Title: Humanism in Pathology Group for Research in Pathology Education Winter 2005 Meeting Loma Linda Unive
1Humanism in PathologyGroup for Research in
Pathology EducationWinter 2005 MeetingLoma
Linda UniversityJanuary 20, 2005
- Cathy J. Lazarus, M.D., FACP Byron E. Crawford,
M.D. - Professor of Medicine Associate Professor of
Pathology - Director, Foundations in Medicine Program
Director of Anatomic Pathology - Tulane University School of Medicine Director,
Mechanisms of Diseases Course - Tulane University School of Medicine
2Humanism in the Medical CurriculumLiterature
Review
- Foundations in Medicine
- Medical Scholars Program
- Arts and Humanities Medical Scholars
- Integrated Clinical Experiences
- Physician, Patient and Society
- Humanities, Ethics, and Professionalism
- Clinical Integration Course
- Osler Program
- Medical Humanities and Bioethics Program
3Humanism Integrated inBasic Science
CoursesAnatomy
- 4NYU - The Experience of Human Dissection
- - Course Director interactions with donor and
family - - Student reactions
- - Expression of professionalism during human
dissection
4Anatomy cont . . .
- 3Northwestern University Feinberg School of
- Medicine (part of Medical Humanities and
- Bioethics Program, but integrated in Gross
- Anatomy).
- - Student essay or story to assist processing
of the gross anatomy experience - - Donor closing ceremony - selected students
read essays - - 2nd year - students write about a patients
experience or their own experience as a patient
51Yale University
- Extensive incorporation of humanism in a basic
science course -
- Humanism/Gross Anatomy covers
- - End of Life Care
- - Student confrontation with death
- - Diverse cultural and religious attitudes of
patients - - Psychosocial issues of patient care
- - Informed consent
- - Sanctity of human remains
- - Necessity for human dissection
- - Grief, depression, and suffering effects on
patient decision making
6Yale University
- Promote dissection of cadavers (donors)
- Anatomy potential to instill humanistic values
- Acknowledge the donor as an instructor
7Yale UniversityProcess
- Students - 136 4-5 per donor
- Faculty 4 research scientist, 3 retired
surgeons, 1-2 surgery residents, hospice nurse,
chaplains, social workers, 2nd year medical
students - Objective Create an environment in which
students routinely compare, contrast, and
challenge their interpretation of each anatomy
experience - Settings Gross anatomy lab
- Small group session
- Luncheon group sessions
- Lectures
- Closure and appreciation setting
8Humanism in Other Basic Science Courses
- 2University of Texas at San Antonio
- Cardiovascular Block
- Cardiac Transplantation - Richard Selzer
Whither Thou Goest - Neurology Block
- Selective readings - scientific, spiritual, and
imaginative quest to understand human
consciousness
9Tulane UniversityMechanisms of Diseases -
Pathology and Pathophysiology Course
- Autopsy Rotation (small groups)
- - one or multiple cases
- - interesting case with multiple disease process
- - history, student organ review, faculty review
- - written report
- - 150 students participated
- - end of the year
10History
- 30-year-old man presented in late stage liver
failure, renal failure, and heart failure.
Initial work-up revealed a large abdominal
tumorous mass. Family members decided the
patient should not be resuscitated and was
categorized as DNR. He died undiagnosed about
72-84 hours after admission. - Autopsy diagnosis Aggressive form of Hodgkins
Lymphoma involving multiple organs
11Potential Humanistic Topics
- Family consent for autopsy
- DNR criteria
- Physician - Patient relationship
- Physician - Patient - Family relationship
- Support care
- Depression, denial - effects on patient decision
making - Physician - family discussion of autopsy results
12Questions For Students (N150)
- 1. Discuss reasons why you would or would not
- consent to an autopsy on a family member
- - Did not answer - 52
- - Gave reasons why others would or would not
consent - 13.3 - - Gave reasons why student would or would not
consent - 34.7
13Reasons Against Autopsy Consent
- Religious - 19 students (26)
- Emotional - 2 (3)
- Know the Dx - 9 (14)
- Cultural - 3 (4)
- Too invasive - 10 (14)
- Deceased is very old - 1 (1)
- Deceased wishes - 4 (5)
- Would always refuse - 1 (1)
- Results might be embarrassing - 1 (1)
- Transplantation organ donation - 3 (4)
14Reasons For Autopsy Consent
- Diagnosis in doubt - 22 students (31)
- Learn from autopsy - 5 (7)
- Would never refuse consent - 2 (7)
- Suspected malpractice - 3 (4)
- Determine genetic diseases - 6 (8)
- Family closure - 2 (3)
- Determine health risk of others - 4 (5)
- Sudden death - 5 (7)
15Questions For Students (N150)
- 2. Describe your role as a physician in the case
of - this dying patient regarding medical support,
- support care and physician - patient - family
- relationship
- - No answer or poor answer - 49
- - Acceptable answer - 31
- - Good answer - 20
16No Answer or Poor Answer
- No answer - 6 students (8)
- Medical support only - 36 (49)
- Comfort support only - 17 (23)
- Compassion toward family only - 2 (3)
- Family support only - 13 (18)
17Excellent Responses
- Discuss post-autopsy results - 6 students
- Discuss grieving process - 6
- Explain DNR / Living Will - 6
- Hospice care - 3
18AcknowledgmentsDoreen Barrett