 Your new post is loading...
|
Scooped by
Susan Myburgh
March 15, 2021 10:37 PM
|
This blog was written by guest Christine Haslett, Head of Primary at Dulwich College Shanghai Puxi, one of our partner schools. It first appeared on LinkedIn. How can we give students the tools that they will need to tackle problems that we don't even know about yet?
|
Scooped by
Susan Myburgh
March 15, 2021 10:36 PM
|
It is crucial for organizations to identify and develop their future leaders. This article highlights some of the key strategies in leadership development.
|
Scooped by
Susan Myburgh
March 15, 2021 10:35 PM
|
Unless you are reading this article by candlelight, you can thank Humphrey Davy, Warren de La Rue, and Joseph Swan.But you have probably only appreciated the man who never invented the light bulb —…...
|
Scooped by
Susan Myburgh
March 15, 2021 10:34 PM
|
Everyone's heard the saying in support of teamwork that two heads are better than one. But once you get the right heads together, how do you turn that group of people into a team?
|
Scooped by
Susan Myburgh
March 15, 2021 10:34 PM
|
High quality reading comprehension worksheets for all ages and ability levels. Teachers in the classroom and at home are sure to find our materials very useful. They are fun, colorful, educational, and provide factual information about interesting subjects.
|
Scooped by
Susan Myburgh
March 15, 2021 10:33 PM
|
Coding is becoming an essential skill for children. Here are reasons that showcase why coding classes for kids are important to develop them at early age.
|
Scooped by
Susan Myburgh
March 15, 2021 10:33 PM
|
Cognitive biases are unavoidable. They're something we all have to deal with. But with these strategies, you can minimize your susceptibility to them, and ultimately make more rational, objective decisions as an entrepreneur. March 15, 2021 5 min read Opinions expressed by Entrepreneur...
|
Scooped by
Susan Myburgh
March 15, 2021 10:32 PM
|
CRITICAL THINKING SKILLS AND MEANING IN ENGLISH LANGUAGE TEACHING...
|
Scooped by
Susan Myburgh
March 15, 2021 10:30 PM
|
Learn how to help students analyze, synthesize, interpret, and communicate the results of their inquiry during the fifth step in the ANSWERS inquiry process.
|
Scooped by
Susan Myburgh
March 11, 2021 6:27 PM
|
Learn how to turn numbers and spreadsheets into visual stories using data visualization. This post also includes 6 free courses.
|
Scooped by
Susan Myburgh
March 11, 2021 6:12 PM
|
Find out here if the qualifications you hold are at degree level or above.
|
Scooped by
Susan Myburgh
March 10, 2021 9:20 PM
|
Peter Woolfolk drops his best tips on media relations, crisis comms and delivering meaningful messages amid turmoil. When it comes to comms, Peter Woolfolk has done it all. Before founding Communications Strategies in 2004, Woolfolk served as a Clinton White House appointee in the U.S.
|
Scooped by
Susan Myburgh
March 10, 2021 9:19 PM
|
The impact of COVID-19 has forced companies to rethink their ways of working, with the rapidly changing circumstances pushing the workplace deeper into a state of flux — and it's arriving too early for many businesses out there.
|
|
Scooped by
Susan Myburgh
March 15, 2021 10:36 PM
|
Critical thinking is one of the most important competencies we can teach our children. Being a critical thinker helps children to navigate the world around them and understand their experiences in meaningful ways.
|
Scooped by
Susan Myburgh
March 15, 2021 10:36 PM
|
Unburdened by academic silos, SUTD is a pioneer in interdisciplinary education to nurture design innovators to develop human-centric solutions that better the world. Read more at straitstimes.com.
|
Scooped by
Susan Myburgh
March 15, 2021 10:35 PM
|
Image by 圆 张 from Pixabay If you’re a registered nurse seeking a new challenge – to make a difference using your experience and critical thinking skills for more income – you might want to consider launching your own business. Can you identify problems? Develop solutions? Coach or train others? Provide an insider’s perspective on medical issues? Yes, with your own business, you’d have more autonomy in your work and more income — if you do it right. But even with nursing experience, launching your own consulting practice would entail all-encompassing responsibilities and would be the toughest challenge you’ve ever faced. Life for entrepreneurs has its benefits, but it can be grueling. Why? You’d be a healthcare provider and a business owner, too. As an entrepreneur, forget about getting employee bonuses, raises, and benefits such as health insurance, retirement plan, daycare and tuition reimbursement. You’d have to be able to market and manage your business – actually, you must also be aware of the 11 best practices for new entrepreneurs. However, with savvy, hard work you could conceivably double your current salary. For many RN consulting services, the startup cost is low. Many successfully work from home in an office with a computer, printer and filing system. If your dream is to become a consultant, you must develop your vision plan. To realize your vision, focusing on the right details is a skill conducive in best practices in setting goals. Marketing is also important. Why do seemingly great marketing plans fail to yield the desired results? Well, one reason: Such plans don’t turn the ideas into reality because they’re not action-oriented. What counts is the scheduled specific footwork, and then tracking the results. There’s a second reason, quality of execution. So take the right steps for best results from your marketing plan. Social media takes huge amounts of time, not only to implement innovations, but to succeed. But you must think about attracting fans with your blogging, social media and PR. As in any business, it’s recommended you investigate liability insurance and register as a limited liability corporation (LLC) to legally protect your personal assets from business debt and to capitalize on tax deductions. But as a nurse taking nursing actions, an LLC does not automatically protect you against legal judgments. OK, so after all this you’re not dissuaded from going into business for yourself? Here are some business ideas: Nurse educator Opportunities abound away from hospitals. Nurse educators are hired by community clinics, public agencies, medical-device manufacturers, pharmaceutical companies, research firms, textbook publishers, and colleges. Note: Colleges would likely require an advanced degree. Stress relief and wellness coaching Globally, companies and hospitals are looking for ways to reduce health-care costs. But absenteeism, accidents, burnout and sickness are huge financial and staffing obstacles for them. Nurse health coach As the label implies, nurse health coaches provide coaching services. In addition, insurance companies minimize their costs by hiring health coaches to help policyholders stay healthy. Legal nurse consulting As a legal nurse consultant, you’d share your expertise and earn excellent hourly pay. Although it’s often best if you can negotiate a project retainer as opposed to hourly billing. Take for example, a legal nurse consultant. Such nurses function as health experts in legal cases. They help lawyers and other professionals – consulting on health-care matters, advising on medical charts and records, or explaining medical terminology. You might be hired to provide expert witness testimony. Caution: It’s advised that you first check out the American Association of Legal Nurse Consultants. Forensic nurse consulting Criminal defense attorneys, prosecutors and law enforcement agencies have all been known to hire forensic nurse consultants. Note: You can get certification and learn more about it at the International Association of Forensic Nurses. Nurse navigator If you enjoy paperwork in helping others, nurse navigators help patients understand insurance policies to get care they need and afford. Nurse practitioner With an increasing shortage of doctors and countless under-served regions, many states are hoping nurse practitioners will launch private practices to fill a growing void in healthcare. You should have considerable experience in nursing and ideally a post-graduate degree. Again, you’d face the same challenging obstacles as typical entrepreneurs — from startup expenses to cash flow issues. If you want to launch a full-scale nurse practitioner business, here are the basics you need to consider: 1. Management You should learn about business management, including market analysis. It’s vital that you research the patient demand in your area, and how you’ll get paid. 2. Business plan It’s best to develop a business plan. You’ll need marketing expertise to get patients. Referrals are important. In addition to individual patients, you can contract your services for local businesses, jails and long-term care facilities. You’ll also need to decide how you’ll manage your financials, implement medical coding and billing, manage employees, pay taxes, and manage the risks faced by your practice. As a provider, especially in low-income or under-served regions, you’ll need to consider Medicaid and Medicare enrollment. Don’t forget about your firm’s health insurance, as well as malpractice and liability insurance. 3. Regulations and licensing You should allow at least a year for planning. That would include negotiating third-party insurance reimbursement contracts, possible hospital privileges and obtaining all necessary state licensing as a nurse-practitioner firm and business. Your authority for prescriptions will depend on your state. Licensure in your state might require you to negotiate collaborative agreements with doctors in your locale to establish a private practice. Of course, you’ll have to limit your practice to your expertise — areas in which you’re certified and credentialed. In conclusion, this is not intended to be a comprehensive list of tips, as each situation is different. For more information, see the American Association of Nurse Practitioners. From the Coach’s Corner, see these related tips: The 6 Most Important Steps for Success as a Consultant — In order to succeed as a consultant, bear in mind it’s a challenging occupation. It entails a lot more than just being knowledgeable and providing good counsel. Sales, Networking Strategies to Build Strong Relationships — Knowledge has always been essential for success. But the ability to sustain strong relationships was and is both gratifying and important for success. Here are tips for strong sales and relationships. 19 Best Practices in Due Diligence for Profitability — To lead your company to high profitability – and to stay there – due diligence is needed in critical values. Checklist: 21 Top Marketing Tips for New Entrepreneurs — Would you like to be your own boss? Are you gainfully employed but have a great entrepreneurial idea? Why not start a new business? Here’s what you need to know about marketing. Checklist – 10 Legal Basics for New Entrepreneurs — Thinking about legal matters can be tedious when you have a lot of details on your plate. But laws and regulations are important. 6 Keys for Successfully Launching a Business Startup — It’s important to imagine success as an entrepreneur while making sure it’s not a pipe dream. Business owners have all kinds of stress. The stress list is long: Fuel, energy and utility costs; taxes, regulatory costs; insurance costs; labor costs, banking fees, product development costs, capital expenses and facility costs. Checklist to Increase Your Startup’s Cash Flow — It’s true that cash flow is the salient dynamic that leads to the failure or success of a business. Whether your new company’s performance is stagnant or you’re growing quickly, cash flow is paramount. There are at least 11 ways you can increase cash flow for your business to function properly. “To make a difference in someone’s life, you don’t have to be brilliant, rich, beautiful or perfect. You just have to care.” -Mandy Hale __________ Author Terry Corbell has written innumerable online business-enhancement articles, and is a business-performance consultant and profit professional. Click here to see his management services. For a complimentary chat about your business situation or to schedule him as a speaker, consultant or author, please contact Terry.
|
Scooped by
Susan Myburgh
March 15, 2021 10:34 PM
|
Become a. Code Ninja. At hundreds of our centers worldwide, kids learn to code in a fun, safe, and inspiring learning environment, with a game-based curriculum ... Find a Center About Locations FAQ Covid-19 Update Code Ninjas is a fun & inviting place where kids learn to code by building video games. Kids have a blast while learning coding, math, logic, and teamwork. 3886 Followers, 317 Following, 495 Posts - See Instagram photos and videos from Code Ninjas (@codeninjas) Code Ninjas | 4 173 abonnés sur LinkedIn. Kids have fun, parents see results.R | Code Ninjas® is the world's largest and fastest-growing coding franchise. 5 sept. 2020 · Code review gurus look for them in test tasks. Novice developers sometimes use them even better than programmer ninjas. Read them carefully ... One-letter variables · Soar high. Be abstract. · Smart synonyms · Reuse names 4 févr. 2020 · Code Ninjas teaches kids problem-solving and critical thinking skills through building video ...Durée : 3:04 Postée : 4 févr. 2020 Coding Ninjas is a one stop destination for understanding data structures and building algorithms from scratch.With great quality online content and video support, ... Recherches associées Code Ninjas - Roblox Code Ninjas twitter Code Ninjas Calgary Code Ninja Naruto Code Ninjas reviews Code Ninjas UK Code Ninjas discount
|
Scooped by
Susan Myburgh
March 15, 2021 10:34 PM
|
The buzz around data science has sent many youngsters and professionals on an upskill/reskilling spree. Prof. Raghunathan Rengasamy, the acting head of Robert Bosch Centre for Data Science and AI, IIT Madras, believes data science knowledge will soon become a necessity.
|
Scooped by
Susan Myburgh
March 15, 2021 10:33 PM
|
Critical thinking is the ability to think rationally and clearly about solving a problem. Critical thinking can be improved by solving brain teasers.
|
Scooped by
Susan Myburgh
March 15, 2021 10:33 PM
|
Top Arts Grants is a collection of resources on the grants awarded to Arts Organizations in the United States.
|
Scooped by
Susan Myburgh
March 15, 2021 10:31 PM
|
Background: Heartland Alliance is one of the world’s leading anti-poverty organizations, working in communities in the U.S. and abroad, while serving those who are homeless, living in poverty, or seeking safety, by partnering with communities to break cycles of poverty and inequality. The organization is comprised of five nonprofit corporations that provide a comprehensive array of services in the areas of health, housing, economic opportunity, safety, and justice. Additionally, the organization leads state and national policy efforts that target lasting change for individuals and society. The Research & Policy Division was established in 1989 to address the root causes of poverty and inequity. The division’s teams work individually and together to advance social and economic change in to further our mission of equity and opportunity for all. Our core areas of work include research and evaluation, data analytics, policy and advocacy, government affairs, technical assistance and field building, and innovation. We center the experiences of our program participants and people with lived experience in the systems we are trying to change, and we impact well over 4 million individuals’ lives annually through policy and systems change efforts. Our policy advocacy work advances proven solutions to poverty at the local, state, and federal levels. We lead by developing policy proposals, building strategic alliances, and pursuing legislative and administrative action. Our policy areas and subject matter expertise include criminal legal system reform, health care access, and economic security and financial justice. Our goal is to pass and implement research-driven, meaningful policy and systems change efforts that strengthen communities and advance equity. Summary: Heartland Alliance is seeking a policy and advocacy professional to lead its health policy work. This person will play a central role in Heartland Alliance's groundbreaking efforts to advance policy solutions and strategies to eliminate poverty and realize equity and human rights. The Senior Project Manager is responsible for advancing key initiatives and campaigns to promote healthcare systemic reform – in particular improving people’s access to healthcare and behavioral health - and address racial inequities. The Senior Project Manager develops and implements strategies to advance change, and engages in policy analysis and development, coalition and campaign building, and direct advocacy with decision-makers. Legislative and administrative initiatives will include work related to Medicaid expansion, healthcare services, and mental and behavioral health supports, such as addressing the opioid crisis. Our policy team members are also expected to contribute to the communications and outreach efforts related to their work, as well as the overall work of the Policy and Advocacy team. Travel to Springfield, Illinois is required for this position when pandemic-related restrictions are lifted in the State of Illinois. Essential Duties and Responsibilities: Lead Heartland Alliance’s strategies to address inequities of the healthcare system and to provide solutions that center people with lived experience of struggling to make ends meet and having unmet health needs. Develop legislative and administrative policy proposals and lead efforts to successfully advance those efforts. Develop and lead successful advocacy strategies for educating policymakers and other decision makers about the health-related needs of people impacted by poverty and inequity. Analyze state and national public policies, programs, and legislation for their impact on people experiencing poverty and inequity. Provide policy information and analyses, both verbally and in writing, to agency leadership, policymakers, advocates, the general public and other stakeholders. Execute strategies to advance legislative and administrative change by building relationships with legislators and other key decision-makers, educating legislators and other decision-makers about policy initiatives, and collaborating with advocacy partners toward policy and administrative change. Contribute to the development and delivery of appropriate communications strategies for the Policy & Advocacy team, including fact sheets, policy briefs, action alerts, website and new media content, letters to the editor, and other written materials. Develop strategic partnerships with allied individuals, coalitions, and organizations to pursue specific program and policy changes affecting people directly impacted by a lack of access to healthcare or having unmet health needs. Develop relationships with policymakers, funders, community leaders, public audiences and other stakeholders to create champions and community support for key Heartland Alliance policy and administrative initiatives. Represent Heartland Alliance externally at events, speaking engagements, trainings and presentations, with policymakers, community leaders, and other key stakeholders and, when appropriate, contribute to or lead efforts to develop those trainings and presentations. Identify and support community members, allies and experts to give testimony at key hearings and act as spokespeople with the press. Participate in key national, regional, and local meetings and working groups as they relate to specific legislative and administrative initiatives. Collaborate with Heartland program staff to identify policy/systems barriers, identify macro-level solutions, and contribute to overall advocacy activities in support of Heartland Alliance priorities. Supervise coalition managers, policy associates, or interns or other temporary employees that support health policy work. Integrate values of equity and inclusion throughout our health policy work. Prioritize engagement of impacted populations throughout our policy and advocacy work from conception to design to action. Collaborate with internal Heartland Alliance teams and stakeholders to intergrate this work into the oranization’s and division’s ongoing strategy development work. Support fundraising efforts including contributing to funder reporting requirements. Other duties as assigned. Qualifications: Wondering whether you have the right credentials or background to apply? The truth is, we don’t care where you went to school or what your connections are. We value lived experience. We are looking for people who care about addressing poverty and fighting for equity, and who have experience doing great policy work. Experience working in coalitions is a plus, as is familiarity with the Illinois legislature and politics. Here are other traits and standards we value: Commitment to Human Rights and Equity: We are looking for people who are passionate about ending poverty, advancing racial and gender equity and justice, reforming the healthcare system, and ensuring basic human rights for all. We are looking to see these values exhibited in your life and experiences, both personal and professional. Curiosity and Eagerness to Learn: The best advocates ask good questions, dig deep to understand the details of complex issues, and are always learning and growing. We are also looking for evidence of the following types of skills. These may be acquired through lived experience, education, and/or employment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Project Management Skills: We are looking for someone with strong organization skills and the ability to manage multiple assignments under deadlines. This person will have a demonstrated capacity for working in a collaborative environment, while still working independently with a high degree of initiative. Coalition Building Skills: We are looking for someone who can develop and manage relationships with diverse partners, build coalition buy-in, develop coalition strategy, and execute and organize coalition activities for advocacy purposes, including meetings, communications, canvassing, and lobby days. Critical Thinking Skills: We are looking for someone who is a ble to analyze and creatively solve the factors contributing to social problems. Language/Communication Skills: We are looking for a demonstrated ability to speak and write persuasively to a range of audiences. We are looking for the ability to respond to inquiries from stakeholders, regulatory agencies, senior-level policymakers, or elected officials; communicate effectively with diverse audiences; write speeches and articles for publication that conform to a prescribed style and format; and effectively present information to senior leaders, public groups, and at public hearings. Technical Skills: Proficiency with skills in word processing, spreadsheets, Internet, and social media. Familiarity with Microsoft Office package. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel and reach with hands and arms The employee is regularly required to sit, stand and walk The employee must occasionally lift and/or move up to 10 pounds. Due to computer usage, the employee will need vision abilities such as close vision and ability to adjust focus. This position involves significant travel. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Travel is required, including overnight stays The noise in the work environment is moderate Heartland Alliance makes all hiring and employment decisions without regard to race, creed, color, age, gender, gender identity, marital or parental status, religion, ancestry, national origin, physical or mental disability, sexual orientation, sexual identity, immigrant status, political affiliation or belief, criminal justice involvement (depending on the offense and position to be filled), unfavorable military discharge, membership in an organization whose primary purpose is the protection of civil rights or improvement of living conditions and human relations, height, weight, or HIV infection, in accord with the Organization's AIDS Policy Statement of September, 1987. Individuals with disabilities requiring accommodation should contact the Employee Services Office at (312) 660-1431.
|
Scooped by
Susan Myburgh
March 15, 2021 10:30 PM
|
Critical Thinking is the Lifeblood of the Most Essential Workplace Skills.
|
Scooped by
Susan Myburgh
March 11, 2021 6:13 PM
|
Teens In Action™ Now Accepting Applications for the Teens In Action™ 2021-2022 Program Year! Application Deadline: Friday, June 11, 2021 at 11:59 p.m. Join a youth leadership program where you can make a difference in the Tampa Bay community and earn 80+ service hours! Please read the criteria and guidelines for the program before submitting your application to ensure you can meet the requirements. Learn More and Apply Now Civic Engagement & Leadership Program Teens In Action™ is a 10-month civic engagement and leadership program grounded in social and emotional learning (SEL). Teens In Action’s 9th-12th grade participants from schools across Hillsborough County engage in SEL workshops with insightful guest speakers to equip them with the emotional intelligence skills necessary for personal, academic, and professional success. The teens then apply these skills through weekly volunteerism, enriching both the community and themselves. Community Service Participating teens earn 80+ community service hours that can be used toward a Bright Futures Scholarship. Teens select a partnering service site in their field of interest to volunteer at on a weekly basis, applying the emotional intelligence skills learned at monthly workshops. Ultimately, participants develop a deeper level of empathy for others and leadership skills to carry forward to college and beyond. In addition to weekly community service at their site (Tier 1), teens have optional but encouraged opportunities to provide additional, ongoing service to the community (Tier 2), and to support one-time events needing volunteers (Tier 3). These events provide ample opportunities for teens to earn community service hours while applying the skills of emotional intelligence for the benefit of our community. Building Crucial Life Skills Teens In Action™ is supported by data. At the beginning of each program year, Teens In Action™ participants evaluate themselves in a survey about key social and emotional competencies. The teens then complete the same survey as a post-assessment after they graduate. According to teens’ self-reports from the 2019-2020 program year: 65% of teens improved their self-management skills (such as using calming strategies, showing resilience, and taking initiative) 65% of teens improved their social awareness (such as listening to others and understanding how others think and feel) 70% of teens improved in relationship skills (such as solving problems with others, expressing disagreement in constructive ways, and working well in teams) Capstone Service Project The Capstone Service Project is an all-team initiative that gives Teens In Action™ participants the opportunity to work toward a common goal as a group. This culminating service project gives teens experience in both planning and execution, allowing them to apply the knowledge and skills they have acquired throughout the year to give back to the community. “Teens In Action really encourages you to be a leader and to be an effective one. The leadership skills I’ve gained will help me throughout my career.” “I have learned a lot about social and emotional learning through TIA, and I am sure that all competencies will help me in my career and life in general. Self-management, social awareness, self-awareness, decision making, and relationship skills are all crucial to a successful career.” “Teens In Action has helped me grow as a person by constantly challenging me to be a better version of myself. I have learned new ways to communicate with adults and I have also found my love for volunteering.” “Teens In Action has helped me grow so much in my leadership skills. I have learned how to effectively communicate with a larger group while also listening to everyone’s input. My work in the Capstone Service Project has taught me how to take initiative to meet deadlines and stay on task. Finally, I learned how to be more confident in front of big groups and really have stepped out of my shell.” “The thing I valued most about Teens In Action this year was the incredible guest speakers at our… workshops. It was such a privilege to hear from some of the most hardworking, compassionate people in the Tampa Bay Area.” “My favorite part about Teens In Action is getting to connect with so many people in our community outside of my normal group. I love getting to know all the Teens In Action members, especially since some of them don’t go to the same school as me and I otherwise would not have met them. I especially love getting to connect with the children from [my service site] on a personal level and watch them develop socially and emotionally throughout the year.” “One way Teens In Action has helped me grow academically is through the many tips we have learned for stress management through workshops. I have learned tips to deal with stress from school such as going on walks, keeping a journal, listening to music, and more. I use these tips every day at school whenever I feel overwhelmed with tests and homework.” “Teens In Action has helped me in a multitude of ways such as expanding my comfort zone, strengthening my leadership skills, and making new connections with different people. Becoming a team lead has helped me learn many different leadership skills that I had previously lacked, and I have confidence that I will carry those skills with me outside of Teens In Action and in real-life applications.” “Teens In Action has helped me grow academically by teaching me new ways to deal with my problems. If I encounter a problem with school, I now have better strategies to solve it and, if need be, talk to my teachers with respect.” “Teens In Action has helped me become a more personable leader. I’ve always had the kind of attitude to go out and take control, but Teens In Action has taught me to do it in a respectful manner and has taught me to lead through involvement and example.” Learn More and Apply Now Learn More About Teens In Action™ Contact Us
|
Scooped by
Susan Myburgh
March 10, 2021 9:22 PM
|
Perm J. 2011 Fall; 15(4): 92–94. Published online Fall 2011. PMCID: PMC3267572 PMID: 22319427 Humanity before Science: Narrative Medicine, Clinical Practice, and Medical Education Samir Johna, MD and Simi Rahman, MD This article has been cited by other articles in PMC. A patient saw a physician for the first time. The physician wanted to learn everything about the new patient, and listened attentively without interruption. The patient paused after a while and wept. When asked why, “No one let me do this before,” was the response.1 There is growing public opinion that the current medical care has lost its human aspects, widening the gap between patients' expectations and physicians' performance. Many forces today restrict physicians' ability to reflect on their clinical experiences and relationships. The marketplace speeds up medical work, interrupts continuity with patients, and erodes the autonomy of the physician-patient relationship.2 The current revolution in technology of medical informatics complicates matters further. The cut-and-paste functions of electronic medical records undermine the psychological and therapeutic value of face-to-face personal and compassionate encounters between physicians and their patients. This transformation in the physician-patient relationship did not take place overnight. Modern American medical education in charge of preparing future physicians was transformed by Flexner's report in 1910. Flexner was chosen by the Carnegie Foundation for the Advancement of Teaching to head up a commission to assess medical education in the US.3 Flexner narrowly defined the proper goals of medicine as the “attempt to fight the battle against disease.”4 He argued that the future of pathology, therapeutics, and medicine depends upon those trained in the methods of natural science. Clinicians must be “impregnated with the fundamental truths of biology,” ignoring the human aspects of the disease in favor of biology and natural science. But we know that patients are not just bodies, organs, and tissues. They live meaning-centered lives, and they have complicated emotional and historical relationships with their bodies.5 Flexner's vision of medical education created physicians richly sophisticated in biologic variables and interventions, but all too often they lost touch with the human aspects of health care and the basic tenets of clinical encounters with their patients.5 To understand the gap between patients' expectations and physicians' performance, one must make a distinction between disease and illness.6 Medical philosophers turned to “phenomenology” to better understand the meaning of illness and the moral core of healing.5 Illness is the innately human experience of symptoms and suffering, whereas disease is the clinical perspective of the problem. Flexner's model addresses the alteration in biologic structure and/or function, ie, disease without addressing the psychological and social variables of a disease, ie, illness. This fact was already well recognized in the 1970s when resistance to the Flexner's report started to surface. Wounded Humanity As such, illness, as explained by Pellegrino, is an altered state of existence arising out of an ontologic assault on the humanity of the person, resulting in the “wounded humanity.”7 An ill person suffers four elements: the loss of freedom to act because of bodily impairment, the lack of needed knowledge to make rational steps toward recovery, the loss of some degree of autonomy resulting in more dependence on others, and the transformation of self-image to adapt to the new situation. The patient's wounded humanity, rather than being a secondary aspect of the clinical encounter, must become the cornerstone of the healing relationship. The only way the physician can legitimately enter into a healing relationship is through the understanding of wounded humanity. Tending to biologic variables is one, and only one, part of it. To Pellegrino, “if the professional does not consciously remedy the four deficiencies that impair the patient's expression of humanity, his ‘profession’ is inauthentic.”8 The wounded humanity is the core of any healing relationship between physicians and their patients. Physicians have recognized the need for patient-centered care, which they have attempted to address through various forums. The Schwartz Center Rounds is one example that fosters enhanced communication, teamwork, and provider support.9 The impact on measured outcomes increased with the number of rounds attended. Such rounds may enhance relationship between physicians and their patients.9 Another example is the Balint group, which probes into what evokes unexpected feelings among patients such as anger, fear, frustration, irritation, etc. Such discussion may facilitate an understanding of the physician-patient relationship.10 Narrative Medicine Narrative Medicine on the other hand, is born through contemporary efforts to rehumanize medicine; to counterbalance the many problems of Flexner's model; and to recognize, absorb, interpret, and be moved by stories of illness.11 The human capacity to understand the meaning and significance of stories is being recognized as critical for effective medical practice. Both patients and physicians find some comfort in storytelling. Patients find words very helpful to contain the chaos of illness and enable them to endure it better.12 Physicians, on the other hand, find writing about patients and themselves confers on medical practice a new understanding that is otherwise unobtainable.13 No wonder Narrative Medicine has been thriving over the past several years and is currently reflected in many genres. Stories from medical practice published in reputable medical journals such as “On Being a Doctor” in the Annals of Internal Medicine, and “A Piece of My Mind” in the Journal of American Medical Association. Other genres include writing exercises of medical training, medical fiction, lay exposition, and medical autobiography.2 But does Narrative Medicine hold the answer to the current crisis in the physician-patient relationship? Does storytelling really work? What evidence, if any, supports the positive impact of Narrative Medicine on patient care, clinical practice, and medical education? There is a growing body of literature, though mostly qualitative, suggesting that Narrative Medicine does affect patient care. When a physician practices medicine with narrative competence, s/he can quickly and accurately hear and interpret what a patient is trying to say. Such a physician uses the time of a clinical interaction efficiently, wringing all possible medical knowledge from what a patient conveys about the experience of illness and how s/he conveys it. Also, as physicians describe the emotional and personal aspects of the care they deliver to particular patients, it helps them to comprehend their patients' ordeals as well as their own lives with the sick.1,14 In the effort to help physicians understand what they and their patients experience in the presence of illness, medical educators have been paying increasing attention to narrative competence, defined as the set of skills required to recognize, absorb, interpret, and be moved by stories. Unfortunately, as early in medical training as anatomy class, students learn that patients are predominantly defined by their bodies whereas physicians are defined by their scientific minds. It is also in the training process that such attitudes as professional detachment are learned. Although the field of medicine is dedicated to the examination, diagnosis, and treatment of bodies, the relationship of physicians to their own physicality is poorly understood, if not willfully ignored.15 DasGupta and Charon argue that traditional medical training teaches students that what lies below their white coats is irrelevant to their physicianhood.15 Furthermore, a physician whose body becomes relevant may risk losing his or her identity as a physician. In the case of physicians who are themselves struggling with illness, “the dichotomy of being both a doctor and patient threatens the integrity of the club. To this fraternity of healers, being ill is tantamount to treachery.”16 Physicians' literature is rife with descriptions of physicians continuing to perform medicine while ill themselves. Yet, there is an alternate literature of physicians' transformations through personal illness in which these physicians' experiences were not only because of the physical reality of illness itself but also to the role-reversal that forcibly thrust the hitherto mind-defined physicians into their very real bodies. In the process of witnessing, interpreting, and translating their own illness experiences, these physicians become better able to listen empathically for the stories of their patients.17 Physicians … find writing about patients and themselves confers on medical practice a new understanding that is otherwise unobtainable. Empathy One of the most challenging tasks of medical education is teaching empathy. Empathy consists of three distinct components: a cognitive component in which the physician “enters” the perspective of the patient, an emotional component in which the physician puts himself or herself in the place of the patient, and finally, an action component in which the physician communicates understanding by checking back with the patient.17 In a small study involving medical students, DasGupta and Charon demonstrated that writing “personal illness narratives” allowed participants to benefit from reflective writing in a new way. Rather than maintaining a clinician's point of view, or adopting the point of view of an “other,” such narrative writings allow medical students to explore subjective experiences of illness. Furthermore, such experiences may critically inform the nature of students' professional caregiving. 15 Pearson et al tested the value of narrative writings during surgical residency. They demonstrated in a small study that the use of a narrative-based approach in surgical resident education has the potential to capture and measure the general competencies of system-based practice, practice-based learning, communication skills, and professionalism.18 Levine et al explored the value of prompted narrative writing in internal medicine residency. They concluded from a small study among interns that writing throughout the year resulted in reflection and encouraged interns to reconsider their core values and priorities. Some found that the exercise promoted greater self-awareness and provided an emotional outlet. Writing about difficult experiences coupled with reflection motivated some interns to want to improve.19 It seems from the available literature that Narrative Medicine is promising in addressing some of the flaws of Flexner's model of medical education, and may be the answer to the current crisis in the physician-patient relationship. Its impact extends beyond empathic and compassionate delivery of care to patients; it extends well into physicians' own wellness. Medical educators should consider incorporating narrative writings as early as medical school education and all the way into residency and fellowship education. Disclosure Statement The author(s) have no conflicts of interest to disclose. References Charon R. Narrative and medicine. N Engl J Med. 2004 Feb 26;350(9):862–4. [PubMed] [Google Scholar] Charon R. Narrative medicine: form, function, and ethics. Ann Intern Med. 2001 Jan 2;134(1):83–7. [PubMed] [Google Scholar] Starr P. The social transformation of American medicine. New York: Basic Books; 1982. pp. 118–21. p. [Google Scholar] Flexner A. Medical Education in the United States and Canada. A report to the Carnegie Foundation for the Advancement of Science. New York: Carnegie Foundation for the Advancement of Teaching; 1910. p. 23. p. [Google Scholar] Lewis BE. Narrative medicine and healthcare reform. J Med Humanit. 2011 Mar;32(1):9–20. [PubMed] [Google Scholar] Kleinman A. The illness narrative: suffering, healing and the human condition. New York: Basic Books; 1988. p. 3. p. [Google Scholar] Pellegrino ED. Being ill and being healed: some reflections on the grounding of medical morality. Bull N Y Acad Med. 1981 Jan–Feb;57(1):70–9. [PMC free article] [PubMed] [Google Scholar] Pellegrino ED. Humanism and the physician. Knoxville, TN: University of Tennessee Press; 1979. p. 127. p. [Google Scholar] Lown BA, Manning CF. The Schwartz Center Rounds: evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support. Acad Med. 2010 Jun;85(6):1073–81. [PubMed] [Google Scholar] Wilson H. Reflecting on the ‘difficult’ patient. N Z Med J. 2005 Apr 1;118(1212):U1384. [PubMed] [Google Scholar] Charon R. The narrative road to empathy. In: Spiro HM, Curene MG, Peschel E, St. James D, editors. Empathy and the practice of medicine: beyond pills and the scapel. New Haven, CT: Yale University Press; 1993. pp. 147–59. p. [Google Scholar] Smyth JM, Stone AA, Hurewitz A, Kaell A. Effects of writing about successful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: a randomized trial. JAMA. 1999 Apr 14;281(14):1304–9. [PubMed] [Google Scholar] Verghese A. My own country: a doctor's story of a town and its people in the age of AIDS. New York: Simon & Schuster; 1994. [Google Scholar] Valenti MP, Mehl-Madrona L. Humanizing patients through narrative approaches: the case of Murphy, the “ motor-mouth.” Perm J. 2010 Summer;14(2):47–50. [PMC free article] [PubMed] [Google Scholar] DasGupta S, Charon R. Personal illness narratives: using reflective writing to teach empathy. Acad Med. 2004 Apr;79(4):351–6. [PubMed] [Google Scholar] Rabin D, Rabin PL, Rabin R. Occasional notes. Compounding the ordeal of ALS: Isolation from my fellow physicians. N Eng J Med. 1982 Aug 19;307(8):506–9. [PubMed] [Google Scholar] Coulehan JL, Platt FW, Egener B, et al. “Let me see if I have this right ...”: words that build empathy. Ann Intern Med. 2001 Aug 7;135(3):221–7. [PubMed] [Google Scholar] Pearson AS, McTigue AP, Tarpley JL. Narrative medicine in surgical education. J Surg Educ. 2008 Mar–Apr;65(2):99–100. [PubMed] [Google Scholar] Levine RB, Kern DE, Wright SM. The impact of a prompted narrative writing during internship on reflective practice: a qualitative study. Adv Health Sci Educ Theory Pract. 2008 Dec;13(5):723–33. [PubMed] [Google Scholar] Articles from The Permanente Journal are provided here courtesy of Kaiser Permanente
|
Scooped by
Susan Myburgh
March 10, 2021 9:20 PM
|
As society is becoming more dynamic and unpredictable, preparing graduates for the workplace is today a challenge to higher education. It is widely acknowledged that students will need to acquire more than knowledge to navigate this complex world.
|