ash the white clothes on Monday and put them on the stone heap; wash the color clothes on Tuesday and put them on the clothesline to dry; don't walk bare-head in the hot sun.These are the opening lines of "Girl," a story by author Jamaica Kincaid (The New Yorker, 1978). In it, Kincaid distills thousands of experiences from an Antiguan childhood into 49 instructions from mother to daughter. They are instructions for many tasks-for cooking, for survival, for household peace. They are delivered quickly, with precise detail, with smothering affection, without apology. They resonate, unsurprisingly, in our narrative medicine workshop with young physicians who are joining hospital teams, caring for patients, and learning a culture of medicine that asks them to rapidly adopt the knowledge, style, and practices of senior physicians they are working for. Kincaid offers the group a type of education not unlike their own training-a curriculum that can be unofficial yet forceful. With striking similarity to a young girl growing up in an adult world, new physicians join a system that demands they quickly learn the skills of their craft, the rules of survival, and the values they will fight for all while navigating their instinctive psychological responses to illness, injury, healing, injustice, and grief.The power of arts and literature to interpret a complicated world is well understood if still underleveraged in medical training. As a 3-person faculty group (a Pulitzer Prizewinning journalist as director, an emergency medicine physician as assistant director, and an internist as Associate Dean for Student Affairs and Medical Humanities) in a burgeoning narrative medicine department of a busy urban hospital and medical school, we pursue a mission outlined in The Principles and Practice of Narrative Medicine: "To develop deep and accurate attention to the accounts of self that are told and heard in the contexts of healthcare." 1 We began with a single workshop with surgical residents in 2017, using "Girl" after seeing it used at Columbia University that same year. Since the 2018-2019 academic year, we have conducted quarterly 1-hour narrative medicine workshops as part of the didactic curriculum of 7 residency programs, typically with residents of a single specialty at various levels of their training. The workshops are mandatory for residents; faculty occasionally attend. We also conduct elective coursework in the medical school, writing workshops for all employees of the health care system, and a voluntary lunchtime gathering that brings together students with interests in narrative medicine. In all, we constantly explore ways to help physicians, nurses, staff, and students "develop attention."After a brief introduction explaining who we are and our hope for the role of this work in graduate medical education,

Bone responds to mechanical stimulus and a range of pre-existing finite element models have been suggested to reproduce the internal physiological structure of bone. Inflammation effects are not included in these models, yet inflammation is a key component of bone repair in trauma. Therefore, a model is proposed and tested here that extends these methods to include parameters that could be considered to represent the behaviour of bone remodelling when influenced by inflammation. The proposed model regulates remodelling based on findings from recent studies into the nature of heterotopic ossification, the formation of heterotopic bone, which have revealed information about the nature of bone after high levels of trauma. These parameters include consideration of the distance from the zone of trauma, the density of mesenchymal stem cells, and substrate stiffness as a trigger for cells becoming osteogenic. The method is tested on a two-dimensional plate model and shows that the new extended algorithm can produce a range of structures depending on inputs that could be used in the future to replicate physiological scenarios.

Heterotopic ossification (HO) is the process of bone formation in tissues that are not usually osseous. It occurs in 60% of those with blast-related amputations. HO can result in reduced range of motion, pain, nerve impingement and can affect prosthesis fitting and is caused by a combination of mechanical, biological, local and systemic factors. As with normal bone formation and remodelling, it is expected that heterotopic bone responds to mechanical stimuli and understanding this relationship can give insight into the pathology. The objective of this research was to investigate whether a physiological 2D computational model that considers both mechanical and biological factors can be used to simulate HO in the residual limb of a trans-femoral amputee. The study found that characteristic morphologies of HO were reproduced by adjusting the loading environment. Significant effects were produced by changing the loading direction on the femur; this is potentially associated with different initial surgical interventions such as muscle myodesis. Also, initial treatment such as negative pressure through a dressing was found to change the shape of heterotopic bone.

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