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En el contexto de la salud, la angustia moral (AM) se refiere a las emociones negativas que surgen cuando una persona conoce el curso de acción correcto en una situación determinada pero no es capaz de seguirlo debido a impedimentos personales, jerárquicos o institucionales. La AM se ha relacionado con diversos problemas profesionales, tales como desorientación vocacional, baja motivación laboral, trato despersonalizado a los pacientes, abandono de funciones y cambios de especialidad o profesión. Si bien este fenómeno no ha sido suficientemente estudiado en Chile, se asume que existe e incluso habría aumentado durante la pandemia de COVID-19, siendo desconocidas sus repercusiones. En consecuencia, este artículo tiene como objetivos, en primer lugar, promover el estudio fenomenológico de la AM en nuestro país, considerando la importancia de prevenir su potencial impacto adverso en la salud mental de futuros profesionales, y, en segundo lugar, destacar la necesidad de incluir enfoques narrativos en la educación médica, a fin de desarrollar una aproximación más holística hacia la comprensión de los pacientes y de su condición de vulnerabilidad. En última instancia, se espera que el abordaje de las implicancias de la AM en la educación y la práctica médica contribuya con su humanización, optimizando la calidad de la atención en salud.
In the healthcare context, moral distress (MD) refers to the negative emotions that arise when a person knows the correct course of action in a given situation but is not able to follow it due to personal, hierarchical or institutional impediments. MD has been related to various professional problems, such as vocational disorientation, low work motivation, depersonalized treatment of patients, abandonment of duties, and changes of specialty or profession. Although this phenomenon has not been sufficiently studied in Chile, it presumably exists and would have even increased during the COVID-19 pandemic, leaving its repercussions unknown. Accordingly, this article has the objectives, firstly, to promote the phenomenological study of MD in our country, considering the importance of preventing its potential adverse impact on the mental health of future professionals, and, secondly, to highlight the need to include narrative approaches in medical education, in order to develop a more holistic approach to understanding patients and their condition of vulnerability. Ultimately, it is expected that addressing the implications of MD in medical education and practice will contribute to its humanization, optimizing the quality of healthcare.
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More medical schools are incorporating wellness activities and the medical humanities into their curriculum. Finding implementable programming that is feasible and enjoyable is challenging. Both student participants and faculty who might facilitate programs are busy with clinical and educational responsibilities. Book club discussions in general are an activity that bring people together and expose groups to literature. In medical education, informal books clubs have been shown to increase camaraderie and expose participants to topics in medicine that they may not have encountered without the structure of the group assignment. At one large private urban medical school, all fourth year medical students were required to participate in a one-time hour-long book discussion with a faculty member one week before Match Day 2021. This paper describes the implementation of that program and discusses survey results from 179 students who broadly indicated that the books were enjoyable, the discussions were enriching, and that the program should continue for future classes of medical students.
Assuntos
Educação Médica , Estudantes de Medicina , Humanos , Docentes , Currículo , Ciências Humanas/educação , Docentes de MedicinaRESUMO
Este ensaio almejou refletir sobre a relação entre medicina narrativa, redes sociais e humanização a partir da utilização, por um dos autores, das redes sociais para compartilhamentos de histórias vivenciadas no contexto da Atenção Primária à Saúde. Questões acerca dos modelos de atenção em saúde vigentes, da escuta e da narrativa como dispositivos de humanização do cuidado e da emergência das redes sociais como potencializadoras da prática de saúde humanizada surgiram como importantes pontos a serem analisados à luz da literatura vigente. Ao fim, foram compartilhados apontamentos para utilização da medicina narrativa como ferramenta para uma prática humanizadora.(AU)
Abstract This essay reflects on the relationship between narrative medicine, social media, and humanization based on the use of social media by one of the authors to share experiences in the context of primary health care. Questions about prevailing health care models, listening, and narrative as dispositives of the humanization of care and the emergence of social media as drivers of humanized health practices arose as important points that need to be analyzed in the light of current literature. In the conclusion we present some considerations relating to the use of narrative medicine as a tool for promoting humanizing practices.(AU)
Resumen El objetivo de este ensayo fue reflexionar sobre la relación entre la medicina narrativa, las redes sociales y la humanización, a partir de la utilización, por parte de uno de los autores, de las redes sociales para compartición de historias vividas en el contexto de la Atención Primaria de la Salud. Surgieron preguntas sobre los modelos de atención de salud vigentes, de la escucha y de la narrativa como dispositivos de humanización del cuidado y de la emergencia de las redes sociales como potenciadoras de la práctica de salud humanizada como puntos importantes a analizar a la luz de la literatura vigente. Al final, se compartieron observaciones para la utilización de la medicina narrativa como herramienta para una práctica humanizadora.(AU)
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Resumo A comunicação, a despeito de ser considerada um aspecto primordial no exercício da prática médica, não ganhou tanta proeminência na literatura e formação médica quanto os aspectos tecnológicos e biomédicos. Em resposta a esse contexto, surgiram campos de conhecimento que se propõem a refletir e fortalecer aspectos da comunicação entre o médico e o paciente. No presente artigo, realizamos uma análise narrativa da literatura de três abordagens de comunicação em Saúde: Grupos Balint, Método Clínico Centrado na Pessoa e Medicina Baseada em Narrativa. Foram destacados aproximações e distanciamentos entre tais abordagens, com o reconhecimento da potência própria de cada uma delas nos diversos contextos da prática médica.
Resumen La comunicación, a pesar de considerarse un aspecto primordial en el ejercicio de la práctica médica, no obtuvo tanto destaque en la literatura y en la formación médica como el que tuvieron los aspectos tecnológicos y biomédicos. Como respuesta a ese contexto, surgieron campos de conocimiento cuya propuesta es reflejar y fortalecer aspectos de la comunicación entre el médico y el paciente. En este artículo, realizamos un análisis narrativo de la literatura de tres abordajes de comunicación en salud: Grupos Balint, Método Clínico Centrado en la Persona y Medicina Basada en la Narrativa. Se destacaron aproximaciones y distanciamientos entre tales abordajes, con el reconocimiento de la potencia propia de cada una de ellas en los diversos contextos de la práctica médica.
Abstract Communication, despite being considered a key aspect in medical practice, has not received the corresponding attention both on literature and medical training as has the technological and biomedical aspects. As a reaction to this context emerged fields of knowledge proposing to reflect and strengthen aspects of communication between the physician and the patient. In this article, we perform a narrative analysis of the literature of three of such approaches to communication in health: the Balint Groups, the Patient Centered Care and Narrative-Based Medicine. The study highlights the approximations and distances between these approaches, along with the recognition of the potency of each of them in the different contexts of medical practice.
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Clinical practice in Brazil has rapidly transformed. Doctor-patient relationships are the focus of these transformations, either within health policies or in the context of medical training. The Brazilian Curriculum Guidelines have emphasized the doctor-patient relationship as part of medical skills and competences, based on patient-centered care. In this article, we present the political advances in patient-centered care. In addition, we address an overview of the Brazilian status quo of decision aids tools. Finally, we share experiences in curriculum reform for the advances of communication skills and the interfaces with narrative medicine and the arts in curricular medical training as a means to advance towards the practice of shared decision making.
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This work is a bibliographical review of the challenges of professionalism in medical training. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. By virtue of the changes in the practice of medicine during the last years, professionalism values emerge as qualities that should reshape medicine. Several medical associations are redefining professionalism and insist that this issue should be included in the training curriculum. Thus, several medical education institutions are pursuing strategies to teach and assess professionalism. Modeling is still relevant as a learning strategy, but it must be tutored and directed. Also, timely and formative feedback appears as the most frequently suggested evaluative action. Both processes incorporate a personal reflective practice. Several recent studies suggest that a reflective experience is relevant for the formation of a professional identity. Narrative Medicine methodology emerges as an innovative strategy to address this issue, as it seeks to deliver valuable learning experiences to the students through reflection and the search for a new paradigm for medical practice.
Assuntos
Humanos , Estudantes de Medicina , Educação Médica , Educação de Graduação em Medicina/métodos , Medicina Narrativa , Competência Profissional , Currículo , ProfissionalismoRESUMO
The pursuit of an integrated health education has led higher education institutions to question themselves on the ideal training for medical students which would foster a real connection with their surroundings: "educate to learn to live in the world and with others, knowing that the other person is both the same and different from me, oriented towards the same end: the shaping of the human being and the social good."1 Treating complex topics such as the processes underlying immunity, genetic transcription and metabolic diseases, among others, presents significant academic challenges for teachers and students in the learning process. However, there is an equally relevant hidden curriculum which may warrant the use of unconventional epistemological tools such as music, and which may be a good complement for acquiring clinical and humanistic skills, notably the capacity to develop semiological abilities and the capacity to develop empathy in critical health situations. From this point of view, the rehumanization of medicine has become a primary requirement today. Below, we will discuss three complex health situations described in salsa songs which analyze the underlying human emotions, as an invitation to explore the hidden curriculum behind the objectively viewed disease. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2243).
La búsqueda de una formación en salud integral ha llevado a que las instituciones de educación superior se cuestionen sobre la formación ideal que se debe brindar a los estudiantes de medicina en la que se fomente una conexión real con el entorno: "educar para aprender a vivir en el mundo y con el otro, a sabiendas de que el otro es una persona a la vez igual y diferente que yo, orientados a la misma finalidad: la conformación del ser humano y el bien social" 1. El abordaje de temas complejos como los procesos subyacentes a la inmunidad, la transcripción genética, las patologías metabólicas, entre otros, representan retos académicos importantes para los docentes y los estudiantes en el proceso del aprendizaje. Sin embargo, hay un currículo oculto que es igualmente relevante, y que puede ameritar el uso de herramientas epistemológicas no con vencionales, como la música, y que puede ser un buen complemento para adquirir las habilidades clínicas y humanísticas, entre las que destaca la capacidad de desarrollar habilidades semiológicas y la capacidad de desarrollar empatía frente a una situación crítica de salud. Desde este punto de vista, la rehumanización de la medicina se ha convertido en la actualidad en un requisito primordial. A continuación, se expondrán tres situaciones de salud complejas descritas en canciones de salsa, en las que se analiza las emociones humanas subyacentes, como una invitación a explorar el currículo oculto detrás de la enfermedad vista objetivamente. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2243).
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Romper com o modelo biomédico é necessário, e o ponto inicial pode vir com a compreensão da narrativa do usuário ou da usuária. Este estudo buscou avaliar a compreensão de estudantes de medicina das narrativas de adoecimento, utilizando a entrevista McGillIllness Narrative Interview (MINI). Trata-se de estudo exploratório, descritivo e qualitativo, realizado durante cinco semanas com 11 estudantes do quinto ano de uma universidade privada, no internato de Medicina de Família e Comunidade, que prestavam atendimento a 29 pessoas usuárias de unidades de saúde. Por meio de encontros individuais on-line, foram levantadas questões sobre essa experiência. Os relatos foram inseridos em núcleos argumentais, o que possibilitou o estabelecimento de relações com o referencial teórico da Medicina Narrativa, da Antropologia Médica e da Clínica Ampliada. Para os alunos e alunas houve uma nova experiência de entrevista clínica, uma valorização da narrativa e o desejo de incorporar uma abordagem mais ampliada à sua prática, embora não contemplem incorporar o MINI na sua forma integral, atribuindo a isso dificuldades na rotina médica. Acreditamos que o MINI pode colaborar com a aquisição de competências interpretativa e narrativa em estudantes, embora o ensino esteja ainda, emparte, vinculado ao modelo biomédico.
It is essential to break with the biomedical model. The starting point for that can come from the understanding of patients' narratives. This study sought to evaluate medical students' comprehension of illness narratives using the McGill Illness Narrative Interview (MINI). This is an exploratory, descriptive, and qualitative study, carried out with 11 fifth-year students at a private university in the internship of Family and Community Medicine, for five weeks, involving the care of 29 patients in health units. Through individual online meetings, questions were raised about the experience.The reports were inserted into categories, which allowed us to establish relationships among the theoretical referential elements of Narrative Medicine, Medical Anthropology, and Expanded Clinic. It was a new experience of clinical interviews for the students, with a new appreciation of narratives and a desire to incorporate a more extended approach to their practice, although they do not contemplate incorporating the MINI in its full form due to difficulties in the physician's routine. We believe that MINI can collaborate with the acquisition of interpretative and narrative competence in students, although teaching is still partly linked to the biomedical model.
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Humanos , Estudantes de Medicina , Medicina Narrativa , Internato e Residência , Anamnese/métodos , Pesquisa QualitativaRESUMO
I apply Gloria Anzaldúa's "borderlands theory" to Jamie Cortez's Sexile, an HIV/AIDS prevention publication created as a first-person narrative of the journey of queer, trans activist Adela Vasquez who fled to the US from Cuba in 1980. I argue that Sexile is a borderlands text and operationalizes Anzaldúa's mestiza consciousness at various levels- ranging from the essence of the text and what its existence represents to the literary techniques used in the telling of Adela's narrative. In the first half of this paper, I explore Anzaldúa's borderlands theory and the ethos of Sexile as a text, including Vázquez's story as inherently a borderland narrative; as a product of democratized knowledge; the praxis of the text's creation; and the technology of the graphic novel. Throughout the second half, I look more closely at the content of the text using close reading to explore notions of the "borderland" represented throughout Adela's narrative. Through both its content and the praxis of creation, Sexile represents the power of graphic medicine in illustrating the nuances of narratives at the interstices of marginalized identities and captures the multitudes and ambiguities of trauma, loss, rebirth, kinship, and joy at the margins.
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Estado de Consciência , Narração , Cuba , Humanos , Conhecimento , LeituraRESUMO
Resumo: Introdução: Nas últimas décadas, mudanças importantes ocorreram nas ciências médicas, abrangendo desde a criação de novas condutas terapêuticas até reformulações de práticas relacionadas ao ensino, sobretudo no que concerne ao desenvolvimento de habilidades que promovam uma melhor relação entre o profissional de saúde e o paciente. Nesse contexto, a medicina narrativa (MN) surge como uma importante ferramenta transformadora da prática profissional na saúde por utilizar diferentes estratégias de comunicação para compreender as vivências dos indivíduos quanto aos seus processos de adoecimento. Objetivo: Este estudo teve como objetivo conhecer como a MN tem sido abordada no processo de ensino-aprendizagem nas graduações das profissões da saúde. Método: Trata-se de uma revisão integrativa da literatura, baseada na pergunta "Quais são os impactos do uso da MN no processo de ensino-aprendizagem nas graduações da área da saúde?". Foram incluídos artigos indexados nas bases de dados SciELO, LILACS, BVS e MEDLINE, publicados no período de janeiro de 2010 a junho de 2020 e disponíveis na íntegra. Resultado: Nove artigos foram selecionados e analisados, revelando que o uso e a aplicação da MN nas graduações das profissões da saúde são heterogêneos, com diferentes populações de estudo, metodologias de pesquisa, formas de abordagens e/ou cenário de aplicação. Contudo, a análise qualitativa evidenciou que a MN contribuiu de forma significativa para o processo de formação dos discentes e profissionais, estimulando o desenvolvimento de habilidades narrativas. Destacam-se a empatia na relação profissional de saúde-paciente, o respeito e reconhecimento da importância de outros profissionais da área no cuidado destinado à saúde e atitudes críticas e reflexivas nos cenários práticos, elementos que, na percepção dos sujeitos, só foram alcançados por meio do uso dessa abordagem. Conclusão: A formação do profissional de saúde requer competências narrativas que envolvem habilidades associadas à escuta e ao diálogo, bem como a capacidade de aprender e interpretar as vivências fornecidas pelos pacientes. No entanto, diante da escassez de estudos relacionados a essa temática, mais pesquisas são necessárias para melhor avaliar o uso dessa ferramenta como recurso didático nas graduações das profissões da saúde.
Abstract: Introduction: In recent decades, significant changes have occurred in the medical sciences, ranging from creating new therapeutic approaches to reformulations of practices related to teaching, above all, to develop skills that promote a better relationship between the health professional and the patient. In this context, narrative medicine (NM) emerges as an essential transforming tool in professional health practice because it uses different communication strategies to understand the experiences of individuals regarding their illness processes. Objective: This study aimed to knowing how in the teaching-learning process NM is addressed in undergraduate health care. Method: This is an integrative literature review based on the question "What are the impacts of the use of NM medicine in the teaching-learning process in undergraduate healthcare courses?". Publications in the form of complete articles were included, indexed in the SciELO, LILACS, BVS, and MEDLINE databases, published from January 2010 to June 2020, and full text available. Result: Nine articles were selected and analyzed, revealing that the use and application of NM in undergraduate health courses are heterogeneous with different study populations, research methodologies, forms of approaches and/or application scenarios. However, the qualitative analysis showed that the NM contributed significantly to training students and professionals, stimulating the development of narrative skills. Empathy in the professional health-patient relationship, respect, and recognition of the importance of other professionals in health care, critical and reflective attitudes in practical scenarios, elements that in the perception of the subjects stand out and were only achieved using this approach. Conclusion: The training of health professionals requires narrative skills that involve skills associated with listening and dialogue, as well as the ability to learn and interpret the experiences provided by patients. However, given the scarcity of studies related to this theme, more research is needed to better assess this tool's use as a teaching resource in undergraduate health.