Impact of a narrative medicine program on reflective capacity and empathy of medical students in Iran

Saeideh Daryazadeh,Payman Adibi,Nikoo Yamani,Roya Mollabashi 한국보건의료인국가시험원 2020 보건의료교육평가 Vol.17 No.-

Purpose: Narrative medicine consists of the expression of medical experiences and the reflection on narratives to foster empathic communication with patients. Reflecting on narratives increases self-awareness and recognition of the feelings of the narrator or the story’smain character, which in turn affects the audience. This study was conducted to examine the impact of a narrative medicine program onthe reflective capacity and empathy of medical students. Methods: A quasi-experimental study was performed during the 2018–2019 academic year at Isfahan University of Medical Sciencesin Iran involving 135 medical interns in 2 groups (control [n=66] and experimental [n=69]). Interns in the experimental group tookpart in seven 2-hour reflective practice sessions, while those in the control group underwent no educational intervention. Pre-test andpost-test assessments were conducted for both groups using 2 valid and reliable tools for the assessment of reflective capacity and empathy. Mean reflection and empathy scores were compared within groups (between pre- and post-test values) and between groups (usingthe paired-t test and the t-test; P≤0.05). Results: The mean reflection and empathy scores of the experimental group significantly increased from pre-test to post-test, but thoseof the control group did not. Moreover, the mean post-test scores were significantly different between the 2 groups (P<0.001). Conclusion: Narrative medicine is an effective teaching method that can improve reflective capacity and empathy, thereby ultimatelypromoting professionalism as a core competency in medicine. Consideration of learning conditions and interdisciplinary teaching arenecessary for implementing a narrative medicine program.

Development of a checklist to validate the framework of a narrative medicine program based on Gagne’s instructional design model in Iran through consensus of a multidisciplinary expert panel

Saeideh Daryazadeh,Nikoo Yamani,Payman Adibi 한국보건의료인국가시험원 2019 보건의료교육평가 Vol.16 No.-

Purpose: Narrative medicine is a patient-centered approach focusing on the development of narrative skills and self-awareness that incorporates “attending, representing, and affiliating” in clinical encounters. Acquiring narrative competency promotes clinical performance, and narratives can be used for teaching professionalism, empathy, multicultural education, and professional development. This study was conducted to develop a checklist to validate the framework of a narrative medicine program through consensus of a panel. Methods: This expert panel study was conducted from 2018 to 2019 at Isfahan University of Medical Sciences, Iran. It included 2 phases: developing a framework in 2 steps and forming an expert panel to validate the framework in 3 rounds. We adapted a 3-stage narrative medicine model with 9 training activities from Gagne’s theory, developed a framework, and then produced a checklist to validate the framework in a multidisciplinary expert panel that consisted of 7 experts. The RAND/UCLA appropriateness method was used to assess the experts’ agreement. The first-round opinions were received by email. Consensus was achieved in the second and third rounds through face-to-face meetings to facilitate interactions and discussion among the experts. Results: Sixteen valid indicators were approved and 100% agreement was obtained among experts (with median values in the range of 7–9 out of a maximum of 9, with no disagreement), and the framework was validated by the expert panel. Conclusion: The 16 checklist indicators can be used to evaluate narrative medicine programs as a simple and practical guide to improve teaching effectiveness and promote life-long learning

Somatic Complaints Are Significantly Associated with Chronic Uninvestigated Dyspepsia and Its Symptoms: A Large Cross-sectional Population Based Study

( Zahra Heidari ),( Ammar Hassanzadeh Keshteli ),( Awat Feizi ),( Hamid Afshar ),( Payman Adibi ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2017 Journal of Neurogastroenterology and Motility (JNM Vol.23 No.1

Background/Aims Somatization may influence persistence and severity of symptoms in gastrointestinal diseases. Some studies suggest that somatization is associated with chronic uninvestigated dyspepsia (CUD); however, the association is unclear. We aimed to determine the association between the profiles of somatic complaints with CUD and its symptoms. Methods In a cross-sectional study conducted on 4763 Iranian adults, somatic complaints were assessed using a comprehensive 31-items questionnaire. Patients with CUD were identified by the Rome III diagnostic criteria. Profiles of somatic complaints were derived from factor analysis. Logistic regression analysis was used to assess the relationship between extracted profiles with CUD and its symptoms. Results CUD, bothersome postprandial fullness, early satiation, and epigastric pain or burning was identified in 723 (15.2%), 384 (8.1%), 302 (6.3%), and 371 (7.8%) of the study population. The frequency of all 31 somatic complaints was significantly higher in patients with CUD compared with controls (P < 0.001), and the most frequent was severe fatigue (45.1%). The profiles of somatic complaints were extracted in 4 domains, including “psychological”, “gastrointestinal”, “neuro-skeletal”, and “pharyngeal-respiratory”. The psychological (OR, 1.49; 95% CI, 1.44-1.54), gastrointestinal (OR, 2.22; 95% CI, 2.09-2.37), neuro-skeletal (OR, 1.52; 95% CI, 1.44- 1.59), and pharyngeal-respiratory (OR, 2.09; 95% CI, 1.94-2.25) profiles were significantly associated with greater odds of CUD. Conclusions CUD and its symptoms are strongly associated with higher levels of somatic complaints and their related extracted profiles. This perhaps explains that why it can be difficult to treat, however further prospective investigations are required to confirm these associations. (J Neurogastroenterol Motil 2017;23:80-91)

Iranian Registry of Crohn’s and Colitis: study profile of first nation-wide inflammatory bowel disease registry in Middle East

Masoud M Malekzadeh,Alireza Sima,Sudabeh Alatab,Anahita Sadeghi,Nasser Ebrahimi Daryani,Payman Adibi,Iradj Maleki,Hassan Vossoughinia,Hafez Fakheri,Abbas Yazdanbod,Seyed Alireza Taghavi,Rahim Aghazade 대한장연구학회 2019 Intestinal Research Vol.17 No.3

Background/Aims: A recent study revealed increasing incidence and prevalence of inflammatory bowel disease (IBD) in Iran. The Iranian Registry of Crohn’s and Colitis (IRCC) was designed recently to answer the needs. We reported the design, methods of data collection, and aims of IRCC in this paper. Methods: IRCC is a multicenter prospective registry, which is established with collaboration of more than 100 gastroenterologists from different provinces of Iran. Minimum data set for IRCC was defined according to an international consensus on standard set of outcomes for IBD. A pilot feasibility study was performed on 553 IBD patients with a web-based questionnaire. The reliability of questionnaire evaluated by Cronbach’s α. Results: All sections of questionnaire had Cronbach’s α of more than 0.6. In pilot study, 312 of participants (56.4%) were male and mean age was 38 years (standard deviation=12.8) and 378 patients (68.35%) had ulcerative colitis, 303 subjects (54,7%) had college education and 358 patients (64.74%) were of Fars ethnicity. We found that 68 (12.3%), 44 (7.9%), and 13 (2.3%) of participants were smokers, hookah and opium users, respectively. History of appendectomy was reported in 58 of patients (10.48%). The most common medication was 5-aminosalicylate (94.39%). Conclusions: To the best of our knowledge, IRCC is the first national IBD registry in the Middle East and could become a reliable infrastructure for national and international research on IBD. IRCC will improve the quality of care of IBD patients and provide national information for policy makers to better plan for controlling IBD in Iran.