Four Years of Medical Humanities in Nepal: What Worked and What Did Not

September 12, 2010 at 2:56 pm

Everest region: Living in harmony with nature. Photograph

Commentary by P. Ravi Shankar, M.D. and Rano Mal Piryani, M.D., Department of Medical Education, KIST Medical College, Lalitpur, Nepal

In previous articles in the Literature, Arts, and Medicine blog we discussed sowing the seeds of Medical Humanities in the Himalayan country of Nepal; teaching Medical Humanities (MH) in English which, though the language of instruction, is not the native language of the participants; and also the challenge of creating and maintaining participant interest in MH.

MH was started as a voluntary module at Manipal College of Medical Sciences (MCOMS), Pokhara (1) and then we (PRS and RMP) conducted modules for faculty members at KIST Medical College (KISTMC), Lalitpur. In 2009 and 2010 we conducted modules for first year students at KISTMC. In this blog article we describe what in our opinion worked in the four modules and what did not and reflect on possible reasons for the same. Our experiences may be of interest to other MH educators, especially in developing countries.

What Worked

Small groups:

Small groups worked well in all four modules we organized and are an excellent way to learn MH. Small groups work together at a given activity and share ideas. In MH, unlike other more formal medical subjects, there may be no particular well defined solution of a problem. Participants mainly reflect on a painting, a case scenario, or a problem and share their views. In social sciences as opposed to the biological and physical sciences there may not always be a 'particular' way to solve a problem. One problem we faced was that not all members of small groups were active. We could only gently nudge the reluctant individuals into more active participation. We tried giving participants greater responsibility for self-managing small groups. We asked the groups to select from among themselves a group leader, a time keeper, a recorder and a presenter and rotate these roles during different sessions.

Paintings:

Paintings were a great success. We incorporated them more and more in successive modules. We have described our experience of using paintings in MH in a recent article. (2) Our major source of paintings was the Literature, Arts, and Medicine Database maintained by New York University. The database arranges literature excerpts, paintings, and videos according to different subject categories. Online access to photos of paintings and their annotations were useful. Participants were able to relate to the paintings, which were mainly from a western context. In Nepal only students from a science background take up medicine and most were not previously exposed to art appreciation and critical analysis of paintings. Most participants enjoyed the paintings but also recommended more use of art from Nepal.

Case scenarios and role-plays:

These were extensively used throughout. The case scenario usually had an ethical or a social issue which had to be explored wit role-plays by participants. A variety of issues such as diseases with social stigma, abortion, euthanasia, mental illness, patient confidentiality-among others-were explored. Student participants enjoyed role-play and interpreting different scenarios. Students brought out many issues and sometimes interpreted the scenario in a novel manner. Role-plays in KISTMC also served to bridge to a certain extent the language barrier as they were conducted in Nepali, the national language. We also introduced an exercise of interpreting scenarios depicted in paintings using role-plays, which was extremely popular with students. Interestingly, participants of the faculty module had problems with certain role-plays dealing with sexual and reproductive issues.

Debates:

Debates were used to explore certain issues in MH, for example, euthanasia, whether students from non-science backgrounds should be allowed to take up medicine, the nature of the doctor-patient relationship. Participants enjoyed debates but due to time constraints, full fledged debates-which require more thought and deliberation-could not easily be organized. Debates were more effective in the recently concluded MH module (2010). Students showed greater interest in the module as evidenced by their greater participation in group activities and high attendance (above 80%) even before assessments. In light of our previous experience, we modified the format so that the group/s speaking for the proposition would first put forward their points and then the group/s speaking against would counter those points. In addition to arguments prepared during the ten minutes allotted to the activity, students also had to oppose arguments put forward by the opposing group/s on the spot. We concluded that debates can be a good way to explore controversial issues.

Flip charts and flip boards:

These have the advantages of flexibility and ease of use. Flip charts are an excellent way for noting down the results of small group work and for small groups to present their findings to the whole house. We have been using flip charts effectively during Pharmacology practical sessions. During MH sessions flip charts were used to note main points and by presenters to guide their presentations. Flip charts are an excellent way for noting down the results of small group work and for small groups to present their finding to the whole house. On reflecting after the sessions it was our opinion that participants used flip charts in the same manner during both MH and Pharmacology practical sessions. Flip charts could have been used in a more creative manner during MH sessions. Certain groups did so but we could have developed and given guidelines to the groups. Creativity also may require a certain amount of artistic talent and ability among group members.

Venue of the sessions:

All student sessions were conducted in the college auditorium. The auditorium offers an empty space about 30 m x 30 m which can be arranged and organized to meet specific requirements. Students could be arranged in small groups with a separate area for role-plays and a main projection area. The only problem was the auditorium was being used for a variety of activities and we had to rearrange it before each session. A free area that can be reconfigured and rearranged to meet specific requirements is ideal for small group sessions that require creativity and flexibility, unless you can get a dedicated area for sessions, which can be difficult in developing nations.

What Did Not Work

Literature excerpts:

Literature excerpts have been widely used in MH sessions in the west. In the module at MCOMS, Pokhara, and in the faculty module at KISTMC we used literature excerpts. The excerpts were in English and participants often felt they were difficult to understand and the language was difficult. In MCOMS the participants were multinational. In KISTMC the major problem was getting literature excerpts in Nepali relevant to MH and the particular topic being covered. For English excerpts the Literature, Arts, and Medicine Database made the task easier as excerpts were arranged according to subject matter. We did not use literature during the two student modules; however, considering the complexity of issues which can be provoked and addressed by good literature we are thinking about how to incorporate it in future modules.

Reflective writing assignments:

MH is basically a process of reflection about various events in medicine. Reflective writing can be a good method to get participants to reflect. We tried giving reflective writing assignments to participants, but only participants in the MCOMS module, which was voluntary, were regular in submitting their assignments. Assignments were not used in the faculty module. In the 2009 student module submission was irregular. In the 2010 module students submitted more regularly. In South Asia compared to the west students are younger and less mature when they enter medical school. There is a dichotomy between arts and science in the education system. Creative writing and keeping a personal diary are not very common. These could be reasons why students were not very comfortable with reflective writing. However the interest and participation of the 2010 batch gives us hope that this could be a modality to be considered in future.

Medical Humanities online:

We created a medical Humanities group on the web (a private Google group). Slides of various topics, other material and selected publications related to MH were uploaded. There is also a discussion forum where individuals can discuss and comment on various topics. Participation in the group is voluntary. We invited selected faculty and other experts and sent an invitation to all students who participated in the module. Problems of net access, lack of time, and a hectic academic schedule were cited as possible reasons for not joining and not being active in the group.

Creating interest among other faculties:

Over the four years of MH only few faculty members were interested in being module facilitators. During the 2009 student MH module six faculty members from various departments joined as co-facilitators. Many of them were not entirely comfortable with small group learning and with using art and role-plays in medical education. Many were clinicians and their tight clinical schedule could have been a hindering factor. During informal discussion with western MH educators a factor which emerged was only faculty with a personal interest in the arts or with a hobby related to the arts like photography, painting, sculpture and creative writing may be interested in MH. Lack of success in creating new facilitators may be a limiting factor for the module in future.

Creating linkages with persons outside the traditional world of medicine:

In the west MH programs use resources and facilities from many sources. Artists, writers, philosophers and others have made a significant contribution to MH. In the west most medical schools are in a University sharing a campus with other disciplines while in Nepal medical schools usually exist in isolation. We were successful to a certain extent in that we wrote about using art in the education of doctors for a Nepalese magazine and created a certain amount of interest among people outside traditional medicine. The challenge will now be to transform interest into action.

The situation in South Asia is in many ways different from the west. Also batches of students and individuals vary in their interests and aptitude. Tailoring a module to meet the aspirations of groups and individuals is a challenge. Flexibility and an open mind could be important in meeting the challenge!

References

1.Shankar, P. R. A voluntary Medical Humanities module at the Manipal College of Medical Sciences, Pokhara, Nepal. Family Medicine 2008; 40: 468-70.

2.Shankar, P. R. and Piryani R. M. Using paintings to explore the Medical Humanities in a Nepalese medical school. BMJ Medical Humanities 2009; 35:121-122.

A Summer of Books

July 6, 2010 at 2:51 pm


Commentary by Felice Aull, Ph.D, M.A., Editor, Literature, Arts, and Medicine Database
. Now that summer is upon us, I hope you have access to a cool, restful place where you can burrow into a book and get lost in it. Here are some books I read during the past year or so that I found particularly absorbing, listed in no particular order. Perhaps some will appeal to you as well.

Novel, Await Your Reply, by Dan Chaon. A suspenseful, dark story of identity in which three parallel narratives eventually find each other. (Now available in paperback)

Nonfiction, Zeitoun, by Dave Eggers. A harrowing story, told simply and directly but with growing menace, of what happened to one Muslim American family during Hurricane Katrina in New Orleans. The hurricane was the least of their traumas. (Now available in paperback)

Novel, A Gate at the Stairs, by Lorrie Moore "Ms. Moore has written her most powerful book yet, a book that gives us an indelible portrait of a young woman coming of age in the Midwest in the year after 9/11 and her initiation into the adult world of loss and grief." Michiko Kakutani, New York Times book review. (Now available in paperback)

Novel, A Person of Interest, by Susan Choi. "…say[s] something about what it means to live in a society that is simultaneously tolerant and suspicious, inclusive and all too ready to punish its citizens for the crime of being their authentic selves . . . making us feel deeply for characters who are profoundly flawed. . . . beautifully written. Choi's precise, cadenced prose alternates between plain-spokenness and lyrical dazzle." Francine Prose, New York Times book review. (Available in paperback)

Short Story Collection by Jhumpa Lahiri, Unaccustomed Earth. "Most of Lahiri’s insightful writings concern the betwixt and between challenges associated with immigration and with generational shifts. This collection of engaging and beautifully written stories examines both challenges." Lois LaCivita Nixon, Literature, Arts, and Medicine Database. (Available in paperback)

Novel, Then Came the Evening, by Brian Hart. The author’s first novel is a story of people living harsh lives in the harshly beautiful landscape of Idaho. "Quietly exceptional". . . short review in the New Yorker.

Poetry: Unincorporated Persons in the Late Honda Dynasty, by Tony Hoagland. Hoagland is witty and observant as he focuses relentlessly on contemporary American culture.

Poetry: My Life As a Doll, by Elizabeth Kirschner. The speaker spins out "a narrative of embattled childhood" and its long-range effects.

Interdisciplinary Arts Project in a Family Medicine Residency Training Program

May 24, 2010 at 9:32 am

Photograph of pregnant woman with gold painted hand of partner on her abdomen

Commentary by Maureen Rappaport MD, FCCFP, Assistant Professor of Medicine, St Mary’s Hospital Center, and McGill University, Montreal, Canada

I am trained as a family physician but one third of my practice is as a clinical supervisor and teacher of residents in a family medicine teaching unit. I am based at St. Mary’s Hospital, a small community hospital in the heart of urban Montreal. Our residents have to do a "research" project as part of their training. Like most of our clinicians, I am not a trained researcher but I have had extra training as an educator (McGill Scholar in Medical Education 2004). A research project was a requirement of that program and through the courses I took in the Department of Education I discovered academic researchers were exploring different theories of knowledge and research (Barone and Eisner, Clandinin and Connelly, Cole and Knowles, and Patton)): i.e. Qualitative Inquiry, Interdisciplinary Artistic Inquiry, and Reflexive Inquiry. I used these methods in my own research project and although I initially met with skepticism, in the end my project was well received.

Past resident projects at St. Mary’s Hospital were mostly literature reviews and chart audits and, though interesting, the topics tended to repeat themselves year after year. My experiences in the Scholar’s program gave me the idea to propose an "Interdisciplinary Art Project" stream to my colleagues. I was excited about this new development, other staff members became inspired to develop other projects, and best of all, the residents engaged wholeheartedly with this new project paradigm.

I developed the guidelines for the Interdisciplinary Art Project based on work done by Dr. Ruth Martin, at University of British Columbia Family Medicine, who was generous enough to send me her documents. (Draft guidelines for Interdisciplinary Art Resident Project,Version #7, September 2005).

Interdisciplinary Art Project Stream Guidelines

Goals:

To integrate an artistic activity that includes photography, painting, sculpture, music, poetry, drama, film, or creative writing in a project that contributes to the existing knowledge base of Family Medicine

  1. To increase clinician self-understanding and/or understanding about the physician patient relationship
  2. To produce an oral/visual/audio/performance presentation which consists of the work of art itself AND
  3. To produce an abstract and a report written in a format similar to scientific research, however, you may write this report in the first person like a personal diary or field notes

Objectives:

  1. Demonstrate an academic understanding of the integration of the chosen artistic discipline with the discipline of family medicine
  2. To produce a scholarly work that attempts to understand, explain, and/or interpret a clinical question or enigma and to explain your motivation for choosing an artistic medium
  3. To include a historical and contemporary overview citing past examples of interdisciplinary work
  4. To explain how your project relates existing interdisciplinary knowledge or published literature
  5. To outline the ethical considerations encountered. ( Physician artistic activity can lead to ethical conflicts between what is research, art, or journalism, or when artistic activity interfaces with clinical care)
  6. To fully explain your methods ie. why, when and what materials/medium were used and if other participants were involved what consent process was used and did they have input in editing
  7. To present your results (the work of art) and a summary of the written report on resident day
  8. To have a full discussion about the impact and limitations of your project
  9. To demonstrate how the process of completing an interdisciplinary art project resulted in your personal growth or increased understanding

Preliminary Project Excerpts for Research Day June 16, 2010

Four projects are in the Interdisciplinary Arts Project stream this year:

1. The Exploration of a Patient’s Experience with Injury, Illness and Healthcare in Montreal -A short documentary film (Dr. Isaac Berman)

2. Poetry Therapy (Dr. Anne-Marie Leblanc)

3. Narrative Medicine, A Reflection (Dr. Tara McCarty)

4. Life-casting Project of Pregnant Woman and Her Partner (Dr. Tim Lussier)

Below are excerpts of three projects in their preliminary form:

Poetry Therapy: Anne-Marie LeBlanc

"As [Arthur] Lerner [is reputed to have] said, ‘poetry has the potential to help you be your best possible self… it brings us back to our own humanity’. I think I could say this is exactly what poetry brings me: humanity."

Outline of Project

  1. Intro
  2. Development
    1. History of Poetry Therapy
    2. Poetry and humanity
      1. Presentation of poems
    3. Research Method
    4. Four beneficial effects
      1. "Finding the Words to Say It"
      2. "It Takes a Whole Doctor to Treat a Whole Patient"
      3. "Paying Witness to the Unfolding Occurence of Life Itself"
      4. "Becoming a Better Professional"
  3. Conclusion

"The poem named ‘Une Femme Morte’ was written during my palliative care rotation."

Une femme. Morte.

Et moi qui entre

Devant elle

Un regard, en fait deux

L’un eteint et l’autre en peine

Deux coeurs

Qui ont aime… et cesseAd’aimer.

Trop difficile cette vie

La-haut ce sera plus calme…

Et la musique quiAla transporte

Je souffle sur son ame

Et reviens sur Terre

Lui ouvre les yeux…

Rien.

Que du vide. Que du vitreux

De l’ordinaire extraordinaire

Incroyablement effrayant.

Saisissant.

Le rideau derriere moi

Je le saisis. Un dernier regard

Trite, livide.

Je la laisse

Et je marche hors de moi.

Narrative Medicine, A Reflection: Tara McCarty

"This is a little piece I wrote in the call room last week after a particularly difficult night. Small reflections such as these are known as narrative medicine. AThe doctors, nurses and staff who care for the ill are exploding with stories of beauty, sadness, and unique information that they are privileged to know about their patients’ lives. Narrative medicine, as described by Rita Charon, internist and writer, is a way of practicing medicine that enables the physician to practice it with empathy, reflection, professionalism and trustworthiness. It can be conceived as a model for a new way to practice medicine, a way that perhaps is a form of reincarnation from the old."

It’s late in the evening and I’ve been paged by the attending who asked me to see Mr McDonald. He hadn’t been doing well and the attending wanted me to check on him and re evaluate his pain control later on tonight. Actually, I knew this patient from a couple months ago when I was on call- a sweet 91 year old man who still had all his mental capacities and a great photo of his nine grandchildren by his bedside. He came with pancreatic cancer and a CVA, and when I saw him, he was desatting and short of breath from a likely aspiration pneumonia. On top of that, he had gone into fast a fib at around 160, and at 4 am, alone on the eighth floor, I put him on a monitor and pushed some IV metoprolol until he slowed down.

Once my heart rate and his were both down to the double digits, he smiled at me, amused. "It’s Ok, my dear", he said, "You don’t have to look so worried anymore". When I left later that morning he was satting well, had a heart rate of 70-90 and he patted my hand gently when I left.

Tonight, I go in to check on him. Much has changed. He has had two more CVAs, and he is now Level 5 care, existing on that lovely trifecta of nasal prong O2, morphine and scopo. I walk into his room, introduce myself, explaining that we have met before. He is breathing at about six during the minute that I count but seems to be focusing on my eyes. I realize the sound that is coming from his throat is what we doctors so eloquently call "the death rattle". I am holding his hand and with my free one press the call bell to ask the nurse to phone his family, but once she answers, the only one left breathing in the room is me. Mr McDonald, the sweet man who only a couple months ago had told me to "stop being worried", had just died, here in front of me, his hand in mine.

In a haze, I did the usual, the exam needed to pronounce, the papers, the signatures, the call to the family, helped the nurses clean him up, take out the IVs, take out the foley, take off the EKG stickers. I left his peaceful body in his room, waiting for his family. But his spirit stayed with me for a while. I left his room and walked down the dark hall, Mr McDonald’s ghost floating beside me, calm. And so he walked beside me, holding my hand, all the way from 5 main to 5 south, and then he let me off at the elevators. I pushed the down button for me, and the up button for him. His elevator came first, and he waved softly and smiled as the doors closed, his eyes once again telling me that everything was OK.

Life Casting of a Pregnant Woman’s and Her Partner’s Hands

Resting on Her Belly: Timothy Lussier

Introduction: The bond between a family and the unborn fetus is not very well discussed in the medical profession as the pregnancy is quickly reduced to a checklist of symptoms and signs. Art can help to capture this relationship in a way that is informative and powerful for the observer whether it be a patient, passerby or the responsible physician. Objective: Use sculpture to help capture the bond between the mother, partner, and the unborn fetus. Design/Method: Research aspect-to explore what is known concerning the bond between the mother/family and the developing fetus; Creative arts aspect-life-casting project of a pregnant woman and her partner symbolically representing the connected union. This will be followed by a survey of observers to verify the art assists in the intended purpose. Results: 1) Written report 2) Sculpture 3) SurveyADiscussion: Art can be a transforming experience and has shaped minds and history through time. It is our way of expressing complex ideas or emotions and communicating this to others. The nine months of pregnancy is a powerful experience for the family not formally recognized by the mother’s interaction with the medical profession. A life-cast sculpture of this bond may help us to better understand this experience and promote this experience within the family.

The above excerpts are just tastes of what these projects hold. I can’t wait for research day, to hear my residents present these works to their peers and my colleagues, to see poetry, stories, and art next to evidence- based searches. Medical Humanities has taken yet another place in the Academy.

Note: Although the projects are in various stages of development the residents have generously agreed to share their work so far.

References

Barone, T.E. & Eisner, E. (1997). Arts-based educational research. In R.M. Jaegar (Ed), Complementary methods for research in education. (2nd Ed.) (pp.73-116). Washington, D.C.: AERA.

Clandinin, D.J. & Connelly, F.M. (2000). Narrative inquiry: Experience and story in qualitative research. San Francisco: Jossey-Bass.

Coles, A. & Knowles, G.J. (2000). Researching teaching: Exploring teacher development through reflexive inquiry. Boston: Allyn and Bacon.

Lerner, Arthur. Cited by McARDLE, S. and BYRT, R., in Journal of Psychiatric & Mental Health Nursing. 8(6):517-524, December 2001. p. 521.

Patton, M.Q. (2002) Qualitative research and evaluation methods. Sage Publications: California


Walk a Mile in My Moccasins

May 9, 2010 at 5:05 pm

photograph of native american man and woman 1898

Commentary by Amy Ellwood, MSW, LCSW; Professor of Family Medicine & Psychiatry, University of Nevada School of Medicine, Las Vegas, Nevada

Communicating Through Story

Storytelling has been around since the dawn of time. Before the invention of paper, the Gutenberg press, telephone, television, internet, Kindle, texting, tweeting, Skyping, and emailing, people communicated by actually talking to each other face to face. Before language evolved, animal species communicated through grunts, howls, screeches, and gestures. Body language and micro expressions say more than most verbal communication (Ekman, 2003).The story teller often had a place of status in tribal cultures because he/she was the keeper of the tribe's history. When there was no written word, people would gather around the fire and tell stories. Stories provided entertainment, education, history and cultural preservation (Biesele, 1986). Adults and children alike, fully present, would sit with each other listening to the stories. Sharing time and history helped to develop a sense of community and adaptation.

Today many of the younger generation communicate with electronic devices in incomplete sentences and symbols rather than talking to another person. The context and body language are obliterated. Watching someone fixated on an inanimate smart phone while texting reminds me of a baby mesmerized while watching a crib mobile. Smart phones have positive uses but the list of problem behaviors associated with smart phones is growing (Bianchi, Phillips, 2005). Some of the problems include "BlackBerry Thumb" (Avitzur, 2009), texting tendonitis (Menz, 2005), increased risk for automobile accidents, escape from aversive situations, loss of sleep, decreased work productivity, excessive mobile phone bills, and others.

Reading Stories with Resident Physicians

Within the medical culture, communication is often a staccato-like list of acronyms and laboratory data shared among medical professionals. Translating this information into a language that the patient or patient's family can understand to make informed decisions is difficult for some clinicians. Developing empathy for those experiencing a health crisis and teaching about empathy can be challenging. Some feel that you either have it or you don't, based on lessons learned in the family of origin and quality of attachments. Using medical humanities concepts and tools to teach about ethics, empathy and other issues is a newer approach in medical education that is becoming more prevalent.

Several years ago I attended a family medicine conference where one of the workshops was on medical humanities. We read poems, short stories and discussed ways literature could be used to teach in medical education programs. I had been using movie segments to teach about various behavioral science topics for years (Alexander, 2005). Following the humanities workshop, I decided to try something new that would be more interactive.

Family Medicine and OB/GYN Residents Read "Indian Camp"

After perusing many short stories from my own library, I selected "Indian Camp" by Ernest Hemingway. Resident teaching conferences are usually one hour. It was important to find a story that was not too long or too short, too simple or too complex. This is a short story of a white physician who is called to an Indian camp in the Great Lakes area to assist an Indian woman in prolonged labor. The white doctor takes his young son and the child's uncle along. Other characters in the story include the birthing Indian woman, her husband, an old Indian woman, and the Indian guides. The woman has been in labor for days and is not progressing. Her husband lies in the bunk above her because he had cut his foot with an ax three days before. The doctor tells his young son that, "her screams are not important". The doctor does a crude C-section while the young boy witnesses the birth of the infant. In the bunk above, the Indian husband slits his throat from ear to ear and the blood pools down to the bunk below. On the way home, the young boy asks his father if ladies always have a hard time having babies and wonders if many men kill themselves. The doctor tells him that no, not many men kill themselves and that birthing babies is not difficult. The white men then get back in the canoe and return to their white world.

"Indian Camp" can be read in 10-15 minutes, although resident physicians whose primary language is not English might need more time and might not get the subtle nuances of the story. The story is an initiation story from life to death. The images of light and dark mirror the events in the story and the author's own life. "Indian Camp" is filled with issues for discussion: gender, culture, power, Native American healing practices, suffering, suicide, impact of witnessing trauma on a young child, and much more. After the residents read the story, I had them break into groups of 2-3. A colleague helped make fold over name cards that were placed on the table in front of each group. Each card had the name of one of the characters in the story and with a clip art picture of the character.

The story is told from the perspective of the doctor's son, not from that of the birthing mother. The residents were asked to tell the story from the perspective of the other characters. As a family systems trained clinician, I have learned to listen to the other voices in the family narrative. Medical education tends to focus on one system using a high powered lens. Asking probing questions about the other characters’ perspectives helped residents to see from a wider lens.

Another faculty member and I started the discussion by asking, "Is Dr. Adams a villain or hero?" What did it mean when he didn't hear the woman's screams? Why did he bring his young son along? Why was the uncle there? Why did the Indian husband kill himself? What was it like for the Indian medicine woman to have a white male come in and take over? These are questions that resonated in my mind when reading the story for the first time.

The family medicine residents quickly focused on the issues of gender and power as well as what it must have been like for the Indian medicine woman to have a white male physician come in and take over the care of the laboring Indian woman. In many tribal cultures, men are not allowed in the birthing hut. Family medicine residents wondered why the doctor used crude instruments rather than bringing his own instruments. All of the family medicine residents expressed concern for the doctor's young son who witnessed the traumatic events. When discussing why the doctor did not hear the woman's screams, the OB-GYN residents voiced that the doctor was focused on doing the C-section to save the woman and the infant.

Reading "The Yellow Wallpaper"

I tried the process again with "The Yellow Wallpaper" by Charlotte Perkins Gilman after finding Tucker's article about reading this story with medical students (2004). "The Yellow Wallpaper" is rich with issues for discussion. Postpartum psychotic depression, repression of women's intellectual interests and role outside the home as well as the ethics of the physician husband treating his wife offer a plethora of possibilities for discussion. Gilman's story is longer than "Indian Camp" and took the family medicine residents 25-30 minutes to read. This left only 30 minutes to have the discussion from various perspectives. Residents reported that they were not used to reading stories with such flowery language and found it less enjoyable than "Indian Camp". Most of our residents are currently male but the one female resident found it pleasurable reading. None of the family medicine residents were familiar with "The Resting Cure" that was prevalent in the early 1900's.

Final Comments

There are always a couple of residents who ask, "Why are we doing this?" "How will this help me run a code?" I only read medical journals, why do I have to read this?" The majority of the family medicine residents did not question the validity of this teaching process. The OB-GYN residents were initially very reserved not knowing what to expect but then became activated as the story unfolded. As the process evolved, the facilitators were less directive and the group took off. As in most groups, the group does the work! At the end of the hour, residents were making positive comments about what an enjoyable learning experience this was and that they would like to do it again but with stories that were more like "Indian Camp" than like "The Yellow Wallpaper".

During the past six years I have utilized "Indian Camp" three times with family medicine residents and once with OB-GYN residents. I used "The Yellow Wallpaper" once with family medicine residents and plan to use it with psychiatry and OB- GYN residents in the future. It will be interesting to see how the process evolves with different specialties and to learn which issues become the focus of the discussion.

References

Alexander M, Lenahan P, Pavlov A (Eds). Cindemeducation: A Comprehensive Guide to Using Film in Medical Education, Oxford: Radcliffe Publishing, 2005

Avitzur O. Rx for BlackBerry thumb, Consumer Reports, January 2009, p. 12

Bianchi A, Phillips JG. Psychological predictors of problem mobile phone use. Cyberpsychol Behav. 2005 Feb; 8(1): 39-51

Bisele M, How hunter-gatherers' stories "make sense": semantics and adaptation, Cultural Anthropology, Vol 1. No. 2, The Dialectic of Oral and Literary Hermeneutics (May 1986), pp. 157-170

Ekman P. Emotions Revealed: Recognizing Faces and Feelings to Improve Communication and Emotional Life, New York City: Henry Holt and Company, LLC, 2003

Menz RJ. "Texting" tendonitis. Med J. Aus. 2005, March 21, 182:6: 308

Tucker P, Crow S, Cuccio A, Schleifer R, Vannatta JB. Helping medical students understand postpartum psychosis through the prism of "The Yellow Wallpaper" by Charlotte Perkins Gilman, Academic Psychiatry 2004, 28: 247-250

English Departments and Healthcare

May 5, 2010 at 12:05 pm

Commentary by Bernice L. Hausman, Ph.D., Professor, Department of English; coordinator of the undergraduate minor in Medicine and Society, Virginia Tech.

In answer to a listserv question about how professors of English might benefit from interaction with health care professionals:

I think one real benefit is widening the range of impact for English studies. Even our English majors can sometimes not see the importance of their knowledge and their competencies in the larger world, and often we can only suggest to the best of them that they go to graduate school to become like us. But undergraduates in English who are educated in the medical humanities begin to see places for themselves in the policy world, in public health, and in other careers in health care. That is one specific tangible benefit.

Another benefit is widening our own sense of efficacy as faculty. We have much to offer in terms of interpreting medical discourses in the contemporary world. Susan Sontag first noted in 1977 that all experiences of cancer are metaphorized into "fights" or "battles." That terminology rages on, and impacts cultural and medical thinking and practice about cancer. Our engagement with these issues and dissemination of our ideas in the public sphere is important, and it is an often neglected element of our scholarly practice. Engagement with physicians is one place to start.

Finally, we can benefit from collaborative funding endeavors. I am currently leading a research group studying discourses of vaccine refusal. As head of a multimodal team that includes faculty (humanities and public health), graduate students, and undergraduates, I find the research synergies energizing. In addition, we are going to submit a funding proposal to the NIH or CDC concerning the social and cultural contexts of vaccine refusal. Working with physicians and other health care professionals would only strengthen our proposal. Such research projects are intellectually and socially valuable, and can potentially bring in much needed funds to humanities departments increasingly strapped for operating funds and graduate student stipends.

Immigration in the News

April 28, 2010 at 4:56 pm

Immigration is much in the news these days. The law that was passed in Arizona will, according to many legal experts, certainly be challenged as unconstitutional, and one hopes that the courts will strike it down. Perhaps we should all do as Linda Greenhouse suggested: wear buttons that say "I could be illegal." Greenhouse wrote (in a recent New York Times Op Ed piece) that she was glad she had already seen the Grand Canyon because she wasn’t planning to return to Arizona. As someone who has regularly enjoyed the spectacular scenery in that state and hiked many a trail there, I am in distress about the politics of the place and torn about going back.
Felice Aull

Below is a link to a commentary about immigration and heath care, "Immigrants, patients have unique stories", by physician author Danielle Ofri. Ofri is Associate Professor of Medicine at New York University School of Medicine, editor of The Bellevue Literary Review, and author most recently of Medicine in Translation: Journeys with My Patients.

Physicians' Storytelling via Webinar

April 6, 2010 at 3:49 pm

Commentary by Katherine D. Ellington, Class of 2011, St. George’s University School of Medicine; Creator, Producer and Host, AMSA National Book Discussion Webinars

Over the last year, I've had the opportunity to create, develop and implement the American Medical Student Association (AMSA) National Book Discussion Webinars. A diverse group of physicians have discussed their books, writing pursuits, work experiences, and lives. The AMSA National Book Discussion Webinars offer a unique online experience between physician-authors and medical students to encourage reading beyond the medical school curriculum, both for professional development and for personal enrichment. The group of physician-authors selected represent a cross-section of backgrounds and their books were chosen based on relevant themes to engage the AMSA community.

New technology: What is a webinar?

Webinar technology is a new tool emerging in the world of medicine and elsewhere, making it possible to connect people beyond conference calls and e-mails. During webinar sessions online participants have the opportunity to watch, listen, use text chat, ask questions and have a discussion with the presenter and host. There's also a presentation area for slides and document sharing. Desktop sharing and audience polling are also possible. The real-time session includes time for questions or discussions either via chat or live by phone or VoIP (voice over Internet Protocol) for a complete online experience.

While some physicians presenters were concerned about being able to use the technology, doing a trial-run before the session made it possible to setup and then present during the actual webinar with ease. Physician comments indicate overwhelmingly positive experiences with the webinar technology.

Exploring texts beyond the medical school curriculum

The inaugural session was held in February 2009 with well-known psychiatrist-author Samuel Shem, M.D.(pen-name of Steve Bergman, M.D., Ph.D.) discussing his new book, The Spirit of the Place, along with his Annals of Internal Medicine article, "Fiction as Resistance." In contrast, the following month a young cardiologist and physician-writer Sandeep Jahaur talked about his book, Intern, and New England Journal of Medicine essay "The Demise of the Physical Exam." The webinar sessions have allowed for conversations beyond the books and articles selected; for example Dr. Katrina Firlik's discussion about women in medicine offered themes beyond her memoir Another Day in the Frontal Lobe. Neurosurgeon Nozipo Maraire participated in this session as a special guest to provide her insights on family life and medicine. Dr. Maraire's work of fiction Zenzele: A Letter to My Daughter, was written during the long nights of her residency training at Yale.

AMSA National Book Discussion Webinars have also touched on dilemmas within health care. Dr. Audrey Young's discussion of her latest book, The House of Hope and Fear: Life Inside in a Big City Hospital, helped us think about how the commitment of public hospitals to indigent communities is complicated by the need to control health care costs, and how the complexity of "cost-shifting" becomes the physician's burden and affects everyone. This conversation continued on through the summer to the fall when Dr. Young joined in a dialogue with pediatrician and health policy expert Dr. Fitzhugh Mullan. In this webinar on Narrative Matters, Dr. Mullan described health policy writing as political narrative that falls between editorial and short story memoir.

"I was telling stories that were pertinent to people's concerns about health care and that were, to some degree, a goad to those in charge. My writing was an invitation to change things."
Fitzhugh Mullan, M.D.

Like Samuel Shem, Dr. Mullan and Dr. Young talked about their writing as a tool for advocacy and activism in medicine, a long-held AMSA theme.

Bringing physician's stories closer to students

Book titles have been selected in some cases many months in advance, yet the webinar announcements and schedule give participants at least a few weeks to read the book and articles before registering and joining a webinar session. The selected articles provide a glimpse of the physician's writing in a different context. The hour-long program format also allows for a "reader's response" when participants can take a few minutes to comment about their perspectives on a book and/or article, further enriching the dialogue. These webinars close the distances that separate dispersed but enthusiastic students who read and wish to share in a group experience.

To date, the AMSA National Book Discussion Webinars has had more than 500 participants and 18 physician-writer presenters. Webinars are scheduled to accommodate physician and physician-in-training schedules in order to encourage participation of a national audience. Each webinar session is limited to 25 participant connections; preference is given to AMSA members and chapters viewing as groups. Feedback and audience survey results indicate positive experiences among participants. The power of physicians' storytelling resonates through these webinars that connect storytellers and medical and premedical students, interns and residents, physicians, health professionals, and those in the medical humanities field. The live webinar is authentic and allows for an informal, shared experience and unique learning opportunity.

For further information: bookdiscussiongroup@amsa.org

References

Firlik, Katrina. Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside. New York: Random House;2007

Jauhar, Sandeep. Intern: A Doctor's Initiation. New York: Farrar Strauss Giroux;2009.

Jauhar S. The demise of the physical exam. N Engl J Med. 2006;354(6):548-51.

Maraire, Nozipo, Zenzele: A Letter to My Daughter. New York: Delta;1997

Mullan, Fitzhugh and Ficklen E. ed. Narrative Matters: The Power of the Personal Essay in Health Policy. Baltimore: Johns Hopkins Press;2006.

Shem S. The Spirit of the Place. Kent: Kent State University Press;2008.

Shem S. Fiction as resistance. Ann Intern Med. 2002;137:934-7.

Young, Audrey. The House of Hope and Fear: Life in a Big City Hospital. Seattle: Sasquatch Books;2009.


Sherman Alexie Wins PEN/Faulkner Award

March 24, 2010 at 11:18 am

I’d like to call attention to yesterday’s announcement of the 2010 PEN/Faulkner Award for fiction, Author Sherman Alexie is the winner for fiction (War Dances, annotated in the Literature, Arts, and Medicine Database) and if you haven’t read any of his work you are missing a treat. He is a prolific author of essays, fiction, poetry, and also wrote three screenplays. Figuring in much of his work are his experiences as a Coeur d’Alene/Spokane Indian who lived on the "rez" interfacing with "white" society and who continues to span these borders off the reservation. His style and point of view are unique — humorous, perceptive, original, pointed, poignant. Coincidentally, I had just finished annotating and posting the film, Smoke Signals, for which Alexie wrote the screenplay, when I learned that he was the recipient of this award. Every time I watch that film I find something new to savor so I was particularly pleased to learn of this award.

Felice Aull

The "Parallel 'Parallel Chart'"

March 8, 2010 at 5:58 pm

an illustration of hands reaching outCommentary by Hedy S. Wald, Ph.D., Clinical Assistant Professor of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI

May, 2006. We treated our Doctoring small group to a nice home-cooked meal to celebrate the conclusion of their first year of medical school-eight students, two lucky teachers. Students, after all, are hungry for knowledge but they're also hungry. We had grown to know these now 25% doctors through didactic but more so through their reflective narratives that we were privileged to receive and respond to…After dessert, I surprised each of them with a personalized binder of all their narratives plus the written feedback they had received over the course of the year from their co-teachers-Hedy (me), a clinical psychologist and Steve, a family physician. The teachers lugged home extra large binders with all the students' writings and feedback, precious cargo indeed. I hoped the students would hold onto the experience, maybe even look back one day upon those texts, tangible evidence of their metamorphosis. I got choked up that evening. With good reason.

It is a mysterious process, this reading and responding with written individualized feedback to students’ reflective narratives as we accompany them on their journey of personal and professional identity development. Rita Charon captured the awe: "What a remarkable obligation toward another human being is enclosed in the act of reading or listening" (1, p.53) This became my mantra as I diligently typed at my computer, striving to craft meaningful, quality feedback to the students’ narratives that had sailed across cyberspace to land on my screen. I tried hard to establish a "comfort zone", a trusting "mentor" relationship where an embryo doc could safely share vulnerabilities and uncertainties, personal angst and yes, triumphs, dramatic moments and perhaps even more meaningfully, everyday moments of caring that should be recognized by a self-aware, mindful practitioner (student and teacher alike). And, I learned, it wasn't a bad idea to keep "oven mitts" (2) nearby for the "hot" stuff, the personal and/or professional content that can be challenging for both writer and reader, albeit less frequently encountered. Life is not sanitized, homogenized, or neatly packaged. Neither are narratives.

Interactive Reflective Writing

Some background. Several years ago, Warren Alpert Medical School of Brown University (Alpert Med) included an interactive reflective writing innovation within their Doctoring course (3) for first and second year students; the current curriculum includes this as well. I was there from the get-go. Students send confidential "field notes" by email throughout the year- in response to structured narrative prompts on patient encounters and other topics-and receive written feedback from an interdisciplinary team. Early on, I sensed something special unfolding…Narrative medicine enthusiasts will not be surprised to hear about the perceived benefits of hearing a student’s voice within narrative (valued as distinct from the usual group dynamic), witnessing the representation of their experience in the written word to give it meaning, and deepening learners' reflective capacity through this process. "Clinicians donate themselves as meaning-making vessels to the patient who tells of his or her situation", Charon observed (1, p.132)…And the embodiment of this? The meaning-making vessel of narrative. Written feedback, I would suggest, is potentially a "meaning-making vessel" in its own right. Indeed, the "interactive" nature of this paradigm has pedagogic value, students have noted, as they appreciate writing with an "audience" in mind. (4) Narratively humbling indeed for those in that audience. (5)

Narrative content in a longitudinal context, Steve and I noticed, documented our students’ learning journey. But what of the teachers, the "seasoned travelers"? (6) It’s not about us, it’s about them (our learners). I know this. But maybe, just maybe, it’s about us too. Narrative connects on so many levels. We know this. It reminds us, inspires us, nourishes us. Students’ revelations within confidential interactive reflective writing can have a powerful impact, touching one’s heart and soul. Through authentic engagement, I found that their writings about clinical encounters (including personal and professional issues) served as narrative triggers for my associations. I experienced a flow, sometimes tidal wave of cognitive and affective responses, personal and clinical recollections, a potential treasure trove to share. Yet I would not share it all; educational responsibility prevails, judgments need to be made, and students don't want to read novels on their narratives anyway. Ultimately, something about this experience resonated with a key concept I had learned in narrative medicine: the "parallel chart" teaching tool, (1) inviting further contemplation.

Rita Charon appreciated the value of considering the nuance and texture of patients' experiences of illness as well as what students themselves were undergoing in providing patient care, even though "you cannot write that in the hospital chart, we will not let you". (1, p.156) "And yet", she instructed clerkship students (and later, residents as well), "it has to be written somewhere. You write it in the parallel chart" (1, p.156) In similar fashion, I suggest, the teacher's experience of the student's narrative, of the student's "narrative writing in the service of the care of a particular patient" (1, p.157) can be considered a "parallel 'parallel chart'". In essence, my narrative writing evoked by the student's text is in "the service of the care of a particular student", regardless of whether all of it or none of it appears in my formal written feedback.

The Teacher's Experience

What of this living organism, this "parallel 'parallel chart'"? Might it offer opportunities for a parallel process of transformative growth of a teacher? Let the student's narrative "brew". (7) Allow the narrative to speak to us, guide us, enhance our awareness, then trust our instincts, use our curiosity, and sift through our "parallel 'parallel chart'" to craft feedback of substance and worth…all in the service of the student, yet with mutual benefit. Let the teacher's narrative "brew" too. Professor Lee Jacobus' observation that "time moves on once the book is gone from the writer's hand and the writer is no longer the person who wrote the book" is germane (blog review of Margaret Atwood's Negotiating With the Dead: A Writer on Writing). (8) The student is no longer the person who wrote the reflective narrative; neither, I would assert, is the teacher who responded to it. It's called Education. And it gives "faculty development" a whole new meaning. The intersubjective process of transformative growth (1), I now realize, is not the student’s sole proprietorship. (9)

So we sift, filter, craft, and mold our "parallel 'parallel chart'" for most effective educational impact. My research colleagues at Alpert Med (Drs. Reis, Monroe, and Borkan) and I recently offered the BEGAN tool, the Brown Educational Guide to the Analysis of Narrative to help guide faculty with this process, describing integration of personal and clinical experiences, reflection-inviting questions, elements of close reading, as well as student text quotes within written feedback to students' narratives. (10) Be a "generous listener" (11) but more than that, use that "parallel 'parallel chart'" to support and challenge the learner toward deeper reflection, understanding, and meaning making. Oh, and be sure to pause before hitting the SEND button, we advise, to avoid foot in mouth disease and other such maladies.

Concluding Reflections

The literature is replete with explorations of what doctors find meaningful about their work, what it is that sustains them-making a difference in someone's (the patient's) life is often mentioned. (12) Within medical education, connecting to students through their narratives about connecting with patients can help make a difference in students' lives and our own. "Learn from every patient", the teacher teaches the student. "Learn from every student", the narrative teaches the teacher. And we do. Impressed with the power of narrative, a primary care doc, for example, recently remarked to me that reading and responding to students' narratives was helping remind him why he went into this business. As for me, I've grown as a teacher, colleague, and writer. Teacher me now routinely uses my "parallel 'parallel chart'" (with deepened insights) and BEGAN tool to craft what I hope is useful, meaningful individualized feedback to reflective narratives in the Alpert Med family medicine clerkship. My colleague self "ping-pongs" ideas (based on my response flow) with co-facilitators within small group teaching and with research colleagues, sparking creative output. I'm also fortunate to be able to reflect on their written feedback to students derived from their own "parallel 'parallel charts'". As a writer, narrative flow has led to gratifying creative and academic writing accomplishments; JAMA, Newsweek, Academic Medicine, and more. Correlation does not imply causation, but it sure feels that way. It's been a remarkable journey.

I ran into one of my original first-year Doctoring course students recently at an Alpert Med seminar. He looked good, more polished and self-assured, excited about Match Day in March, he told me. We took a moment to reminisce about the "good ol' days" of Doctoring and my, how time had flown. "I still have the binder", he grinned as he walked away and made my day. "So do I", I whispered, "So do I".

References

1. Charon, R. Narrative medicine - honoring the stories of illness. New York: Oxford University Press, 2006.

2. Ellis, K. Plenary on Close Reading. Advanced Narrative Medicine Workshop - Program in Narrative Medicine. College of Physicians & Surgeons of Columbia University, June 23, 2008.

3. Monroe A, Ferri F, Borkan J, Dube C, Taylor J, Frazzano A, Macko M. Doctoring. Providence, RI: Warren Alpert Medical School of Brown University, 2005-10.

4. Wald HS, Davis SW, Reis SP, Monroe AD, Borkan, JM. Reflecting on Reflections: Medical Education Curriculum Enhancement with Structured Field Notes and Guided Feedback. Acad Med, 2009; 84(7): 830-7.

5. DasGupta, S. Narrative Humility. Lancet, 2008; 371: 980-1.

6. Kerka, S. Journal writing and adult learning. ERIC Dig., 1996; 174:1-4.

7. Wald HS, Reis SP. A Piece of My Mind. Brew. JAMA, 2008; 299:2255-6.

8. Jacobus, L. http://literatureartandideas.blogspot.com/ [Accessed February 16, 2010].

9. Wald, HS. I've Got Mail. Fam Med, 2008; 40(6): 393-4.

10. Reis SP, Wald HS, Monroe AD, Borkan JM. Begin the BEGAN (The Brown Educational Guide to the Analysis of Narrative): A framework for enhancing educational impact of faculty feedback to students' reflective writing. Patient Educ Counseling, 2010; doi:10.1016/j.pec.2009.11.014.

11. Rabow MW, Remen RN, Parmelee DX, Inui TS. Professional Formation: Extending Medicine's Lineage of Service Into the Next Century. Acad Med, 2010; 85(2): 310-7.

12. Horowitz CR, Suchman AL, Branch WT, Frankel RM. What Do Doctors Find Meaningful about Their Work? Ann Intern Med, 2003; 138(9): 772-5.


Fostering Interdisciplinary Community: A Humanities Perspective

February 18, 2010 at 6:42 pm

Commentary by Jessica Howell, Ph.D., Wellcome Postdoctoral Research Fellow, Centre for the Humanities and Health, King's College London

Described as a "free destination for the incurably curious", the Wellcome Collection in London consists of several galleries, a cafe, bookstore and library. The library houses "collections of books, manuscripts, archives, films and pictures on the history of medicine from the earliest times to the present day". I knew that this particular library's holdings would be an invaluable resource for my research in the medical humanities, so I decided to pay the Collection building a visit, soon after I arrived in London this January. I was doubly interested because the Wellcome Trust, established by Sir Henry Wellcome's will in 1936 and meant "to advance medical research and understanding of its history", funded the Centre for the Humanities and Health at King's College London, where I hold my current position as postdoctoral research fellow.

I enjoyed the Wellcome Image Award gallery, which displays winning medical and historical images made by light and electron microscopy as well as illustration and photography. But I was perhaps most forcibly struck by "Medicine Man: The forgotten museum of Henry Wellcome", which exhibits objects from Wellcome’s personal collection. Sir Henry was apparently a dedicated gatherer of medical and anthropological artifacts and curiosities. Amongst the assortment are forceps, chastity belts, ceremonial masks, early surgical instruments such as bone saws, and even torture chairs. I found myself thinking of the exhibit for a long time afterwards. Imagine the research that could be done, and no doubt already has begun, on each of these object’s long, fraught histories, and what such research tells us about a culture's values, practices, even aesthetics. Because I found certain objects disturbing, I also felt responsible to pay even closer attention to what they had to teach me-about medicine's relationship with gender and race, as well as about common human experiences of birth, death, pain, suffering, and healing. I wished I had a medical doctor, artist and social scientist, amongst others, standing in the room, contemplating with me this window into complex and often troubling moments of human history.

Though I was alone at the Wellcome Collection itself, I am in the fortunate position of being able to participate in just such meaningful discussions in my role as Wellcome Research Fellow. I am part of a multi-strand program called the "Boundaries of Illness", convened in the Centre for Humanities and Health here at King's College. I work within a strand of this program titled "Nursing and Identity: Crossing Borders". For my project, I will examine the lifewriting of nurses traveling in the late nineteenth and early twentieth centuries under the auspices of the Colonial Nursing Association. I will analyze their work in terms of its implications for medical history, literary, postcolonial, gender and travel studies, and help to write a database for future researchers. To the research team at King's College, I bring a background in literary studies. I received my Ph.D. in English literature from University of California, Davis in 2007. My own work has been concerned with racial science and climate in nineteenth-century travel narratives. I applied to the research fellowship at King's partly due to my own long-standing interest in interdisciplinary scholarship and colleagueship. For example, while at UC Davis, I co-organized a medical humanities research group with Faith Fitzgerald (Internist and Professor of Medicine and Associate Dean of Humanities and Bioethics), and we also hosted two conferences on "Literature and Pathology."

Through these experiences, I have found that being part of an interdisciplinary scholarly community can enhance my own work in both tangible and intangible ways: on a pragmatic level, I produce better honed research when I analyze my arguments from alternate perspectives, testing the validity of my assertions outside of my own discipline. I may follow up leads provided by my colleagues that will take my work in new and creative directions. I also use research methodologies drawn from various academic traditions. Less measurable, but still critical to my work, are the interpersonal benefits: I find myself energized and encouraged when surrounded by scholars who have chosen this kind of study-speaking generally, I find that they tend to be more willing to explicitly discuss the ethical implications of their research, or even the underlying ideals and values they hold, such as human connection, compassion and understanding. Specifically, many of us in the interdisciplinary field of medical humanities believe that it is only through a meeting of the minds between biomedicine and other fields such as literature, art, philosophy and history that we can understand the experiences of patients and providers of care (roles that almost all of us will inhabit at some point in our lives). The Centre's website says it well: "Patient subjectivity and values - sometimes bundled together as 'the patient voice' - are expressed in a wide diversity of cultural objects and settings (texts, symbolic figurings rendered in portraits, films and in conceptual constructions), which it is the task of the Medical Humanities to identify, research and illuminate" (http://www.kcl.ac.uk/research/groups/chh/about.html).

As I have stated that I value my colleagues' diverse perspectives and the collaborative quality of interdisciplinary research, it would be remiss of me not to include the experiences of some of my King's coworkers. Dr. Rosemary Wall began her post in 2007, and so has seen the Centre develop through the stages of proposal, planning, and now implementation. She mentioned that it has been rewarding to help bring together scholars from within King's College and from other institutions who have common interests and complementary training, but may not have known each other or had the opportunity to share their ideas before (personal interview 2/4/2010). Ms. Elisabetta Babini asserts that, while "commitment to Medical Humanities" is "highly challenging", the field also has great potential to "broaden traditional research horizons." Both of my colleagues discussed the rich professional opportunities provided by their work in the Centre. As just one example, they are currently co-planning Screening the Nurse: Call to Service, a two-day event of talks and film screenings organized around the theme "British Nurses and Wars", hosted by the Florence Nightingale School of Nursing and Midwifery at King’s College in collaboration with the Imperial War Museum film archive (e-mail interview, 2/7/2010). These kinds of projects offer researchers in the medical humanities unique venues and opportunities through which to broaden their professional network and gain valuable cross-disciplinary experience, as well as to make their research accessible to the public. I am very pleased to have joined with the Centre in supporting its initiatives. Further, I look forward to sharing in the future some of my findings regarding nurses' writing, which I agree, with recent commentators Cortney Davis and Thomas Long, is a topic of ongoing interest.

References:
1 For more on Sir Henry's personal collection, see An Infinity of Things: How Sir Henry Wellcome Collected the World by Frances Larson. (Oxford: Oxford Univ. Press, 10 Sep 2009)

2 Within the "Nursing and Identity" strand of this project, I am supervised by Professor Anne Marie Rafferty, Dean of the School of Nursing and Midwifery, and Dr. Anna Snaith, Reader in Twentieth-Century Literature. My co-researchers include Dr. Rosemary Wall, postdoctoral medical historian, and Elisabetta Babini, Ph.D. student in Film Studies/ Nursing, who both kindly agreed for me to include their comments.