Reflection has been proclaimed as a means to help physicians deal with medicine’s inherent complexity and remedy many of the shortcomings of medical education. Yet, there is little agreement on the nature of reflection nor on how it should be taught and practiced. Emerging neuroscientific concepts suggest that human thought processes are largely nonconscious, in part inaccessible to introspection. Our knowledge of the world is fraught with uncertainty, ignorance and indeterminacy, and influenced by emotion, biases and illusions, including the illusion (...) of not having illusions. Neuroscience also documents that lifelong learning processes may hone nonconscious cognition to high levels of sophistication, allowing rapid and precise perceptions, judgments and actions in complex situations. We argue that knowledge of mechanisms underlying human thought may be useful in designing educational programs to foster desired attributes such as curiosity, critical self-awareness and intuitive acumen in medical professionals. The juxtaposition of neuroscientific insights with ideas from Kant on reflective judgement, van Manen on tact, and Aristotle on phronésis, supports a concept of reflection that manifests as wise practice. We suggest that reflection in medical education should be an imperative for educators seeking to guide learners to manage the complexity and “messiness” of medical practice, and a role-modelling mode of medical practice characterized by self-correcting behaviors that culminate in good and right professional actions. An example illustrates reflective practice in the teaching and learning of physicianship. (shrink)

Despite medical leaders’ increasing acceptance of the idea that the whole person should be the focus of care, empirical studies show clinicians generally remain focused on narrower goals: disease categories, standardized treatment procedures, and objective measurements of health improvements. We assume doctors want to do a good job, consistent with their perception of the goals and norms of their profession, so they practice medicine based on the illusion that clinical medicine is “knowledge treating disease,” not people treating people. We believe (...) that doctors’ seeming reduction of patients to clinical objects results from not seeing themselves as leaders for their patients or accepting their constructive power in clinical encounters. (shrink)

Sounds are all around us, all the time. We constantly engage in listening: to the everyday sounds of the streets on our way to work, to the black-bird's soft nattering an early morning in spring, to a teacher's tiresome talk. Nature speaks to us with a thousand voices, and a place sounds of its inhabitants. Normally, we take our ability to hear as a matter of course; hearing is an implicit and mostly unreflected engagement in our daily activities. As educators, (...) however, we cannot take our students' capability of listening for granted. One problem of education, Angelo Caranfa argues, is that it fails to teach the significance of listening and silence. The present predominant focus on discourse and critical thinking... (shrink)

Two of the most influential works of the Western nineteenth century were completed in 1859: Charles Darwin’s The Origin of Species and Richard Wagner’s opera Tristan and Isolde. Although created within very different cultural traditions, these works show some striking similarities: both brought about a critical, long-lasting debate and caused conflicting reactions after their publications, and both had fundamental and compelling impact on their disciplines. The perspective discussed in this paper, however, is that both works address the notion of evolutionary (...) thought. In 2009 we could have thus celebrated a double anniversary: it was 150 years since the manifestation of the evolutionary idea in such different .. (shrink)

In this article, Music-in-Becoming, I explore the integrative practices of composing music and researching its emergence. The article reports from an artistic research project on composition as lived experience. The music that serves as the raw material for my inquiry consists of four pieces for three overtone-skilled singers and one double bass player for the concert Ørenslyd, all performed in Berlin in October 2019. My intention is to show how composing music takes place in a phenomenological in-between of composer and (...) work that is driven by attentive listening and the complementary skills of activeness and receptiveness. In this in-between, the skill of listening plays a crucial role as it is both participatory and receptive. I further examine and discuss the methods I use during this exploration, influenced by both artistic research and phenomenological research. The two methodological approaches are compared regarding their characteristic differences and their potential kinships. My presumption is that the active-receptive act of composing at its core is a phenomenological-hermeneutic practice. I conclude that artistic research seems to be profoundly influenced by phenomenology, whereas not all phenomenological research is influenced by art as practices or as a research approach. (shrink)

In this article, I explore the music-in-becoming as a dialogue. The thesis of my inquiry is that during musical composition, the composer’s listening is marked by both activeness and receptiveness; actively structuring the sounding work, and receptively letting the work express itself as it takes its form. Composer and work merge in sudden moments of attunement, the sensation of coherence between the so-fare completed and the anticipation of the as-of-yet unformed work. Composition is all about balancing writing as a handicraft (...) with those rare, unexpected moments of attunement. I discuss the emerging work’s invitational character and the fact that during composition, the piece seems to request the composer’s attention. The audibility of the work’s voice depends on the composer’s ability to listen. Finally, the methodological considerations concerning sonic-artistic research show that researching sonic experiences requires competencies of being attentive, responsive, and reflective. Attentiveness is related to thorough listening experiences of the emerging music, responsiveness appears as a vital skill in a composer’s dialoguing with the music-in-becoming, and reflectiveness is associated with empirically documenting the processes. At the heart of this sonic research project, I place my lived experience of composing and the intimate relation between sound and listening. (shrink)

Adjustments of everyday life in order to prevent disease or treat illness afflict partly unconscious preferences and cultural expectations that are often difficult to change. How should one, in medical contexts, talk with patients about everyday life in ways that might penetrate this blurred complexity, and help people find goals and make decisions that are both compatible with a good life and possible to accomplish? In this article we pursue the question by discussing how Habermas’ theory of communicative action can (...) be implemented in decision-making processes in general practice. The theory of deliberative decision-making offers practical guidelines for what to talk about and how to do it. For a decision to be rooted in patients’ everyday life it has to take into consideration the patient’s practical circumstances, emotions and preferences, and what he or she perceives as ethically right behaviour towards other people. The aim is a balanced conversation, demonstrating respect, consistency and sincerity, as well as offering information and clarifying reasons. Verbalising reasons for one’s preferences may increase awareness of values and norms, which can then be reflected upon, producing decisions rooted in what the patient perceives as good and right behaviour. The asymmetry of medical encounters is both a resource and a challenge, demanding patient-centred medical leadership, characterised by empathy and ability to take the patient’s perspective. The implementation and adjustments of Habermas’ theory in general practice is illustrated by a case story. Finally, applications of the theory are discussed. (shrink)

In the exploratory study reported here, we tested the efficacy of an intervention designed to train teenagers with Möbius syndrome (MS) to increase the use of alternative communication strategies (e.g., gestures) to compensate for their lack of facial expressivity. Specifically, we expected the intervention to increase the level of rapport experienced in social interactions by our participants. In addition, we aimed to identify the mechanisms responsible for any such increase in rapport. In the study, five teenagers with MS interacted with (...) three naïve participants without MS before the intervention, and with three different naïve participants without MS after the intervention. Rapport was assessed by self-report and by behavioral coders who rated videos of the interactions. Individual non-verbal behavior was assessed via behavioral coders, whereas verbal behavior was automatically extracted from the sound files. Alignment was assessed using cross recurrence quantification analysis and mixed-effects models. The results showed that observer-coded rapport was greater after the intervention, whereas self-reported rapport did not change significantly. Observer-coded gesture and expressivity increased in participants with and without MS, whereas overall linguistic alignment decreased. Fidgeting and repetitiveness of verbal behavior also decreased in both groups. In sum, the intervention may impact non-verbal and verbal behavior in participants with and without MS, increasing rapport as well as overall gesturing, while decreasing alignment. (shrink)