Philosophers and scientists alike argue that wonder-that emotion or state of consciousness in which one's attention is fixed on phenomena beyond one's comprehension-is the central virtue and driving ...force of all education. As in general education, wonder is central to all aspects of academic medicine's tripartite mission; a sense of wonder fuels the delivery of humanized patient care, sparks scientific discoveries, and supports engagement in lifelong learning. Despite its importance throughout medicine, developing a capacity for wonder among physicians has not been a stated goal of medical education, and innovative methods to foster a capacity for wonder have not been explored. There is a growing interest in the arts and humanities in medical education, and evidence suggests that these can support the development of a diverse array of clinically relevant skills and attitudes (including close observation, critical thinking, empathy, and tolerance for ambiguity) in medical learners across the learning continuum. However, even the potential of these methods to support a capacity for wonder has not yet been fully explored. In this article, the authors explore how one of the most widely used and studied arts-based learning activities in medical education, Visual Thinking Strategies, can help develop a capacity for wonder among physicians. They illustrate how Visual Thinking Strategies support the central elements of wonder-based pedagogy (i.e., exploration, improvisation, imagination, personal interest, and the ethos of educators) previously developed in education theory.
Traditionally, scholars focused their efforts in the domains of clinical care, research, and education; however, the last decade has witnessed the rise of novel areas of development such as ...innovation, quality improvement, informatics, and recently, digital scholarship. Academic institutions adapted and began considering these fields for academic promotion and tenure. Social media has become a critical space for the dissemination of knowledge and outreach to community and policy makers and also for the creation of communities of practice. This new realm brings multiple challenges, such as the appraisal of the quality and appropriateness of the content, the evaluation of impact on the academe and general populations, coupled to the creation of a system to reward scholars engaged in this novel endeavor. In this article, we describe the current state of academic promotion and the definition, nature, and merit of digital scholarship. We outline new strategies and tools for the assessment of dissemination and impact of these works, such as altmetrics, and finally, we reference innovative concepts on how to organize and use this digital academia on career promotion and tenure.
PURPOSEThe authors conducted a systematic review of the published literature on social media use in medical education to answer two questions(1) How have interventions using social media tools ...affected outcomes of satisfaction, knowledge, attitudes, and skills for physicians and physicians-in-training? and (2) What challenges and opportunities specific to social media have educators encountered in implementing these interventions?
METHODThe authors searched the MEDLINE, CINAHL, ERIC, Embase, PsycINFO, ProQuest, Cochrane Library, Web of Science, and Scopus databases (from the start of each through September 12, 2011) using keywords related to social media and medical education. Two authors independently reviewed the search results to select peer-reviewed, English-language articles discussing social media use in educational interventions at any level of physician training. They assessed study quality using the Medical Education Research Study Quality Instrument.
RESULTSFourteen studies met inclusion criteria. Interventions using social media tools were associated with improved knowledge (e.g., exam scores), attitudes (e.g., empathy), and skills (e.g., reflective writing). The most commonly reported opportunities related to incorporating social media tools were promoting learner engagement (71% of studies), feedback (57%), and collaboration and professional development (both 36%). The most commonly cited challenges were technical issues (43%), variable learner participation (43%), and privacy/security concerns (29%). Studies were generally of low to moderate quality; there was only one randomized controlled trial.
CONCLUSIONSSocial media use in medical education is an emerging field of scholarship that merits further investigation. Educators face challenges in adapting new technologies, but they also have opportunities for innovation.
Psychiatric conditions (including substance misuse disorders) are serious, potentially life threatening illnesses that can be successfully treated by psychotropic drugs, even during pregnancy. ...Because few rigorously designed prospective studies have examined the safety of these drugs during pregnancy, the default clinical recommendation has been to discontinue them, especially during the first trimester. However, in the past decade, as more evidence has accumulated, it seems that most psychotropic drugs are relatively safe to use in pregnancy and that not using them when indicated for serious psychiatric illness poses a greater risk to both mother and child, including tragic outcomes like suicide and infanticide. This review presents an up to date and careful examination of the most rigorous scientific studies on the effects of psychotropic drugs in pregnancy. The lack of evidence in several areas means that definite conclusions cannot be made about the risks and benefits of all psychotropic drug use in pregnancy.
Objective:Prescription opioid use disorder and overdose have emerged as significant public health challenges in the past 15 years. Little is known about public attitudes toward individuals who have ...developed a prescription opioid use disorder and whether these attitudes affect support for policy interventions. This study examined social stigma toward individuals with prescription opioid use disorder and tested whether stigma was associated with support for various policy interventions.Methods:A nationally representative Web-based survey was conducted from January 31 to February 28, 2014. The 1,071 respondents reported on their beliefs about and attitudes toward persons affected by prescription opioid use disorder and rated their support for various policy interventions. Ordered logistic regression models estimated the association between stigma and public support for punitive and public health–oriented policies.Results:Most respondents viewed this disorder as affecting all groups—racial and ethnic, income, and geographic area of residence groups—fairly equally, despite epidemiological data demonstrating that certain populations have been disproportionately burdened. Respondents expressed high levels of stigma toward individuals with prescription opioid use disorder. Levels of stigma were generally similar among those with and without experience with prescription opioid use disorder, either one’s own or that of a relative or close friend. Higher levels of stigma were associated with greater support for punitive policies and lower support for public health–oriented policies.Conclusions:Reframing the issue to emphasize the structural factors contributing to prescription opioid use disorder and the barriers to accessing evidence-based treatment might improve support for policies that benefit affected individuals.
PURPOSESome research shows that empathy declines during medical school. The authors conducted an updated, systematic review of the literature on empathy-enhancing educational interventions in ...undergraduate medical education.
METHODThe authors searched PubMed, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science (January 1, 2004 through March 19, 2012) using key words related to undergraduate medical education and empathy. They independently selected and reviewed all English-language articles that described an educational intervention designed to promote empathy in medical students, assessing the quality of the quantitative studies using the Medical Education Research Study Quality Instrument (MERSQI).
RESULTSThe authors identified and reviewed the full texts of 18 articles (15 quantitative and 3 qualitative studies). Included interventions used one or more of the following—patient narrative and creative arts (n = 7), writing (n = 3), drama (n=1), communication skills training (n = 4), problem-based learning (n = 1), interprofessional skills training (n = 1), patient interviews (n = 4), experiential learning (n = 2), and empathy-focused training (n = 1). Fifteen articles reported significant increases in empathy. Mean effect size was 0.23. Mean MERSQI scorewas 10.13 (range 6.5–14).
CONCLUSIONSThese findings suggest that educational interventions can be effective in maintaining and enhancing empathy in undergraduate medical students. In addition, they highlight the need for multicenter, randomized controlled trials, reporting long-term data to evaluate the longevity of intervention effects. Defining empathy remains problematic, and the authors call for conceptual clarity to aid future research.
A growing movement to integrate the arts and humanities into health professions education is afoot. While educators may easily conceive how arts-based teaching can improve clinically relevant skills ...such as observation and critical thinking, they may not realize it also has the potential to transform learners in myriad ways beyond sharpening these fundamental skills. In this Perspective, the authors review how visual arts-based education can promote clinical excellence by enhancing communication and interpersonal skills, professionalism and humanism, diagnostic acumen and clinical reasoning, and passion for clinical medicine. They describe the most widely studied visual arts-based education method, Visual Thinking Strategies, in detail as an exemplar of how arts-based pedagogy can help health care professionals strive for and ultimately achieve clinical excellence.
In spite of the growing knowledge and understanding of addiction as a chronic relapsing medical condition, individuals with substance use disorders (SUD) continue to experience stigmatization. ...Pregnant women who use substances suffer additional stigma as their use has the potential to cause fetal harm, calling into question their maternal fitness and often leading to punitive responses. Punishing pregnant women denies the integral interconnectedness of the maternal-fetal dyad. Linking substance use with maternal unfitness is not supported by the balance of the scientific evidence regarding the actual harms associated with substance use during pregnancy. Such linkage adversely impacts maternal, child, and family health by deterring pregnant women from seeking both obstetrical care and SUD treatment. Pregnant women who use substances deserve compassion and care, not pariah-status and punishment.
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