Health scan: Short course to make medical students more empathetic

The one-week introductory clinical oncology course at BGU for second-year medical students presented a holistic approach to caring for patients with cancer.

Shaare Zedek Hospital (photo credit: MARC ISRAEL SELLEM/THE JERUSALEM POST)
Shaare Zedek Hospital
Although only some medical students pursue a career in oncology, all should have a basic understanding of the issues surrounding cancer and its treatment, according to Ben-Gurion University of the Negev researchers.
The team led by Dr. Leeat Granek recently published a paper on the course in the journal Academic Medicine.
The one-week introductory clinical oncology course for second-year medical students presented a holistic approach to caring for patients with cancer that goes beyond the biological aspects of the disease.
Last year, the researchers interviewed four former students and surveyed all current students before and after they completed the course to evaluate its reception and effectiveness. Of the 86 students in the course, 77 (90 percent) completed both the pre- and post-course surveys.
After participating, more students reported being concerned about ethical issues, emotionally stirred by the course, comfortable speaking with a cancer patient about death and dying and accepting the fact that the course dealt with issues of death and loss and how to live with cancer. More students also said they feared they would causing a cancer patient to suffer through treatment yet viewed the disease optimistically.
Although these changes indicated that the complex ethical, moral, emotional, and intellectual issues that are part of being an oncologist were effectively transmitted to the students, they also indicate that additional discussion around these particular issues might be necessary to avoid causing excessive anxiety and deter the students from going into the field, the researchers said.
Israel is facing an urgent shortage of oncologists and oncology personnel. In 2010, the ratio of newly diagnosed patients to oncologists was 24,992 cancer patients to 180 oncologists. To this figure add the thousands of cancer patients who had been treated or received follow- up or palliative care (pain relieving care for terminal disease).
“That students reported increased empathy toward cancer patients despite increased trepidation about causing them suffering is promising,” according to the researchers, “Such courses may be one way to counteract the decrease in empathy among students as they progress through medical school. As such, medical schools might consider including this type of curriculum in their pre-clinical oncology studies.”
For the first time in Israel, a single incision was made in the lower lobe between the ribs at Jerusalem’s Shaare Zedek Medical Center to remove a patient’s malignant lung tumor. Called thoracoscopy, the medical procedure is used under general anesthesia or under sedation with local anesthetic to perform minimally invasive surgery, a biopsy or an internal examination. As in laparoscopy in the abdominal cavity, a tiny video camera and surgical implements are inserted through the incision. But until now, thoracoscopy has been performed here with several incisions, which at SZMC, it was done with one, just four centimeters long.
Dr. Faras Abu Acher and Dr. Danny Fink (head of cardiothoracic surgery performed the recent surgery.
The technique was developed by a Spanish surgeon named Dr. Diego Gonzales, who visited SZMC a year ago and taught doctors there his method. After the three-hour operation, the female patient was discharged only four days later. Fink said the technique minimizes pain and scars and speeds recovery.
New research is challenging the decades-old belief that tobacco helps keep you slim. A Brigham Young University study published in the American Journal of Physiology: Endocrinology and Metabolism found that exposure to someone else’s cigarette smoke can actually cause weight gain. “For people who are in a home with a smoker, particularly children, the increased risk of cardiovascular or metabolic problems is massive,” said physiology Prof. Benjamin Bikman.
Data shows half of the US population are exposed at least once daily to secondhand cigarette smoke and one fifth of young children live with someone who smokes in the home. Every day, almost 4,000 young adults smoke their first cigarette and 1,000 become habitual smokers.
The researchers had actually been interested in metabolic function; they wanted to pinpoint the mechanism behind why smokers become insulin resistant. To carry out their study, they exposed lab mice to sidestream (or secondhand) smoke and followed their metabolic progression.
Sure enough, those exposed to smoke put on weight. When they drilled down to the cellular level, they found the smoke triggered a tiny lipid called ceramide to alter mitochondria in the cells, causing disruption to normal cell function and inhibiting the cells’ ability to respond to insulin.
“The lungs provide a vast interface with our environment and this research shows that a response to involuntary smoking includes altering systemic sensitivity to insulin,” Reynolds said. “Once someone becomes insulin resistant, their body needs more insulin. And any time you have insulin go up, you have fat being made in the body.”
The key to reversing the effects of cigarette smoke, they discovered, is to inhibit ceramide. The researchers found the mice treated with myriocin (a known ceramide blocker) didn’t gain weight or experience metabolic problems, regardless of their exposure to the smoke. However, when the smoke-exposed mice were also fed a high-sugar diet, the metabolic disruption could not be fixed. Now Bikman and his team are in a race with other researchers to find a ceramide inhibitor that is safe for humans.
“The idea that there might be some therapy we could give to innocent bystand-ers to help protect them from the consequences of being raised in a home with a smoker is quite gratifying,” he said. The only way to help the smokers is to get them to kick the habit. “Perhaps our research can provide added motivation as they learn about the additional harmful effects to loved ones,” Bikman said.