Narrative medicine as a means of training medical students toward residency competencies

Objective

This study sought to explore the perceived influence of narrative medicine training on clinical skill development of fourth-year medical students, focusing on competencies mandated by ACGME and the RCPSC in areas of communication, collaboration, and professionalism.

Methods

Using grounded-theory, three methods of data collection were used to query twelve medical students participating in a one-month narrative medicine elective regarding the process of training and the influence on clinical skills. Iterative thematic analysis and data triangulation occurred.

Results

Response rate was 91% (survey), 50% (focus group) and 25% (follow-up). Five major findings emerged. Students perceive that they: develop and improve specific communication skills; enhance their capacity to collaborate, empathize, and be patient-centered; develop personally and professionally through reflection. They report that the pedagogical approach used in narrative training is critical to its dividends but misunderstood and perceived as counter-culture.

Conclusion/Practice implications

Participating medical students reported that they perceived narrative medicine to be an important, effective, but counter-culture means of enhancing communication, collaboration, and professional development. The authors contend that these skills are integral to medical practice, consistent with core competencies mandated by the ACGME/RCPSC, and difficult to teach. Future research must explore sequelae of training on actual clinical performance.     

Development of a coronavirus social distance attitudes scale

ObjectiveOur goal was to develop a scale to assess social distance attitudes related to COVID-19.MethodsWe performed an online national survey of US adults (n = 1,074) to assess social distance attitudes, COVID-19 related beliefs and behaviors, and demographics. We assessed scale structure using confirmatory factor analysis and evaluated internal consistency and validity. We assessed association of scale factors with respondent characteristics.ResultsConfirmatory factor analysis supported a hypothesized two-factor solution. Internal consistency was high for both positive (Alpha = 0.92) and negative (Alpha = 0.91) attitude factors. Analyses supported construct and predictive validity with expected associations between scale factors and perceived norms and behavior (e.g. trips out of the home). We found an interaction suggesting that holding highly negative attitudes reduced the effect of holding positive beliefs. Both attitude factors were related to age, gender, race/ethnicity, and political affiliation. Perceived COVID-19 risk (to others but not for self) and perceived severity were consistently associated with higher positive and lower negative attitudes.ConclusionThis COVID-19 Social Distance Attitude Scale contains positive and negative factors with high internal consistency and construct and predictive validity.Practice implicationA greater understanding and ongoing assessment of COVID-19 social distance attitudes could inform policymakers, researchers, and clinicians who seek to promote protective social distance behaviors.     

Family climate in children living with parents who harmfully consume alcohol

The family climate has notable impact on cognitive, emotional, behavioural, social and physical development of children and adolescents and can be influenced by parents' health status. The present study aimed at evaluating whether living with a parent with alcohol use disorder negatively influences the perceived emotional family climate, parental attitudes and internal representations of family relationships. Forty-five children living with a parent with alcohol use disorder and 45 controls, matched for sex and age, completed the Level of Expressed Emotion Scale and the Family Attitudes Questionnaire. Their significant parent completed the Parental Attitudes Scale. The results suggested that living with a parent with an alcohol use disorder increased the risk of having perceived higher levels of emotional response, attitude towards illness and expectations from their parents; it also increased the probability of being exposed to lower parental pleasure and of having represented worse family relationships. Emotion regulation interventions might be useful to protect children living with a parent with alcohol use disorder from a potential chaotic and unpredictable family environment.     

Consulting the community: public expectations and attitudes about genetics research

Genomic discoveries and technologies promise numerous opportunities for improving health. Key to these potential health improvements, however, are health-care consumers'' understanding and acceptance of these new developments. We identified community groups and invited them to a public information-consultation session in order to explore public awareness, perception and expectations about genetics and genomics research. One hundred and four members of seven community groups in Newfoundland, Canada took part in the community sessions. Content analysis of participant comments revealed they were largely hopeful about genetics research in its capacity to improve health; however, they did not accept such research uncritically. Complex issues arose during the community consultations, including the place of genetics in primary care, the value of genetics for personal health, and concerns about access to and uses of genetic information. Participants unequivocally endorsed the value of public engagement with these issues. The rapid pace of discoveries in genomics research offers exciting opportunities to improve population health. However, public support will be crucial to realize health improvements. Our findings suggest that regular, transparent dialog between researchers and the public could allow a greater understanding of the research process, as well as assist in the design of efficient and effective genetic health services, informed by the public that will use them.     

Psychiatric-mental health education with integrated role-play and real-world contact can reduce the stigma of nursing students towards people with mental illness

Stigma and negative attitudes towards people with mental illness are frequently found among nursing students. Interventions targeting mental illness stigma are the critical elements in altering the status. The aim of the present study was to examine the effects of the psychiatric-mental health education with role-play and real-world contact on stigma of nursing students towards people with mental illness in China. A single group pretest and posttest study design was adopted and total 373 students were recruited whilst 343 completed the course. We integrated the role-play and contact with patients in the routine psychiatric-mental health education. After the education was completed, the students' stigma towards people with mental illness were positively changed (pretest mean score of stigma: 53.77, posttest mean score of stigma: 49.01, 95% CI: 2.63–6.87) and their willingness to care for the people with mental illness was also significantly increased (pretest mean score of willingness: 5.45, posttest mean score of willingness: 7.38, 95% CI: −2.22–−1.65). The psychiatric-mental health education especially with integrated role-play and real-world contact is an effective way to reduce nursing students’ stigma and negative attitudes towards people with mental illness and increases their willingness to care for people with mental illness.     

Implementation of evidence‐based dentistry into practice: analysis of awareness,perceptions and attitudes of dentists in the World Dental Federation–European Regional Organization zone

Based on evidence‐based dentistry (EBD) being a relatively new concept in dentistry, the attitudes, perceptions and level of awareness of dentists regarding EBD, and perceived barriers to its implementation into daily practice, were comparatively analysed in six countries of the FDI (World Dental Federation‐Federation Dentaire Internationale)‐European Regional Organization (ERO) zone (France, Georgia, Poland, Portugal, Slovakia and Turkey). For this purpose, a questionnaire, ‘The Relationship Between Dental Practitioners and Universities’, was developed by the FDI‐ERO Working Group and applied by National Dental Associations (NDAs). A total of 850 valid responses were received, and cumulative data, comparisons between countries and potential impact of demographic variables were analysed. Regarding EBD, similar percentages of respondents reported that they ‘know what it is’ (32.8%) and ‘they practice’ (32.1%). Most respondents believed that ‘EBD is beneficial’ (89.1%); however, they had different thoughts regarding ‘who actually benefited from EBD’. Of the participants, 60% believed that ‘dentists experience difficulties in implementing EBD’. Although lack of time, lack of education and limited availability of evidence‐based clinical guidelines were among the major barriers, there were differences among countries (P < 0.05). Significant differences were also observed between countries regarding certain questions such as ‘where EBD needed to be taught’ (P < 0.05), as both undergraduate and continuing education were suggested to be suitable. Age, practice mode and years of practice significantly affected many of the responses (P < 0.05). There was a general, positive attitude toward EBD; however, there was also a clear demand for more information and support to enhance dentists’ knowledge and use of EBD in everyday practice and a specific role for the NDAs.