Lessons from the Nocebo Effect 

As psychiatry post-graduate education aims to bridge core clinical skills, ethical practice, and professionalism with emerging neuroscience in a model of competency-based education, novel methods for enhancing resident learning are increasingly called upon. This is particularly true in the context of a shift away from didactic teaching methods and toward inquiry-based and curiosity-driven exploration in adult learning (Pluck and Johnson 2011). This project develops and pilots a humanities-based companion curriculum piece using a graphic medicine animation to supplement resident learning in the ethics and professionalism content of the PGY-1 year.  

The pilot animation examines how processes of informed consent are interrelated to emerging neuroscience regarding the “nocebo effect.” “Nocebo” refers to the induction of harms such as medication side effects through processes of verbal suggestion. The implications of nocebo effects for informed consent practices is a lively debate in contemporary bioethics (Colloca 2017) and one worth residents’ consideration in light of their role as medical expert, communicator, and professional. This pilot project will: 

  1. Develop companion curriculum content that enables a self-guided exploration of the relationships between informed consent and nocebos in the context of psychiatric practice, through the creation of a graphic medicine comic; and  
  1. Explore the extent to which an arts-based graphic medium is able to engage residents’ curiosity and facilitate linkages between issues and challenges in clinical care, ethics and professionalism, and neuroscience. 

Collaborators: Ms. Eva-Marie Stern, Ms. Maya Morton Ninomaya, Drs. Ada Jaarsma, Ariel Lefkowitz, and Mark Fefergrad 

Project Funding: University of Toronto Medical Humanities Education Matching Fund