with fourth-year medical students (n = 12). All participants engaged in video-recorded standardized patient (SP) simulated encounters to assess TM clinical skills before and after the intervention. Participants were randomized to either the OLP or OLP + Virtual Coaching Institute (VCI) intervention cohort. Quantitative and qualitative data were collected to address self-reported skills, attitudes, and self-efficacy before the 1st SP encounter and after the 2nd SP encounter. SP encounter recordings were scored by two blinded non-investigator raters based on a standardized rubric to measure the change in TM care delivered pre- and post-intervention. Statistical analysis of quantitative data included descriptive statistics and mixed effects ANOVA.
Findings:
Recruitment and retention of participants exceeded expectations, pointing to significant enthusiasm for this educational opportunity. Self-reported skills and scored simulation skills demonstrated significant improvements for all participants receiving the interventions. Both OLP and VCI interventions were well received, feasible, and demonstrated statistically significant efficacy in improving TM clinical skills. Participants who received coaching described more improvements in self-efficacy, confidence, and overall virtual clinical skills. This study provides evidence that virtualized clinical learning environments can positively impact the development of TM clinical skills among medical students. As TM continues to evolve, the implementation of innovative training approaches will be crucial in preparing the next generation of healthcare professionals for the demands of modern healthcare delivery.
Although ethics is increasingly integrated in the curriculum of U.S. medical schools, it remains not well integrated with system issues, and social and structural contexts of illness. Moreover, ethical analysis is not often taught as a clinical skill. To address these issues, an outcomes driven course in Social Sciences, Humanities, Ethics and Professionalism (SHEP) was created. Within the course, a web-based concept mapping device, SHEP Case Analysis Tool (SCAT), was created which schematizes the structure and flow of clinical cases from diagnosis to treatment options, to shared decision making to outcome, and includes key stakeholders, influences, and structural features of the health system. In the course, each student analyzes a case in which they were directly involved using SCAT and presents their analysis to faculty and peers. This exercise 1) reinforces knowledge-based portions of the course pedagogy, 2) supports meta-cognition and critical thinking through concept mapping, 3) applies multidimensional analysis to identify ethical, social, and system issues that impact patient-care. 4) develops problem solving skills, 5) counters the hidden curriculum/support professional identity formation, and 6) develops skills in reflective discourse. This paper outlines the development and use of this concept mapping case analysis tool in an undergraduate medical education curriculum.
If you love neuroanatomy, chances are that you also love a good puzzle. Providing a fun and refreshing alternative method of learning and reviewing neuroanatomical structures, this engaging book is perfect for those who love both neuroanatomy and riddles. 150 four-line riddles describe specific high-yield neuroanatomical structures in cryptic form. These could be lobes or general regions of the brain, blood vessels supplying key neurological structures, specific anatomical brain structures, or neuroanatomical spaces and passages. Hints such as general location in the body, the structure's function or dysfunction if impaired, or its Latin or Greek name origin are incorporated. On the following page from each riddle, the answer is given along with a complete description of the structure, history of the structure, clinical correlation and more key information For even more challenging neuroscience puzzles, consider the Neurology Riddle Book, which includes riddles about neurological syndromes, conditions and diseases.
If you love neurology, chances are that you also love a good puzzle. Providing a fun and refreshing alternative method of learning and reviewing neurological syndromes, conditions and diseases, this engaging book is perfect for those who love both neurology and riddles. 150 four-line riddles describe common neurodegenerative diseases and movement disorders as well as rare but commonly board-tested stroke syndromes, seizure disorders and infectious diseases. Each riddle contains cryptic clues such as patient demographic, clinical presentation and underlying pathophysiology for each condition and there are hints in case you get stuck. On the following page you will find the answer to the riddle along with a complete description of the condition, including the history of the disease, pathophysiology, clinical presentation, diagnostics, treatment and prognosis to aid learning. For even more challenging neuroscience puzzles, consider the Neuroanatomy Riddle Book, which includes riddles about clinically-relevant neuroanatomical structures.
Otology training solely using cadavers is challenging because of scarcity and high costs. The use of additive manufacturing technology is a promising alternative. This study aimed to qualitatively validate new additive manufacturing temporal bone specimens for their realism and ability to train surgical skills.
Methods
Three additive manufacturing models generated using cadaveric temporal bones were evaluated. Three otologists with experience as trainers dissected and evaluated each specimen.
Results
The additive manufacturing specimens scored an average of 4.26 ± 0.72 (out of 5) points and received positive feedback. The agreement between the three expert raters was high (intra-class correlation coefficient of 0.745).
Conclusion
The results suggested that the additive manufacturing temporal bones were able to faithfully reproduce a training experience similar to that on cadaveric temporal bones. Further studies that investigate the effectiveness of these specimens in training surgical skills are needed before integrating them into surgical training curricula.
Medical ethics education is crucial for medical students and trainees, helping to shape attitudes, beliefs, values, and professional identities. Exploration of ethical dilemmas and approaches to resolving them provides a broader understanding of the social and cultural contexts in which medicine is practiced, as well as the ethical implications of medical decisions, fostering critical thinking and self-reflection skills imperative to providing patient-centered care. However, exposure to medical ethics topics and their clinical applications can be limited by curricular constraints and the availability of institutional resources and expertise. Podcasts, among other Free Open Access Medical Education (FOAMed) resources, are a novel educational tool that offers particular advantages for self-directed learning, a process by which learners engage in asynchronous educational opportunities outside of traditional academic or clinical settings. Podcasts can be readily distributed to wide audiences and played at any time, reducing barriers to access and offering a level of flexibility that is not possible with traditional forms of education and is well-suited to busy schedules. Podcasts can also use real voices and storytelling to make the content memorable and eminently human. This paper describes the development, production process, and impact of Core IM’s “At the Bedside,” a podcast focusing on issues in medical ethics and the medical humanities, intending to supplement standard bioethics curricula in an accessible, relevant, and engaging way. The authors advocate for broad incorporation of podcasts into medical ethics education.
This study demonstrates a national programme which has been accepted in Wales as a mandatory part of the induction process for the rotating ENT SHO cohort.
Methods
The ENT Induction Bootcamp was established based on the learning needs of ENT SHOs. Pre- and post-course assessment of the subjective and objective benefit of the 1-day course was captured.
Results
Between 2022 and 2024, 152 participants have attended the bootcamp; all of whom (100 per cent) found the course beneficial. The greatest improvements in participant confidence were observed in emergency tracheostomy management, flexible nasendoscopy and nasal examination (all p < 0.01). Based on objective assessment, participant knowledge improved from a mean of 68.5 per cent to 96.5 per cent.
Conclusion
This initiative highlights the value of a bootcamp approach to standardise junior doctors’ abilities to manage ENT emergencies. This bootcamp is now a mandatory component for all SHO entering ENT attachments in Wales, in an easily adoptable format.
There are increasing calls for coverage of medicine during the Holocaust in medical school curricula. This article describes outcomes from a Holocaust and medicine educational program featuring a study trip to Poland, which focused on physician complicity during the Holocaust, as well as moral courage in health professionals who demonstrated various forms of resistance in the ghettos and concentration camps. The trip included tours of key sites in Krakow, Oswiecim, and the Auschwitz-Birkenau concentration camps, as well as meeting with survivors, lectures, reflective writings, and discussions. In-depth interviews and reflective writings were qualitatively analyzed. Resulting themes centered on greater understanding of the relationship between bioethics and the Holocaust, recognizing the need for moral courage and social awareness, deeper appreciation for the historical roles played by dehumanization and medical power and their contemporary manifestations, and the power of presence and experiential learning for bioethics education and professional identity formation. These findings evidence the significant impact of the experience and suggest broader adoption of pedagogies that include place-based and experiential learning coupled with critical reflection can amplify the impact of bioethics and humanism education as well as the process of professional identity formation of medical students.