“He told me my pain was in my head”: Testimonial injustice in patient-physician relationships

Women living with chronic pain are more likely than men to experience pain dismissal, receive nonspecific diagnostics, receive fewer follow-ups, have their condition undertreated, and be told that it results from a psychological condition. This is particularly concerning for adolescent girls living with scoliosis, who, given the progressive nature of their condition, require timely diagnosis to allow for less invasive treatment options to be explored. This population is also significantly more likely to have their condition progress to a curve angle where treatment such as bracing or spinal fusion surgery is required, both of which are associated with chronic pain. However, timely diagnosis depends on clinicians taking patients’ testimony regarding their health concerns seriously and investigating their claims. This presentation will dive into the gender gap in care for adolescent girls living with chronic pain caused by scoliosis, focusing on their experiences of pain dismissal and its negative short and long-term effects. Leveraging the concept of intersectionality, the authors argue that adolescent girls may suffer a testimonial injustice when their pain is dismissed by clinicians. This presentation will also explore gender-specific peer support groups as a possible mitigating factor to testimonial injustice and other negative outcomes from chronic pain and pain dismissal. The researchers interviewed members from scoliosis peer support group Curvy Girls using open-ended questions, gathering narrative data about their experiences that was subsequently analyzed using an applied philosophical hermeneutics approach, along with intersectionality and testimonial injustice as part of their framework

Why the hermeneutic wager

While progressing through my ongoing cancer treatments, in particular the reflection or re-reflections guided by Richard Kearney’s hermeneutic wager. I prefer a wager over the traditional cancer metaphors because it replaces the blatant harshness of a battle in a war. I am not saying in any way of form to be a passive observer during one’s cancer treatment journey, but to replace the winner-looser paradigm with carnage associated with war, shrapnel dismembered bodies unrecognizable to themselves and others. This does not mean that I am not standing up to and confronting cancer with vigor and intensity. The wager offers dignity during participation where all the “cards” are delt from both the cancer and the treatments with the integrity of the whole person who is living with cancer with their healthcare team and family play together as a community to successfully support the wager’s cause. The wager is respectful and addresses the risks involved and is fully c  onscientious of outcomes as an unpredictable event. This wager is comprised of five reflections and/or conversations to engage in that I have adapted to learn about living with cancer and its treatments. The hermeneutic wager has five points of reflection: imagination, humility, commitment, discernment, and hospitality. These will be used to provide examples of how to offer insight into one’s experiences. Through these kinds of reflections on cancer, uncertainty can help us develop wings for the journey into the unknown uncertainty that often a diagnosis of cancer requires

Facing our own dying: exploring conflicts between our individual professional stance and our own personal views on MAiD

Physician-administered euthanasia (Medical-Aid-in-Dying or MAiD) has been legally available in Canada since 2016, with ever-widening indications. Most palliative care physicians in Canada do not provide MAiD themselves but will refer to colleagues who provide this procedure. The author was involved in a qualitative research project on MAiD, looking at the views of Montreal-based palliative care physicians regarding their role. One interesting finding from that project is that our own individual personal views (i.e., what I would want for myself when I will inevitably face my own death) versus my professional views as a palliative care physician (i.e., the kind of end-of-life care that I am ready to provide, or what I think patients should receive) may radically differ. We teach our trainees (and the community beyond) that dying can have meaning up to the end of one’s natural life. Patients facing terminal illness commonly express a fear of becoming a burden to others. Yet we teach that this sentiment is often not well-founded, based on the expressed views of the patient’s loved ones. And yet dying can be difficult, even when patients receive the best available palliative care. Our professional view of what constitutes a dignified end-of-life and what patients and families (and I, eventually) will experience may be different. This presentation will spark reflection regarding this dichotomy. What feelings might this inner split provoke, when our professional and personal views conflict with each other?  Am I being a dishonest physician? And yet

“I get to know them as a whole person”: family physician stories of proximity to patients experiencing social inequity

Canadians’ health outcomes are inextricably tied to social inequities. While family medicine is aptly situated to provide care that addresses social factors through longitudinal knowledge of patients and their contexts, family physicians have come under increased pressure to do more for their patients with less time and resources due to financial and resource demands within primary care. Nursing scholar Ruth Malone has argued that remaining proximal, or close to patients, is a form of resistance to these demands. Using a critical narrative methodology, we conducted 36 interviews with 20 family physicians working with persons experiencing health needs related to social inequity in Ontario, Canada, whose stories expressed and expanded upon Malone’s proximity. Notions of proximity were invoked through descriptions of the role of family physicians in: i) generating physical proximity based on the patients’ needs for more time, space, and care; ii) developing narrative proximity through storytelling over time, both between colleagues and patient communities; and iii) engaging in moral proximity, or recognizing the vulnerabilities of their patients, by going “above and beyond” in their care and advocacy roles inspired by the needs of their patients. The findings add theoretical depth to proximity, extending this conceptualization into a new clinical context. These stories also complement current health services and health policy research that advocates for collaborative primary care approaches, as elements of these approaches are conducive to establishing proximity with patients who need care the most

Culturally-adapted resilience-building curriculum for medical students: a comprehensive approach at Showa University School of Medicine, Japan

The growing prevalence of psychological morbidity, depersonalization, and low personal accomplishment among medical students underscores the need for resilience-enhancing programs tailored to their specific needs. Incorporating cultural perspectives and societal context into these interventions is crucial to ensure their effectiveness and relevance. In response, Showa University School of Medicine in Japan has pioneered a culturally-adapted, resilience-based curriculum for medical students from their first through sixth years since 2020. This presentation will outline the comprehensive framework of the resilience-focused curriculum, including course objectives, content, learning resources, timetables, and pedagogical approaches. Key components of the curriculum encompass self-assessment and reflection, stress management strategies, effective communication and conflict resolution skills, and fostering a growth mindset. Additionally, interdisciplinary collaborations with psychology and social work departments provide individual supports and resources for students. Emphasizing the distinct challenges faced by medical students, such as academic stressors, relationships with senior clinical educators, patient and family interactions, and managing errors and burnout, the presentation will highlight the classes on the curriculum, support systems and mentorship programs in promoting mental well-being and resilience. The experiences and outcomes of the 2020-2022 cohorts will be shared, offering valuable insights into the effectiveness of the resilience-building curriculum in the Japanese context. Lessons learned from the implementation process, including challenges faced and strategies employed, will provide practical examples for other medical schools seeking to develop similar programs

‘The view from here’ - Anxiety and defences against anxiety in the provision of maternity care to one mother and baby

Being emotionally open in a maternity setting is a necessary part of the job of the midwife and consultant doctor. In fact it is recognised as a key aspect of relationship-based work.  However, it can be complex and uncertain, particularly in the face of a mother and baby who are separated through death at birth or serious illness at birth. This paper is interested in exploring the necessary conditions for relating and reflecting in maternity settings when babies are born with life threatening illnesses. With particular emphasis on one case example from personal experience this paper offers wisdom from the margins in the hope that it might contribute positively to thinking and learning about these experiences in frontline hospital settings.  It will focus on how the intensity of the work with one mother and baby and the strength of emotion associated with that work disrupted the nurses capacity to think. Drawing on the classic work of Isabel Menzies Lyth (1968) and lat  er Sebastian Kraemer (2015), the paper will consider the types of anxiety and defences present in the encounter and in the ongoing treatment of this mother and baby. The paper will explore how treatment and care was received by the mother and what might have enhanced that provision of car

Ethical challenges for children undergoing surgery: Evaluation of graduate nursing students' learning

Background Multiple barriers can impede the holistic care of children and their meaningful involvement in their healthcare in the context of surgery. These include lack of clinician knowledge of the ethical concerns impacting children and scarce educational resources. Our team created an open-access training module (https://childsxethics.net) to enhance clinicians’ understanding of ethical challenges for children undergoing surgery.  Objective To evaluate the level of Bloom’s Taxonomy cognitive, affective, and psychomotor learning reached by graduate nursing students after completing the module.  Methods A qualitative descriptive study was conducted. Data sources comprised of participants’ course assignments. Data were analysed inductively and deductively using Bloom’s Taxonomy and the Childhood Ethics Framework. Results Nineteen participants wrote online reflections and peer responses. Two subgroups completed group assignments. The module and associated class assignments successfully promoted high levels of cognitive and affective learning of ethical challenges impacting children undergoing surgery. The type of assignment influenced participants’ level of learning and achievement of learning objectives. Cognitive and affective learning processes were enhanced when integrating reflections and fostering dialogue/interaction among peer learners.  Implications Study findings will be used to improve the module. Future iterations will include collaborations with international clinicians to enhance the global relevance of the module contents, which will be evaluated with other clinicians/trainees. Providing educational resources for clinicians on ethical challenges in children’s surgery will help facilitate the recognition of children as active moral agents and improve their surgical experiences by promoting holistic patient care

Narrative medicine and narrative practice: partners in the creation of meaning

Background Narrative medicine has emerged as an approach to whole person care and to support the clinician-patient therapeutic relationship. Although training in narrative medicine is usually based on the study of literary or artistic works, the same attitude of close reading can also be applied in conversations with patients or learners.MethodWe held a two-day narrative medicine workshop, incorporating two approaches: 'Conversations Inviting Change' (CIC) and humanities-based narrative medicine as taught by Columbia University. The workshop was primarily experiential, with theoretical components of both approaches. Participants brought active concerns for confidential breakout sessions and engaged in text-based and reflective writing exercises. Participants generated metaphors to describe these approaches to narrative medicine.Results Participants included a mix of community and hospital-based practitioners, pre-dominantly doctors. Participants considered the two approaches to be compatible and enhance each other. One metaphor generated was that Columbia style narrative medicine is ’like an individual lens which allows you to see things clearer’, it allows practitioners a different perspective on their patients and that CIC teaching ‘is a frame of glasses in which the lenses could be placed to enhance the ease of use’. Another metaphor was that the former ‘is like learning from a cadaver in the anatomy lab’, while the latter ‘is like running a clinical simulation’.Conclusion We believe this was the first workshop integrating these approaches to narrative medicine. They appear to be highly complementary. Both approaches lead to enhanced attention to narratives which has clear applicability to clinical practice

Simulating a situation of homelessness: nursing students' perceptions of learning through virtual embodiment

Individuals experiencing homelessness encounter unique challenges in accessing and receiving care in our health systems[1,2,3,4]  Preparing emerging health professionals to respond to their complex health needs will require innovative educational approaches that promote person-centered care, and stimulate critical reflection and action towards the personal, interpersonal and structural factors that shape health care delivery.[5,6,7] This presentation reports on preliminary findings of phase 1 of a critical qualitative case study of nursing student’s perceptions of learning about the experience of homelessness, through a virtual reality educational experience.  The study design was informed by critical transformative learning theories and theories of embodiment.  Twenty nursing students were engaged in a virtual reality experience of 12 minutes, followed by a 1:1 debrief interview. The debrief interview used an adapted version of the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework to elicit students’ reflections on the experience. The interviews were audio recorded and transcribed verbatim. Data analysis involved a process of reading all of the transcripts for a sense of the whole, mindmapping each of the transcripts, identifying themes that permeated the data set, and coding data in Quirkos software. Six preliminary themes include: a) seeing the person through story, b) destabilizing assumptions and questioning stereotypes, c) embodied emotional awareness, d) challenges to care, e) recognizing vulnerability of people experiencing homelessness, and f) quality of the immersive experience in learning. The findings contribute to our knowledge about virtual reality simulation as an innovative approach to fostering learning about homelessness in health professions education. &nbsp