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The role of the humanities in the medical curriculum: A cross-sectional survey of UK medical students
Full text linkStudenta: Maya Pirie | Supervisor(s)b: Dr Frances Wedgwood
Abstract
Background: Current literature suggests that the humanities can serve as a valuable addition to medical curricula, with several papers suggesting how medical students want these activities to be implemented within their degree. However, most studies focus on single institutions or specific humanities programmes. This presented an opportunity to explore the student perspective using broader sample sizes. This study explores the opinions of UK medical students regarding the impact of the arts and humanities upon their professional and personal development, and how they wish for these practices to be implemented into their curricula.
Methods: An online questionnaire was constructed for data collection. A parallel, mixed-methods approach was adopted, utilising a mixture of close-ended Likert-type questions and open-ended free text responses. The resultant quantitative data underwent frequency and comparative analysis, with free text responses thematically analysed.
Results: Participants totalled 87 students from 14 UK universities. The majority reported access to the humanities through their degree, with 43 students having already participated in these activities. Those who had already participated displayed the most positive views, and those with access but no personal experience were found to be the least positive. Despite these variations, most students predicted benefits to participation. The majority of participants wished for greater inclusion of the humanities within medical curricula, however indicated that these should not be mandatory or assessed. Thematic analysis revealed 5 themes: ‘personal growth and clinical competence’; ‘divergent thinking’; ‘supporting emotional wellbeing’; ‘reinforcing clinical knowledge’ and ‘student choice’.
Conclusions: The results of this study indicate that many but not all UK medical students have access to creative and humanities based teaching in their curricula. They hold positive views of the medical humanities and identify multiple benefits from exposure to creative and humanities-based teaching, and want more opportunities to explore these. Further exploration using larger sample sizes across more institutions is recommended to understand more fully the benefits to UK medical students of humanities teaching. Incorporating students’ perspectives may also help to enhance curriculum planning and improve the delivery of arts and humanities activities within medicine.
Keywords: Medical education | Humanities | Student perspective | Professional development | Personal development
a Maya Pirie, 4th Year Medical Student, Kent and Medway Medical School, Canterbury, United Kingdom
b Dr Frances Wedgwood, Associate Clinical Lecturer, Kent and Medway Medical school, and Academic GP
Main contact email: [email protected]
Cherokee High School Literary Journal Spring 2024
No full textPoems, Stories, Essay, Art from students at Cherokee High School (North Carolina)
Intercultural barriers to communication in healthcare; is it the disparities in cultural background themselves, or internal biases and assumptions at the root of the problem?
Full text linkBackground: The National Health Service is one of the largest employers in the world and is currently employing the most diverse workforce in its history (Editor, 2023). This diversity reflects a broad spectrum of cultural backgrounds, values, beliefs, and most importantly, a range of languages and linguistic competencies. According to the Office for National Statistics, the 2021 census reported that in England and Wales, 1.5% (880,000) of usual residents aged three years and over could not speak English well, and 0.3%, (161,000) of the overall population could not speak English at all (Waddington, 2022). Intercultural communication within healthcare settings presents challenges when cultural disparities and personal biases conflict. This research aims to explore the root causes of intercultural communication barriers within the NHS. It seeks to determine whether these barriers stem mainly from cultural disparities, or whether internal biases and ingrained assumptions play a significant role too. Understanding the influence of cultural diversity on communication within healthcare settings is essential for developing more effective strategies and interventions to improve communication efficacy across different cultural contexts within the NHS.
Methods: This study began with a review of existing literature to identify prevalent misnomers and prejudices surrounding intercultural communication in healthcare. Subsequently, the author created fictionalised ethnographic accounts to re-enact real-world scenarios of communication barriers experienced in healthcare settings. Thematic analysis was used due to its ability to help identify common themes across ethnographic accounts. Three major themes emerge: age-related communication barriers, language as a barrier, and biases in disability culture. These themes underscore the complexities of intercultural communication, revealing how assumptions and biases hinder effective patient- provider interactions.
Results: Key findings from this study included 1. Assumptions and prejudices play a significant role in shaping communication dynamics, often leading to misinterpretations and misunderstandings; 2. Cultural sensitivity, awareness, and the ability to challenge one’s own biases are essential for improving communication and enhancing patient care, and 3. Effective communication in healthcare is not solely about overcoming language barriers or cultural differences but involves addressing deeper biases that pervade healthcare settings.
Conclusions: In conclusion, addressing intercultural barriers in healthcare requires a holistic approach that considers both cultural and internal factors. Healthcare providers should develop critical awareness to identify and challenge the biases that hinder effective communication. By actively engaging with the diverse perspectives and experiences of patients, healthcare systems can better meet the needs of all individuals, thereby enhancing the quality of care and patient outcomes. This research highlights the importance of an inclusive healthcare system where diversity is understood and respected, and where communication barriers are actively addressed to ensure equitable and effective patient care. The conclusions drawn from this study will act as a foundation for future research and practice, emphasising the continuous need for improvement in intercultural communication within healthcare settings
Supporting patients to maximise well-being after treatment for primary breast cancer in Kent and Medway: a service evaluation.
Full text linkBackground: Research shows there is a negative impact on mental well-being in primary breast cancer patients following treatment. Impact of cancer treatments on mental well-being is not fully understood and it is important to know what matters to these patients and how to support them. Services are provided by the NHS to support patients mentally and physically; which leads on to the following research question: How can services be improved to maximise mental well-being to support patients after treatment for primary breast cancer in Kent and Medway through a service evaluation?
Methods: Qualitative data was collected as an interview study was undertaken in a single NHS Trust to evaluate services. Ethical approval was obtained using the KMMS REAG checklist. Five individual interviews were conducted with 2 clinical staff members, 1 breast cancer charity trustee and 2 patient representatives to best understand how mental well-being has been negatively impacted and what can be done to improve this for future patients. Interviews were transcribed and thematically analysed.
Results: Three themes emerged from the interview data: resilience and strength, feeling safe and supported, and feeling well and healthy. These themes were shown to be involved in improving mental well- being in primary breast cancer patients. Furthermore, a toolkit was identified which is a package involving the basis of the thematic analysis. Key components of the toolkit included shorter waiting times for results, counselling sessions and physical activity guidance.
Conclusions: Mental well-being in future primary breast cancer patients can be maximised by using a toolkit as part of their care plan. This toolkit will equip them in better ways to cope as well as ensure they feel resilient and strong, safe and supported, and well and healthy. Further research collecting more data through interviews will allow the formation of a more robust toolkit
The risk factors of perinatal mental illness in forced migrant women: a systematic review.
Full text linkBackground: Perinatal mental illness is a common complication of pregnancy and the post-partum period, with anxiety and depression being the most common disorders. Despite efforts to improve identifying women at risk, forced migrant women are often missed out leading to a higher prevalence of perinatal mental illness in this vulnerable group. This qualitative systematic review aimed to comprehensively review the literature on the risk factors for perinatal mental illness in forced migrant women to further understand their increased vulnerability.
Methods: A comprehensive literature search was conducted on PubMed, CINAHL and PsycINFO (OVID), using keywords such as ‘perinatal’, ‘’antenatal’, ‘postnatal’, ‘migrant’, ‘refugee’, ‘asylum seeker’, ‘depression, ‘and ‘anxiety’ to identify studies published between 2013 and 2023. Following screening and critical appraisal, 21 papers were included in the systematic review. The papers selected then underwent thematic analysis.
Results: Five themes emerged which identified pertinent risk factors for perinatal mental illness in forced migrant women. These were a: lack of social support, trauma and adverse events, poor emotional wellbeing, socioeconomic inequalities, and barriers to healthcare access. Forced migrant women were experiencing social isolation, stigma, marginalisation, and relationship distress which contributed to a poor social network. They were also exposed to traumatic experiences including violence which increased their level of fear during and after arrival to the host country. Consequently, this caused poor emotional wellbeing increasing the risk of suicide. Moreover, socioeconomic inequalities were significant in forced migrant women with low educational attainment, economic insecurity, and poor living conditions contributing to further marginalisation. In addition, communication challenges including poor language proficiency, produced barriers to healthcare access. All these risk factors were found to exacerbate perinatal mental illness and cause long term impacts both medically and socially.
Conclusion: The risk factors identified were found to contribute to worsening perinatal mental illness with higher levels of anxiety and depression symptoms present in forced migrant women. However, the effects also included chronic health issues such as post- traumatic stress disorder, leading to maladaptive coping mechanisms such as smoking and substance misuse. The risk factors identified also contributed to wider societal impacts including unemployment, poor living conditions and increased violence, all of which promoted the socioeconomic inequalities already present. This led to continued marginalisation and poverty within forced migrant women. Although risk factors were established, further research is required to disentangle the complexity and understand the interplay of these factors to improving screening and provide effective interventions for forced migrant women.
 
Visualising Justice: Teaching Sexual Violence and Law Through Engagement with Artwork
Full text linkNikki Godden-Rasul (as a legal scholar), Tina Sikka (as an arts and cultures scholar) and Jayne Jackson (an independent empowerment photographer, activist and PhD researcher) reflect on the use of Jackson’s photographic artwork Asking For It, which challenges sexual violence victim blaming, in a Law and Gender LLB module. In particular, they explore the role art plays in students’ learning, and its potential to challenge the supposed objectivity, neutrality and disembodied rationality of law, by bringing visual culture and emotions into the frame
Nutritional Education in Medical Curricula and Clinical Practice: A Scoping Review on the Knowledge Deficit amongst Medical Students and Doctors (MSADs)
Full text linkBackground: This scoping review critically synthesises the literature on nutrition education to understand why there is a gap in nutrition knowledge and skills among medical students and doctors (MSADs) in English-speaking countries, and the solutions which have been proposed in the literature to close this gap. Non-communicable diseases (NCDs), accounting for 74% of deaths worldwide (World Health Organization, 2022), are a major health concern and are often the result of poor dietary habits. To reduce the prevalence of chronicdiseases health-care professionals must encourage healthy eating, and therefore require the appropriate nutritional knowledge and skills.
Methods: To collect the literature this scoping review used four databases (PubMed, WebOfScience, Embase and ERIC) and grey literature sources (Google, Bing and Perplexity AI). Papers which fit the eligibility criteria were included in the analysis. Papers which did not fit the eligibility criteria were removed from the data pool. The 28 selected peer-reviewed papers were then critically appraised and relevant data was extracted. Then, they were thematically analysed using qualitative a coding software analysis tool, Delve, to help identify two principal themes and 20 sub-themes.
Results: The results identified four reasons for the gap in nutrition knowledge, including insufficient curriculum time dedicated to nutrition education, perceptions and confidence, stigmas and health habits, and challenges in clinical practice. The review also identified four potential solutions to minimise this gap,including curriculum changes, enforcement of standardised nutrition education guidelines, integration ofnutrition in clinical practice and promotion of a multidisciplinary approach to nutrition education.
Conclusions: This scoping review shows that the principal and underlying reason for why there exists a gap in nutrition knowledge among MSADs is their perception of nutrition. In summary, understanding why there is a gap in nutrition knowledge among MSADs, and identifying potential solutions to close this gap, can help toincrease the nutrition education received by MSADs. This would improve patient care and likely contribute to better eating habits worldwide, thereby reducing the burden of NCDs to both patients and healthcare professionals
The acute and recovery effects of combined isometric and high intensity interval training sessions on office and ambulatory blood pressure.
Full text linkBackground: Hypertension is associated with development of cardiovascular disease, a major cause of death worldwide. Multiple training methods have been implemented as conservative options to reduce blood pressure (BP); two common methods being high- intensity interval training (HIIT) and isometric exercise training (IET). To date there has been minimal research into combining these two training methods to assess a possible cumulative effect on BP reductions. This study aimed to investigate potential benefits of a combined HIIT and IET exercise training session on both short- and long-term BP reductions.
Methods: 10 healthy adult participants were recruited to take part in two training sessions combining both HIIT and IET in two different forms. Throughout each session, and in the immediate recovery period,intermittent BP, and heart rate (HR) monitoring was performed, recorded using a Dinamap vital signs monitor. Following completion of each session, participants were fitted with a Welch Allyn 6100 ambulatory BP monitor to record several haemodynamic markers across the 24-hour period following exercise. Participants also completed a 24-hour baseline ambulatory monitoring as a control.
Results: Significant reductions in systolic blood pressure, diastolic blood pressure and heart rate were present in the immediate period following completion of both exercise sessions (all p<.05). There was no significant difference in reduction of BP when directly comparing both exercise sessions (p>.05), however a significant difference in the effect on HR was observed (p<.05). A significant reduction in HR following thewatt bike protocol was seen 2-hours post exercise (p<.05), but no significant reductions in any other haemodynamic markers were seen across the 24-hour ambulatory monitoring for either training session (both p>.05).
Conclusions: The findings are consistent with existing literature that both HIIT and IET are effective training methods for producing BP reductions in the immediate period following exercise. A small sample size and confounding variables led to insignificant results in the analysis of long-term trainingeffects which, if rectified, may allow for a significant change in BP to be observed in future studies
Barriers and facilitators affecting healthcare delivery in Rural Philippines: A Thematic Analysis of Ethnographic Data
Full text linkBackground: The Philippines is a Low – Middle income Country (LMIC) with over 50% of its
inhabitants living in rural areas. Healthcare in these areas face significant delivery challenges
due to limited access and resource disparities. This study works with the SOLACE project, a
collaborate effort with UK-based and Philippines-based researchers to engage with local
communities and co-produce public health initiatives in the Philippines.
Methods: Using a qualitative research methodology, this study conducts an in-depth analysis
of ethnographic field notes and semi-structured interviews originally collected by the SOLACE
project. Narratives and experiences from two rural communities, Laoang and Catarman, were
examined. The analysis focused on identifying and understanding the underlying themes that
influence healthcare dynamics.
Results: The study highlights several key barriers including cultural stigma against seeking
medical assistance and logistical issues such as geographical remoteness and low
socioeconomic status. There was also a significant reliance on traditional healers due to
reasons such as mistrust towards the formal healthcare system. Lack of education and stigma
caused many inhabitants to believe mental health issues could not be treated with medicine.
Conclusions: The findings coincide with previous literature and elaborate on the socio-
cultural, economic, and infrastructural challenges impacting healthcare delivery in rural areas
of the Philippines. While the study operates independently, it builds upon the data and
insights provided by the SOLACE project, underlining the necessity for culturally adapted and
geographically tailored public health interventions
Can sarcopenia inform postoperative outcomes in orthogeriatric patients? A systematic review
Full text linkBackground:
Sarcopenia is an age-related musculoskeletal disorder in which there is a progressive loss of muscle function and mass. Despite its association with adverse health outcomes, there is little evidence on the extent of the possible harmful effects of sarcopenia in relation to orthopaedic outcomes in patients with a hip fracture. This systematic review evaluates the effects of sarcopenia on postoperative outcomes in orthogeriatric patients with a hip fracture.
Methods:
A search strategy was conducted. The qualifying papers were then classified based on predefined themes: mortality, length of hospital stay, mobility/gait performance, readmission, quality of life and functional status/activities of daily living.
Results:
The literature search generated 450 papers, 17 of which were included in this research project, and then categorised based on their theme. Nine papers fulfilled the criteria for the mortality theme, four for length of hospital stay, four for mobility/gait performance, two for readmission, three quality of life and nine for functional status/activities of daily living. It was found that sarcopenia informs mortality rates in patients post-hip fracture, but evidence does not support its effect on the other pre-defined outcomes.
Conclusions:
This study demonstrates the association between sarcopenia and mortality in orthogeriatric patients with hip fractures when compared to patients without sarcopenia. The lack of conclusive and homogenous data in the remaining outcomes meant that the correlation between sarcopenia and post-operative outcomes in patients with a hip fracture could not be demonstrated
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