Journal of evaluation in clinical practice
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Conventional models of cultural humility - even those extending analysis beyond the dyad of healthcare provider-patient to include concentric social influences such as families, communities and institutions that make clinical relationships possible - aren't conceptually or methodologically calibrated to accommodate shifts occurring in contemporary biomedical cultures. More complex methodological frameworks are required that are attuned to how advances in biomedical, communications and information technologies are increasingly transforming the very cultural and material conditions of health care and its delivery structures, and thus how power manifests in clinical encounters. ⋯ Engaging evaluative inquiry diffractively allows for a different ethical practice of care, one that attends to the forms of patient and health provider accountability and responsibility emerging in the clinical encounter.
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How to classify the human condition? This is one of the main problems psychiatry has struggled with since the first diagnostic systems. The furore over the recent editions of the diagnostic systems DSM-5 and ICD-11 has evidenced it to still pose a wicked problem. ⋯ The promises of AI for mental disorders are threatened by the unmeasurable aspects of mental disorders, and for this reason the use of AI may lead to ethically and practically undesirable consequences in its effective processing. We consider such novel and unique questions AI presents for mental health disorders in detail and evaluate potential novel, AI-specific, ethical implications.
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In today's culture of the medical profession, it is fairly unusual for students to actually witness physicians talking with patients about anything outside scientific explanation. That other side of medicine - the one that goes beyond explanation to understanding - goes unexplored, and the patient's personal narrative is consequently less understood. Meanwhile, though reflective writing is the most frequently used didactic method to promote introspection and deeper consolidation of new ideas for medical learners, there is robust evidence that other art forms - such as storytelling, dance, theatre, literature and the visual arts - can also help deepen reflection and understanding of the human aspect of medical practice. ⋯ BEAM is envisioned as a modular, online resource of "third things" that any clinician anywhere will be able to access via a smartphone application to deliver brief, focused, humanistic clinical teaching in either hospital or ambulatory care settings. This commentary foregrounds a learner's perspective to model BEAM's usage in an in-depth manner; it examines the relation of a painting by Edward Hopper to medical education through the lens of a poem by Victoria Chang, in the context of the BEAM web-based app educational resource. By assessing the poignancy of the painting via the poem, I demonstrate the capacity of the arts and humanities in medical education, with a specific focus on the development of interpretative skills and tolerance for ambiguity that all authentic, engaged physicians need.
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Transdisciplinary research and generalist practice both face the task of integrating and discerning the value of knowledge across disciplinary and sectoral knowledge cultures. Transdisciplinarity and generalism also both offer philosophical and practical insights into the epistemology, ontology, axiology, and logic of seeing the 'whole'. Although generalism is a skill that can be used in many settings from industry to education, the focus of this paper is the literature of the primary care setting (i.e., general practice or family medicine). Generalist philosophy and practice in the family medicine setting highly values whole person care that uses integrative and interpretive wisdom to include both biomedical and biographical forms of knowledge. Generalist researchers are often caught between reductionist (positivist) biomedical measures and social science (post-positivist) constructivist theories of knowing. Neither of these approaches, even when juxtaposed in mixed-methods research, approximate the complexity of the generalist clinical encounter. A theoretically robust research methodology is needed that acknowledges the complexity of interpreting these ways of knowing in research and clinical practice. ⋯ The concurrence between these approaches to knowing is offered here as Transdisciplinary Generalism - a coherent epistemology for both primary care researchers and generalist clinicians to understand, enact, and research their own sophisticated craft of managing diverse forms of knowledge.
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Evidence-based medicine (EBM), the dominant approach to assessing the effectiveness of clinical and public health interventions, focuses on the results of association studies. EBM+ is a development of EBM that systematically considers mechanistic studies alongside association studies. ⋯ (a) Assessment of combination therapy for MERS highlights the need for systematic assessment of mechanistic evidence. (b) That hypertension is a risk factor for severe disease in the case of SARS-CoV-2 suggests that altering hypertension treatment might alleviate disease, but the mechanisms are complex, and it is essential to consider and evaluate multiple mechanistic hypotheses. (c) Confidence that public health interventions will be effective requires a detailed assessment of social and psychological components of the mechanisms of their action, in addition to mechanisms of disease. (d) In particular, if vaccination programmes are to be effective, they must be carefully tailored to the social context; again, mechanistic evidence is crucial. We conclude that coronavirus research is best situated within the EBM+ evaluation framework.