Monday, 10 June 2019

How Technology, Applied Storytelling, and Theatre can Humanise Values for Effective Practice





How Technology, Applied Storytelling, and Theatre can Humanise Values for Effective Practice

The pre-conference workshop will explore, illustrate and demonstrate how technology, applied storytelling, and theatre can nurture values for effective practice. The workshop will be highly interactive and experiential. From the use of simple storytelling techniques to more complex roleplays, participants will experience moments that promote reflection, and improve empathy, communication skills, teamwork, and professionalism.

A follow-up main conference panel discussion will go deeper into the literature and evidence underpinning the use of technology, applied storytelling, and theatre to humanise our values for effective practice. It will also involve the audience in interactive discussions, and a theatrical experience. Our aims for both the pre-conference workshop and main conference panel discussion are for participants to understand the pedagogical implications of applied storytelling and theatre in medical education, to immediately use and apply practical techniques in clinical setting, and to evoke feelings and convictions related to the session theme – to know, do, and feel.




Empathy is "seeing with the eyes of another, listening with the ears of another and feeling with the heart of another.” – Alfred Adler

"“In your career, you’ll have a choice: to be a physician or a healer. Be a healer.”

"Nurses are proof that superheroes live among us." - Tan Hsueh Yun, The Straits Times, Sunday, Jul 7, 2019 


Goh, P.S., Sandars, J. (2019). Using Technology to Nurture Core Human Values in Healthcare. MededPublish, 8, [3], 74, https://doi.org/10.15694/mep.2019.000223.1




















"Theoretical publications about narrative medicine in health education typically describe a pedagogic strategy consisting of three basic steps. The first step involves a reflective engagement with a patient narrative, literary text, film fragment, art work, or piece of music. ... . The insights gained during this engagement are reinforced in the second step of the pedagogic strategy by means of a corresponding writing assignment or personal reflection. The encounter is further enriched in the third step, which consists of sharing and discussing these small acts of self-reflection ... "
above quote from article below
M. M. Milota, G. J. M. W. van Thiel & J. J. M. van Delden (2019) Narrative medicine as a medical education tool: A systematic review, Medical Teacher, 41:7, 802-810, DOI: 10.1080/0142159X.2019.1584274



Kiosses, V.N., Karathanos, V.T. & Tatsioni, A. Empathy promoting interventions for health professionals: a systematic review of RCTs. J of Compassionate Health Care 3, 7 (2016) doi:10.1186/s40639-016-0024-9

Christiansen, Angela & O'Brien, Mary & Kirton, Jennifer & Zubairu, Kate & Bray, Lucy. (2015). Delivering compassionate care: The enablers and barriers. British journal of nursing (Mark Allen Publishing). 24. 833-7. 10.12968/bjon.2015.24.16.833. 




Technology to humanise values in healthcare from Poh-Sun Goh




...just 40 seconds needed to deliver a message of compassion...“We’re going to be here with you. We’re going to go through this together. I’ll be with you every step of the way.”
above quote from article below
https://knowledge.wharton.upenn.edu/article/the-compassion-crisis-one-doctors-crusade-for-caring/





"Fifty-two studies (total n = 5,316) met inclusion criteria. Most (75%) studies found that the tested curricula improved physician empathy and/or compassion on at least one outcome measure. We identified the following key behaviors to be effective: (1) sitting (versus standing) during the interview; (2) detecting patients’ non-verbal cues of emotion; (3) recognizing and responding to opportunities for compassion; (4) non-verbal communication of caring (e.g. eye contact); and (5) verbal statements of acknowledgement, validation, and support. These behaviors were found to improve patient perception of physician empathy and/or compassion."
above from article below




















Technology to Nurture Values for Effective Practice
Poh-Sun Goh

(Why before What and How)

How can technology inspire, role model, promote reflection and interactive discussion, and offer a roadmap on how to nurture values for effective practice?

We are inspired by stories. These may be told or recounted orally, in written form, performed (as a simulated performance, in theatre or the media - video, television or the movies), observed in person or from video - all of these with added reflection, which may be guided or as an interactive peer review, learning and insight developing exercise.

These stories may mimic, or be a record of real life. Professional practice, health and disease, and healthcare, are replete with narratives of suffering, comfort, and joy. These can be told from a patient’s, relatives, caregivers or professional healthcare practitioner (or member of the healthcare team’s) perspective. Or from multiple perspectives. An example of a narrative-story which gives insight into how a professional in the palliative care sector-practice might approach dying patients was recently published in the New York Times (Puri, 2019). The ending scene from the 1991 movie ‘The Doctor’ illustrates how an initially insensitive, emotionally distant medical practitioner develops a very personal insight into the perspective of the healthcare system when he himself became a patient, and was motivated to introduce a patient centred experience for medical students in his medical school’s medical program. The book ‘A taste of my own medicine: When the doctor is the patient’ by Edward E Rosenbaum in 1991 narrates a similar story.

While not only engaging, and thought provoking, these narratives and stories can encourage all of us to reflect on our roles in health and disease. As healthcare practitioners to improve our empathy, communication skills, teamwork, organisational abilities and professionalism. We can become more sensitive to a patient’s, or relative’s-caregiver’s point of view. We can become better at showing first that we care, to reassure, comfort, and communicate better. With more skill and sensitivity. To give attention to the the human side of medicine, to complement the scientific and technical side of medical practice.

Technology is one method to disseminate and share stories and narratives (Goh, 2016). To scale up our educational and training efforts. To engage students and practitioners beyond the classroom. Before, during and after traditional classroom training. We can use open source content, and low cost-free platforms to communicate with, and engage our students, and fellow practitioners. Technology makes it easier for us to create and curate content. And share this. Through websites, blogs, apps. Mobile devices with free and low cost, easy to use software and apps make it relatively simple and easy to create and edit, or curate multimedia, and video content.


We can think of a spectrum of realism to abstraction, from real life, through VR, interactive theatre, video and multimedia, audio narratives and podcasts, illustrations and photos, through written narratives, stories and texts. A complementary range of technologies ranging from most expensive and complex to “low tech” would have VR and AI on one end, through theatre, video, multimedia, audio and written narratives shared through mobile applications or Apps, websites and blogs. Examples of the use of technology to nurture core values are listed in section below.



As with all use of technology to enhance, and augment our educational and training efforts, these efforts should be driven first by our instructional and educational objectives, or pedagogy before technology. With no tech, or low cost, open source, free technology and platforms then carefully and intelligently chosen to support, and augment our teaching and learning objectives.


References

Goh, P.S. A series of reflections on eLearning, traditional and blended learning. MedEdPublish. 2016 Oct; 5(3), Paper No:19. Epub 2016 Oct 14.

Puri, S. 2019. The lesson of impermanence. New York Times. Published and accessed on 7 March 2019.


Movie ‘The Doctor’ 1991

Review of ‘A taste of my own medicine: When the doctor is the patient’ by Edward E. Rosenbaum
https://journals.lww.com/plasreconsurg/citation/1991/03000/a_taste_of_my_own_medicine__when_the_doctor_is_the.41.aspx#pdf-link

Robert G. Picard (2015) The humanisation of media? Social media and the reformation of communication, Communication Research and Practice, 1:1, 32-41, DOI: 10.1080/22041451.2015.1042421
https://www.tandfonline.com/doi/full/10.1080/22041451.2015.1042421


Opening Comments

Welcome to this session, titled how Technology, Applied Storytelling and Theatre can Humanise Values for Effective Practice

We feel strongly that the theme of this years conference (APMEC 2020), and topic of this session, addresses an aspect of professional practice, education and training that has been relatively neglected to date.

We will examine this topic by reviewing the illness journey that all of us will undergo, as patients, relatives, healthcare practitioners and educators. We are healthy, then become ill. This may be a minor or major illness, requiring outpatient or inpatient care. We will recover, suffer chronic illness, and disability, or proceed to become critically ill, possibly require palliative care, and at some point die.

Let us examine this illness journey from several viewpoints. By posing a series of questions, and getting you to reflect on this, and discuss this as a group.

We hope to start by raising awareness, getting you to feel and experience the emotional impact of these questions, so that you might refine your professional practice, training and educational designs, to assist future patients and their relatives, as well as our junior colleagues and students.

What are these questions?

Is this a serious or minor illness?
Will I recover?
What is the prognosis?
Will I suffer?
Will it be painful?

As we reflect and discuss these questions, notice that these questions and concerns are not only universal, but reflect a very human, personal, and emotional reaction to illness.

Our patients and relatives require acknowledgement, empathy, reassurance. Their fears and concerns recognised, acknowledged and addressed.

Edmund will now take over, to lay the background of the use of storytelling and theatre in facilitating this process, and to guide us through an interactive, experiential journey.


Google search for "Art and illness"

https://journals.sagepub.com/doi/pdf/10.1177/1363459310397972

http://www.bbk.ac.uk/art-history/research/visualising-illness

https://www.folio.ca/psychiatry-student-uses-art-to-shed-light-on-the-darkest-shades-of-illness/

https://brocku.ca/brock-news/2019/02/event-to-explore-bodies-and-illness-through-art-and-literature/

Google search "using VR and AR for promoting empathy in illness"

Learning Empathy Through Virtual Reality: Multiple Strategies for Training Empathy-Related Abilities Using Body Ownership Illusions in Embodied Virtual Reality

Schoeller, F., Bertrand, P., Gerry, L. J., Jain, A., Horowitz, A. H., & Zenasni, F. (2019). Combining Virtual Reality and Biofeedback to Foster Empathic Abilities in Humans. Frontiers in psychology, 9, 2741. doi:10.3389/fpsyg.2018.02741


Examples of Digital Content that can be Shared, and Technology Used to Build Empathy and Compassion

Text (quotes) - Short quotes can be memorable, easily shared, and convey the essence of an idea in brief.
“Empathy is seeing with the eyes of another, listening with the ears of another and feeling with the heart of another.” – Alfred Adler

"“In your career, you’ll have a choice: to be a physician or a healer. Be a healer.”


seek to "cure sometimes, treat often, comfort always" - Hippocrates
https://rebelem.com/hippocrates-osler-foam/

Narratives - form the essence of storytelling, conveying messages, contexts, and when presented well evoking an intended response
(for example regarding inequality)

Empathy courses within medical curriculum - can form the backbone of systematic instruction and guidance for medical students and healthcare practitioners
(example below)

Examples of Digital Content that can be Shared, and Technology Used to Build Empathy and Compassion

Text (quotes) - Short quotes can be memorable, easily shared, and convey the essence of an idea in brief.
Empathy is "seeing with the eyes of another, listening with the ears of another and feeling with the heart of another.” – Alfred Adler

"“In your career, you’ll have a choice: to be a physician or a healer. Be a healer.”

Narratives - form the essence of storytelling, conveying messages, contexts, and when presented well evoking an intended response
(for example regarding inequality)

Empathy courses within medical curriculum - can form the backbone of systematic instruction and guidance for medical students and healthcare practitioners
(example below)

Podcasts - take advantage of the qualities of the human voice and sounds to convey emotion and feeling, to move the listener
(multiple examples within blog below)
and

Illustrations and Art - the traditions of art, illustrations and photography to capture scenes of illness and healthcare can broaden the exposure and experience of healthcare practitioners to situations and points of view
and

Video - is a powerful visual and auditory medium that can be used to depict health and illness, and be easily shared on multiple mobile and online platforms
(for example facing depression in the elderly)


Theatre and Drama - being an audience member of live theatre and drama, viewing dramatisations of healthcare offer the opportunity to experience settings of healthcare and illness.

Matthiessen, Christian & Law, Locky. (2019). Dramatised Medical Consultations: What Are They Like and How Can We Use Them. 10.13140/RG.2.2.11929.88161.

Dow, A. W., Leong, D., Anderson, A., Wenzel, R. P., & VCU Theatre-Medicine Team (2007). Using theatre to teach clinical empathy: a pilot study. Journal of general internal medicine, 22(8), 1114–1118. doi:10.1007/s11606-007-0224-2

Reilly, J., Trial, J., Piver, D. E, & Schaff, P. B. (2012). Using Theatre to Increase Empathy Training in Medical Students. Journal for Learning through the Arts, 8(1). http://dx.doi.org/10.21977/D9812646 Retrieved from https://escholarship.org/uc/item/68x7949t

Bee Teng Lim, Helen Moriarty & Mark Huthwaite (2011) “Being-in-role”: A teaching innovation to enhance empathic communication skills in medical students, Medical Teacher, 33:12, e663-e669, DOI: 10.3109/0142159X.2011.611193





Video games - interactive video, online and mobile games can be designed as guided reflective exercises, to build empathy
(for example to build empathy in children)

Kral, T.R.A., Stodola, D.E., Birn, R.M. et al. Neural correlates of video game empathy training in adolescents: a randomized trial. npj Science Learn 3, 13 (2018) doi:10.1038/s41539-018-0029-6

Virtual Reality - has the ability to place the viewer in the healthcare and illness scenario, and has the unique ability to give the viewer an appreciation of the setting from the point of view of the participants



Dyer E, Swartzlander BJ, Gugliucci MR. Using virtual reality in medical
education to teach empathy. J Med Libr Assoc. 2018 Oct;106(4):498-500. doi:
10.5195/jmla.2018.518. Epub 2018 Oct 1.

Schoeller, F., Bertrand, P., Gerry, L. J., Jain, A., Horowitz, A. H., & Zenasni, F. (2019). Combining Virtual Reality and Biofeedback to Foster Empathic Abilities in Humans. Frontiers in psychology, 9, 2741. doi:10.3389/fpsyg.2018.02741

Artificial Intelligence - will have an increasing role in augmenting the impact of educators by scaling up our efforts to provide customised, personalised guidance and instruction


Touch - "Our sense of touch provides the most profound, deepest, emotional connection between people," Mr Rogers said in a statement.



Closing Comments

We hope this session has touched your hearts, and been a thought provoking, and positive experience.

We hope that by examining the emotional fears, concerns and experiences of our patients and their relatives through the illness journey has been an illuminating one.

We hope that the examination of the use of Technology, Applied Storytelling and Theatre to highlight, and examine very human, personal, and emotional issues has been helpful.

We hope you will go on to reflect upon, and refine your professional, educational and training practices. And that you will go on to use the ideas, approaches and techniques discussed to humanise our professional practice, and that of our colleagues and students.





'creativity and compassion - teamwork, communication, empathy, and winning trust'





























Hinnant, A., Len-Ríos, M. E., & Young, R. (2013). JOURNALISTIC USE OF EXEMPLARS TO HUMANIZE HEALTH NEWS. Journalism studies, 14(4), 10.1080/1461670X.2012.721633. doi:10.1080/1461670X.2012.721633

Snyderman R, Gyatso T the 14th Dalai Lama. Compassion and Health Care: A
Discussion With the Dalai Lama. Acad Med. 2019 Aug;94(8):1068-1070. doi:
10.1097/ACM.0000000000002709.

Thibault GE. Humanism in Medicine: What Does It Mean and Why Is It More
Important Than Ever? Acad Med. 2019 Aug;94(8):1074-1077. doi:
10.1097/ACM.0000000000002796.











Hinson, Katrina & Sword, Ben. (2019). Illness Narratives and Facebook: Living Illness Well. Humanities. 8. 106. 10.3390/h8020106. https://eandt.theiet.org/content/articles/2019/06/empathetic-technology-experiencing-life-through-the-looking-glass/


























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