ObjectiveReports from caregivers and other witnesses describe episodes of unexpected or paradoxical lucidity among adults diagnosed with dementia. However, until now, there has not been a representative national survey documenting its prevalence in the U.S. adult population. This study reports on (a) the prevalence of terminal or unexpected lucidity in adults diagnosed with Alzheimer's disease or other dementias, and (b) its distribution across sociodemographic characteristics and parameters of clinical cases.MethodData are from a nationally representative population-based survey of observers (N = 5940) of dementia patients, aged 40+, who experienced one or more episodes of unexpected lucidity.ResultsThe national prevalence of unexpected lucidity, according to observers, is 43.6% (weighted n = 2587). Episodes occur regardless of the age or sex of patients, parameters of the clinical case, or characteristics of observers.ConclusionFindings reveal that lucid episodes are not rare, but possibly a normative feature of the dementing process. If so, this has implications for clinical practice and ethical decision-making involving "deeply forgetful people."

BACKGROUND:There are limited comprehensive descriptions of character strengths and virtues specific to the professional identity formation of medical students in the literature. This absence of a satisfactory summation of virtues has stimulated us to attempt a conceptual framework utilizing a tripartite taxonomy. This taxonomy reflects recent interest in and importance of justice and care of the self. METHODS:Our taxonomy is grounded within a perennial tradition of medical ethics that focuses on the moral "excellences" or "virtues" that form the character of a good doctor, as acquired over time within a community of practice. Character refers to the whole set of excellences of a practitioner as a member of the medical community. RESULTS:We propose a tripartite taxonomical classification of virtues as Other-Regarding Virtues, Self-Regarding Virtues, and Equal-Regarding Virtues. Though synergistic, each category is readily distinguishable with regard to a fundamental mindset. To thrive, a medical student must develop character strengths that encompass all three categories. CONCLUSIONS:Our goal in introducing this tripartite taxonomy is to provide a framework of virtues to contribute to the definition of professional identity. We envision the taxonomy will provide a structure for professional identity formation curriculum development and organize the ever-elusive assessment of professionalism in learners. This taxonomy can also be viewed as an aspirational roadmap for practicing physicians and educators, and as a compass for their daily consciousness. We believe that this taxonomy will enhance the well-being and development of physicians and medical students, and the patients in their care.

Background: Even in severe states of Alzheimer’s disease and related dementias (ADRD), accounts of an unexpected or paradoxical return of awareness and lucidity have been reported in some patients, documented formally, and studied. Objective: A scoping review was undertaken to survey the literature on the topic. Methods: Five databases were searched using pertinent search terms. Results were deduplicated and subsequently screened by title and abstract for relevance. Remaining reports were read and included or excluded using specific inclusion criteria. 30 results consisted of a mix of perspective papers, case reports, qualitative surveys of caregivers, law journal comments, and mechanistic speculation. Results: An equal mix of primary and secondary research was identified. Conclusions: The papers collected in this review provide a valuable methodological outline for researching the topic of lucid episodes in ADRD. The verified legitimacy and simultaneous inexplicability of these events promote philosophical discussion, mechanistic investigations, and sorely needed research in the field of ADRD.

Background Compassionate care lies at the foundation of good patient care and is a quality that patients and providers continue to value in the fast-paced setting of contemporary medicine. Compassion is often discussed superficially in medical school curricula, but the practical aspect of learning this skill is often not taught using a formal framework. In the present work, the authors present an 8-session curriculum with a mindfulness-based approach to compassion that addresses this need. It is hypothesized that students in this curriculum will improve in their levels of compassion based on validated scales. Methods The curriculum was delivered to fourth-year medical students at Renaissance School of Medicine at Stony Brook University who had just completed their clerkship year. It was developed as a customizable set of modules that could be delivered in various ways. The students were taught with evidence-based cognitive exercises followed by group discussions and written reflections based on compassion-focused thematic questions. All students completed a pre- and post-Self-Compassion Scale, Compassion Scale, and Toronto Mindfulness Scale. Students in this course were compared with students in different courses about non-clinical topics delivered at the same time. Wilcoxon Signed Rank tests and Mann Whitney U tests were used to assess potential associations between pre- and post-survey responses for the validated scales and subscales. Results 17 fourth-year medical students completed pre- and post-course tests, 11 participated in the compassion curriculum while 6 participated from the other courses. Before any of the courses began, all students performed similarly on the pre-test across all scales. The students in the compassion curriculum demonstrated a significant increase in their total Self-Compassion score by 8.7 [95% CI 4.3 to 13.2] points ( p = 0.008), total Compassion score by 6.0 [95% CI 1.4 to 10.6] points ( p = 0.012), and the curiosity component of the Toronto Mindfulness Scale by 4.4 [95% CI 1.0 to 7.7] points ( p = 0.012). There was no statistically significant difference between pre- and post-tests among the non-compassion curriculum students in the aforementioned scales ( p = 0.461, p = 0.144, p = 0.785, respectively). Conclusions Our results indicate that the students in our course developed an enhanced ability to engage in self-compassion, to understand the shared human experience, and to be motivated to act to alleviate suffering. Regardless of a program’s existing compassion education, this customizable model allows for easy integration into a medical student’s crowded curriculum. Furthermore, although teaching compassion early and often in a clinician’s training is desirable, our study that targeted fourth-year medical students suggests an additional benefit of rekindling the loss of compassion well described in a medical student’s clinical years.

Empathic distress in medical trainees may evolve into burnout in the workplace. Medical trainees are particularly susceptible. To assist in the development and implementation of effective programs to combat empathic distress, a literature review of the various available interventions aimed at increasing compassion was conducted. An investigation into whether the mindfulness component offered any benefit to the medical trainee was also performed. Twenty relevant studies were identified and analyzed. The results indicated that interventions with a mindfulness-component were effective at improving trainee well-being and compassion, and may have an impact on burnout.

Background Despite the prevalence and challenge of Alzheimer's disease and related dementias, glimmers of hope arise during lucid moments. Caregivers, often burdened, play a crucial role. The study explored emotional responses to witnessed episodes of unexpected lucidity in deeply forgetful people, aiming to highlight the significance and varying reactions, especially among caregivers of this population. Objective The aim of this study was to elucidate how moments of unexpected lucidity are experienced by those who witness them, and to examine whether caregivers and non-caregivers, as well as different types of caregivers may have different emotional reactions to the episodes. Methods A probability-based sample representative of the United States adult population aged 40 and older with internet access was employed. 5944 respondents completed screening questions regarding whether they knew an individual with dementia and had witnessed unexpected lucidity. Close to 2000 individuals answered questions regarding their emotional reactions to witnessing unexpected lucidity, which we aimed to examine in more detail. Results Both caregivers and non-caregivers showed a tendency towards positive emotions in response to lucid episodes, yet negative emotions were also mentioned. We observed group differences (caregivers versus non-caregivers, different caregiver types) in the emotional responses for some of the examined emotions. Conclusions Caregivers can find inspiration in these fleeting moments. The research aims to guide caregivers and enhance the understanding of the enduring self-identity of deeply forgetful people, promoting compassionate care and recognizing the significance of our shared humanity.

This Viewpoint discusses the role of touch in medical tradition and its importance in medicine today.

BACKGROUND:Empathy and compassion currently receive the most attention in healthcare with respect to the medical humanities and while these skills are important for any clinician to learn, they are complex and can be daunting to healthcare trainees when first encountered. Kindness is a simple, time-sensitive behavior not yet well characterized in the healthcare setting. With this study, we aim to clearly define it as well as investigate a few common examples of kindness that might be used to create a scale for use in the healthcare setting.METHODS:A literature search was performed to rigorously define kindness. A kindness scale based on this definition was then compiled and administered to 45 patients across three outpatient clinical settings to evaluate the association between several actions and the patient's perception of kindness.RESULTS:Kind actions are small, take little effort, and are short in duration to their intended effect. We define kindness as an action that benefits another, as perceived by the recipient of the kind action. The results from our clinical study indicate several actions such as greeting the patient with a smile, asking questions about the patient's daily life, listening carefully, and appearing interested in the patient have a moderate strength correlation to a perception of kindness. The physician being perceived as kind also had a weak-moderate strength correlation to the patient subjectively reporting improvement after their visit.CONCLUSIONS:Definitions in the medical humanities are important as they guide the scales used to measure them. This article defines kindness and describes some examples of its manifestation in the healthcare setting. Our study indicates that performing kind actions may improve a patient's subjective perception of their care, however, future studies are needed to evaluate whether this benefit extends to health outcomes as has been demonstrated for skills such as empathy and good communication. "Constant kindness can accomplish much. As the sun makes ice melt, kindness causes misunderstanding, mistrust, and hostility to evaporate." ~Albert Schweitzer.

An inadvertent consequence of advances in stem cell research, neuroscience, and resuscitation science has been to enable scientific insights regarding what happens to the human brain in relation to death. The scientific exploration of death is in large part possible due to the recognition that brain cells are more resilient to the effects of anoxia than assumed. Hence, brain cells become irreversibly damaged and “die” over hours to days postmortem. Resuscitation science has enabled life to be restored to millions of people after their hearts had stopped. These survivors have described a unique set of recollections in relation to death that appear universal. We review the literature, with a focus on death, the recalled experiences in relation to cardiac arrest, post–intensive care syndrome, and related phenomena that provide insights into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We also identify issues and controversies related to the study of consciousness and the recalled experience of cardiac arrest and death in subjects who have been in a coma, with a view to standardize and facilitate future research.

An inadvertent consequence of advances in stem cell research, neuroscience, and resuscitation science has been to enable scientific insights regarding what happens to the human brain in relation to death. The scientific exploration of death is in large part possible due to the recognition that brain cells are more resilient to the effects of anoxia than assumed. Hence, brain cells become irreversibly damaged and “die” over hours to days postmortem. Resuscitation science has enabled life to be restored to millions of people after their hearts had stopped. These survivors have described a unique set of recollections in relation to death that appear universal. We review the literature, with a focus on death, the recalled experiences in relation to cardiac arrest, post–intensive care syndrome, and related phenomena that provide insights into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We also identify issues and controversies related to the study of consciousness and the recalled experience of cardiac arrest and death in subjects who have been in a coma, with a view to standardize and facilitate future research.

Effectively training medical students in compassion, communication, and empathy is essential in fostering a holistic approach to patient care. We sought to address this by implementing an early clinical experience service learning program for medical students in the initial years of their medical education. Medical students at Stony Brook University initiated, designed, and facilitated the volunteer program, which provides students a framework to learn magic therapy and engage with pediatric patients. The program includes an introductory presentation, training course, and organized bedside sessions with patients. To evaluate the program, a sample of participants partook in a focus group, written questionnaire, and/or online survey. From 2015 to 2020, 130 students participated in magic therapy rounds, engaging 1391 patients. Nine themes of student benefit emerged from qualitative analysis, including acquisition of familiarity with the hospital and healthcare team, cultivation of communication skills, contribution to improvement of patient affect, development of empathic qualities and techniques, and improvement in psychological health. Students were very satisfied with their experiences and viewed the activity as helpful for patients, parents, staff, and themselves. The program engaged students in compassionate patient care within a holistic approach to patient care early in training.

Educating medical students to be physicians involves many dimensions. But in an educational culture where science and technology dominate the curriculum, these subjects also too often dominate the academic value system as well. While a firm grasp of scientific knowledge and technical skill is essential, cultivating humanistic virtues is at the core of all good medical care and the full well-being of those within it. This article describes a formative educational process that points towards compassionate flourishing and unfolds through dialogue and reflection on the human aspects of patient care and the student experience, a process coequal in value to scientific development. This educational process has been successfully implemented at the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook. When supported by a broader institutional culture through an ongoing reflective group process in residencies and other clinical settings, this process fosters professional flourishing, which leads to deeper meaning and compassionate care of patients.

Volunteerism represents an important mechanism to promote resilience, empathy, and general well-being in medical students, a group that stands to benefit. Medical students report feelings of fatigue, burnout, exhaustion, and stress that correlates with poor academic performance, and significant decline in empathy over the 3rd year of both MD and DO programs. Volunteer motivations have been shown to mediate participant well-being. The relationship between medical student volunteer motivations and specific outcomes during the COVID-19 pandemic has not been addressed. We characterized features of medical student volunteers during the COVID-19 pandemic in 2020, including volunteering motivation using the Volunteer Functions Inventory, the types of activities in which they participated, and the physical, psychosocial, and emotional outcomes they experienced following volunteering. Altruistic and humanitarian values–centric motivation predicts positive volunteering outcomes including increased resilience, ability to deal with disappointment and loss, and ability to cope with the COVID-19 pandemic. Values-centric motivation also increases volunteer empathy independent of educational stage. Values-centric participants were more likely to select volunteering activities with patient contact, which promotes student empathy and resilience. Conversely, career-centric motivation does not predict positive outcomes. These students are more likely to engage in research-oriented activities. The efficacy of integrating volunteerism into medical school curricula may be limited by professional pressure that manifests as career-oriented motivation. We propose that practical integration should promote altruistic and humanitarian values–centric participant orientation to the volunteering process, which is associated with enhanced recruitment, preservation of empathy, and additional positive volunteering outcomes of interest.

BACKGROUND AND OBJECTIVES:Schwartz Rounds (SR) is an interdisciplinary program that focuses on compassionate care by allowing the formation of an interprofessional community around the human and emotional testimonies of caregivers. The purpose of this study was to examine the impact of implementing departmental SR on pediatric care providers at a tertiary care children's hospital in New York.METHODS:We applied the logic outcomes model for program evaluation to examine the impact of SR on pediatric providers. The standard evaluation form provided by the Schwartz Center was used to collect data after every SR. Descriptive statistics and qualitative data content analysis methods were used to analyze the evaluation data from the SR.RESULTS:A total of 820 standard evaluation forms were collected from 17 of the 23 SR sessions offered (response rate: 74.8%). Most participants felt that, during the SR sessions, challenging social and emotional aspects of patient care were discussed and that they gained better perspectives of their coworkers and their patients/families. They reported less isolation and more openness to express their feelings about patient care to their coworkers. The analysis of 299 written comments identified 5 themes: understanding other people's perspectives, the importance of communication, empathy and compassion, awareness of personal biases, and maintaining boundaries.CONCLUSIONS:Schwartz Rounds can provide an effective venue for pediatric care providers to gain insights into coworker and patient/family perspectives and process emotional experiences while providing patient care in a variety of circumstances.

I enjoyed reading the commentary by Drs. Mangione, Mandell, and Post1Mangione S Mandell BF Post SG The language game: we are physicians, not providers.Am J Med. 2021; 134: 1444-1446Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar regarding the use of the word “provider,” and its contribution to the degradation of physician professionalism, with resultant burnout. I'm writing to contribute a couple of historical perspectives. In days of yore, it was common for physicians who worked 5 days per week to devote 1 afternoon each week to volunteer health care at a public health clinic. It was also common for physicians to provide free health care to fellow physicians and their immediate families. (The latter practice, which was considered an honor as well as a cherished duty, was driven out by the rise of private health insurance. Other than for financial hardship, other such perks are considered insurance fraud). Volunteer care reinforced the sense of mission, which is at the core of all health care. Providing free care to fellow physicians promoted the sense of community and collegiality (whether it's ethical to provide financial breaks to people not in need is a different issue). It's obvious that we're not going to return to ancient systems of health care. Nevertheless, it's my humble suggestion that promoting mission, collegiality, and community can help to combat physician burnout.

A physician’s duty to care for patients and to care for self are in significant tension during epidemics. Especially when the infectivity and fatality of the epidemic remains unclear, the internal professional identity of a physician in training is challenged. There are various elements of moral significance that medical students may reflect on in the context of professional identity formation (PIF). These elements include: 1) the duty to treat concept, 2) societal role expectations, 3) beneficence, 4) distributive justice, 5) balancing risks and benefits and 6) faculty role modeling. Licensed physicians and those in training will balance multiple perspectives to make their personal decisions as to how to approach the pandemic and define their own role in it. During times of pandemics, when the entire physician workforce is called upon to help with the emerging crisis, positive role models emerge and that invisible pedagogy profoundly influences PIF of medical students. Physicians in training balance the values of altruism and self-care in their decision making. COVID-19 since its first recognition in December 2019 has caused major disruption of medical educational activities in the United States. The role of medical students during such crises can vary greatly depending on their level of training, competence and their evolving professional identities. Given the enormity of the COVID-19 crisis, many will act in solidarity with patients and colleagues. PIF may remain abstract to students throughout much of their medical training, but it becomes concrete during epidemics in which students personally confront deepened awareness of what it means to be a physician. The concept of PIF rapidly crystallizes into tangible thoughts, emotions, beliefs, and actions. This article elaborates on a framework consisting of six moral elements that guides one’s decision in contributing to pandemic relief efforts and posit that a crisis accelerates the rapid crystallization of PIF in medical students (Figure 1). These decisions must still allow room for individual conscience and students may take the six elements of moral significance into consideration when determining their role. The epidemic becomes a “giant leap” in PIF. Regardless of which decision students make, the way trainees reflect on their participation and choose to approach this novel COVID-19 pandemic marks a pivotal moment in each medical student’s academic career and PIF journey.