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      Palliative care and the arts: vehicles to introduce medical students to patient-centred decision-making and the art of caring

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          Abstract

          Background

          Medical Schools are challenged to improve palliative care education and to find ways to introduce and nurture attitudes and behaviours such as empathy, patient-centred care and wholistic care. This paper describes the curriculum and evaluation results of a unique course centred on palliative care decision-making but aimed at introducing these other important competencies as well.

          Methods

          The 20 h-long optional course, presented in an art museum, combined different learning methods, including reflections on art, case studies, didactic sessions, personal experiences of faculty, reflective trigger videos and group discussions. A mixed methods approach was used to evaluate the course, including a) a post-course reflective exercise; b) a standardized evaluation form used by the University for all courses; and c) a focus group.

          Results

          Twenty students (2nd to 6th years) participated. The course was rated highly by the students. Their understanding of palliative care changed and misconceptions were dispelled. They came to appreciate the multifaceted nature of decision-making in the palliative care setting and the need to individualize care plans. Moreover, the course resulted in a re-conceptualization of relationships with patients and families, as well as their role as future physicians.

          Conclusions

          Palliative care decision-making therefore, augmented by the visual arts, can serve as a vehicle to address several competencies, including the introduction of competencies related to being patient-centred and empathic.

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          Most cited references25

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          Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge.

          Despite nursing's enthusiastic endorsement of the applicability of qualitative research approaches to answering relevant clinical questions, many nurse researchers have been hesitant to depart from traditional qualitative research methods. While various derivations of phenomenology, grounded theory, and ethnography have been popularized within qualitative nursing research, the methodological principles upon which these approaches are based reflect the foundations and objectives of disciplines whose aims are sometimes quite distinct from nursing's domain of inquiry. Thus, as many nurse researchers have discovered, nursing's unique knowledge mandate may not always be well served by strict adherence to traditional methods as the "gold standard" for qualitative nursing research. The authors present the point of view that a non-categorical description, drawing on principles grounded in nursing's epistemological mandate, may be an appropriate methodological alternative for credible research toward the development of nursing science. They propose a coherent set of strategies for conceptual orientation, sampling, data construction, analysis, and reporting by which nurses can use an interpretive descriptive approach to develop knowledge about human health and illness experience phenomena without sacrificing the theoretical or methodological integrity that the traditional qualitative approaches provide.
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            Formal art observation training improves medical students' visual diagnostic skills.

            Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation. To improve students' visual acumen through structured observation of artworks, understanding of fine arts concepts and applying these skills to patient care. Prospective, partially randomized pre- vs. post-course evaluation using mixed-methods data analysis. Twenty-four pre-clinical student participants were compared to 34 classmates at a similar stage of training. Training the Eye: Improving the Art of Physical Diagnosis consists of eight paired sessions of art observation exercises with didactics that integrate fine arts concepts with physical diagnosis topics and an elective life drawing session. The frequency of accurate observations on a 1-h visual skills examination was used to evaluate pre- vs. post-course descriptions of patient photographs and art imagery. Content analysis was used to identify thematic categories. All assessments were blinded to study group and pre- vs. post-course evaluation. Following the course, class participants increased their total mean number of observations compared to controls (5.41 +/- 0.63 vs. 0.36 +/- 0.53, p < 0.0001) and had increased sophistication in their descriptions of artistic and clinical imagery. A 'dose-response' was found for those who attended eight or more sessions, compared to participants who attended seven or fewer sessions (6.31 + 0.81 and 2.76 + 1.2, respectively, p = 0.03). This interdisciplinary course improved participants' capacity to make accurate observations of art and physical findings.
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              Humanities in undergraduate medical education: a literature review.

              Humanities form an integral part of undergraduate medical curricula at numerous medical schools all over the world, and medical journals publish a considerable quantity of articles in this field. The aim of this study was to determine the extent to which the literature on humanities in undergraduate medical education seeks to provide evidence of a long-term impact of this integration of humanities in undergraduate medical education. Medline was searched for publications concerning the humanities in undergraduate medical education appearing from January 2000 to December 2008. All articles were manually sorted by the authors. Two hundred forty-five articles were included in the study. Following a qualitative analysis, the references included were categorized as "pleading the case," "course descriptions and evaluations," "seeking evidence of long-term impact," or "holding the horses." Two hundred twenty-four articles out of 245 either praised the (potential) effects of humanities on medical education or described existing or planned courses without offering substantial evidence of any long-term impact of these curricular activities on medical proficiency. Only 9 articles provided evidence of attempts to document long-term impacts using diverse test tools, and 10 articles presented relatively reserved attitudes toward humanities in undergraduate medical education. Evidence on the positive long-term impacts of integrating humanities into undergraduate medical education is sparse. This may pose a threat to the continued development of humanities-related activities in undergraduate medical education in the context of current demands for evidence to demonstrate educational effectiveness.
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                Author and article information

                Contributors
                ccenteno@unav.es
                carole.robinson@ubc.ca
                anoguera@unav.es
                marantz@unav.es
                fecharri@unav.es
                jpereira@cfpc.ca
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                16 December 2017
                16 December 2017
                2017
                : 17
                : 257
                Affiliations
                [1 ]ISNI 0000000419370271, GRID grid.5924.a, Faculty of Medicine, , University of Navarra, ; Pamplona, Navarra Spain
                [2 ]ISNI 0000000419370271, GRID grid.5924.a, ATLANTES Research Programme, Institute for Culture and Society, , University of Navarra, ; Edificio Bibliotecas, Campus Universitario, 31009 Pamplona, Spain
                [3 ]IdiSNA, Pamplona, Spain
                [4 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, Faculty of Health and Social Development, School of Nursing, , University of British Columbia, ; Okanagan, Vancouver, Canada
                [5 ]ISNI 0000000419370271, GRID grid.5924.a, Area Educational, , University of Navarra Museum, ; Pamplona, Navarra Spain
                [6 ]ISNI 0000 0001 2182 2255, GRID grid.28046.38, Department of Family Medicine, , University of Ottawa, ; Hamilton, Canada
                [7 ]ISNI 0000 0004 1936 8227, GRID grid.25073.33, Division of Palliative Medicine, Department of Family Medicine, , McMaster University, ; Ottawa, Canada
                Author information
                http://orcid.org/0000-0003-3738-1196
                Article
                1098
                10.1186/s12909-017-1098-6
                5732457
                29246258
                7370bf40-ac3a-499f-bf22-95bb7023c60b
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 November 2016
                : 6 December 2017
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Education
                medical education,palliative care,arts
                Education
                medical education, palliative care, arts

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