Humanism in Pathology Group for Research in Pathology Education Winter 2005 Meeting Loma Linda Unive - PowerPoint PPT Presentation

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Humanism in Pathology Group for Research in Pathology Education Winter 2005 Meeting Loma Linda Unive

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Medical Humanities and Bioethics Program. Humanism Integrated in. Basic Science Courses ... Bioethics Program, but integrated in Gross. Anatomy) ... – PowerPoint PPT presentation

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Title: Humanism in Pathology Group for Research in Pathology Education Winter 2005 Meeting Loma Linda Unive


1
Humanism 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

2
Humanism 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

3
Humanism 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

4
Anatomy 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

5
1Yale 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

6
Yale University
  • Promote dissection of cadavers (donors)
  • Anatomy potential to instill humanistic values
  • Acknowledge the donor as an instructor

7
Yale 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

8
Humanism 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

9
Tulane 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

10
History
  • 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

11
Potential 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

12
Questions 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

13
Reasons 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)

14
Reasons 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)

15
Questions 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

16
No 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)

17
Excellent Responses
  • Discuss post-autopsy results - 6 students
  • Discuss grieving process - 6
  • Explain DNR / Living Will - 6
  • Hospice care - 3

18
AcknowledgmentsDoreen Barrett
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