The International Journal of Whole Person Care
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The early encounter: shallow looking and the manifest presence in medical education
Get PDFIf the pressure of patient flow limits a doctor’s visit to fifteen minutes, the importance of the early encounter is increasing. My proposal is dedicated to the first moment of the intersubjective encounter (with art or otherwise), that defined by the unconscious assessment a priori to conscious interpretation, its authority in the clinical encounter, and how to address this moment in medical education.The dynamics between observer and artwork occur in two stages. First, the observer’s senses are attacked, indeed overwhelmed, by the work. Our adaptive unconscious uses reflexive techniques (e.g. thin-slicing) to triage and resolve this information to a more manageable load. Because pattern collection, discovery, and comparison are under unconscious control, the question arises concerning accountability for snap judgments. By studying the patterns that thin-slicing utilizes and our immediate reaction given these patterns, the conscious self can predict—or at least become more accountable—for these judgments.Second, uncomfortable as the victim of a sensory attack, the observer dominates the artwork through the act of interpretation. The observer’s intellect and desire to interpret (both under conscious control) dissolve the uncertainty of the encounter by categorizing it into a comfortable system. Once attuned to this conscious power reversal, we can restrain the unconscious desire prompting the reversal and maintain space in the intersubjective encounter.As visual art is a strong vehicle to discuss the theory behind the dynamics of the early encounter, it is also the appropriate method by which to coach medical students through the early medical encounter
Facing our own dying: exploring conflicts between our individual professional stance and our own personal views on MAiD
Get PDFPhysician-administered euthanasia (Medical-Aid-in-Dying or MAiD) has been legally available in Canada since 2016, with ever-widening indications. Most palliative care physicians in Canada do not provide MAiD themselves but will refer to colleagues who provide this procedure. The author was involved in a qualitative research project on MAiD, looking at the views of Montreal-based palliative care physicians regarding their role. One interesting finding from that project is that our own individual personal views (i.e., what I would want for myself when I will inevitably face my own death) versus my professional views as a palliative care physician (i.e., the kind of end-of-life care that I am ready to provide, or what I think patients should receive) may radically differ.
We teach our trainees (and the community beyond) that dying can have meaning up to the end of one’s natural life. Patients facing terminal illness commonly express a fear of becoming a burden to others. Yet we teach that this sentiment is often not well-founded, based on the expressed views of the patient’s loved ones. And yet dying can be difficult, even when patients receive the best available palliative care. Our professional view of what constitutes a dignified end-of-life and what patients and families (and I, eventually) will experience may be different.
This presentation will spark reflection regarding this dichotomy. What feelings might this inner split provoke, when our professional and personal views conflict with each other? Am I being a dishonest physician? And yet
A new communication model for procedure-oriented health care professionals
Get PDFMany health care communication models have been proposed, yet previous models have focused on the consultation and omit the communication needs of patients during procedures. Consider the challenges of communicating during a dental procedure, for example, in which the patient cannot talk or is experiencing anxiety or pain. How does the health care provider convey care and respect during such encounters?
A new communication model, ISLEEP, fosters patient-centered interactions for consults and procedures. There are six categories of actionable, observable behaviors in ISLEEP: introduce/interconnect, solicit, listen, empathize, explain, and affirm the power of the patient. Here, we discuss the basics of each ISLEEP skill as well as the applications of these skills for each phase of care, including consultations, immediately before procedures, during procedures, after procedures, and health counseling. Several included videos demonstrate the ISLEEP skills during live patie nt encounters
The empathy imperative in whole person care - for patients and physicians
Get PDFClinical empathy is associated with improved patient satisfaction, treatment compliance, and better health. At the same time, empirical evidence shows that strong empathic connections between physicians and patients increase job satisfaction and decrease malpractice complaints. Plus, doctors with higher levels of empathy also experience less stress, cynicism, and burnout. Empathy in healthcare should be the norm. Unfortunately, that’s not the case. Physicians encounter emotionally taxing situations—illness, trauma, suffering, and dying—on a frequent or ongoing basis. Which might explain why they may miss or dismiss signs of patient distress. But there’s a growing body of evidence that points to overwork and a lack of self-care as a major problem. In fact, relative to the general population, doctors suffer from higher rates of compassion fatigue, burnout, depression, and suicide. The long hours, administrative workload, and financial imperatives of today’s medical practice means that many physicians struggle to prioritize self-care, including a lack of sleep, exercise, and healthy eating habits. All of this was further exacerbated by the pressure of the recent COVID pandemic. Yet physicians are not permitted to appear vulnerable or weak because doing so is inconsistent with the culture of medicine.This session will explore why empathy and self-empathy are both imperative to whole person care - for physicians and their patients. And will suggest several strategies and practices to combat empathy fatigue
Invitations to think and feel in forensic nursing; the role of clinical supervision and reflective practice
Get PDFProviding nursing care to people who have experienced child sexual abuse, assault and rape is a highly specialised and psychologically demanding task. Necessarily much focus is on the technical aspects of the task of providing care to patients. The specialist administrative and nursing team in the Sexual Assault and Treatment Units (SATUs) in Ireland provide complex treatment to a particularly vulnerable group of people from various backgrounds in Irish Society. The service is open to all genders and gender identities, aged 14 and over. The care is free and it is a recognised safe place to go to if you have been raped or sexually assaulted. In the Department of Health’s Policy Review of the SATUs in Ireland they recognised the challenging nature of the work and recommended the provision of high quality emotional supports for all staff (core and on-call).
This paper considers the provision of reflective practice to members of the SATU team, with a particular emphasis on their emotional and psychological experience at work. The introduction of reflective practice into a nursing setting will be discussed including opportunities and challenges that emerged, and how the service gained momentum over a year. The paper will reflect on one case example in the form of a supervisee/supervisor relationship in an effort to deepen and broaden our understanding of the need for professional spaces in which to consider ones experience at work. 
Narrative medicine and narrative practice: partners in the creation of meaning
Get PDFBackground
Narrative medicine has emerged as an approach to whole person care and to support the clinician-patient therapeutic relationship. Although training in narrative medicine is usually based on the study of literary or artistic works, the same attitude of close reading can also be applied in conversations with patients or learners.MethodWe held a two-day narrative medicine workshop, incorporating two approaches: 'Conversations Inviting Change' (CIC) and humanities-based narrative medicine as taught by Columbia University. The workshop was primarily experiential, with theoretical components of both approaches. Participants brought active concerns for confidential breakout sessions and engaged in text-based and reflective writing exercises. Participants generated metaphors to describe these approaches to narrative medicine.Results
Participants included a mix of community and hospital-based practitioners, pre-dominantly doctors. Participants considered the two approaches to be compatible and enhance each other. One metaphor generated was that Columbia style narrative medicine is ’like an individual lens which allows you to see things clearer’, it allows practitioners a different perspective on their patients and that CIC teaching ‘is a frame of glasses in which the lenses could be placed to enhance the ease of use’. Another metaphor was that the former ‘is like learning from a cadaver in the anatomy lab’, while the latter ‘is like running a clinical simulation’.Conclusion
We believe this was the first workshop integrating these approaches to narrative medicine. They appear to be highly complementary. Both approaches lead to enhanced attention to narratives which has clear applicability to clinical practice
Reframing perceptions: A phenomenological inquiry into students’ written reflections on learning about mindfulness
Get PDFIntroduction
Mindfulness practices offer approaches to reflection that have been argued to contribute to positive outcomes for students in the health professions. Despite calls for more phenomenological investigations in the field, few studies examine the lived experience of learning about mindfulness in professional schools. Objective
The objective of this study was to inquire into first-hand written accounts of students’ experiences of learning about mindfulness. Methods
This study reports on occupational therapy health professions students’ phenomenological reflections written during and following a 5 week, 15 hour, mindfulness elective course offered at a Canadian University. The study adopts a hermeneutic phenomenological methodology and is informed by theoretical frameworks of embodiment and practice theories. An indepth thematic analysis of twenty-one students' written reflections on the experience of integrating mindfulness practices into their lives was undertaken. Results
Predominant themes identified in students’ written reflections include: reframing perceptions, ‘being’ while ‘doing’, witnessing the struggle, and compassion for self and others. Conclusions
This research contributes richly textured accounts that advance understandings about the affordances of mindfulness education in the lives of future health care practitioners. The results also hold implications for educational design in higher education professional school contexts, considerations of mindfulness practices in future professional practitioners’ everyday and workplace occupations, and identification of promising avenues for future research. This study is funded by the Social Science and Humanities Research Council of Canada (SSHRC). 
Culturally-adapted resilience-building curriculum for medical students: a comprehensive approach at Showa University School of Medicine, Japan
Get PDFThe growing prevalence of psychological morbidity, depersonalization, and low personal accomplishment among medical students underscores the need for resilience-enhancing programs tailored to their specific needs. Incorporating cultural perspectives and societal context into these interventions is crucial to ensure their effectiveness and relevance. In response, Showa University School of Medicine in Japan has pioneered a culturally-adapted, resilience-based curriculum for medical students from their first through sixth years since 2020.
This presentation will outline the comprehensive framework of the resilience-focused curriculum, including course objectives, content, learning resources, timetables, and pedagogical approaches. Key components of the curriculum encompass self-assessment and reflection, stress management strategies, effective communication and conflict resolution skills, and fostering a growth mindset. Additionally, interdisciplinary collaborations with psychology and social work departments provide individual supports and resources for students.
Emphasizing the distinct challenges faced by medical students, such as academic stressors, relationships with senior clinical educators, patient and family interactions, and managing errors and burnout, the presentation will highlight the classes on the curriculum, support systems and mentorship programs in promoting mental well-being and resilience.
The experiences and outcomes of the 2020-2022 cohorts will be shared, offering valuable insights into the effectiveness of the resilience-building curriculum in the Japanese context. Lessons learned from the implementation process, including challenges faced and strategies employed, will provide practical examples for other medical schools seeking to develop similar programs