Clinical realism: a new literary genre and a potential tool for encouraging empathy in medical students

Background: Empathy has been re-discovered as a desirable quality in doctors. A number of approaches using the medical humanities have been advocated to teach empathy to medical students. This paper describes a new approach using the medium of creative writing and a new narrative genre: clinical realism. Methods: Third year students were offered a four week long Student Selected Component (SSC) in Narrative Medicine and Creative Writing. The creative writing element included researching and creating a character with a life-changing physical disorder without making the disorder the focus of the writing. The age, gender, social circumstances and physical disorder of a character were randomly allocated to each student. The students wrote repeated assignments in the first person, writing as their character and including details of living with the disorder in all of their narratives. This article is based on the work produced by the 2013 cohort of students taking the course, and on their reflections on the process of creating their characters. Their output was analysed thematically using a constructivist approach to meaning making. Results: This preliminary analysis suggests that the students created convincing and detailed narratives which included rich information about living with a chronic disorder. Although the writing assignments were generic, they introduced a number of themes relating to illness, including stigma, personal identity and narrative wreckage. Some students reported that they found it difficult to relate to “their” character initially, but their empathy for the character increased as the SSC progressed. Conclusion: Clinical realism combined with repeated writing exercises about the same character is a potential tool for helping to develop empathy in medical students and merits further investigation

Cell morphology governs directional control in swimming bacteria

The ability to rapidly detect and track nutrient gradients is key to the ecological success of motile bacteria in aquatic systems. Consequently, bacteria have evolved a number of chemotactic strategies that consist of sequences of straight runs and reorientations. Theoretically, both phases are affected by fluid drag and Brownian motion, which are themselves governed by cell geometry. Here, we experimentally explore the effect of cell length on control of swimming direction. We subjected Escherichia coli to an antibiotic to obtain motile cells of different lengths, and characterized their swimming patterns in a homogeneous medium. As cells elongated, angles between runs became smaller, forcing a change from a run-and-tumble to a run-and-stop/reverse pattern. Our results show that changes in the motility pattern of microorganisms can be induced by simple morphological variation, and raise the possibility that changes in swimming pattern may be triggered by both morphological plasticity and selection on morphology

Variability and Action Mechanism of a Family of Anticomplement Proteins in Ixodes ricinus

Background: Ticks are blood feeding arachnids that characteristically take a long blood meal. They must therefore counteract host defence mechanisms such as hemostasis, inflammation and the immune response. This is achieved by expressing batteries of salivary proteins coded by multigene families. Methodology/Principal Findings: We report the in-depth analysis of a tick multigene family and describe five new anticomplement proteins in ixodes ricinus. Compared to previously described Ixodes anticomplement proteins, these segregated into a new phylogenetic group or subfamily. These proteins have a novel action mechanism as they specifically bind to properdin, leading to the inhibition of C3 convertase and the alternative complement pathway. An excess of non-synonymous over synonymous changes indicated that coding sequences had undergone diversifying selection. Diversification was not associated with structural, biochemical o, functional diversity, adaptation to host species or stage specificity but rather to differences in antigenicity. Conclusion/Significance: Anticomplement proteins from I. ricinus are the first inhibitors that specifically target a positive regulator of complement, properdin. They may provide new tools for the investigation of role of properdin in physiological and pathophysiological mechanisms. They may also be useful in disorders affecting the alternative complement pathway, Looking for and detecting the different selection pressures involved will help in understanding the evolution of multigene families and hematophagy in arthropods. © 2008 Couveur et al.Journal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Just a spoonful of humanities makes the medicine go down: introducing literature into a family medicine clerkship

This project introduced medicine-related poetry and prose to a Year 3 family medicine clerkship with the purpose of determining students' perception of the usefulness of such materials to enhance empathy, improve patient management, and reduce stress. Although humanities are represented in the curricula of many medical schools, we need more information on how best to incorporate them during the clinical years.In 2000, we used a needs assessment survey to identify learner perceptions of medical humanities. Using this information, in 2001-03 we developed and implemented a humanities-based curriculum consisting of readings linked to clinical vignettes, comments about humanities reading in required clinical Subjective, Objective, Assessment, Plan (SOAP) notes, and either station-specific or general poetry accompanying student end-of-clerkship objective structured clinical examinations. We collected both quantitative and qualitative data assessing student reactions and examined the data using non-parametric statistics and content analysis, respectively.Students showed moderate interest in incorporating humanities in medical education as a way of enhancing empathy, improving understanding and reducing frustration. Assessment of the clerkship humanities curriculum suggested a positive influence on students in terms of empathy for the patient's perspective, and a lesser, but still positive, impact on patient management.Responses from this group of learners suggest that there is receptivity toward introducing medical humanities into family medicine curricular venues and that such effort can have a generally positive effect on learner empathy, awareness and understanding toward patients and doctors

Expert and Trainee Determinations of Rhetorical Relevance in Referral and Consultation Letters

BACKGROUND: Referral and consultation letters ferry patients among providers, negotiating co-operative care. Our study examined how relevance is signalled and decoded in these letters, from the perspective of both experts and trainees in three clinical specialties. METHODS: 104 letters were collected from 16 physicians representing family medicine, psychiatry and surgery. Interviews were conducted with 14 of these physicians and 13 residents from the three specialties. All documents and transcripts were analysed for emergent themes. RESULTS: Six rhetorical factors influenced expert physicians\u27 decisions about what material is relevant: educational, professional, audience, system-institutional, medical-legal, and evaluative. Each specialty placed different emphasis on these factors. Trainees reported having no instruction regarding how to construct rhetorically relevant letters, and they demonstrated awareness of only three of the factors identified by experts--professional, audience and evaluative. Experts and trainees differed in their understanding and application of these three factors. CONCLUSIONS: This research demonstrates that six rhetorical factors influence relevance decisions in letter writing, and that experts address these factors in tacit, dynamic and discipline-specific ways. Trainees share with experts an appreciation of the rhetorical functions of referral and consultation letters, but lack a comprehensive understanding of the influential factors and do not receive instruction in them. These findings provide a framework for instruction in this domain to equip novices to meet the expectations of their professional audiences successfully