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Biomedical subjects

Delese Wear

Publications and source records attributed to Delese Wear.

16 recordsLinked to original sources
PubMed2005

The limits of narrative: medical student resistance to confronting inequality and oppression in literature and beyond.

INTRODUCTION: Upon designing and implementing a literature course on family values for Year 4 medical students, we found that while the supposed benefits of literary inquiry were to lead students to a deeper understanding of difficult issues such as illness and violence in the family, many of our students were unable to engage critically with the course material. This, we believe, was a result of their resistance to confronting issues such as inequality and oppression. This paper is an attempt to theorise student resistance to difficult, unruly subjects they encounter in a literature class, particularly those surrounding race, gender, social class and sexual identity. METHODS: We modify some of the expansive claims made by narrative medicine and put forth a new pedagogical and curricular approach to the uses of literature in medical education. RESULTS: We found that many students resisted course material and corresponding discussions, especially those related to sexual identity and non-traditional family values, male-female relationships and white racism. DISCUSSION: To reduce student resistance, we pose a more critical approach to narrative inquiry in medical settings that may deepen students' willingness to imagine what it is like to be someone who is suffering, and to work against oppressive social structures that sustain such suffering. Thus, we recommend moving narrative inquiry beyond a focus on the self and the patient in that individualised, circumscribed relationship and into a collective process involving the social, political, cultural and economic conditions that affect health and well-being.

Curriculum↗
PubMed2005

Pimping: perspectives of 4th year medical students.

BACKGROUND: A well-known phenomenon among U.S. medical students known as pimping, or the pedagogical device of questioning students in the clinical setting, receives virtually no attention in medical literature. PURPOSE: Identifying 4th-year medical students' relevant knowledge and attitudes about pimping may help educators understand the range of beliefs about pimping and the role it plays in the socialization process into the medical community. METHODS: Over a 2-month period, 11 fourth-year medical students at a Midwest medical school were asked 6 open-ended questions focusing on pimping as understood and experienced in the clinical setting. Investigators individually analyzed the interview data using qualitative methods to characterize students' experiences and recurring ideas and concepts. RESULTS: All students noted the hierarchical nature of pimping, viewing it as a tool for attendings or residents to assess students' levels of knowledge. Although some students experienced malignant pimping, humiliated by incessant questioning or questions inappropriate to their level of training, all the students in the sample were positive about pimping and its effectiveness as a pedagogical tool. Investigators found that location within the clinical setting determines how students define and understand the motives for pimping. CONCLUSIONS: Understanding how students define and experience the pimping phenomenon prepares medical educators to scrutinize pimping as a pedagogical tool and to provide the most effective and encouraging environment for students.

Clinical Clerkship↗
PubMed2004

Attitudes of female nurses and female residents toward each other: a qualitative study in one U.S. teaching hospital.

PURPOSE: To describe the attitudes of female nurses and female resident physicians toward each other in surgery, internal medicine, obstetrics-gynecology, and emergency medicine in one Midwest teaching hospital in the United States. METHOD: Using a qualitative methodology, 51 women were interviewed in 2002: 28 nurses and 23 residents. Questions were asked to determine if and how female nurses and female residents believed gender was a factor in their interprofessional relationships, how each described their relationship with the other, the kind of assistance female nurses provide to female residents, the kind of assistance sought by female residents, and the strengths and challenges of the female nurse-female resident relationship. Data were analyzed using NUD*IST software. RESULTS: Consistent with similar studies conducted in Norway and Australia, the results include the following: For female nurses, occupation is secondary to gender, which is to say that gender is the most important link between female nurses and female residents. For female residents, gender is secondary to occupation/occupational status. CONCLUSIONS: With the number of female residents increasing each year in hospitals, this relationship should be further examined so that dysfunctional communication patterns between the two groups can be challenged.

Attitude of Health Personnel↗
PubMed2004

The professionalism movement: can we pause?

The topic of developing professionalism dominated the content of many academic medicine publications and conference agendas during the past decade. Calls to address the development of professionalism among medical students and residents have come from professional societies, accrediting agencies, and a host of educators in the biomedical sciences. The language of the professionalism movement is now a given among those in academic medicine. We raise serious concerns about the professionalism discourse and how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label of "professionalism." In particular, we argue that the professionalism discourse needs to pay more attention to the academic environment in which students are educated, that it should articulate specific positive behaviors, that the theory of professionalism must be constructed from a dialogue with those we are educating, and that this theoretical and practical discourse must aim at a deeper understanding of social justice and the role of medicine within a just society.

Curriculum↗
PubMed2004

Medical students' experience of academic review and promotions committees.

BACKGROUND: Like all medical schools, Northeastern Ohio Universities College of Medicine (NEOUCOM) has an elaborate committee system for academic review and promotions (ARP). Little research exists locally or nationally on this system. PURPOSE: E-mail invitations to all 420 NEOUCOM currently enrolled students were sent seeking their participation in a qualitative study that involved interviewing students who had appeared before an ARP committee at any time for any reason to understand how they experienced the process. METHOD: NUD*IST software was used to analyze the data generated by the interviews. RESULTS: The invitation drew 19 volunteers from the pool of 84 students who, at the time of the messages, had appeared before an ARP committee at least once. Themes were discovered surrounding students' perceptions of the committee's purpose, their experience of it, their beliefs about students' honesty when appearing before the committee, how they felt about themselves after a committee appearance, and how they would improve the process of academic review.

Adult↗
PubMed2003

Insurgent multiculturalism: rethinking how and why we teach culture in medical education.

The author proposes a theoretical orientation for cultural competency that reorganizes common curricular responses to the study of culture in medical education. What has come to be known in medical education as cultural competency is theoretically truncated and may actually work against what educators hope to achieve. Using Giroux's concept of insurgent multiculturalism, she suggests that the critical study of culture might be a bridge to certain aspects of professional development. Insurgent multiculturalism moves inquiry away from a focus on nondominant groups to a study of how unequal distributions of power allow some groups but not others to acquire and keep resources, including the rituals, policies, attitudes, and protocols of medical institutions. This approach includes not only the doctor-patient relationship but also the social causes of inequalities and dominance. Linked to professional development efforts, insurgent multiculturalism can provide students with more opportunities to look at their biases, challenge their assumptions, know people beyond labels, confront the effects of power and privilege, and develop a far greater capacity for compassion and respect.

Attitude of Health Personnel↗
PubMed2003

The Medical Humanities at the Northeastern Ohio Universities College of Medicine: historical, theoretical, and curricular perspectives.

The Human Values in Medicine Program (HVM) at the Northeastern Ohio Universities College of Medicine is composed of 120 required hours in medical humanities, social sciences, and behavioral sciences. In addition to a required HVM month in the fourth year when the bulk of the course work is completed, students can also choose from lectures, seminars, and short courses during the first, second, and third years. The broad goal of the HVM program as originally conceived was for students to use the content and skills of the humanities disciplines to reflect on their own and others' values, and to appraise their role in the patient-physician relationship, both in the community and in the larger culture. During the past several years, a cultural studies orientation has also been included, particularly the practice of critical analysis aimed at identifying the inequities and injustices within the doctor-patient relationship, in medical training, and in health care access and delivery in the U.S. and beyond. Current program development includes standardizing a bioethics curriculum for all students and developing a required fourth-year course that all students take during their HVM elective month.

Bioethics↗
PubMed2003

Medical Students for Choice: origins, current orientations, and potential impact.

BACKGROUND: Medical Students for Choice is a U.S.-based organization concerned with the shortage of abortion providers, the lack of abortion education in medical schools, and violence against abortion providers. Created in 1993, MSFC has 110 chapters in North America with 7,000 student affiliates. DESCRIPTION: The rapid spread of MSFC chapters since its creation prompted the Northeastern Ohio Universities College of Medicine's chapter to undertake group interviews of 40 medical students affiliated with 7 MSFC chapters in 4 midwestern states in the United States. EVALUATION: Interview questions were developed to identify students' motivations for affiliation with MSFC, how abortion was currently addressed in the medical curriculum and where it should be, how students think abortion providers are perceived by the medical community, and how they plan to integrate their commitment to reproductive choice in their future practice. CONCLUSIONS: Not all students affiliated with MSFC will become abortion providers, but they are politically enthusiastic and committed to the inclusion of abortion in medical training and to legitimizing and normalizing its provision. More research tracking this group across time and geography will add much to understanding abortion services in the United States and what part the medical curriculum plays in educating students to provide comprehensive reproductive health services for women.

Abortion, Induced↗
PubMed2002

"Face-to-face with It": medical students' narratives about their end-of-life education.

Medical schools have been slow to include meaningful end-of-life (EOL) educational experiences in their curricula. As an area of inquiry and focused clinical experience, death is "conspicuous" by its absence, reflecting a medical culture that defines death as failure. The author asked fourth-year medical students at one institution to describe their experiences with dying patients and their families, the skills and attitudes they brought to these encounters, the support they received from attendings and residents while caring for dying patients, and suggestions for the medical curriculum that would help prepare them for care of the dying. Using a qualitative method, she analyzed ten students' written narratives, which dealt with experiences during their third-year clerkships, and compared these reflections with the literature on EOL care in medical education. The themes that emerged provided four organizers for this essay: (1) students' worry and uncertainty about EOL care, (2) guidance and role modeling in EOL care, (3) preparation for EOL care, and (4) conclusions and recommendations for the medical curriculum. In general, students did not feel well prepared or supported as they cared for their first dying patients, including, for example, delivering a terminal prognosis or obtaining a DNR. However, while they did wish for more support and role modeling from residents and attendings, they generally believed that care of the dying can be learned only through direct clinical experience. These beliefs call into question curricular issues of placement of EOL inquiry--most often in the preclinical curriculum--and the teaching of its content, currently overwhelmingly by lectures. The author concludes with recommendations for thoughtful, integrative, interdisciplinary curriculum changes in EOL education.

Anecdotes as Topic↗
PubMed2002

The House of God : another look.

Since its publication in 1978, Samuel Shem's The House of God has sold over two million copies in over 50 countries. While it has remained popular among medical students, its value as a literary text to promote critical reflection on self and profession continues to be unrecognized in professional spheres. In spite of the ongoing conditions in medical training that prompted Shem's satirical novel, The House of God continues to evoke negative responses from academic medicine and has even been dismissed as "dated." This article examines the novel, its reception by academic medicine, and the relevance of its satire through an analyses of articles, reviews, and letters, along with Shem's observations on the novel and its controversies. Finally, the future of The House of God is proposed.

Attitude of Health Personnel↗
PubMed2002

From pragmatism to politics: a qualitative study of abortion providers.

Twenty-eight years after the United State Supreme Court issued its landmark Roe v. Wade, the struggle continues to ensure that all women have the full range of reproductive choices, including abortion. While the struggle can be addressed through its political, religious, and medical dimensions, it also can be examined through the perspectives of those who actually provide abortions. This paper examines the perspectives of physician abortion providers to understand more fully their motivations, the quality of their personal and professional lives, their views on the future of abortion services, and their recommendations for undergraduate and residency medical education. Such questions are often best answered through qualitative inquiry, particularly when the subject at hand has had little interpretive scrutiny, lacks theoretical understandings, and remains in general an under-investigated phenomenon. Because abortion providers and the work they do fit those criteria, a qualitative study of physician providers in Ohio was undertaken. This paper is divided into the following sections: a literature review of abortion services in the United States, methods, interview data and discussion, and last, recommendations and conclusions.

Abortion, Legal↗
PubMed2002

Literary inquiry and professional development in medicine: against abstractions.

The professional development discourse currently circulating in academic medicine owes much to the work of the American Board of Internal Medicine (ABIM) and their Project Professionalism. They identify the elements of altruism, duty, excellence, honor and integrity, accountability, and respect for others as forming the basis of professional development. While an admirable effort, Project Professionalism remains primarily an abstract set of attitudes and behaviors with a number of vignettes that are of limited use to medical educators attempting to foster the development of professionalism in medical students. This paper outlines an approach to professional development grounded in medical narratives written by physicians, including memoirs, essays, and poetry, that may help students grapple with the challenges of medicine that involve those very elements put forth by ABIM. An argument is made that literature may be a superior medium for engagement with these elements because of its ability to evoke discomfort and vulnerability in ways the case report does not.

Altruism↗
PubMedDate not supplied

Instructional issues in the medical humanities.

This paper examines instructional issues such as how, when, and where the medical humanities are taught in medical school settings. The author interviewed seven humanities scholars teaching in medical schools using open-ended questions which elicited data illustrating 1) informants' teaching styles; 2) where/how their teaching currently fits in the medical curriculum; 3) their suggestions on ideal curricular integration of the medical humanities; and 4) informants' teaching successes.

Education, Medical↗