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Coverdale, John, Colin P. West, and Laura Weiss Roberts. "Courage and Mental Health: Physicians and Physicians-in-Training Sharing Their Personal Narratives." Academic Medicine 96, no. 5 (April 27, 2021): 611–13. http://dx.doi.org/10.1097/acm.0000000000004006.
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Macdonald, Catriona M. M. "Andrew Lang and Scottish Historiography: Taking on Tradition." Scottish Historical Review 94, no. 2 (October 2015): 207–36. http://dx.doi.org/10.3366/shr.2015.0257.
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The career and posthumous reputation of Andrew Lang (1844–1912) call into question Scottish historiographical conventions of the era following the death of Sir Walter Scott which foreground the apparent triumph of scientific methods over Romance and the professionalisation of the discipline within a university setting. Taking issue with the premise of notions relating to the Strange Death of Scottish History in the mid-nineteenth century, it is proposed that perceptions of Scottish historiographical exceptionalism in a European context and presumptions of Scottish inferiorism stand in need of re-assessment. By offering alternative readings of the reformation, by uncoupling unionism from whiggism, by reaffirming the role of Romance in ‘serious’ Scottish history, and by disrupting distinctions between whig and Jacobite, the historical works and the surviving personal papers of Andrew Lang cast doubt on many conventional grand narratives and the paradigms conventionally used to make sense of Scottish historiography.
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Varricchio, M. "Personal Narratives of Irish and Scottish Migration, 1921-65: "For Spirit and Adventure"." Oral History Review 35, no. 2 (May 30, 2008): 238–40. http://dx.doi.org/10.1093/ohr/ohn051.
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Sørlie, Venke, Anders Lindseth, Gigi Udén, and Astrid Norberg. "Women Physicians’ Narratives About Being in Ethically Difficult Care Situations in Paediatrics." Nursing Ethics 7, no. 1 (January 2000): 47–62. http://dx.doi.org/10.1177/096973300000700107.
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This study is part of a comprehensive investigation of ethical thinking among male and female physicians and nurses. Nine women physicians with different levels of expertise, working in various wards in paediatric clinics at two of the university hospitals in Norway, narrated 37 stories about their experience of being in ethically difficult care situations. All of the interviewees’ narrations were concerned with problems relating to both action ethics and relation ethics. The main focus was on problems in a relation ethics perspective. The most common themes in an action ethics perspective were overtreatment and withholding treatment. The more experienced physicians reasoned differently from the group of less experienced physicians and they coped with pressure in different ways. The less experienced physicians disclosed their professional experience yet seemed uncertain, while putting on an air of certainty, but the more experienced physicians disclosed both their professional and personal experience of caregiving and they seemed to allow themselves to feel uncertain in their certainty. Both groups emphasized a need for deep discussion between colleagues about their being in ethically difficult care situations.
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Hernandez, Barbara Couden, Jessica L. ChenFeng, and Naomi J. Schwenke. "Supporting Physicians During the COVID-19 Pandemic: A Cumulative Feminist Autoethnography." Journal of Systemic Therapies 42, no. 1 (March 2023): 56–73. http://dx.doi.org/10.1521/jsyt.2023.42.1.56.
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Three marriage and family therapists discuss their experience providing therapy and support interventions for physicians during the COVID-19 pandemic. They present three feminist autoethnographic accounts about the unique intersectionality of their lives as they served physicians on the frontlines of the pandemic whilst also negotiating the pandemic themselves. Three themes from the narratives are presented and explored and implications are given for other therapists whose clinical services for medical care professionals also carried a personal and emotional cost.
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Kraege, Vanessa, Amaelle Gavin, Julieta Norambuena, Friedrich Stiefel, Marie Méan, and Céline Bourquin. "Core stories of physicians on a Swiss internal medicine ward during the first COVID-19 wave: a qualitative exploration." Swiss Medical Weekly 154, no. 3 (March 29, 2024): 3760. http://dx.doi.org/10.57187/s.3760.
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INTRODUCTION: The first COVID-19 wave (2020), W1, will remain extraordinary due to its novelty and the uncertainty on how to handle the pandemic. To understand what physicians went through, we collected narratives of frontline physicians working in a Swiss university hospital during W1. METHODS: Physicians in the Division of Internal Medicine of Lausanne University Hospital (CHUV) were invited to send anonymous narratives to an online platform, between 28 April and 30 June 2020. The analysed material consisted of 13 written texts and one audio record. They were examined by means of a narrative analysis based on a holistic content approach, attempting to identify narrative highlights, referred to as foci, in the texts. RESULTS: Five main foci were identified: danger and threats, acquisition of knowledge and practices, adaptation to a changing context, commitment to the profession, and sense of belonging to the medical staff. In physicians’ narratives, danger designated a variety of rather negative feelings and emotions, whereas threats were experienced as being dangerous for others, but also for oneself. The acquisition of knowledge and practices focus referred to the different types of acquisition that took place during W1. The narratives that focused on adaptation reflected how physicians coped with W1 and private or professional upheavals. COVID-19 W1 contributed to revealing a natural commitment (or not) of physicians towards the profession and patients, accompanied by the concern of offering the best possible care to all. Lastly, sense of belonging referred to the team and its reconfiguration during W1. CONCLUSIONS: Our study deepens the understanding of how physicians experienced the pandemic both in their professional and personal settings. It offers insights into how they prepared and reacted to a pandemic. The foci reflect topics that are inherent to a physician’s profession, whatever the context. During a pandemic, these foundational elements are particularly challenged. Strikingly, these topics are not studied in medical school, thus raising the general question of how students are prepared for the medical profession.
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Venkatesan, Sathyaraj, and Livine Ancy A. "Changing Configurations in the Portrayal of Doctors in Graphic Narratives: A Study of The Bad Doctor and The Lady Doctor." SAGE Open 11, no. 3 (July 2021): 215824402110361. http://dx.doi.org/10.1177/21582440211036114.
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The figure of the doctor has always been surrounded by a heroic aura, warranted by the possession of hard-earned medical knowledge and the tenacious reliance on doctors’ ability to heal and emancipate from pain and suffering. However, recent literary and visual-cultural representations of doctors have unsettled the dominant and homogenized perception of physicians as heroes. Particularly, representations in mainstream books, popular media, and comics, which have predominantly offered unilaterally positive initial portrayals of doctors as superhuman figures, eventually provided people with more nuanced and realistic representations, disclosing the “undesirable and unprofessional attitudes” of physicians and their sufferings. Ian Williams’ graphic narratives The Bad Doctor (2014, Oxford: Myriad Editions) and The Lady Doctor (2019, Oxford: Myriad Editions) serve as a critical lens to reflect on the postmodern perspective of doctor as a “wounded healer” and illuminate the problematic view of physicians as heroes. Drawing instances from the aforementioned graphic narratives, this essay aims to provide a revisionary understanding of physicians from heroes to victims of larger-than-life forces such as bureaucracy and the demands of patients. The essay scrutinizes how the verbal-visual medium of comics facilitates the envisioning and enunciating of the troubled personal and professional lives of physicians and the complexities involved in the medical profession.
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Purtilo, Ruth B. "Narratives on Pain and Comfort." Journal of Law, Medicine & Ethics 24, no. 4 (1996): 287. http://dx.doi.org/10.1111/j.1748-720x.1996.tb01866.x.
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Pain management has no meaning without the stories of men and women, and boys and girls whose lives are dramatically altered by the presence of pain in their own and their loved ones lives. In this narrative section, four people present their perspectives on the enigma and challenge of pain, its power, and our on-going efforts to limit its hold on our lives.In the first story, Dr. Robert McQuillan, an anesthesiologist with Creighton University School of Medicine, conveys the fear some patients suffering chronic pain face when seeking pain medication over the long term. Dr. Christine Cassel, chair of the Department of Geriatrics and Adult Development at Mount Sinai Medical Center and immediate past president of the American College of Physicians, recounts the plight of a fellow physician whose pain treatment of a patient led to suspension of his professional license and to personal bitterness after many years of exemplary medical practice.
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MURDOCH, ALEX. "Personal Narratives of Irish and Scottish Migration, 1921-65: ‘For Spirit and Adventure’- By Angela McCarthy." History 94, no. 313 (January 2009): 125–26. http://dx.doi.org/10.1111/j.1468-229x.2009.444_53.x.
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Mackay, Rob, Margot Fairclough, and Michael Coull. "Service users and carers as co-educators of social work students." Journal of Practice Teaching and Learning 9, no. 1 (December 20, 2012): 95–112. http://dx.doi.org/10.1921/jpts.v9i1.387.
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This paper considers issues related to the requirement by the Scottish Social Services Council (SSSC) and the Scottish Government that service users and carers are partners and stakeholders in social work education. This requirement is one of many used by the SSSC in the approval of Scottish universities to deliver social work courses.This paper explains and reflects on the experiences of including service users and carers as co-educators with the social work courses at the Robert Gordon University (RGU) making particular reference to one module. It examines the issues around the process of their involvement with the education of social work students, and considers student evaluations of this module. Lastly it discusses the broader implications for partnership working in relation to the education and training of students for professional practice. The focus is on the role that service users and carers can play as partners in the classroom through the use of personal narratives. The experience of presenting as a service user or carer is discussed and the contributions highlight how such presentations can heighten student awareness as to the lived experience of a disability or a mental health problem.
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Greene, Jessica, Judith H. Hibbard, and Rebecca M. Sacks. "Testing a Personal Narrative for Persuading People to Value and Use Comparative Physician Quality of Care Information: An Experimental Study." Medical Care Research and Review 76, no. 4 (September 9, 2017): 497–511. http://dx.doi.org/10.1177/1077558717730156.
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Objective: This study tests whether a personal narrative can persuade people to value comparative data on physician quality. Method: We conducted an online experiment with 850 adults. One group viewed a cartoon narrative on physician quality variation, another saw text on physician quality variation, and there was a control group. Study participants hypothetically selected a physician from a display of four physicians. The top-quality physician was furthest away and most expensive. We conducted multivariate models examining the relationship between experimental group and choice of the top-quality physician. Results: There was no overall relationship between narrative or text information and choice of the highest quality physician. Among higher numerate participants, however, those who viewed the narrative had odds 2.7 times higher of selecting the top-quality physician compared with the control group. Discussion: Personal narratives can persuade higher numerate people to consider quality when selecting physicians.
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Fischer Grönlund, Catarina EC, Anna IS Söderberg, Karin M. Zingmark, S. Mikael Sandlund, and Vera Dahlqvist. "Ethically difficult situations in hemodialysis care – Nurses' narratives." Nursing Ethics 22, no. 6 (August 7, 2014): 711–22. http://dx.doi.org/10.1177/0969733014542677.
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Background: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose. Research question: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses’ experiences of being in ethically difficult situations that give rise to a troubled conscience. Research design: This study has a phenomenological hermeneutic approach. Participants: Narrative interviews were carried out with 10 registered nurses working in dialysis care. Ethical considerations: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University. Results: One theme, ‘Calling for a deliberative dialogue’, and six sub-themes emerged: ‘Dealing with patients’ ambiguity’, ‘Responding to patients’ reluctance’, ‘Acting against patients’ will’, ‘Acting against one’s moral convictions’, ‘Lacking involvement with patients and relatives’ and ‘Being trapped in feelings of guilt’. Discussion: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience. Conclusion: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.
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Kannampallil, Thomas, Steve Jones, and Joanna Abraham. "‘This is our liver patient…’: use of narratives during resident and nurse handoff conversations." BMJ Quality & Safety 29, no. 2 (July 3, 2019): 135–41. http://dx.doi.org/10.1136/bmjqs-2018-009268.
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ObjectiveHandoffs are often framed as the co-construction of a shared understanding relying on narrative storytelling. We investigated how narratives are constructed and used during resident and nurse handoff conversations.MethodWe audio-recorded resident (n=149) and nurse (n=126) handoffs in an inpatient medicine unit. Qualitative analysis using grounded theory was conducted to identify and characterise the structure of resident and nursing handoff narratives.ResultsHandoff conversations among both residents and nurses used three types of narratives: narratives on creating clinical imagery, narratives on coordinating care continuity and narratives on integrating contextual aspects of care. Clinical imagery narratives were common during patient introductions: residents used a top-down approach relying on overarching patient clinical situations (eg, ‘a liver patient’), whereas nurses used a bottom-up approach using patient-specific identifying information. Narratives on the coordination of care continuity for residents focused on managing internal and external coordination activities, whereas nurse narratives focused on internal coordination, emphasising their role as an interface between patients and their physicians. Both resident and nurse narratives on the contextual aspects of care had considerable focus on highlighting ‘heads up’ anticipatory information and personal patient information; such information was often not present in patient charts, but was important for ensuring effective care management.DiscussionThe presence of narrative structures highlights the need for new perspectives for the design of handoff tools that allow for both informational and cognitive support and shared awareness among conversational partners during handoff conversations. We discuss the implications of the use of narratives for patient safety and describe specific design considerations for supporting narrative interactions during handoffs.
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Talen, Mary R., Jeffrey Rosenblatt, Christina Durchholtz, and Geraldine Malana. "Turning the tables: Using resident physicians’ experiences as patients for leveraging patient-centered care." International Journal of Psychiatry in Medicine 53, no. 5-6 (September 25, 2018): 405–14. http://dx.doi.org/10.1177/0091217418802163.
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Training physicians to become person-centered is a primary goal of behavioral health curriculum. We have curriculum on doctor–patient communication skills and patient narratives to help physicians relate to the patient’s experiences. However, there is nothing more effective than actually being the patient that gives providers an “aha” experience of the patient’s perspective. In this article, we will share personal resident physician-patient stories based on their experiences within acute urgent care, chronic disease management, and routine well health care. In each narrative, the physician-patient will describe how their experiences had an impact in three areas: (1) their professional identity, (2) their connection with patients, and (3) their experience of the health-care system and teams. Drawing from the key emotional and cognitive experiences from these stories, we will identify training strategies that can bridge the personal to professional experiences as a way to enhance person-centered care. Our goal is to use the physician’s insider perspective on the patient experience as a means to augment the awareness of professional physician role, team-based care, and navigating the health-care system.
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Habti, Driss. "Differentiated Embedding and Social Relationships Among Russian Migrant Physicians in Finland: A Narrative Socio‐Analysis." Social Inclusion 9, no. 4 (December 15, 2021): 266–77. http://dx.doi.org/10.17645/si.v9i4.4546.
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Migrants’ processes of (dis)embedding in local and transnational social networks have received growing attention in recent years, but most research focuses on low‐skilled migration. This study explores the affordances and challenges that Russian physicians, as a high‐skilled migrant group in Finland, experience in these processes in work and non‐work domains. Based on semi‐structured biographical interviews with 26 Russian physicians, the study employs Bourdieu’s socio‐analysis to analyze their narratives. The results reveal that Russian migrant physicians negotiate and experience differentiated embedding across work–life domains in local and transnational contexts. They mostly develop collegial relationships with Finnish colleagues and benefit from fulfilling professional relationships in the work domain. However, alongside time and efforts needed for building social ties, various factors often impede friendship making and socialization with locals beyond the work domain. These physicians cope with individual life circumstances through their enduring and supportive relationships with their Russian relatives and colleagues–friends. These results indicate that high‐skilled migrants have a greater opportunity to connect professionally with locals than low‐skilled migrants, but experience similar challenges to the latter in building close personal relationships.
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Morton, Graeme. "The Social Memory of Jane Porter and her Scottish Chiefs." Scottish Historical Review 91, no. 2 (October 2012): 311–35. http://dx.doi.org/10.3366/shr.2012.0104.
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Formed within the interplay of history, culture and cognition, the concept of social memory is introduced to evaluate a key element of Scotland's nineteenth-century national tale. Being never more than partially captured by state and monarchy, and only imperfectly carried by institutions and groups, the national tale has comprised a number of narratives. Within the post-Union fluidity of Scotland's place within Britain, and at a time of European conflict, this tale coalesced around social memories of the mediaeval patriot William Wallace. Distinctive to that process was the historical romance The Scottish Chiefs (1810), as it was merged with the public life of its author, Jane Porter (bap. 1776–1850). By situating this fictional account of the life of Wallace within the social memories of its author, and in society more widely, attention is directed towards a set of stories formed in Porter's own cognition. These living memories were forged in her childhood experiences of a new life in Scotland; her claim to have pioneered the historical novel, confirmed by her friend Walter Scott; her personal, familial, and fictional projections of her public self; and in how contemporaries returned to her, and made known to society, their reception of her personality, her deportment, and her fiction. It was in combination that a leading social memory of the nation's tale was formed out of living memory that could not have transcended time and place.
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Caddell, Martha, and Kimberly Wilder. "Seeking Compassion in the Measured University." Journal of Perspectives in Applied Academic Practice 6, no. 3 (October 8, 2018): 13–23. http://dx.doi.org/10.14297/jpaap.v6i3.384.
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In the context of league tables, national student surveys and increasing competition for students and resources, measurement and comparison is an ever-present – and ever more significant – aspect of contemporary academic life. Institutional definitions of prestige and success intertwine with individuals’ sense of value, career-progression and everyday work activity in varying ways, from active championing of particular dominant visions of ‘excellence’ through to varying forms of resistance, both passive and active. Faced with such challenges, increasing attention is being given to where academics find support, value and motivation in their working lives. This paper explores academics’ narratives of the relationship and practices that shape their career decisions and frame their academic practice, highlighting the everyday pressures that squeeze space for compassionate collegiality.
The paper draws on narrative interviews that explored how academics experienced kindness and collegiality as they transition through their careers, examining detailed personal narratives of 23 academics based at Scottish universities. Participants shared their CVs and three artefacts (pictures, objects, or events) that were significant to their career journey. The resulting narratives offer detailed insight into how participants negotiate institutional pressures and frame relations with colleagues in order to create meaning, value and (degrees of) ‘happiness’ in their work.
The paper argues that while there is recognition of the impact of universities’ strive for ‘excellence’ on staff interactions and work priorities, this is largely de-politicised in institutional contexts, with attention given to personal resilience, finding work-life balance, and individuals developing soft-skills to manage everyday interactions. The more socially-oriented concept of ‘compassion’ offers a fresh perspective from which to explore the everyday interactions within the university and consider the practical and political steps required to create supportive work environments.
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Jamison, Kay Redfield. "Disorders of Mood: The Experience of Those Who Have Them." Daedalus 152, no. 4 (2023): 151–65. http://dx.doi.org/10.1162/daed_a_02036.
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Abstract Mood disorders are common, painful, and closely tied to suicide and alcohol and substance use. They are also treatable. Mania and depression, a part of the human record for as long as it has been kept, were well-recognized and described by physicians of antiquity. Our knowledge of mood disorders has broadened and deepened in the many centuries since those early times, and crosses many scientific and clinical fields, including genetics, neuropharmacology, neuroimaging, psychopathology, and neuropsychology. We have as well a rich history of personal narratives of depression and bipolar disorder that gives a different but essential perspective; I present several of these accounts here.
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Kasselstrand, Isabella. "‘We Still Wanted That Sense of Occasion’: Traditions and Meaning-Making in Scottish Humanist Marriage Ceremonies." Scottish Affairs 27, no. 3 (August 2018): 273–93. http://dx.doi.org/10.3366/scot.2018.0244.
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As a secularising nation in Northern Europe, Scotland has, over the last few decades, experienced a steep decline in religious belonging, church attendance, and beliefs. Ritual participation, which is arguably an understudied dimension of secularisation, follows a similar pattern of decline, with a significant majority of Scottish marriage rituals now being conducted in secular ceremonies. Using data from semi-structured in-depth interviews with 17 married couples, this study examines the decisions that secular Scots make when planning their wedding. Moreover, it places a particular focus on humanist marriage ceremonies, which have seen a noteworthy increase in popularity since they became legally recognised in Scotland in 2005. The secular participants emphasised the role of personal convictions and family expectations in choosing a particular type of marriage ceremony. The narratives also revealed how positive attitudes toward humanist ceremonies, in contrast with civil ceremonies, are centred around their ability to create personalised, nonreligious, celebrations that nevertheless give attention to culture and heritage. Ultimately, the findings suggest that repeating history through cultural traditions are an important aspect of both secular and religious rites of passage.
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Nations, Marilyn K., Geison Vasconcelos Lira, and Ana Maria Fontenelle Catrib. "Stigma, deforming metaphors and patients' moral experience of multibacillary leprosy in Sobral, Ceará State, Brazil." Cadernos de Saúde Pública 25, no. 6 (June 2009): 1215–24. http://dx.doi.org/10.1590/s0102-311x2009000600004.
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In response to the call for a new Science of Stigma, this anthropological study investigates the moral experience of patients diagnosed with severe multibacillary leprosy. From 2003 to 2006, fieldwork was conducted in the so-called "United-States-of-Sobral", in Ceará State, Northeast Brazil. Sobral is highly endemic for leprosy, despite intensified eradication efforts and a 30% increase in primary care coverage since 1999. Of 329 active leprosy cases at two public clinics, 279 multibacillary patients were identified and six information-rich cases selected for in-depth ethnographic analysis, utilizing illness narratives, key-informant interviews, home visits, participant-observation of clinical consultations and semi-structured interviews with physicians. A "contextualized semantic interpretation" revealed four leprosy metaphors: a repulsive rat's disease, a racist skin rash, a biblical curse and lethal leukemia. Far from value-free pathology, the disease is imbued with moral significance. Patients' multivocalic illness constructions contest physicians' disease discourse. "Skin Spot Day" discriminates more than educates. Patients' "non-compliance" with effective multi-drug therapy is due to demoralizing stigma more than a rejection of care. "Social leprosy" in Northeast Brazil deforms patients' moral reputations and personal dignity.
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Perchard, Andrew. "“Broken Men” and “Thatcher's Children”: Memory and Legacy in Scotland's Coalfields." International Labor and Working-Class History 84 (2013): 78–98. http://dx.doi.org/10.1017/s0147547913000252.
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AbstractThis article explores the legacy of the demise of the deep coal mining industry in Scotland. It places particular emphasis on the cultural scars of this process as witnessed through miners' and managers' memories, positioning these within the context of occupational socialization, conflict, and alienation. The piece explores the enduring importance of these cultural scars in shaping broader collective narratives of decline in Scotland, and how responses were manifest in shifting political outlooks and the emergence (at both a local and national level) of a resurgent nationalism from the early 1960s onward. Drawing on the notion of the “cultural circuit,” the article examines how and why personal experience of the loss of the coal industry informed and conformed to the politics of the miners' union in Scotland, the National Union of Mineworkers Scottish Area (NUMSA). As the article makes clear, the program of closures in the industry has left profound psychological scars in coalfield communities—ones that, like the closure of other major industrial sites, shape a powerful national narrative.
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Sorrell, Sara, and Halah Ibrahim. "First year medical students’ perceptions of the impact of wearing scrubs on professional identity: a narrative analysis in the United Arab Emirates." BMJ Open 10, no. 11 (November 2020): e039357. http://dx.doi.org/10.1136/bmjopen-2020-039357.
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ObjectivesMedical school serves as a critical developmental period for future physicians, during which students begin to form a professional identity. Just as personal appearance, particularly clothing, is an important external expression of one’s personal identity, ‘uniforms’ in healthcare, including white coats and scrubs, symbolise status and a group identity. There are, however, limited studies on the impact of physician attire on medical students’ formation of professional identity. Accordingly, through qualitative analysis of written narratives, we sought to analyse medical students’ experiences of wearing professional physician attire, namely scrubs, and how the uniform impacted their confidence level, performance and behaviours, as well as their identity as future physicians.DesignQualitative analysis of medical student’s written narratives.SettingKhalifa University College of Medicine and Health Sciences (KU CMHS) is a new medical school in the United Arab Emirates, with an inaugural class of 30 students admitted in August 2019. It is the only medical school in the city of Abu Dhabi, and the only school in the country that follows a postgraduate medical curriculum.ParticipantsAll first year medical students at KU CMHS were purposively sampled.MethodsStudents completed a voluntary online anonymous questionnaire. We employed a social identity approach to data analysis. Thematic content analysis was conducted on their narratives to identify themes.ResultsWe identified three major themes, namely (1) emotions, (2) logistics and (3) interpersonal relationships.ConclusionsMedical students form early perceptions regarding physician attire and its impact on their professional identity. Engaging in conversations regarding professional attire with educators or mentors could provide an important opportunity for students to discuss and explore professional identity early in training.
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Hatem, David S., and Thomas Halpin. "Becoming Doctors: Examining Student Narratives to Understand the Process of Professional Identity Formation Within a Learning Community." Journal of Medical Education and Curricular Development 6 (January 2019): 238212051983454. http://dx.doi.org/10.1177/2382120519834546.
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Background: Professional identity formation is a key aim of medical education, yet empiric data on how this forms are limited. Methods: Our study is a qualitative analysis of student reflections written during the final session of our Becoming a Physician curriculum. After reading their medical school admission essay and their class oath, students wrote about a “time, or times during your third year when you felt like a doctor.” The reflections were qualitatively analyzed by the evaluation team, looking for themes found in the reflections. Results: Narrative themes separated into 4 distinct categories, specifically that performing physician tasks can make one feel like a doctor, demonstrating caring is a fundamental task of doctors, integrating personal ideals with professional values promotes professional identity formation, and the theme of never feeling like a doctor. Subsets of these broad categories provide further insight into individual and integrative tasks. Patients, patient families, and students through their own reflection prompted learners to feel like doctors in 74% of narratives, whereas physicians or the care team did so in 26% of our narratives. Conclusion: Students are able to reflect on times during their principal clinical year where they feel like doctors, taking a step toward forming a professional identity. Having faculty prompt and support such reflection can help faculty understand the student experience of their principal clinical year and promote professional identity formation.
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Emerson, Roger L. "The Scottish Enlightenment and the End of the Philosophical Society of Edinburgh." British Journal for the History of Science 21, no. 1 (March 1988): 33–66. http://dx.doi.org/10.1017/s0007087400024377.
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The story of the end of the Philosophical Society of Edinburgh (P.S, E.) in 1783, is linked with that of the founding of the Society of Antiquaries of Scotland (S.A.S.) (1780) and the Royal Society of Edinburgh (R.S.E.), both of which were given Royal Charters sealed on 6 May 1783. It is a story which has been admirably told by Steven Shapin. He persuasively argued that the P.S.E. was a casualty of bitter quarrels rooted in local Edinburgh politics, in personal animosities and in disputes about the control of cultural property and intellectual leadership. In all this he was surely correct just as he was in finding the principal actors in this controversy to be: David Erskine, 11th Earl of Buchan; the Reverend Dr John Walker, Professor of Natural History in Edinburgh University; Dr William Cullen, Professor of the Theory and Practice of Medicine and Vice-President of the P.S.E.; Mr William Smellie, Printer to the Society of Antiquaries; Henry Home, Lord Kames, S.C.J. and President of the P.S.E.; Sir George Clerk-Maxwell, Vice-President of the P.S.E.; John Robison, Professor of Natural Philosophy and Secretary to the P.S.E.; Edinburgh University's Principal, William Robertson; the Curators of the Advocates Library: Ilay Campbell, Robert Blair, Alexander Abercromby, Alexander Fraser Tytler, Professor of Public Law; Henry Dundas, Lord Advocate (1775–August 1783) and M.P. for Midlothian. In a peripheral way, the Royal Colleges of Physicians and Surgeons were probably also involved; so too were Lord Buchan's brothers, Henry and Thomas Erskine, Foxite Whigs who opposed Dundas politically. Henry Erskine displaced Dundas as Lord Advocate in August 1783. After the change of ministry on 18 December 1783 he was ousted, but became Dean of the Faculty of Advocates in 1785. National as well as burgh politics touched these disputes and gave the parties of the Erskines and Dundas and his friends some leverage in London.
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Gino, Sebastiano. "Archibald Pitcairne and the Newtonian Turn of Medical Philosophy." Journal of Scottish Philosophy 21, no. 2 (June 2023): 211–28. http://dx.doi.org/10.3366/jsp.2023.0362.
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Archibald Pitcairne’s medical writings are inspired by Newton’s Principia mathematica, as the Scottish physician assumed Newtonian physics as a model for scientific inquiry that should be applied to other branches of natural philosophy, including physiology and pathology. The ideal of a comprehensive mathematical science was very appealing to late seventeenth-century intellectuals, including physicians. This essay focuses on how Pitcairne tried to implement these ideas. In particular, I argue that Pitcairne’s medical thinking is based on three philosophical assumptions: first, a methodological assumption, for which medical knowledge should be sought in the form of a deductive system; second, an epistemological assumption, that is, that our knowledge of physiological processes is sound only when we reduce them to a set of mathematical laws; and, third, an ontological assumption that identifies blood as the substance on which animal life most directly depends. I also suggest that such ideas should be studied against the backdrop of Pitcairne’s general mindset, including his personal sympathy for political conservativism. I further argue that his insistence on the reduction of natural processes to mathematical relations and his search for the universal order of nature also connect to his religious and political ideals.
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Hughes, Annmarie. "Angela McCarthy, Personal Narratives of Irish and Scottish Migration, 1921–65 ‘For spirit and Adventure’, Manchester, Manchester University Press, 2007. Pp. 256. Hardback ISBN 9780719073526, £55.00." Journal of Scottish Historical Studies 29, no. 1 (May 2009): 83–85. http://dx.doi.org/10.3366/e1748538x09000417.
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Lieven, Michael. "Heroism, Heroics and the Making of Heroes: The Anglo-Zulu War of 1879." Albion 30, no. 3 (1998): 419–38. http://dx.doi.org/10.1017/s0095139000061093.
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In recent years a number of studies have examined the function of heroic narratives in the propaganda of empire and the construction of “Britishness.” Graham Dawson has argued that such narratives “became myths of nationhood itself providing a cultural focus around which the national community could cohere.” In the light of the nineteenth-century chivalric ideal, the Victorian military hero was expected to be “the embodiment of the virtues of bravery, loyalty, courtesy, generosity, modesty, purity, and compassion, and endowed with an indelible sense of noblesse oblige towards women, children and social inferiors.” The English and upper-class image of the “British” hero served, among other things, to inculcate these supposedly English characteristics in the Irish, Scottish, and Welsh. Courage was taken for granted as the essential characteristic of British imperial officers in the Victorian period but, while courage is a personal quality and is not in itself a quality belonging to the public domain, heroism is, by contrast, something definitionally public. The courageous man becomes a hero only when he is declared to be one. The roots of the hero are in dramatic narrative, which spans the epic myth and the reality of war. The hero is “made” whether in a dramatic fiction or in the representation of events, though the latter produces the problem of molding reality to the requirements of the genre. Military heroes in the genre of the imperial adventure story and in the representation of “real” events are hardly distinguishable, for they are “made” to serve the same purposes. The hero is part of a story and, as Northrop Frye has argued, that story or langue has certain generic features throughout history. On the other hand, though the hero is made, the individual can, and often did, prepare and present himself for the role.
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Chagas, Sabrina, Ana Coradazzi, and Ricardo Caponero. "The power of writing: Impact of writing for health professionals working with oncology patients." Journal of Clinical Oncology 41, no. 16_suppl (June 1, 2023): e23002-e23002. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e23002.
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e23002 Background: Healthcare professionals are subject to stressful events, especially in areas such as oncology or palliative care. Writing is a valuable tool for dealing with stress, increasing empathy and job satisfaction. Narratives have therapeutic potential and can provide useful information for diagnosis and individualized strategies. Expressive Writing and Narrative Medicine have been studied in this field, resulting in physical and psychological benefits to health professionals, and can be a medical-educational tool. The practice of writing can promote healthier relationships between patients, professionals, and oneself. However, little is known about the perception that health professionals have about writing as a habit. These data can help to develop strategies for stimulating practice in universities, contributing to better professionals mental health. Methods: An online questionnaire was disseminated through social networks of the authors and professional associations inviting health professionals who deal with cancer patients and have the habit of writing to answer the questions, voluntarily and anonymously. The questionnaire was composed by 13 multiple choice questions and 1 free choice question, divided into 3 categories: 3 related to personal and professional data, 5 to the habit of writing and 5 to the impact that the habit of writing has on their lives. The data were analyzed descriptively, based on the results provided by the platform itself. Results: 177 responses to the form were obtained. Most participants were over 40 years old (53.9%). Eighty-seven participants were physicians (49.4%), 41 psychologists (23.3%), and 27.3% worked in other health fields. The majority (32.1%) declared they write sporadically when they feel the need. Only 17.8% wrote daily. Thirty-two percent write mainly short texts (blogs or social networks); 16.9% write mainly narratives. Most participants have been writing for more than ten years (63.2%). Using writing as a tool for self-knowledge was the main reason to start writing for 19.8%, and improving the ability to understand what is happening to other people for 18.7%. The themes of the texts were personal experiences (21.1%), personal feelings (19.4%), technical issues (14.8%), the process of getting sick (6.2%), or other topics (28.5%). Most reported that writing provides them with serenity (24.4%), comfort (23.8%), pride (19.3%), relief (13.6%), or other. Participants reported that the impact of writing on their lives is essential (32%), very positive (30.9%), or positive (33.7%), and the majority (48.8%) reported that the impact is both immediate and long-term. Conclusions: The personal perception about the impact of writing is extremely positive among healthcare professionals, suggesting that the practice should be stimulated during professional training and considered as a useful tool for the promotion of mental health.
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Iyer, Maya S., Kalah Wilson, Claire Draucker, and Cherri Hobgood. "Physician Men Leaders in Emergency Medicine Bearing Witness to Gender-Based Discrimination." JAMA Network Open 6, no. 1 (January 5, 2023): e2249555. http://dx.doi.org/10.1001/jamanetworkopen.2022.49555.
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ImportanceApproximately 60% of women physicians in emergency medicine (EM) experience gender-based discrimination (GBD). Women physicians are also more likely to experience GBD than men physicians, particularly from patients, other physicians, or nursing staff.ObjectiveTo describe the responses of men who are academic department chairs in EM to GBD directed toward a woman colleague.Design, Setting, and ParticipantsThis qualitative study was a secondary data analysis drawn from interviews of men EM academic department chairs at 18 sites who participated in a qualitative descriptive study between April 2020 and February 2021 on their perceptions of the influence of gender and leadership in academic medicine. Narrative data related to GBD were extracted and coded using conventional content analysis. Codes were clustered into themes and subthemes and summarized. Data were analyzed from November to December 2021.ExposureSemistructured interviews conducted via teleconferencing.Main Outcomes and MeasuresQualitative findings identifying experiences witnessing or learning about incidents of GBD against women colleagues, the impact of these observations, and personal or leadership actions taken in response to their observations.ResultsAll 18 men participants (mean [SD] age, 52.2 [7.5] years; mean [SD] time as a department chair, 7.2 [5.1] years) discussed witnessing or learning about incidents of GBD against women colleagues. The participant narratives revealed 3 themes: emotional responses to GBD, actions they took to address GBD, and reasons for not taking action to address GBD. When witnessing GBD, participants felt anger, disbelief, guilt, and shame. To take action, they served as upstanders, confronted and reported discrimination, provided faculty development on GBD, or enforced “zero-tolerance” policies. At times they did not take action because they did not believe the GBD warranted a response, perceived a power differential or an unsupportive institutional culture, or sought self-preservation.Conclusions and RelevanceIn this qualitative study of men physician leaders, we found all participants reported feeling troubled by GBD against women colleagues and, if possible, took action to address the discrimination. At times they did not take action because of unsupportive workplace cultures. These findings suggest that institutional culture change that supports the interventions of upstanders and does not tolerate GBD is needed.
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Lakha, Meena Afzal, Anindya Bhowmik, Sneha Bisht, Suzani Shrestha, Kantappa Gajanan, and Samir Shah. "Post traumatic growth during COVID-19: unity in diversity." BJPsych Open 7, S1 (June 2021): S2. http://dx.doi.org/10.1192/bjo.2021.69.
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AimsThis poster reflects how the experience of staying with people of diverse nations and cultural background helped the stranded IMGs cope with this agony in a foreign land during an unprecedented tumultuous situation. The aim is to show that despite diversity among people, the hard times made them unite and overcome countless difficulties.BackgroundThe COVID 19 pandemic has been a period of global health crisis and has exponentially affected mental health issues in the world population. In these difficult times, several International Medical Graduates (IMGs), who had come to the UK to attend their PLAB exams, were left stranded as the exams were postponed, flights cancelled and borders sealed. Faced with huge uncertainty their mental health was of great concern.At this time the British Association of Physicians of Indian Origin (BAPIO) came forward to help this cohort of stranded doctors in terms of accommodation, finances, mental health support, preparation for exams to the extent of liaising with General Medical Council (GMC) and Home Office. The virtual support group provided a platform for IMGs from different nations and cultures to get in touch with each other helping overcome mental burden and stress.The stories presented in the poster show how unity in diversity helped these young doctors deal with mental trauma amidst the Pandemic.Method276 doctors from 27 countries were looked after by BAPIO. From those excerpts taken from 26 IMGs, personal narratives was used as a method for qualitative assessment.The percentage of IMGs clearing their exams and getting jobs in the NHS has been used for quantitative assessment.ResultQualitative: The personal narratives of the IMGs show how they were positively impacted by staying together albeit different nationalities and cultural background.Quantitative: A total of 21 IMGs out of the 26 cleared their PLAB 2 exams and got registration under General Medical Council giving a percentage of 81.7%. 20 IMGs have successfully joined the NHS in various posts giving a job success rate of 95.2%.ConclusionThe experience of living and sharing housings with people from different nationalities, has increased appreciation and also prepared them to work in the NHS which has a diverse work force. This learning experience has been integral for all of us in shaping our life in the UK making everyone more compassionate.
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Srivastava, Ranjana. "Handle With Care." International Journal of User-Driven Healthcare 3, no. 4 (October 2013): 84–88. http://dx.doi.org/10.4018/ijudh.2013100114.
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Reflective writing helps people to explore the larger context, the meaning, and the implications of an experience and action. When used well, it promotes the growth of the individual (William, 2002). Just as personal illness narratives help patients understand their illnesses and help in healing similarly reflective writing by physicians can help them see and understand illness, pain and loss from a larger perspective. At the same time reflection on one's lapses or inadequacies can help in one's own healing. They also help people evolve into more empathic and self-aware practitioners (Sayatani, 2004). Here are two case studies which can be used to make future generation of doctors more human. The first raises the issue of the inadequate training and courage to admit one's mistakes. Whenever this happens people are the first casualty for one carries the burden for years when simple disclosure would have helped in the healing and helped in improving the doctor patient relationship by making doctors appear more human. The second advises struggling students and residents trying to find answers and develop reactions to deal with a situation when they can do nothing for patients (Lisa, 2011)—the answer is communication: engage with patients, simply listen to their stories and keep learning by listening.
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Morton, Graeme. "Angela McCarthy, Personal Narratives of Irish and Scottish Migration, 1921–65. ‘For spirit and adventure’ (Manchester: Manchester University Press, 2012. Pp. xi + 257. Paperback 978–0-7190-7353-3, £15.99)." Journal of Scottish Historical Studies 34, no. 2 (November 2014): 245–47. http://dx.doi.org/10.3366/jshs.2014.0125.
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Kilbertus, Frances, Rola Ajjawi, and Douglas Archibald. "Harmony or dissonance? The affordances of palliative care learning for emerging professional identity." Perspectives on Medical Education 9, no. 6 (August 27, 2020): 350–58. http://dx.doi.org/10.1007/s40037-020-00608-x.
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Abstract Introduction Patient demographics demand physicians who are competent in and embrace palliative care as part of their professional identity. Published literature describes ways that learners acquire knowledge, skills and attitudes for palliative care. These studies are, however, limited by their focus on the individual where learning is about acquisition. Viewing learning as a process of becoming through the interplay of individual, social relationships and cultures, offers a novel perspective from which to explore the affordances for professional identity development. Methods Qualitative narrative methods were used to explore 45 narratives of memorable learning (NMLs) for palliative care recounted by 14 graduating family medicine residents in one family medicine residency program. Thematic and narrative analyses identified the affordances that support and constrain the dynamic emergence of professional identity. Results Participants recounted affordances that supported and/or constrained their learning acting on personal (e.g. past experiences of death), interpersonal (e.g. professional support) and systemic (e.g. patient continuity) levels. Opportunities for developing professional identity were dynamic: factors acted in harmony, were misaligned, or colliding to support or constrain an emerging professional identity for palliative care practice. Conclusion Findings highlight how individual factors interplay with interpersonal and structural conditions in the workplace in dynamic and emergent ways that may support or constrain the emergence of professional identity. Viewing learning as a process of becoming allows teachers, curriculum developers and administrators to appreciate the complexity and importance of the interplay between the individual and the workplace affordances to create environments that nurture professional identity for palliative care practice.
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Burton, Elise K. "“Essential Collaborators”: Locating Middle Eastern Geneticists in the Global Scientific Infrastructure, 1950s–1970s." Comparative Studies in Society and History 60, no. 1 (January 2018): 119–49. http://dx.doi.org/10.1017/s0010417517000433.
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AbstractIn the aftermath of World War II, a new international infrastructure based on United Nations agencies took charge of coordinating global biomedical research. Through this infrastructure, European and American geneticists hoped to collect and test blood samples from human populations across the world to understand processes of human heredity and evolution and trace the historical migrations of different groups. They relied heavily on local scientific workers to help them identify and access populations of interest, although they did not always acknowledge the critical role non-Western collaborators played in their studies. Using scientific publications, personal correspondence, and oral histories, I investigate the collaborative relationships between Western scientists, their counterparts in the Middle East, and the human subjects of genetic research. I comparatively examine the experiences of Israeli and Iranian scientists and physicians engaged in genetic anthropology and medical genetics between the mid-1950s and the late 1970s, noting how they both applied nationalist historical narratives to their genetic data and struggled to establish the value of their local knowledge and scientific labor. I argue that the Israeli and Iranian experience of transnational scientific collaboration is representative of how Western scientists relegated their collaborators from “developing” regions to a subordinate positionality as collection agents or native informants. Meanwhile, within their own countries, the elite professional identity of Israeli and Iranian scientists granted them the authority to manipulate their research subjects, who often belonged to marginalized minority communities, and to interpret their biology and history within contexts of Jewish and Persian nationalism.
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Flórez, Karen R., Neil S. Hwang, Maria Hernandez, Sandra Verdaguer-Johe, and Kamiar Rahnama Rad. "“No sufro, estoy bien/I am not suffering, so I am doing OK”: A mixed method exploration of individual and network-level factors and Type 2 Diabetes Mellitus (T2DM) among Mexican American adults in New York City." PLOS ONE 19, no. 1 (January 19, 2024): e0295499. http://dx.doi.org/10.1371/journal.pone.0295499.
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Introduction The prevalence of type 2 Diabetes Mellitus (T2DM) is 2–3 times greater among Mexican Americans than non-Latino whites, and Mexican Americans are more likely to develop T2DM at younger ages and experience higher rates of complications. Social networks might play a crucial role in both T2DM etiology and management through social support, access to resources, social engagement, and health behavioral norms. Objective To quantitatively identify the social network features associated with glycated hemoglobin (HbA1c) in a community sample of Mexican immigrants residing in New York City, and to explore the extent to which these quantitative findings converge with qualitative narratives of their lived experiences. Methods This study used a convergent mixed methods design. To collect personal network data, we used EgoWeb, and obtained 1,400 personal network ties from 81 participants. HbA1c readings were collected using dried blood spots and categorized according to the laboratory criteria of the American Diabetes Association. Additional survey data were collected using Qualtrics software. To investigate the significance of the network-level factors after accounting for the socioeconomic and demographic individual-level factors that the literature indicates to be associated with T2DM, we used a multiple regression model on quantitative data sources. For the qualitative portion of the study, we selected a subset of individuals who participated in the quantitative portion, which represented 500 personal network ties from 25 participants. We conducted in-depth interviews guided by the visualization of these ties to explore who was helpful or difficult in managing their health and health behaviors. Results Individual-level indicators associated with lower HbA1c scores were body mass index (β = -0.07, p<0.05), and healthy eating index scores (β = -0.03, p<0.02). The network-level predictor associated with higher HbA1c levels was the percentage of diabetic alters in the network (β = 0.08, p <0.001, with a 25% increase in the percentages associated 2.0 change in HbA1c levels. The qualitative data highlighted that most of the diabetes-related information diffused through the social networks of our participants was related to dietary practices, such as reducing sugar and red meat consumption, eating out less, and reducing portion sizes. Notably, even among those with elevated levels and diabetes-related health complications, HbA1c was not considered a part of the lay descriptions of good health since they were not “suffering.” Participants regarded doctors as the ultimate authority in diabetes care, even if they had supportive members in their personal networks. Conclusion Our study provides quantitative evidence for the significant role of diabetic network members in the etiology and management of T2DM among Mexican Americans. Our qualitative findings suggest important ley terms for T2DM management and the importance of physicians, which could be included in in future social networks studies seeking to diffuse diabetes-related health information for T2DM prevention and management efforts in this population.
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Bongiovanni, Tasce, Sriram Shamasunder, William Brown, Cristina Rivera Carpenter, Matthew Pantell, Bassem Ghali, and James D. Harrison. "Lessons learned from academic medical centers’ response to the COVID-19 pandemic in partnership with the Navajo Nation." PLOS ONE 17, no. 4 (April 5, 2022): e0265945. http://dx.doi.org/10.1371/journal.pone.0265945.
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Introduction Structural forces that drive health inequalities are magnified in crises. This was especially true during the COVID-19 pandemic, and minority communities were particularly affected. The University of California San Francisco and Health, Equity, Action, Leadership Initiative jointly sent volunteer teams of nurses and doctors to work in the Navajo Nation during the COVID-19 pandemic. This presented an opportunity to explore how academic medical centers (AMCs) could effectively partner with vulnerable communities to provide support during healthcare crises. Therefore, the aims of this study were to describe volunteers’ perspectives of academic-community partnerships by exploring their personal, professional and societal insights and lessons learned based on their time in the Navajo Nation during COVID-19. Methods We recruited key informants using purposeful sampling of physicians and nurses who volunteered to go to the Navajo Nation during the spring 2020 COVID-19 surge, as well as hospital administrators and leaders involved in organizing the COVID-19 efforts. We used in-depth qualitative interviews to explore key informants’ experiences pre-departure, during their stay, and after their return, as well as perspectives of the partnership between an AMC and the Navajo Nation. We used thematic analysis to systematically identify, analyze and report patterns (themes) within the data. Results In total, 37 clinicians and hospital administrators were interviewed including 14 physicians, 16 nurses, and 7 health system leaders. Overall, we found 4 main themes each with several subthemes that defined the partnership between the AMC and the Navajo Nation. Mission and values incorporated civic duty, community engagement, leadership commitment and employee dedication. Solidarity, trust and humility encompassed pre-existing trust, workforce sustainability, humility and erasure of ‘savior narratives.’ Coordination included logistical coordination, flexibility, selectivity of who and what traveled to the response and coordination around media response. Workforce preparation and support encompassed understanding of historical context and providing healthcare in limited settings, dangers of inadequate preparation and the need for emotional support. Conclusion This study provides guidelines which AMCs might use to develop and improve partnerships they have or would like to develop with vulnerable communities. These guidelines may even be broadly applied to partnerships outside of a pandemic response. Importantly, such partnerships need to be built with trust and with an eye towards sustainability and long-term relationships as opposed to ‘medical missions’.
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Koshias, Andreas, Emma Gray, Graeme Currie, and Jennifer Cleland. "28 Do not attempt resuscitation: university of aberdeen student perspectives." BMJ Supportive & Palliative Care 7, no. 3 (September 2017): A357.2—A358. http://dx.doi.org/10.1136/bmjspcare-2017-001407.28.
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IntroductionDo Not Attempt Resuscitation Orders(DNAR) and their contemporary counterparts are cornerstones of End of Life care and as such, of importance within medical education. Previous research indicates the need for a better understanding of patient and physicians perceptions of DNAR topics.Aims and methodsThe objective of the study was to explore medical students(MS) and non-medical students perspectives on DNAR discussions(DNARD), and explore any differences. This was a cross-sectional questionnaire study. MS and Education students(ES) were asked how they felt regarding DNARD taking place in 5 scenarios, a number of questions regarding previous experience, knowledge of DNARD, future preferences, and basic demographics.ResultsThe number of valid respondents was 601 (375[MS],226[ES]) representing a response rate of over 70%. There were statistically significant differences between MS and ES in the presented clinical scenarios and future preferences. Ranking of clinical scenarios, highest agreement to lowest, for DNARD to take place were: before surgery, when critically ill, at a GP appointment, on admission to hospital, at an outpatient appointment. Statistically significant demographic differences were also found: 93% of MS having heard of DNAR previously as compared to 59% of ES. Both groups held the view that a DNARD would be beneficial for them in the future but that they should have the final decision regarding DNAR.ConclusionMS and ES were found to hold differing views regarding DNARD in scenario preferences and personal future preferences. However, the majority of both groups felt that DNARD would be beneficial to them in the future.References. Mary Catherine Beach, R Sean Morrison. The Effect of Do-Not-Resuscitate Orders on Physician Decision-Making.Ethics, public policy, and medical economics2002;50:2057–206.. Cathy Charles, Tim Whelan, Amiram Gafni. What do we mean by partnership in making decisions about treatment?BMJ1999;319:780.. James Downar, Tracy Luk, Robert W Sibbald, Tatiana Santini, Joseph Mikhael, Hershl Berman, Laura. Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients. Journal of internal medicine2011;26(6):582–587.. Thomas H. Gallagher, Steven Z. Pantilat, Bernard Lo & Maxine A. Papadakis (1999) Teaching Medical Students to Discuss Advance Directives: A Standardised Patient Curriculum, Teaching and Learning in Medicine, 11:3, 142–147, DOI: 10.1207/S15328015TL110304. Paul Garrud. (2011). Who applies and who gets admitted to UK graduate entry medicine? - an analysis of UK admission statistics. BMC Medical Education. 11:71.. General Medical Council. (2013). Chapter1: The changing shape of the profession and medical education. In:The state of medical education and practice in the UK report: 2013. General Medical Council. 32.. GMC, 2010. End of life treatment and care: Good practice in decision-making. Specifically paragraphs 11, 132 and 134. Can be accessed at: http://www.gmcuk.org/guidance/ethical_guidance/end_of_life_care.asp. Todd E. Gorman, MD, FRCP(C), Ste'phane P. Ahern, MD, FRCP(C), Jeffrey Wiseman, MD, FRCP(C), MA, and Yoanna Skrobik, MD, FRCP(C). (2005). Residents’ End-of-Life Decision Making with Adult Hospitalised Patients: A Review of the Literature. Academic Medicine. 80 (7), 622–633.. Gorton, A.J., Jayanthi, N.V.G., Lepping, P., Scriven, M.W., 2008. Patients’ attitudes towards “do not attempt resuscitation” status.J Med Ethics. Vol 34; 624–626.. W. Hafferty, Joseph F. O’Donnell (2015).The Hidden Curriculum in Health Professional Education. United States of America: Dartmouth College Press. 5.. Karen Hancock, Josephine M Clayton, Sharon M Parker, Sharon Wal der, Phyllis N Butow, Sue Carrick, David Currow, Davina Ghersi, Paul Glare, Rebecca Hagerty, Martin HN Tattersall . (2007). Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review.Palliative Medicine. 21 , 507–517.. Jan C. Hofmann, Neil S. Wenger, Roger B. Davis, Joan Teno, Alfred F. Connors, Norman Desbiens, Joanne Lynn, Russell S. Phillips. (1997). Patient Preferences for Communication with Physicians about End-of-Life Decisions .Annals of Internal Medicine. 1 July 1997.. NHS Scotland. (2016).NHSScotland.Available: http://www.gov.scot/Topics/Health/About/NHS-Scotland. Last accessed 25th Nov 2016.. NRS: National Records of Scotland. (2013).Religion, Scotland, 2001 and 2011.Available: http://www.scotlandscensus.gov.uk/documents/censusresults/release2a/rel2asbtable7.pdf. Last accessed 25th Nov 2016. ONS: Office for National Statistics. (2011).Full story: What does the Census tell us about religion in 2011?.Available: http://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/religion/articles/fullstorywhatdoesthecensustellusaboutreligionin2011/2013-05-16. Last accessed 25th Nov 2016.. Stephen R. Porter and Michael E. Whitcomb. (2005). NON-RESPONSE IN STUDENT SURVEYS: The Role of Demographics, Engagement and Personality.Research in Higher Education. 46 (2).. Amy Sanderson, David Zurakowski, Joanne Wolfe. (2013). Clinician Perspectives Regarding the Do-Not-Resuscitate Order.JAMA paediatrics. 167 (10), 954–958.. Scottish Government, 2010. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR): Integrated Adult Policy. Reviewed 2015. Can be accessed at: http://www.gov.scot/Topics/Health/Quality-sImprovement-Performance/peolc/DNACPR. Clive Seale. (2010). The role of doctors’ religious faith and ethnicity in taking ethically controversial decisions during end-of-life care.Journal of Medical Ethics. doi:10.1136/jme.2010.036194.. C O Sham, Y W Cheng, K W Ho, P H Lai, L W Lo, H L Wan, C Y Wong, Y N Yeung, S H Yuen, A Y C Wong. (2007). Do-not-resuscitate decision: the attitudes of medical and non medical students.Clinical Ethics. 33 (5), 261–265.. UKMCRG: UK Medical Careers Research Group (2001).1999 cohort of UK Medical Graduates: Report of First Survey. Oxford: Institute of Health Sciences, University of Oxford. 14.. Jacqueline K. Yuen, M. Carrington Reid, and Michael D. Fetters. (2011). Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them.Journal of General Internal Medicine. 26 (7), 791–797.. Rocksheng Zhong, Joshua Knobe, PhD, Neal Feigenson, JD, and Mark R. Mercurio, MD, MA. (2011). Age and Disability Biases in Paediatric Resuscitation Among Future Physicians.Clinical Paediatrics., 1–4.
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Le Bigre, Nicolas. "Contesting ‘Integration’: Personal-Experience Narratives of Scotland’s Immigrants." Cambio. Rivista sulle Trasformazioni Sociali 11 (December 30, 2022). http://dx.doi.org/10.36253/cambio-14092.
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This chapter unpacks ‘integration’ by problematizing the term’s nebulous usage in political contexts and by re-examining it through the personal-experience narratives of immigrants in North-East Scotland. By focusing on three emergent narrative themes, the chapter explores how immigrants recount and make sense of their own experiences and encounters with integration. It considers the concept with relation to other immigrants, Scottish society more generally, and British migration policy. Emphasizing the creative narrative expressions of those most affected by wider discussions of integration, the author calls for the use of ethnographic methods to better examine immigration and integration from a groundlevel perspective.
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Miyachi, Junichiro, Miho Iwakuma, and Hiroshi Nishigori. "An “integration” of professional identity formation among rural physicians experiencing an interplay between their professional and personal identities." Advances in Health Sciences Education, May 13, 2024. http://dx.doi.org/10.1007/s10459-024-10337-z.
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AbstractThe present understanding of professional identity formation is problematic since it underrepresents minority physicians and potentially excludes their professional identity formation experiences. Rural physicians are expected to have similar underrepresented aspects as minority physicians because of their specific sociocultural contexts and consequent private–professional intersection, which lead to ethical complexities. Therefore, to bridge this research gap, we interviewed 12 early- to mid-career Japanese physicians working in rural areas and explored their experiences. Through a narrative analysis guided by Figured Worlds theory, we analysed the data by focusing on the vocabulary, expressions, and metaphors participants used to describe their experiences. A central theme emerged concerning how the rural physicians configurated their personal versus professional participation in their local communities. Further, their identity narratives varied regarding how they constructed their identities, rural communities, and relationships as well as their identity formation ideals and strategies to achieve them. Informed by ‘Big Questions’ concerning worldview framework, we delineated four identity narratives as prototypes to describe how they participated in their communities. These identity narratives provide a preliminary understanding of how diverse identity formation is for rural physicians. In addition, our findings exposed the current professional identity formation framework as potentially biased towards single forms of participation in monolithic communities, overlooking complicated forms of participation in multiple communities. We argue that applying frameworks and concepts to capture these multiple forms of participation as well as revisiting the ‘discourse of integration’ are necessary steps to overcome the limitation of the current understanding of professional identity formation.
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Dunstan, Jocelyn, Thomas Vakili, Luis Miranda, Fabián Villena, Claudio Aracena, Tamara Quiroga, Paulina Vera, Sebastián Viteri Valenzuela, and Victor Rocco. "A pseudonymized corpus of occupational health narratives for clinical entity recognition in Spanish." BMC Medical Informatics and Decision Making 24, no. 1 (July 24, 2024). http://dx.doi.org/10.1186/s12911-024-02609-w.
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AbstractDespite the high creation cost, annotated corpora are indispensable for robust natural language processing systems. In the clinical field, in addition to annotating medical entities, corpus creators must also remove personally identifiable information (PII). This has become increasingly important in the era of large language models where unwanted memorization can occur. This paper presents a corpus annotated to anonymize personally identifiable information in 1,787 anamneses of work-related accidents and diseases in Spanish. Additionally, we applied a previously released model for Named Entity Recognition (NER) trained on referrals from primary care physicians to identify diseases, body parts, and medications in this work-related text. We analyzed the differences between the models and the gold standard curated by a physician in detail. Moreover, we compared the performance of the NER model on the original narratives, in narratives where personal information has been masked, and in texts where the personal data is replaced by another similar surrogate value (pseudonymization). Within this publication, we share the annotation guidelines and the annotated corpus.
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Brito, S., A. Rau, C. Escobar, P. Garza, I. Sriprasert, and N. Mitchell Chadwick. "Raising patient voices in medical education: an assessment of patient perceived effect of social determinants of health conversations and the patient-physician relationship on quality of obstetric care, to inform the development of patient driven medical education curricula." Frontiers in Reproductive Health 6 (February 15, 2024). http://dx.doi.org/10.3389/frph.2024.1283390.
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BackgroundConventional medical education lacks the lived experiences of patients which may authentically convey the social determinants of health (SDOH) and resulting health disparities. Videos of first-person patient narratives may prove a valuable education tool in this regard. The objective of this study is to investigate how patient demographics, satisfaction with care, and patient-physician relationships influence obstetric patient interest and willingness to contribute to a SDOH video curriculum by sharing their lived experiences through first-person narratives.MethodsStudy design included an anonymous, cross-sectional survey and an optional semi-structured telephone interview. Participants were 18 years old with a live-birth delivery <8 weeks prior to recruitment and received care during their pregnancy at Los Angeles General Medical Center (LAGMC). Variables surveyed included demographics, satisfaction with care, aspects of the patient-physician relationship, perceived utility, and personal interest in contributing to an educational SDOH video. A bivariate analysis was conducted to compare participants’ characteristics and responses on interest in contributing and perceived helpfulness of first-person patient SDOH videos.Results72.43% of participants (N = 70) believed a patient's first-person video on SDOH would be “Helpful” in preparing physicians to provide competent medical care; however, 71.43% responded “No” to “Interest” in sharing with physicians their experiences with SDOH. English preference and being U.S. born were factors significantly associated with viewing first-person SDOH video as “Helpful” (P > 0.001). Major themes from telephone interviews reflected enthusiasm for first-person patient narratives and perceived benefits of using patient experiences to educate physicians on SDOH. However, participants cited barriers to disclosing SDOH including brief and strictly clinical interactions with physicians, lack of continuity of care, and fear of being judged by physicians.ConclusionWhile most participants recognized the utility of addressing social needs in medical education and reported satisfaction with their obstetricians and care, these factors did not uniformly translate into willingness to contribute first-person patient narratives. To improve the representation of patients from racial, ethnic, gender, linguistic, and sexual minorities into medical curricula, further research and strategies are needed to overcome the barriers discouraging patient disclosure of social needs to physicians.
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Ben-Arye, Eran, Yael Keshet, Ariel Schiff, Catherine Zollman, Emanuela Portalupi, Rachel Nave, Dorith Shaham, Noah Samuels, and Elad Schiff. "From COVID-19 adversity comes opportunity: teaching an online integrative medicine course." BMJ Supportive & Palliative Care, July 15, 2021, bmjspcare—2020–002713. http://dx.doi.org/10.1136/bmjspcare-2020-002713.
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BackgroundWe examine the impact of a 5-day online elective course in integrative medicine (IM) taking place during the COVID-19 pandemic, attended by 18 medical students from two faculties of medicine in Israel.MethodsThe course curriculum addressed effectiveness and safety of IM practices highlighting supportive and palliative care, demonstrated the work of integrative physicians (IPs) in designing patient-tailored treatments and taught practical skills in communication regarding IM. Group discussions were conducted via Zoom with 32 physicians, healthcare practitioners and IM practitioners working in integrative academic, community and hospital-based settings, in Israel, Italy, UK and Germany. An 18-item questionnaire examined student attitudes and perceived acquisition of skills for implementing what was learned in clinical practice. Student narratives were analysed using ATLAS.Ti software for systematic coding, identifying barriers and advantages of the online learning methodology.ResultsStudents reported a better understanding of the benefits of IM for specific outcomes (p=0.012) and of potential risks associated with these therapies (p=0.048). They also perceived the acquisition of skills related to the IM-focused history (p=0.006), learnt to identify effectiveness and safety of IM treatments (p=0.001), and internalised the referral to IPs for consultation (p=0.001). Student narratives included reflections on the tools provided during the course for assessing effectiveness and safety, enhancing communication with patients, enriching their patient-centred perspective, raising awareness of available therapeutic options, and personal and professional growth.ConclusionsOnline clinical electives in IM are feasible and can significantly increase students’ awareness and modify attitudes towards acquirement of patient-centred perspectives.
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Nicolson, Marcus. "Racial Microaggressions and Ontological Security: Exploring the Narratives of Young Adult Migrants in Glasgow, UK." Social Inclusion 11, no. 2 (March 30, 2023). http://dx.doi.org/10.17645/si.v11i2.6266.
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This study investigates the lived experiences of racial microaggressions faced by young adult migrants in everyday life in Glasgow, UK. The personal stories reported in this study are a direct challenge to the dominant political narrative that Scotland does not have a racism problem. When faced with this discord between narrative and reality, young adultmigrants in Scotland must negotiate both their own lived experiences and biographical narratives to achieve a sense of security. A narrative enquiry methodology is used to explore mundane and everyday interactions for four young adult migrants who have settled in Glasgow over the last 10 years. These accounts of daily life offer a unique view into the everyday racism and racialmicroaggressions faced by this group. Additionally, the opinions of selected Scottish politicians have been collected to gather an additional viewpoint on racism in Scotland. A theoretical perspective stemming from ontological security theory contributes to the racial microaggressions literature in unpacking how individual migrants negotiate traumatic experiences of racism and manage their identities. The analysis explores how migrant individuals may employ coping mechanisms and adopt distinct behaviours to minimise the daily trauma of racism and microaggressions experienced in Scotland. This study, therefore, highlights the potential for interdisciplinary research on racism, narrative, and security studies, and the opportunities for bringing together these distinct perspectives.
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Shukla, Anupama. "Epilepsy in Dostoevsky’s The Idiot - Language, Stigma, and Mythology." FORUM: University of Edinburgh Postgraduate Journal of Culture & the Arts, no. 31 (March 14, 2021). http://dx.doi.org/10.2218/forum.31.5496.
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Around 400 BC, Areatus -- one of Hippocrates’ pupils, proclaimed ‘epilepsy is an illness of various shapes and horrible’. Later, Areatus was also one of the people who called the disease ‘sacred’; according to them, a deity had sent a demon to possess the patient, or the patient had been cursed by the moon. The Hippocratic physicians were among the first to attempt to separate the scientific and the cultural/fictional discourses. However, even till the late nineteenth century, medical narratives were intertwined with the fictional narratives that surrounded epilepsy, and these narratives contributed significantly towards the stigma that has historically been associated with the disease. This paper will examine how medical and non-medical discourses shaped the representation of epilepsy and contributed to the cultural mythology surrounding epilepsy. In the course of this paper, the author will specifically focus on Dostoevsky’s The Idiot, in which the reader sees the author’s personal view of epilepsy, cleverly accommodated into the character of Prince Myshkin, who is surrounded by social stigmatisation. Dostoevsky suffered from epilepsy for a major part of his life, and he maintained detailed accounts of his seizures. His epilepsy had a huge influence on his writings and his perception of the world. Dostoevsky’s epilepsy has been seen as particularly relevant, since being an epileptic himself, his works provide the reader with an insight into the disease which is hard to find elsewhere.
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Solnick, Rachel E., Grace Chao, Ryan D. Ross, Gordon T. Kraft‐Todd, and Keith E. Kocher. "Emergency Physicians and Personal Narratives Improve the Perceived Effectiveness of COVID‐19 Public Health Recommendations on Social Media: A Randomized Experiment." Academic Emergency Medicine, December 27, 2020. http://dx.doi.org/10.1111/acem.14188.
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Quigley, Hannah, and Raymond MacDonald. "A qualitative investigation of a virtual community music and music therapy intervention: A Scottish–American collaboration." Musicae Scientiae, February 9, 2024. http://dx.doi.org/10.1177/10298649241227615.
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This study investigates the experiences of people involved in a virtual intervention involving community music and music therapy for individuals with autism. The intervention blends conventional music therapy and community music approaches. During the COVID-19 pandemic, many community music and music therapy projects shifted to an online format and there is a resultant need to understand more about how virtual music interventions may be of benefit for individuals with autism. We report on the design, implementation, and outcomes of one such intervention. Over an 8-week period, community musicians and music therapists ( music facilitators) based in Scotland and America delivered 16 music sessions, which were recorded using the Zoom software. During the sessions the participants wrote, performed, and recorded two songs. Semi-structured interviews were conducted with two of the participants, using video elicitation techniques, and six of the facilitators. Data were analyzed thematically. The intervention was found to (1) enable participants to explore their personal narratives, (2) promote self-perceptions of achievement, and (3) provide evidence of mastery, creativity, and self-expression. An international collaboration made possible by technology enabled facilitators to work remotely and participants to make use of new opportunities for engagement. This article demonstrates how community music practices focusing on participation and music therapy approaches focusing on clinical outcomes can be integrated. We present the online environment as its own social milieu in which creativity and connection can be explored in new ways.
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Caputo, Sara. "Treating, Preventing, Feigning, Concealing: Sickness, Agency and the Medical Culture of the British Naval Seaman at the End of the Long Eighteenth Century." Social History of Medicine, December 15, 2021. http://dx.doi.org/10.1093/shm/hkab108.
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Summary Seen as a crucial historical step in the development of ‘modern’ institutional healthcare, eighteenth-century British naval medicine has traditionally been studied from the point of view of the state and of physicians and surgeons: naval sailors’ attitudes towards health, medicine and their own bodies remain virtually unexplored. Using official and personal sources, this article sketches a ‘patient’s history’ of late-eighteenth- and early-nineteenth-century British ratings. Aiming to counterbalance Foucauldian interpretations, it highlights some of the ways in which individuals, even when apparently most powerless, confined in ships far from home, and controlled by rigidly disciplined institutions, could take responsibility for their health, successfully or otherwise, within, against or alongside the system. If the unprecedented administrative requirements of the French Wars strengthened and standardised top-down medical authority, they also brought opportunities for evasion and negotiation. This complicates established narratives of the relationship between modern medicine, the armed forces and power.
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Percival, Candace S., Lauren A. Maggio, Tasha R. Wyatt, and Paolo C. Martin. "‘The program director's word … it's stronger than the word of God’: Epistemic injustice revealed through narratives of remediated graduate medical education residents." Medical Education, December 22, 2023. http://dx.doi.org/10.1111/medu.15295.
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AbstractBackgroundThough graduate medical education (GME) residency training provides positive experiences for many trainees, it may also result in major stressors and negative experiences, particularly for those requiring remediation. Residents requiring remediation may experience feelings of dismay, shame and guilt that can negatively affect their training, self‐efficacy and their medical careers. Power differentials between educators and residents may set the stage for epistemic injustice, which is injustice resulting from the silencing or dismissing a speaker based on identity prejudice. This can lead to decreased willingness of trainees to engage with learning. There is a paucity of literature that explores GME experiences of remediation from the resident perspective.ObjectiveTo synthesise the narratives of physician experiences of remediation during residency through the lens of epistemic injustice.MethodsBetween January and July 2022, we interviewed US physicians who self‐identified as having experienced remediation during residency. They shared events that led to remediation, personal perspectives and emotions about the process and resulting outcomes. Interviews were analysed using narrative analysis with attention to instances of epistemic injustice.ResultsWe interviewed 10 participants from diverse backgrounds, specialties and institutions. All participants described contextual factors that likely contributed to their remediation: (1) previous academic difficulty/nontraditional path into medicine, (2) medical disability or (3) minoritised race, gender or sexual identity. Participants felt that these backgrounds made them more vulnerable in their programmes despite attempts to express their needs. Participants reported instances of deflated credibility and epistemic injustices with important effects.ConclusionsParticipant narratives highlighted that deep power and epistemic imbalances between learners and educators can imperil GME trainees' psychological safety, resulting in instances of professional and personal harm. Our study suggests applying an existing framework to help programme directors (PDs) approach remediation with epistemic humility.
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Schimmoeller, Ethan M., and Timothy W. Rothhaar. "Searching for Meaning with Victor Frankl and Walker Percy." Linacre Quarterly, August 13, 2020, 002436392094831. http://dx.doi.org/10.1177/0024363920948316.
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Patients present to physicians searching for more than scientific names to call their maladies. They rather enter examination rooms with value-laden narratives of illness, suffering, hopes, and worries. One potentially helpful paradigm, inspired in part by existentialism, is to see patients on a search for meaning. This perspective is particularly important in the seemingly meaningless ruins of modernity. Here, we will summarize Victor Frankl’s account of logotherapy found in his much-circulated book Man’s Search for Meaning and assess the limitations imposed by his religious agnosticism. At best he can offer patients a finite, impersonal meaning this side of the grave. Following Kierkegaard’s depiction of the religious sphere of existence, American novelist Walker Percy will be shown to supplement logotherapy with a theological mooring. The spiritual crisis of the modern world is treatable only by Christian faith supplying ultimate meaning. Taken together, Frankl and Percy show how Catholic physicians can be guides in their patients’ personal searches for meaning. This paradigm may prove chiefly beneficial in goals of care conversations, encountering “aesthetic” patients living only for pleasure, and engaging patients amidst tragedy-ridden circumstances. Although only Christian faith will ultimately satisfy the search for meaning, we first of all need encouragement to take responsibility for seeking meaning, and confidence that even the most hopeless situation can become meaningful. Summary: Victor Frankl’s Man’s Search for Meaning can enlighten clinical encounters for physicians to see patients on a search for meaning, particularly amidst suffering and tragedy in a post-modern world lacking transcendence. As shown in Walker Percy’s literature, however, ultimate meaning can only be found in Christian faith where the Word became flesh and continues to dwell among us.
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Mancuso, Carol A., and Laura Robbins. "Narratives of Actionable Medical Leadership From Senior Leaders for Aspiring Leaders in Academic Medicine." HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery, June 26, 2023. http://dx.doi.org/10.1177/15563316231179472.
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Background: Physicians understand that certain personal attributes are essential in medical leaders, but they often do not know what actions are expected of them as leaders or what they should do to be more effective leaders. Purpose: We sought to compile, through interviews with senior leaders at an academic institution, real leadership scenarios for a series of case-based examples to be used during group mentoring sessions for aspiring medical leaders. Methods: We conducted one-to-one interviews using open-ended questions with 11 current and emeritus chairpersons or chiefs of major departments or divisions at our academic medical center. Questions were designed to elicit anecdotes and examples of actions that demonstrate effective and ineffective leadership. Responses were analyzed with qualitative techniques to generate topics of leadership behaviors, which then were compiled into a collection of illustrative examples. Results: The leaders interviewed discussed challenges they encountered in daily routines and described how they addressed certain dilemmas. Topics included making decisions without complete information, winning over reluctant administrators, building alliances with peers, involving subordinates in initiatives, and using knowledge to defend one’s position. Actions requiring interpersonal skills also were discussed, including varying modes of communication, avoiding adversity, displaying gratitude toward subordinates, and safeguarding one’s professional image. The leaders’ insights and recommendations were compiled into a themed collection of topics to be used during group mentoring sessions to enhance leadership skills. Conclusions: This qualitative study suggests that the wisdom and experience of senior leaders may be gleaned for a collection of case-based topics that could complement other formal training programs for aspiring medical leaders.