Medicine in Contemporary Society (MCS 4)

Course Goals
MCS 4 gives students an opportunity to expand their knowledge of ethical, social, cultural, and humanistic issues in medicine in a manner reflective of their own career choices and particular interests. MCS 4 focuses on mastery of knowledge and attitudes related especially to the following core competencies: professionalism and ethics, communication, self-awareness, social context of medical care, and health care systems.
The following electives are available for 2012-2013. For a course to be offered the minimum number of students is 5.

Elective Courses Offered
The following electives are available for 2012-2013. or a course to be offered the minimum number of students is 5.

1. Clinical Ethics
2. Compassionate Care and Hope in Clinical Practice
3. Spirituality and Medicine
4. Narrative Medicine and Medical Memoirs in an Electronic Age
5. MCS 4 Independent Project


Course Title: Clinical Ethics
Dates Offered: October 8–October 21, 2012
Faculty: Stephen G. Post, PhD
stephen.post@stonybrook.edu

Description

This course will draw almost entirely on student clinical experiences. Students are asked to write up two ethical cases that they have encountered in their clinical years, and that they deemed remarkable. One case should present a difficult dilemma was handled extremely well, and a second case should present a dilemma handled poorly. These cases should be presented in clear written form and verbally to the seminar class. Each case (no more than two double-spaced pages each) should include at least these elements:

  1. basic medical history and facts
  2. description of the patients illness experience (i.e., how the condition impacts the patients emotionally, socially, and existentially)
  3. description of the dilemma and the moral voices/stakeholders involved
  4. why you selected this case and its significance
  5. what ethical principles were in tension
  6. what decisional/communicative processes contributed to a positive or adverse outcome
  7. how did the qualities of the professionals involved impact the outcome (positive qualities might include such things as attentive listening, empathy, hopefulness, diligence, respect, honesty, social intelligence, self-control, patience, firmness, etc.; negative qualities might include discourteous, abrupt, arrogant, indifferent, intolerant, overbearing, deceptive, etc.)
  8. what was the outcome and what do you think of it
  9. what did you learn from the case about being a good doctor

Students should do an excellent job on these case write-ups. They should be well-crafted and deep. After presentation and peer critique for substance and style, the student can edit the original case write-ups for final submission to the instructor. (It would be nice to see these published as a set on the Journal of Clinical Ethics.)

Each student will present his/her cases to our group (est. 20 minutes per case, five minutes presentation and 15 minutes discussion/feedback). This discussion will allow the student to revise and enhance her/his case write-ups for final submission.

Educational Objectives

  1. Students will draw meaningfully on their clinical experiences and present cases of significance for peer review
  2. Students will develop their writing skills through response to peer critique
  3. Appreciate the art as well as the science of medicine, and the nature of a healing or optimally therapeutic physician-patient relationship, especially in relation to successful navigation of clinical ethical issue

Requirements
Students will be required to attend class sessions, to be actively involved in discussions, and to demonstrate an informed understanding of cases presented. Students will be asked to write up two cases (see above) and revise these after peer discussion and review.

Reading Material
This course does not require any readings. A recommended book is by Jerome Groopman, MD, The Anatomy of Hope: How People Prevail in the Face of Illness (2004).

Evaluation
Students will be graded on class participation/presentation (20%) and their final case descriptions as submitted (80%). Grading will follow the standard range (Honors, High Pass, Pass, Low pass, Fail) using the standard evaluation form.

Feedback
The standard evaluation form includes a faculty feedback section. Student’s papers will receive written comments and evaluation.

Number of Students: 5–20

Course Title: Compassionate Care and Hope in Clinical Practice
Dates Offered: February 4– February 17, 2013
Faculty: Stephen Post, PhD
Director, Center for Medical Humanities, Compassionate Care, & Bioethics
HSC Level 3, Rm 080
631-444-9797
Stephen.Post@stonybrook.edu

Description:
This course focuses on compassionate care and hope. Compassionate care makes otherwise technically competent professionals healers. Absence of compassionate care is currently being singled out across the United States as the most pressing concern not only of patients, but of physicians and other healthcare professionals. Another key “intangible” in patient care is the dynamic of hope. Harvard hematologist-oncologist Jerome Groopman, in his The Anatomy of Hope, writes that hope is “the elevated feeling we experience when we see – in the mind’s eye – a path to a better future” (p. xivi). Without endorsing the exaggerated popular literature on hope and healing, Groopman notes that belief and expectation, two aspects of hope, are fundamental to the placebo effect, and activate brain circuits that release endorphins and dopamine. A careful assessment of the existing research compels Groopman to conclude, “Hope, I have come to believe, is as vital to our lives as the very oxygen that we breathe” (p. 208). The skilled clinician must handle hope empathically, and be able to redirect patient hopes from one goal to another in order to circumvent despair.

Educational Objectives:
In addition to reviewing literature both scientific, clinical and humanistic, students will:

  1. Analyze Hojat’s clinical empathy scale, which is widely used in clinical studies
  2. Assess the role of compassionate care and hope in an optimally therapeutic physician-patient relationship
  3. Write up a case from your clinical experience in which compassionate care and/or hope were handled especially well, and present it for seminar peer review.
This course will rely almost entirely on student clinical experiences. Students are asked to write up a case that they have encountered in their clinical years, and that they deemed optimal in capturing the clinical significance of compassionate care and/or hope in one of their patient’s experience. The cases should be presented in clear written form and verbally to the seminar class. Each case (no more than three double-spaced pages) should include at least these elements:
  1. brief medical history and background
  2. description of the patient’s illness experience (i.e., how the condition impacts the patient emotionally, socially, and existentially)
  3. description of the dynamics of compassionate care and /or hope in the case
  4. how you think these dynamics may have affected outcomes (biopsychosocial)
  5. describe any impressive role models in the case (clinicians, chaplains, etc. as relevant), capturing special details of interaction that inspired you and are worth emulating, such as attentive listening, empathy, respect, social/emotional intelligence, patience, loyalty, “carefrontation,” etc.
  6. any other items you wish to include.
These cases should be well-crafted and deep. After presentation (it worthwhile to read each case aloud) and peer critique for substance and style, the student can edit the original case write-ups for final submission to the instructor. Each student will present his/her cases to our group (est. 20 minutes per case, five minutes presentation and 15 minutes discussion/feedback). This discussion will allow the student to revise and enhance her/his case write-ups for final submission.

Requirements:
Students will be required to attend class sessions, to be actively involved in discussions, and to demonstrate an informed understanding of cases presented. Students will be asked to write up a case (see above) and revise these after peer discussion and review. The class will meet on four days, January 19, 20, 23, & 24.

Reading materials:
Four brief articles and popular book

Evaluation:
Students will be graded on class participation/presentation (20%) and their final case descriptions as submitted (80%). Grading will follow the standard range (Honors, High Pass, Pass, Low pass, Fail) using the standard evaluation form.

Feedback:
The standard evaluation form includes a faculty feedback section. Student’s papers will receive written comments and evaluation.

Number of Students: 5 - 20

Course Title: Spirituality and Medicine
Dates Offered: March 128– March 31, 2012
Faculty: Michael Vetrano, PhD
Michael.Vetrano@stonybrook.edu

This is an intensive course on spirituality in the clinical setting. This elective provides an opportunity for students to work closely with chaplains, hospice personnel, and palliative care specialists, ministering to the spiritual needs of patients. Through clinical experience and theological reflection, the students and their mentors will grapple with issues of suffering, human dignity, mortality, and the role that health care professionals can play in the spiritual journey of the patient. This course will also encourage a careful assessment of the physician's own spirituality as an asset in the clinical setting.

Educational Objectives
At the conclusion of this course you will have the ability to:

1. Define, for yourself, a beneficial spiritual approach to medicine which will include attitudes, spiritual practices, and resources.
2. Integrate spiritual attitudes such as trust, forgiveness, gratitude, mindfulness into your medical practice.
3. Speak with patients' intelligently and compassionately regarding spiritual concerns.
4. Refer patients properly to chaplains and other spiritual counselors.
5. Include spiritual conversation in the process of giving bad news and/or discussing death and dying issues.

Reading Material

  • Can Forgiveness Affect Health, Art.
  • Jerome Groopman, "God at the Bedside," New England Journal of Medicine 350;12.
  • Bernard Lee et. al., "Discussing Religion and Spirituality at End of Life," JAMA, September 20, 2006.
  • Stephen Post, "Physicians and Patient Spirituality" 4 April 2000; Annals of Internal Medicine; Volume 132; Number 7.
  • Christina Puchalski, "The Role of Spirituality in Health Care," Baylor University Medical Center Proceedings, Vol. 14, .4
  • Neil Scheurich, MD, "Reconsidering Spirituality and Medicine," Academic Medicine, Vol. 78 #4 April 2003.
  • Karen Steinhauser, "Factors Considered Important at End of Life," JAMA, November 15, 2000, Vol 284, No. 19.
  • Daniel Sulmassy, "Spirituality and End of Life Care," JAMA, September 20, 2006 Vol. 296, No. 11.
  • Daniel Sulmassy, "Is Medicine a Spiritual Practice," American Academy of Medicine, Sept. 1999.

Students will also be required to select, read, and report on articles in particular areas of their own interest related to the collaborative project above.

Evaluation: Using the standard evaluation form, students will be graded on the standard range (Honors, High Pass, Pass, Low Pass, Fail) based on the following:

1. Attendance at all sessions is mandatory.
2. Being prepared for class vis-a-vis readings and articles is mandatory.
3. Participation in discussion
4. The class will define a collaborative project and working on this together is required.
5. Patient skills will be assessed via a descriptive verbatim for at least one current or past patient encounter.

Feedback: All papers, projects, and reflections will receive written comments.

Number of Students: 5-20

Course Title:Narrative Medicine and Medical Memoirs in an Electronic Age
Dates Offered: April 29–May 12, 2013
Faculty: Maria A. Basile, MD
drbasile@northcountrycolorectal.com

Educational Objectives Upon completion of this course, the student will

  1. Demonstrate an understanding of the skills required for narrative competence in medicine Explain the relationship of narrative competence to clinical empathy, self-awareness, physician-patient communication, and reflective practice.
  2. Describe, compare, contrast, and provide examples of “narrative professionalism” and “rule-based professionalism.”
  3. Utilize personal narratives (written by oneself and others) to explore positive (caring, compassion, altruism, collegiality, affiliation, and self-knowledge) and negative (detachment, alienation, arrogance, depression, and burnout) dimensions of medical practice.
  4. Be conversant with strategies useful in maintaining a reflective approach to practice during residency training.
  5. Discuss the impact of the Internet, including the opportunities and risks involved in publishing ones work online and in more traditional publishing venues.
  6. Discuss the ethical challenges of writing about patients.
  7. Identify the goals of publication and the importance of setting clear goals for ones writing throughout a career in medicine.

Pre-course Journal.Students who enroll in Narrative Medicine will be expected to participate in a private group blog throughout their 4th year. This online journal will document their medical school experience, should contain at least 20 posts per participant, and focus on:

  1. Personal response to clinical situations;
  2. Stories or vignettes about patients, families, and other health care professionals;
  3. Reflections on personal change during your undergraduate medical education.
More specific instructions for the reflective journal will be e-mailed to all registrants in August 2009.

Readings

  1. Campo, Rafael. “Just like a prayer” and “Imagining unmanaging health care,” The Poetry of Healing, New York, W. W. Norton and Company, 1997, pp. 24-49 and 175-196
  2. Charon, Rita. Narrative and medicine. N Engl J Med. 2004; 350(9):862-4.
  3. Coles, Robert. “Stories and theories,” The Call of Stories, Boston, Houghton Mifflin Company, 1989, pp. 1-30
  4. Coulehan, Jack. Written role models in medical education, Med Humanities. 2007; 33 (2): 106-109
  5. Hatem D, Ferrara E. Becoming a doctor: fostering humane caregivers through creative writing. Patient Educ Couns. 2001;45(1):13-22.
  6. Hilfiker, David. “War Stories,” Not All of Us Are Saints, New York, Macmillan, 2004, pp. 42-59
  7. Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001; 286: 3007-3014.
  8. Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan MD Calibrating the physician. Personal awareness and effective patient care. JAMA. 1997; 278: 502-509.
  9. Ofri, Danielle. “Drawing blood,” “The professor of denial,” and “Time of death: 3:27 AM,” Singular Intimacies. Becoming a Doctor at Bellevue. New York, Beacon Press, 2003, pp. 5-16, 89-100, and 130-137
  10. Selzer, Richard. “Imelda,” “Brute,” “Toenails,” and “Mercy,” Letters to a Young Doctor, New York, Touchstone Books, 1982, pp. 21-36, 59-63, 64-69, and 70-74
  11. Williams, William Carlos. “Old Doc Rivers,” The Doctor Stories, New York, New Directions, 1984, pp. 13-41

Course FormatThis elective will consist of 8 two hour seminar sessions (4 each week) organized around topics in narrative medicine and reflective practice. Sessions will include presentation and discussion of material from our blog as well as discussion of course readings relevant to the topic. Attendance is required.

A on all group blogs, authors will have the opportunity to comment in real time to their peers’ posts. The blog is secure, not available to the public or anyone not involved with the class. The instructor will monitor all posts and comments, and provide feedback and comments throughout the year. With the students’ permission, I will copy and distribute selections from blog for consideration during various seminars. Note: Participants must agree to strict confidentiality regarding our seminar discussions and the material posted on our blog.

In addition to the blog, each student will write a “narrative reflection” during the two week period. This short (2 double-spaced pages) reflection should be based on his or her personal response to a story or opinion raised in class. Ideally, the reflection will capture a sudden insight or “ah ha!” experience.

This elective addresses the following core competencies: (a) effective written and oral communication; (b) professionalism, ethics, and personal values; (c) self-awareness, self-care, and personal growth, and (d) social and community contexts of healthcare.

Evaluation. Using the standard evaluation form, the instructor will assess student performance based on (a) attendance and participation in seminars [a make-up assignment permitted for 1 or 2 missed seminars]; (b) complete participation with the blog; and (c) a 2-page written narrative reflection. Students will be graded according to the standard system (Low Pass, Pass, High Pass, Honors).

Number of Students: 5–20

Course Title: MCS 4 Independent Project

You may work with a faculty member from the Center for Medical Humanities, Compassionate Care, and Bioethics for an elective period (2-4 weeks) or during the course of the year (July 1-March 31) on a project.

Each student decides on a project or area of study consistent with the Center’s theme of Medical Humanities, Compassionate Care and Bioethics.

Students must identify a project prior to contacting:
Stephen Post, PhD stephen.post@stonybrook.edu (course director) and
Elisa Nelson at elisa.nelson@stonybrook.edu (course administrator) with a proposal including:

  1. Project title
  2. Project description (2 pages)
  3. Detailed work plan/timeline
  4. Proposed final product (1 page)
  5. The final project requires a 7-10 page paper
Dr. Post, will review the proposal and facilitate selecting a Center faculty mentor.

Evaluation: Students will be graded on their final paper and will follow the standard range (Honors, High Pass, Pass, Low Pass) using the standard evaluation form. Student papers will receive written comments.