Unalterable Testimony: Aesthetic Experience in Poetry and Medical Practice

The interplay of art and medicine is centuries long. In contemporary medical education, “arts and humanities” relevant to medical practice are often instrumentalized and justified in curriculum to “improve” training, increasing empathy, for example. The aesthetic pleasure of engaging with art is less considered. In this essay, as a family physician, I reflect on my aesthetic experience of poetry as a gateway to consider the possibility of aesthetic experience in clinical practice. As I tarry with language in a poem, new horizons of understanding are extended. In a similar way, in clinical practice, when I allow my senses to experience a patient aesthetically, be it by seeing, smelling, touching, I can enter a new appreciation of their personhood. Using a combination of poetry and visual art, I draw on an example of an older man, unstably housed, to elucidate how experiencing arts and humanities in medical practice can answer what Gadamer called the first task of medicine, that is to restore a person to their original state

Physicians’ Experiences of Touch, a Hermeneutic Reflection

Touch is central to clinical practice but can be a “touchy subject” in medical education, simultaneously associated with care, and risk. In the clinical literature, touch is typically categorised as communicative or procedural, with an emphasis on touch as behavioural. Philosophically, touch is also a subject of consideration, yet this literature remains relatively unfamiliar to clinicians. In this essay, I reflect on touch in healthcare and medical education, as explored in my PhD studies, drawing on the work of hermeneutic philosophers, particularly Merleau-Ponty. Interpreting touch, I propose, is inherently hermeneutic, offering many possibilities to deepen our understanding of human interaction and clinical practice. Touch embodies the clinician-patient relationship as a holistic encounter. In high intensity interactions, touch orientates expression of empathy “beyond words". I present the significance of hermeneutics for clinical education, to richly re-imagine, and challenge, the concept of patient-centredness

TRANSITIONING TO A LOW-CARBON IRISH ECONOMY: AN ANALYSIS OF REGIONAL LABOUR IMPACTS. RESEARCH SERIES NUMBER 100 December 2019

Ireland has legally binding emissions reduction targets for 2020 and 2030. To achieve these targets and to become a low-carbon economy, the government uses carbon taxation as one of the primary policy tools. In addition, ceasing of peat and coal, which are the most polluting energy commodities from electricity production, is planned. However, given the concentration of specific production sectors in specific regions, there is a concern that the labour impacts for certain regions/counties will be high, compared to others. This report explores the projected county-level variation in labour demand impacts for 2030, following an increase in the carbon tax and removal of coal and peat in electricity production. More specifically, the electricity production sector will gradually phase out coal and peat from the production process, their usages will be terminated in 2026 and 2029, respectively, and the carbon tax will increase C6 annually starting from 2020 and reach C80 in 2029 per tonne CO2-eq. We combine the labour demand output from the Ireland Environment, Energy and Economy (I3E) computable general equilibrium (CGE) model, with regional employment statistics to highlight sectoral and county-level variation. Firstly, we assess the sectoral labour demand impacts, and these sectoral results are then “shared out” to evaluate labour demand impacts for each county

'Is there Anything Else You'd Like to Say About Community Relations?' Thematic Time Series Analysis of Open-ended Questions From an Annual Survey of 16-Year Olds

Since 2003, respondents to the annual Young Life and Times (YLT) survey have been offered an opportunity to give their thoughts on community relations in Northern Ireland. To date, approximately 4,000 comments have been received. This paper reports on a systematic approach to a content analysis of this question. Our methodological aim is to demonstrate the analytic processes involved in creating a coding scheme and to show how a structured content analysis of these responses can complement the published quantitative survey findings, and, in turn, provide a more nuanced understanding of young people's views on community relations in Northern Ireland over time. By doing so, we feel we also afford a sense of agency to respondents by integrating their opinions and emotions, which ranged from hope to despair, expressed outside the pre-determined survey content, as important data. Our approach shows that a meaningful combination of interpretive and deductive methods can demonstrate the added value that open-ended questions can have for a standardised survey instrument

A scoping review of the potential for chart stimulated recall as a clinical research method.

Background: Chart-stimulated recall (CSR) is a case-based interviewing technique, which is used in the assessment of clinical decision-making in medical education and professional certification. Increasingly, clinical decision-making is a concern for clinical research in primary care. In this study, we review the prior application and utility of CSR as a technique for research interviews in primary care. Methods: Following Arksey & O'Malley's method for scoping reviews, we searched seven databases, grey literature, reference lists, and contacted experts in the field. We excluded studies on medical education or competence assessment. Retrieved citations were screened by one reviewer and full texts were ordered for all potentially relevant abstracts. Two researchers independently reviewed full texts and performed data extraction and quality appraisal if inclusion criteria were met. Data were collated and summarised using a published framework on the reporting of qualitative interview techniques, which was chosen a priori. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines informed the review report. Results: From an initial list of 789 citations, eight studies using CSR in research interviews were included in the review: six from North America, one from the Netherlands, and one from Ireland. The most common purpose of included studies was to examine the influence of guidelines on physicians' decisions. The number of interviewees ranged from seven to twenty nine, while the number of charts discussed per interview ranged from one to twelve. CSR gave insights into physicians' reasoning for actions taken or not taken; the unrecorded social and clinical influences on decisions; and discrepancies between physicians' real and perceived practice. Ethical concerns and the training and influence of the researcher were poorly discussed in most of the studies. Potential pitfalls included the risk of recall, selection and observation biases. Conclusions: Despite the proven validity, reliability and acceptability of CSR in assessment interviews in medical education, its use in clinical research is limited. Application of CSR in qualitative research brings interview data closer to the reality of practice. Although further development of the approach is required, we recommend a role for CSR in research interviews on decision-making in clinical practice

« On se débrouille comme on peut » : la formation des résidents en médecine familiale en matière d’agression sexuelle et violence familiale

Background: Family physicians are uniquely able to provide comprehensive and longitudinal care to those experiencing sexual assault and domestic violence (SADV). To date, we know little about how Canadian family medicine (FM) residents learn about SADV. This study explored SADV teaching in residency from the perspectives of FM residents. Methods: This qualitative study took place in the Western University FM residency program. We conducted semi-structured interviews with first- and second-year FM residents (n=8). We analyzed data using thematic analysis. Results: We identified three inter-related themes: (1) Inconsistent training for SADV, (2) Attitudes towards SADV and (3) Learner hesitancy. Quality and quantity of SADV learning opportunities were inconsistent across learners, fuelling feelings of incompetence and lack of confidence around providing SADV care. This led to hesitant behaviours by learners when encountering SADV clinically. Conclusions: Understanding FM residents’ experiences and ideas regarding SADV education is critical in order to graduate physicians equipped to care for this vulnerable population. This research highlights the relationship among learners’ and teachers’ experiences, attitudes and behaviours; targeting this behavioural cycle may improve SADV learning.   Contexte : Les médecins de famille sont les seuls à pouvoir fournir des soins complets et longitudinaux aux personnes victimes d’agressions sexuelles et de violence familiale (ASVF). À ce jour, nous savons peu de choses sur la façon dont les résidents en médecine familiale (MF) au Canada se familiarisent avec l’ASVF. Cette étude explore la formation sur le sujet dans le cadre de la résidence du point de vue des résidents en médecine familiale. Méthodes : Cette étude qualitative s’est déroulée dans le cadre du programme de résidence en médecine familiale de l’Université Western. Nous avons mené des entretiens semi-structurés avec des résidents en première et deuxième année de médecine familiale (n=8). Les données ont fait l’objet d’une analyse thématique. Résultats : Nous avons relevé trois thèmes interdépendants : (1) Formation inégale en matière d’ASVF, (2) Attitudes envers l’ASVF et (3) Hésitation de la part des apprenants. La qualité et la quantité des occasions d’apprentissage sur le sujet de l’ASVF n’étaient pas uniformes chez les apprenants, alimentant des sentiments d’incompétence et de manque de confiance dans la prestation de soins liés à l’ASVF. En conséquence, les apprenants sont hésitants lorsqu’ils rencontrent des situations liées à l’ASVF en clinique. Conclusions : Il est essentiel de comprendre les expériences et les idées des résidents en médecine familiale concernant la formation sur le sujet de l’ASVF afin de former des médecins qui seront équipés pour prendre soin de la population vulnérable qui est victime de ce type de violence. Cette recherche met en évidence la relation entre les expériences, les attitudes et les comportements des apprenants et des enseignants. On peut améliorer l’apprentissage en matière d’ASVF en ciblant ce cycle comportemental.     

Physicians’ Experiences of Touch, a Hermeneutic Reflection

Touch is central to clinical practice but can be a “touchy subject” in medical education, simultaneously associated with care, and risk. In the clinical literature, touch is typically categorised as communicative or procedural, with an emphasis on touch as behavioural. Philosophically, touch is also a subject of consideration, yet this literature remains relatively unfamiliar to clinicians. In this essay, I reflect on touch in healthcare and medical education, as explored in my PhD studies, drawing on the work of hermeneutic philosophers, particularly Merleau-Ponty. Interpreting touch, I propose, is inherently hermeneutic, offering many possibilities to deepen our understanding of human interaction and clinical practice. Touch embodies the clinician-patient relationship as a holistic encounter. In high intensity interactions, touch orientates expression of empathy “beyond words". I present the significance of hermeneutics for clinical education, to richly re-imagine, and challenge, the concept of patient-centredness

Video documental sobre el análisis de prácticas culturales. Huertos urbanos en la ciudad de Quito

urbanos. Se hace un acercamiento a varias personas y a través de sus historias de vida entendemos la importancia y significación que tienen para ellas esta práctica ancestral. El huerto urbano ha sido generador de convivencia intercultural, creando un espacio colectivo para el intercambio de conocimientos, interacción simbólica, en la cual se recolecta información e ideas, además de la transmisión de saberes ancestrales en el tema de la agricultura, conexión con la tierra, un mejor estilo y calidad de vida. Los huertos son importantes también en las ciudades ya que inciden en la sana alimentación, economía y salud de quienes deciden adoptar esta práctica como una forma de vida; también les ayuda a combatir el estrés y a no depender de la producción alimentaria del campo.This research focuses on the analysis of cultural practices around urban gardens. An approach is made to several people and through their life stories they tell the importance and significance that this ancestral practice has for them. The urban garden has been a generator of intercultural coexistence, creating a collective space for the exchange of knowledge, symbolic interaction, in which information and ideas are collected, in addition to the transmission of ancestral knowledge on the subject of agriculture, connection with the land. and a better style and quality of life. Gardens are also important in cities as they affect the healthy diet, economy and health of those who decide to adopt this practice as a way of life; It also helps them to combat stress and not to depend on the food production of the field

Embodied reflexivity in qualitative analysis: a role for selfies

This article introduces a case study on the use of selfies as a means to support embodied reflexivity in phenomenological research. There is a recognized need to make reflexive practice in qualitative health research more transparent. There is also a move towards an embodied type of reflexivity whereby researchers pay attention to their physical reactions as part of the research process. Being reflexive is especially challenging when researchers work in teams rather than as individuals, and when researchers and participants do not meet because data collection and analysis are separate from one another. We used FINLAY's (2005) model of reflexive embodied empathy to explain how taking selfies allowed an international team of researchers to engage reflexively with a participant when their primary access to her lifeworld was an interview transcript. Key concepts from FOUCAULT's (1988) theory of technologies of self, critical self-awareness and self-stylization, shed light on this phenomenon