Why impaired wellness may be inevitable in medicine, and why that may not be a bad thing

Context: A wellness crisis exists among physicians and medical trainees. High rates of burnout, depression, stress and other states of impaired wellness have driven a sense of urgency to create solutions, and the medical education community has mobilised impressively. However, we argue—and data suggest—that this rush to find solutions has outpaced our efforts to more fully understand the nature of impaired wellness in medicine. This, we believe, has led to the implementation of solutions informed by limited understanding of the problems we intend to solve. Methods: In this paper, we explore three contributors to this situation: (i) shaky definitions and conceptualisations of wellness, (ii) the predominance of deductive, quantitative research informing our understanding and current solutions, and (iii) the reliance on a ‘disease-focused’ approach to addressing impaired wellness in physicians and trainees. We discuss how these contributors have led to the current state of the science of wellness in medicine: one characterised by an expanding array of solutions built upon narrow conceptualisations of wellness and how it can be impaired. Discussion: Moving beyond the current state of the science on wellness in medicine will require three critical developments: (i) consistent use of clear definitions of wellness; (ii) expanding our methodologies to include those utilising direct interaction with participants; and (iii) moving beyond solutions informed by a disease-model approach. We propose a different way of thinking about wellness: one based on what we view as an inherent—and potentially unavoidable—risk of experiencing impairment during a career in medicine. We argue that efforts to extinguish and eliminate all states of impaired wellness may also eliminate opportunities to develop constructive coping mechanisms and future resilience, and that wellness may best be conceptualised as healthy and authentic engagement with the inevitable adversity of a career in medicine

The potential of narrative analysis for HPE research: Highlighting five analytic lenses

Context Health professions education (HPE) has increasingly turned to qualitative methodology to address a number of the field's difficult research problems. While several different methodologies have been widely accepted and used in HPE research (e.g., Grounded Theory), others remain largely unknown. In this methodology paper, we discuss the value of narrative analysis (NA) as a set of analytic approaches that offer several lenses that can support HPE scholars' research. Methods After briefly discussing the 'narrative turn' in research, we highlight five NA lenses: holistic, situated, linguistic, agentive and sequential. We explore what each lens can offer HPE scholars-highlighting certain aspects of the data-and how each lens is limited-obscuring other aspects. To support these observations, we offer an example of each lens from contemporary HPE scholarship. The manuscript also describes methods that can be employed in NA research and offers two different typologies of NA methods that can be used to access these lenses. Conclusions We conclude with a discussion of how different analytic methods can be used to harness each of the lenses. We urge the deliberate selection and use of NA methods and point to the inherent partiality of any NA approach. Reflecting on our position as narrative scholars, we acknowledge how our own lenses illuminate some areas and conceal others as we tell the story of NA. In conclusion, we invite other researchers to benefit from the potential NA promises

Luova hulluus – Lauri Viidan runous

Miten käsittämätöntä kirjallisuus saa olla ennen kuin se lakkaa kokonaan kommunikoimasta lukijansa kanssa? Voiko se ylittää rajan, jossa se ei enää ole kaunokirjallisuutta tai jossa se ei oikeastaan ole enää kieltä lainkaan? Aikalaiset ovat pitäneet usein käsittämättömänä sellaista, mikä myöhemmille lukijoille on hyvinkin selvää. Tuskin nykylukija Lauri Viidankaan kielen parissa enää tuskailee, että ei saa kaikesta selvää. Viita sairasti skitsofreniaa, voisiko hänen kielikoukeroillaan ja skitsofrenialla olla siis jokin yhteys

Suvun musta lammas : Herman Hesekiel Holmströmin elämä

Herman Hesekiel Holmström (1883-1943, vuodesta 1906 Helosalo) oli lähtöisin rautatieläisperheestä. Perheen muut seitsemän lasta rakensivat itselleen vakaan porvarillisen elämänuran itsenäisessä Suomessa. Naimattomana eläneestä Hermanista tuli suvun musta lammas, jonka nimi ja elämänvaiheet haluttiin tyystin unohtaa. Edes valokuvaa ei ole säilynyt. Hermanin elämänvaiheista heijastuvat Suomen historian suuret käänteet. Suonenjokelaispojan koulunkäynti Kuopion lyseossa jäi kesken. Helsinkiin muutettuaan hän toimi muurarina ja suutarina, mutta tempautui samalla mukaan yhteiskunnalliseen toimintaan. Jo 23-vuotiaana hän oli Matti Kurikan sosialistisen reformipuolueen puoluesihteeri ja kiertävä vaalipuhuja valmistauduttaessa ensimmäisiin eduskuntavaaleihin. Sisällissodan loppuvaiheessa Herman tarkasteli punaisen Suomen elämää näköalapaikalta aseettomana kirjurina punakaartin päämajassa senaatin linnassa Helsingissä. Itsenäistyneessä Suomessa hän nousi esiin yllättävässä yhteydessä toimiessaan 1921 Suomen ulkoministeriön hiljaisella hyväksynnällä Itä-Karjalan pakolaisten delegaation sihteerinä. Delegaatio neuvotteli Aunuksen kaupungissa Suomeen tulleiden pakolaisten paluumahdollisuuksista Neuvostoliittoon. Hermanin elämänvaiheiden ja ajattelun selvittäminen on ollut sukututkimuksellinen haaste, jonka selvittelyyn on käytetty paitsi arkistoja myös vanhoja sanomalehtiä

The case for metacognitive reflection:a theory integrative review with implications for medical education

The concepts of metacognitive reflection, reflection, and metacognition are distinct but have undergone shifts in meaning as they migrated into medical education. Conceptual clarity is essential to the construction of the knowledge base of medical education and its educational interventions. We conducted a theoretical integrative review across diverse bodies of literature with the goal of understanding what metacognitive reflection is. We searched PubMed, Embase, CINAHL, PsychInfo, and Web of Science databases, including all peer-reviewed research articles and theoretical papers as well as book chapters that addressed the topic, with no limitations for date, language, or location. A total of 733 articles were identified and 87 were chosen after careful review and application of exclusion criteria. The work of conceptually and empirically delineating metacognitive reflection has begun. Contributions have been made to root metacognitive reflection in the concept of metacognition and moving beyond it to engage in cycles of reflection. Other work has underscored its affective component, transformational nature, and contextual factors. Despite this merging of threads to develop a richer conceptualization, a theory of how metacognitive reflection works is elusive. Debates address whether metacognition drives reflection or vice versa. It has also been suggested that learners evolve along on a continuum from thinking, to task-related reflection, to self-reflection, and finally to metacognitive reflection. Based on prior theory and research, as well as the findings of this review, we propose the following conceptualization: Metacognitive reflection involves heightened internal observation, awareness, monitoring, and regulation of our own knowledge, experiences, and emotions by questioning and examining cognition and emotional processes to continually refine and enhance our perspectives and decisions while thoughtfully accounting for context. We argue that metacognitive reflection brings a shift in perspective and can support valuable reconceptualization for lifelong learning.</p

The case for metacognitive reflection:a theory integrative review with implications for medical education

The concepts of metacognitive reflection, reflection, and metacognition are distinct but have undergone shifts in meaning as they migrated into medical education. Conceptual clarity is essential to the construction of the knowledge base of medical education and its educational interventions. We conducted a theoretical integrative review across diverse bodies of literature with the goal of understanding what metacognitive reflection is. We searched PubMed, Embase, CINAHL, PsychInfo, and Web of Science databases, including all peer-reviewed research articles and theoretical papers as well as book chapters that addressed the topic, with no limitations for date, language, or location. A total of 733 articles were identified and 87 were chosen after careful review and application of exclusion criteria. The work of conceptually and empirically delineating metacognitive reflection has begun. Contributions have been made to root metacognitive reflection in the concept of metacognition and moving beyond it to engage in cycles of reflection. Other work has underscored its affective component, transformational nature, and contextual factors. Despite this merging of threads to develop a richer conceptualization, a theory of how metacognitive reflection works is elusive. Debates address whether metacognition drives reflection or vice versa. It has also been suggested that learners evolve along on a continuum from thinking, to task-related reflection, to self-reflection, and finally to metacognitive reflection. Based on prior theory and research, as well as the findings of this review, we propose the following conceptualization: Metacognitive reflection involves heightened internal observation, awareness, monitoring, and regulation of our own knowledge, experiences, and emotions by questioning and examining cognition and emotional processes to continually refine and enhance our perspectives and decisions while thoughtfully accounting for context. We argue that metacognitive reflection brings a shift in perspective and can support valuable reconceptualization for lifelong learning.</p