Jeffrey Silver Humanism in Healthcare Research Roundup – May 2021

Nurse readingThe Jeffrey Silver Humanism in Healthcare Research Roundup features summaries of recently published studies on humanism in healthcare. To receive email notification of new studies once per month, enter your information here and select “Jeffrey Silver Research Roundup” from the checkboxes at the bottom. See previous posts in this series.

Reflective Writing about Near-Peer Blogs: A Novel Method for Introducing the Medical Humanities in Premedical Education Bracken RC, Major A, Paul A, Ostherr K. J Med Humanit. 2021 Apr 19. doi: 10.1007/s10912-021-09693-3. Epub ahead of print. PMID: 33871756
Since the early 2000s, blogs have become more commonplace among medical and premedical students, thus providing opportunities to understand how students develop their professional identities. To examine the potential of using these blogs as tools for peer-to-peer learning, Dr. Rachel Bracken and colleagues conducted a qualitative analysis of 176 reflective essays by baccalaureate premedical students. Through an iterative approach, they found three core themes – empathic conflict, bias in healthcare, and humanity of medicine – and one overarching theme – near-peer affinities. Altogether, these provide valuable insights into how writing and reading reflective essays impact professional identity formation. The authors speculate that this can be integrated into existing premedical educational curricula to foster empathic learning and facilitate resilience.

Impact of an Educational Comic to Enhance Patient-Physician-Electronic Health Record Engagement: Prospective Observational Study Alkureishi MA, Johnson T, Nichols J, Dhodapkar M, Czerwiec MK, Wroblewski K, Arora VM, Lee WW. JMIR Hum Factors. 2021 Apr 28;8(2):e25054. doi: 10.2196/25054. PMID: 33908891; PMCID: PMC8116991 Free full text Drs. Maria Alkureishi, MaryKay Czerwiec, Vineet Arora and Wei Wei Lee have been Gold Foundation grantees, and this study was funded in part by the Gold Foundation. To learn more about this team’s work with the Gold Foundation and access resources you can use in patient care, visit this article: Turning foe into friend: Leveraging the electronic health record to promote humanism.
Educational comics are an innovative way to promote patient education and engagement. But can they promote patient-physician electronic health record (EHR) communication?  Dr. Maria A Alkureishi and colleagues sought to answer this question through a prospective observational study at the University of Chicago. Among the 475 adult and pediatric patients, 339 (71.3%) agreed that the specially developed comic used in this intervention made them more likely to be involved in their EHR. In fact, 90% of adult patients and 50% of pediatric patients remembered the comic, and about half of participants recalled at least one best-practice behavior portrayed in the comic. African-American, Hispanic, and female adult participants were more likely to be involved, as well as those with lower educational attainment. These results suggest that an educational comic may improve patient self-advocacy and involvement, especially for patients in vulnerable populations.

What is clinical empathy? Perspectives of community members, university students, cancer patients, and physicians Hall JA, Schwartz R, Duong F, Niu Y, Dubey M, DeSteno D, Sanders JJ. Patient Educ Couns. 2021 May;104(5):1237-1245. doi: 10.1016/j.pec.2020.11.001. Epub 2020 Nov 9. PMID: 33234440
Empathy is a key feature of humanistic healthcare, but how individuals conceptualize empathy can vary considerably. To better understand this variability, Dr. Judith Hall and colleagues surveyed 486 undergraduate college students, physicians, community members, and cancer patients. They developed a 49-item list of physician behaviors based on content from previous validated questionnaires on empathy and compassion. They then took the results and analyzed them by group and in aggregate. They identified three dimensions of empathy: conscientious and reassuring, relationship-oriented, and emotionally involved. Among these three, relationship-oriented was endorsed more by physicians and patients (compared to undergraduate students and community members), and emotionally involved was endorsed more by physicians compared to patients. Given the high priority with which all three dimensions of empathy were rated, the authors conclude that communication of empathy should be prioritized at all levels of medical education.

The prism model: advancing a theory of practice for arts and humanities in medical education Moniz T, Golafshani M, Gaspar CM, Adams NE, Haidet P, Sukhera J, Volpe RL, de Boer C, Lingard L. Perspect Med Educ. 2021 Apr 29. doi: 10.1007/s40037-021-00661-0. Epub ahead of print. PMID: 33914287 Drs. Tracy Moniz, Nancy Adams, Paul Haidet, Javeed Sukhera, Rebecca Volpe, and Lorelei Ligard have been Gold Foundation grantees.
Arts and humanities can have a potentially transformative impact on teaching in medical education. However, it is difficult to practically apply lessons because there is no overarching theory of practice. To fill this need, Dr. Tracy Moniz and colleagues conducted a discursive and conceptual analysis of 769 citations from a recent scoping review on the role of arts and humanities in medical education. They also interviewed 15 key stakeholders from this review, and, altogether, combined results to produce a model that represents the complex relationship between discursive functions and learning domains. This “Prism Model” encompasses four epistemic functions (mastering skills, perspective taking, personal insight and social advocacy) that can tie to learning domains, such as communication or social justice. The authors conclude that the Prism Model can aid medical educators in “encouraging greater pedagogical flexibility, critical reflection and strategic planning, offering a foundation for achieving its transformative potential.”

Neighborhood Social Cohesion and Inequalities in COVID-19 Diagnosis Rates by Area-Level Black/African American Racial Composition Ransome Y, Ojikutu BO, Buchanan M, Johnston D, Kawachi I. J Urban Health. 2021 Apr;98(2):222-232. doi: 10.1007/s11524-021-00532-3. Epub 2021 Mar 23. PMID: 33759068; PMCID: PMC7986648  Free full text
The ongoing COVID19 pandemic has demonstrated the continuing presence of racial and geographic inequities in our healthcare system. But little is known about how characteristics of communities play into such inequities. To determine if social cohesion is one such factor, Dr. Yusuf Ransome and colleagues compared COVID-19 diagnosis rates to previously calculated social cohesion measures across 46 zip codes in Philadelphia, Pennsylvania. They found that in zip codes representing populations that were greater than 41% Black, higher collective engagement was associated with an 18% higher COVID-19 diagnosis rate. On the contrary, in zip codes representing populations in which there are fewer than 41% Black people, higher engagement was associated with a 26% lower COVID-19 diagnosis rate. This result highlights the extremely complex relationships that underpin social cohesion. The authors conclude that more detailed and longitudinal studies are needed to better explore these relationships as well as the effectiveness of several social cohesion-based interventions.

MPRO: A Professionalism Curriculum to Enhance the Professional Identity Formation of University Premedical Students Merlo G, Ryu H, Harris TB, Coverdale J. Med Educ Online. 2021 Dec;26(1):1886224. doi: 10.1080/10872981.2021.1886224. PMID: 33606590; PMCID: PMC7899679 Free full text
Medical professionalism has been stated as a core competency for physicians, but the lack of formalized curricula, particularly at the early stages of professional identity formation, makes it difficult for learners to formally learn certain behaviors and attitudes that define professionalism. To fill this gap, Dr. Gia Merlo and colleagues developed the MPRO (Medical Professionalism and Observership) curricula composed of didactics, reflective writing, small- and large- group discussions, and clinical observerships. They implemented the curriculum for 135 university premedical students in Houston, Texas. By analyzing reflective essays and student evaluations, the authors documented integration of values, beliefs, and attitudes of medical professionalism. The authors conclude that the MPRO curriculum provides a guide for developing curricula that support premedical students as they develop their identity as future physicians.

The paradox of teaching wellness: Lessons from a national obstetrics and gynaecology resident curriculum Winkel AF, Fitzmaurice LE, Jhaveri SA, Tristan SB, Woodland MB, Morgan HK. Clin Teach. 2021 May 9. doi: 10.1111/tct.13360. Epub ahead of print. PMID: 33969629 Abigail Winkel has been a Gold Foundation grantee.
Burnout continues to be a major problem for both trainees and physicians in practice. In response, the Council on Resident Education in Obstetrics and Gynecology (CREOG), a division of the American College of Obstetricians and Gynecologists, developed a yearlong wellness curriculum and implemented it in 25 programs. 529 resident physicians participated in six workshops spread throughout the academic year. To assess the impact of this curricula on resident physicians, Dr. Abigail Finkel and colleagues analyzed post-intervention surveys from participants and facilitators. While the majority of respondents rated the activities as “good” or “excellent,” qualitative analysis showed polarized and individualized reactions. Three themes were identified: (1) disagreement about the purpose of the curriculum, (2) the social value of the curriculum in the residency program, and (3) the need to open a broader discussion and take action to address structural barriers to wellness. Recognizing the paradox that this otherwise well-received curricula sparks deeply polarizes reactions among participants, the authors conclude that “while participants found value in learning skills and connecting to colleagues, efforts to promote wellness skills should be accompanied by communication and action to address drivers of burnout.”

Gender Differences in Physician Use of Social Media for Professional Advancement Woitowich NC, Arora VM, Pendergrast T, Gottlieb M, Trueger NS, Jain S. JAMA Netw Open. 2021 May 3;4(5):e219834. doi: 10.1001/jamanetworkopen.2021.9834. PMID: 33983403; PMCID: PMC8120326  Free full text
Physicians have been increasingly using social media to communicate to larger audiences and to advance their professional careers, and social media has been suggested as a helpful tool in promoting gender equality. But how exactly do physicians use social media for professional advancement?  And which physicians are more likely to do so?  Dr. Nicole Woitowich and colleagues developed a survey on Twitter to help answer these questions.  Using a river sampling strategy, they posted invitations to participate using a trackable link and encouraged individuals to share the post.  They received 582 responses, of which 321 identified as women (56%) and 256 identified as men (44%).  Most men and women reported increased collaborations and expanded network through their social media use, and many reported increased job satisfaction. More male physicians than female physicians reported benefits obtained through social media, such as invited talks (39% vs. 30%) and scholarship opportunities (25% vs. 21%). The self-selection bias, a low representation of Black or minority race/ethnicities, and subjective self-assessments make these findings difficult to generalize. Nevertheless, this study represents one of the first steps in determining how to resolve this gender disparity.

Pediatric Family-Centered Rounds and Humanism: A Systematic Review and Qualitative Meta-analysis Fernandes AK, Wilson S, Nalin AP, Philip A, Gruber L, Kwizera E, Sydelko BS, Forbis SG, Lauden S. Hosp Pediatr. 2021 May 21:hpeds.2020-000240. doi: 10.1542/hpeds.2020-000240. Epub ahead of print. PMID: 34021029 Drs. Ashley Fernandes, Laura Gruber, Elize Kwizera, bette Sydelko, Elise Kwizera and Shalini Forbis have been Gold Foundation grantees.
Family-centered rounds (FCRs) for hospitalized children have been shown to improve staff satisfaction, teaching, and rounding efficiency.  But do they promote humanistic pediatric care?  Dr. Ashley Fernandes and colleagues performed a systematic review and qualitative meta-synthesis of 158 articles to determine what published literature has to say. Five themes emerged, each of which correlates to at least one of The Arnold P. Gold Foundation’s seven definitional elements of humanism: (1) Empathy, (2) Enhanced Communication, (3) Partnership, (4) Respect, and (5) Satisfaction and Service.  Of note, only one Gold humanistic element, Integrity, was not represented in these five themes. These results suggest that FCRs should be implemented in more settings, address integrity as a core ethical principle, and be customized to better address the specific concerns of family members within specialized populations.

Words Matter: An Antibias Workshop for Health Care Professionals to Reduce Stigmatizing Language Raney J, Pal R, Lee T, Saenz SR, Bhushan D, Leahy P, Johnson C, Kapphahn C, Gisondi MA, Hoang K. MedEdPORTAL. 2021 Mar 2;17:11115. doi: 10.15766/mep_2374-8265.11115. PMID: 33768147; PMCID: PMC7970642 Free full text
Language used by physicians often has consequences on patient care that may not necessarily be evident. Biased language can lead to feelings of shame and decreased motivation, particularly with stigmatizing conditions like diabetes, obesity, substance use disorder, and chronic pain. To counter this, Dr. Julia Raney and colleagues at Stanford University developed a workshop to help reinforce antibias and antioppressive skills. The workshop consisted of a reflective exercise, role-play, brief didactic sessions, and case-based discussion; these were followed by a post-intervention survey using Likert-style items and open-text responses. 66 participants completed the evaluations and agreed that the workshop met its objectives and strongly agreed that they would apply the skills learned. Through a qualitative analysis of open-ended comments, investigators identified potential barriers, including perceived difficulty in changing entrenched practice habits, burnout, and fatigue. Participants also suggested more time for group discussions and strategies to teach skills to others.  The authors conclude that this workshop is an actionable and feasible step to help address bias in the language of healthcare professionals. A downloadable kit, including PowerPoint slides, is included.

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Bharat Kumar, MD

Humanism in Research Assistant Editor

Updates the staff, databases, and social media about new studies around humanism in healthcare; curates and compiles the monthly Jeffrey Silver Humanism in Healthcare Research Roundup.