Showing 61 - 70 of 251 annotations tagged with the keyword "Medical Education"

The Story of San Michele

Munthe, Axel

Last Updated: Nov-14-2011
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

The author takes us on a highly colorful autobiographical tour of his medical career - his personal life never enters this account - from a classical medical education in Paris as a young expatriate Swede (he remains expatriate the entire book) to his internal medicine practice in France, including a tour of Naples as a volunteer during the cholera epidemic of 1881 and his finally settling in Italy. There are also anecdotes - many of them side-splitting and told with uncommon skill - about conducting a corpse back to Sweden, a truly thrilling journey to Lapland,  encounters with the legendary Charcot, his return to San Michele whence the book begins with a mythopoetic retelling of his first visit there, and his last years at San Michele as patron of a community (both local and international) and as collector and explorer of the nearby Mediterranean.        

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Summary:

Johanna Shapiro, Director of the Medical Humanities Program at University of California Irvine School of Medicine, brings her considerable skills and experience as medical educator, writer and literary critic to this unique volume of medical student poetry. Shapiro collected over 500 poems by medical students not only from her home institution but also from other US medical schools and performed a content and hermeneutic analysis. As Shapiro carefully details in her methodology section, she treats "poetry as a form of qualitative data, and [therefore] techniques of analysis developed for other sources of qualitative data (such as interviews, focus groups, and textual narratives) can be applied to an understanding of poetry." (p. 42)

Relying on the work of Arthur W. Frank (see The Wounded Storyteller), Shapiro devises a typology of student poems: chaos, restitution (and anti-restitution), journey, witnessing, and transcendence (this last category was not Frankian in origin). These categories are developed and explicated in Chapter 2: Functions of Writing for Medical Students. As the author notes, poems traverse the boundaries between types; nonetheless, the framework of the analysis rests with this typology. Further, Shapiro explores the metaphors of topography (illness as a foreign land) and quest (student on a heroic, however tentative or confused, journey) throughout her study.

The book contains many fully reproduced medical student poems, contextualized with academic theory on medical education. Hundreds of references, particularly in the fields of narratology and medical education, are cited. After three chapters of theory and methods, eight topics are explored using the outlined analytic tools: anatomy class, becoming a physician, patient experience, doctor-patient relationship, student-patient relationship, social and cultural issues, death and dying, love and life. Prefacing each of these topics is a scholarly essay providing historical and research foundations; every chapter concludes with a summation.

Within the chapters are examples of poems, not only organized by typology, but also by content. For instance in the patient experience chapter, the topics are: "patient pleas for empathy and compassion," "patient fears and suffering," "stigmatized voices," "vulnerability/courage of child patients," and "personal experiences of illness." Within each topic/subtopic, different poems are highlighted and fully analyzed. Additionally, other poems, not reproduced, are quoted as illustrative examples. Summary arguments are provided at the conclusion of each chapter as well as in the final chapter: "Strangers in a Strange Land: What Matters to Medical Students on Their Journey and How They Tell About It."

Although Shapiro states that her purpose "is not to address the literary and aesthetic attributes and value of the poems", she also notes "when students write authentically about their own experience, the results are uniformly moving, compelling and impossible to ignore." (pp 44-5) Indeed many of the poems are rewarding to read not only for content but also for word choice, word play, imagery and narrative line. For instance, in "Ode to the Peach" Brian McMichael explores the senses Neruda or Pollitt-like: "you invite me with / your voluptuous curves / your feminine little cleft". (p 236) Another example is the humorous, self-deprecating "Piriformis" by Curtis Nordstrom relating an early clinical experience by a medical student who hopes against hope that the patient's presenting complaint will require the student to demonstrate his acumen. Unfortunately the sum total of the student's knowledge base is limited to the location of the piriformis muscle; both the student and patient are "so screwed" when, "Alas, the patient presents with / an upper respiratory infection." (p. 16)

Shapiro's sensitivity and generosity of spirit vis-à-vis the medical student experience are evident throughout the volume. She concludes that "what may be most noteworthy about the analysis of these poems is that, amidst their own difficulties and fears, time and again these students reported engaging deeply with their patients." (p 259) She hopes that medical educators will be encouraged to support "in solidarity" the "idealism and high aspirations" expressed in these student poems. (p. 260)

In a postscript, Shapiro reveals her own experiences as a poet-patient. After noting that "[m]edical students are mostly annoyingly healthy, energetic, smart, and capable young adults who like order, structure, and control", (p 261) she also acknowledges how frequently students grapple with the topic of death and dying in their poems. That her poems emerged from advising a student creative writing group demonstrates how poetry can be renewing and vital not just to the student, but to the educator as well.

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Summary:

Edited by Victoria Tischler (a psychologist in the Division of Psychiatry at The University of Nottingham), with forewords by Dinesh Bhugra (Professor of Mental Health and Cultural Diversity at King's College London) and Allan D. Peterkin (who founded ARS MEDICA: A Journal of Medicine, The Arts and Humanities), this handbook is intended to provide guidance on medical humanities teaching in the field of mental health.  After a short, familiar introduction to the need for such teaching, Tischler offers concrete guidance on how to begin establishing a medical humanities course.  The subsequent chapters deal with topics, perspectives, and forms of art one might include in such a course.  There is a "brief history of psychiatry through the arts" by Allen Beveridge which is, as we are warned in the title, somewhat cursory, but also well-written and thought-provoking.

Following this are chapters on the use of cinema, poetry, literature, creative writing, drama and theatre, and music in medical humanities teaching for mental health, interspersed with essays on Hans Prinzorn, who collected paintings and pictures by the mentally ill; art psychotherapy; community arts (where, as the authors point out, there is no "interpretative component" but rather a focus on participatory creativity); and the blues.  The authors include psychiatrists, artists, mental health nurses, and counselors/therapists, and the book includes a lovely selection of color plates.

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One Breath

Clark-Sayles, Catharine

Last Updated: Sep-03-2010
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

This suggestively titled collection of poems provides a lyric record of a physician’s way of seeing.  The situations to which the poems bear witness are not only medical, though many are.  Some are cityscapes into which are woven surprisingly astute observations of homeless people or hitchhikers or ducks in the park.  Some explore the geography of a body where memories are held in “neuron chains.”  Some articulate bits of personal history from the point of view of a woman who has spent years in medicine, caring for the elderly, seeing bodies with the double vision of a clinician and a person whose spirituality clearly informs all she sees.

Titles like “ER Alphabet of Hurt” or “Looking for God On the Radio” or “Hippocrates Voyeur” or simply “Scars” may give some sense of the range of focus.  Her vision and voice are strongly local; those who know Marin County, north of San Francisco, will recognize the places that become the poet’s personal geography.  Those who don’t will still see in these poems a sensibility shaped and refined by the knowledge that comes from deep habitation.  

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The Parabolist

Ruddock, Nicholas

Last Updated: Sep-01-2010
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Jasper Glass and his brother Jonathan are medical students in Toronto, circa 1975. Their father is a repressed, language professor endlessly writing a never-to-be published book on French idioms.  Jasper is having an affair with a married classmate, and he lusts after his dissection partner, Valerie. But Valerie isn’t interested.

In its wisdom, the medical faculty has decided that electives in the humanities must be taken to broaden the educational experience. Jasper and his friends opt for literature. When the graduate student assigned to the teaching task dissolves in angst over how to communicate with savage medical students, the young, Mexican poet, Roberto Moreno, becomes their instructor. The students love Roberto, and through him they learn to love poetry too. Valerie especially loves Roberto. Jasper learns to deal with it.

Over the course of the year, the friends have many adventures. Jasper rescues a young woman from assault, and she, in turn, defends him from a wrongful accusation. Jonathan loses his way and fails miserably. They meet a sinister psychiatry resident who abuses his position with patients, colleagues, and students. Only slowly do they realize the full potential of his dangerous mind. They deal with that too. 

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The Gross Clinic

Eakins, Thomas

Last Updated: Jul-22-2010
Annotated by:
Shafer, Audrey

Primary Category: Visual Arts / Painting/Drawing

Genre: Oil on canvas

Summary:

Professor Samuel D. Gross of Jefferson Medical College is demonstrating an operation for osteomyelitis of the femur in the surgical amphitheater in 1875 in this highly dramatic, powerful scene. Light glints off his forehead, and his visage is stern, calm, and surrounded by a halo of gray-white hair. The bloody fingers of his right hand hold a blood-tipped scalpel. He appears to have just made an incision and is turning away to demonstrate his work.

To the surgeon’s left is the patient, lying in right lateral decubitus position, with exposed leg and buttocks. Assistants are retracting the wound, further dissecting within it, and holding the patient’s legs. Blood is on their hands, instruments, and the patient’s leg. The patient’s face is obscured by the chloroform soaked towel that the anesthetist is using to administer general anesthesia. The white of this towel and the operating table’s sheet are the only other bright white values besides the surgeon’s head in this mostly dark painting.

Adding to the drama is the stricken pose of the patient’s female relative--to the surgeon’s right. For charity cases, a family member was required to be present during the surgery. She averts her head and raises her hands, clenched in a claw-like fashion, to block her view.

In the gallery are variously interested and disinterested observers--mostly medical students--in casual poses and dimly seen. The exception is the artist’s self-portrayal--he is studiously drawing in the front row. Dr. Gross’s son (also a surgeon) is standing in the entry tunnel.

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Summary:

This guide identifies short film clips designed to support “Cinemeducation,” word and method both coined by the editor Matthew Alexander. The editorial team consists of three family therapists--two psychologists and a social worker—with input from 26 other psychologists, behavioral scientists, and family physicians—all American, with the exception of one Brazilian. Most contributors train residents in family medicine. Both more and less than a scholarly treatise, this book is predominantly an annotated index.

Thirty short chapters are devoted to various subject themes: chronic illness, sexual behavior, aging, substance abuse, research, and medical error. In a paragraph or two, the clinical problem is outlined, then subheadings introduce specific, related keywords exemplified by the scenes selected. The plot and main actors of every film are summarized briefly at its first mention; a single movie can be cited in several different chapters. Each clip is similarly described and located precisely within the film (minutes and seconds).

In this manner, 125 films are parsed for 400 scenes, ranging in length from 1 to 6 minutes.  Most are Hollywood films, released since 1980. Questions for discussion accompany each film clip. The consistency and concise descriptions are admirable, but, sadly, the year of release is not supplied. 

A few chapters break from this format. One discusses aspects of technology. Another attempts evaluation of this teaching method through a ten-year retrospective survey of physicians who had been exposed to films in residency. The response rate was 60% but a fifth were rejected because the respondents could not recall the use of films. The remaining 48% who could remember the use of film clips found the method memorable, fun, and effective; however, they thought it would benefit from more context and amplification.

Appendices point to similar resources and more films under other keywords without details. This database is cited by URL without any description.

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The Anatomy of Deception

Goldstone, Lawrence

Last Updated: Jul-09-2010
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In 1889, young doctor Ephraim Carroll is in Philadelphia working with the team of the famous physician and pathologist, William Osler. In their zeal to learn more, they conduct careful autopsies, but the body of a young woman upsets Osler and teammate Dr. George Turk, and they defer the examination. Baffled when her body vanishes, Carroll becomes preoccupied with identifying the woman and the cause of her death.

A darling of Philadelphia society, Osler arranges for Carroll to attend a dinner where Carroll meets and falls head over heels in love with the unconventional Abigail Benedict. Abigail is a painter and free thinker, friendly with the great artist Thomas Eakins. Both are worried about their missing friend, Rebecca Lachtmann, and they engage Carroll to help find her. Through a series of adventures he is able to locate and identify the missing corpse as hers. He discovers the cause of death by exhuming the body.

In the meantime, Turk is found dead of what appears to be cholera; however, Carroll’s suspicions lead him to conclude that the young doctor was murdered by a dose of arsenic cleverly calculated to mimic symptoms of the infection. Drug addiction and an abortion ring lie at the heart of this crime.

Osler is being courted for a position at the new Johns Hopkins Medical School and he invites Carroll to consider joining him there.  But Carroll decides not to go to Baltimore.

To write more would give too much away. The surprise ending implicates famous doctors for unethical behavior, if not murder.

 

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Annotated by:
Bertman, Sandra

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Holding Our Own: Embracing the End of Life is a documentary film that shows aging and dying as anything but morbid, and death as the final healing in the hospice way. Art and music are combined as a way to bring people into a subject that they'd rather resist.

The film begins with an art opening in New York City and with the commentaries of curator and others as they view Deidre Scherer's large fabric and thread paintings (see annotation of "Surrounded by Family and Friends")--of people at the last moments of their lives. The artist has captured for us, even in the midst of suffering, genuine moments of tenderness.

An interview with palliative care physician Ira Byock guides the conversation, presenting a most refreshing doctor's perspective. The commentaries of hospice personnel, artist, and members of the Hallowell singing group punctuate the profoundly intimate scenes, filmed in institutional settings and in homes. The singers, who sing to the dying patients, see beyond their own fears; they recognize and want to honor dying persons for who they are: "This is not about singing it right for an audience...its about being totally present for the people you're singing for...and wanting it to be a gift." They model the magic of human connection called by Byock "the ground substance of therapeutics" The healing is mutual: "I can feel sad, cry, I can feel a heavy heart...but it's not depressing....It's a wonder...you can feel love, joy, sorrow, but so alive.... you feel the blessing of your own life."

Two additional segments, "More about Deidre Scherer," and "More about the Hallowell Chorus, and a concise study guide are offered with the DVD.

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Annotated by:
Bertman, Sandra

Primary Category: Performing Arts / Film, TV, Video

Genre: Video

Summary:

This groundbreaking international film documents the positive impact of art and other creative activities on people with Alzheimer's disease. The film's intention is to change the way we look at the disease.  It does just that.  Brilliantly.

Narrated by the actress Olivia de Havilland, the film opens with a 96 year old woman reading classical music as she's playing at the piano. Her music becomes gentle background sound track for the first vignette, a group of people intently viewing and commenting on Seurat's canvas, "Sunday in the Park."  From their intense concentration and voiced observations, one would never believe this was a group of nursing facility residents on an outing to the Chicago Art Museum.

Throughout the film--at the circus, visiting museums, or in painting workshops conducted at day care centers, nursing homes and assisted-living facilities in Europe and the US-- the hopeless, fatalistic, nobody's there stereotypes of Alzheimer's sufferers is unequivocally denied.  We continually witness people with serious memory problems being brought back into active communication and a rich quality of life.  This is more than busywork arts and crafts: trained professionals knowledgeable about both art and Alzheimer's are providing essential treatment "just as effective if not more so than the drugs."  The benefits of the non-pharmacological along with the pharmacological not only extend life, but create a life worthwhile, where people find meaning and connection.
 
In direct interview, voice-overs and interacting with "patients" and their family members, eminent experts from multiple medical fields - neurology, gerontology, psychiatry- punctuate the film reviewing the latest technologies and concurring that the essence of the person lives on. The latest brain research provides evidence that the parts of the brain related to emotions and creativity are largely spared by the disease and that our technologies for assessing dementia --dealing with sequencing things, dates in order, and what one did this morning--rely on short term memory which is totally irrelevant when enjoying a masterpiece or listening to a symphony.  The documentary also includes comments from art therapists, occupational therapists, directors of specialized care facilities, but the film is anything but talking heads.  The cutaways and extensive footage of the care giving staff and specialists interacting emotionally and physically, visibly bonding with the residents and family members is sincere, loving and inspiring professionalism.

The inspiration for the film and project is filmmaker Berna Huebner's mother, Hilda Gorenstein, once an accomplished painter known as Hilgos.  In one of Huebner's visits to the nursing home, she asks "Mom, would you like to paint again?"  Quite unexpected came the reply, "Yes, I remember better when I paint."  Learning this, the staff psychiatrist who had been prescribing small doses of a tranquilizer for her apathy, anxiety and agitation suggested Huebner enlist art students from the Chicago Museum school to help her mother to begin painting again.  We are not spared the slow and sometimes discouraging process as Mrs. Gorenstein comes alive regaining mobility and communication skills and interacting--bonding-- with the art students.  The film is replete with her colorful paintings created in the next few years until her death at age 93.

"The creative arts are a doorway.  Once that doorway is opened ... things are tapped ... that are genuine and active and alive that don't get tapped in our normal day social interactions when we sit at a table and make conversations over a meal or we read a newspaper article and then talk about the headlines of the day.... The creative arts bypass the [cognitive] limitations and simply go to the strengths. People still have imagination in tact all the way to the end of their disease."

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