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Training to Heal: Designing Curriculum to Teach and Assess Empathy in Medical Education

By Nikette Neal, MD, Dr Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University

Healing is defined as the process of making or becoming sound or healthy again. Alleviate, ease, help, lessen, improve, resolve, correct, and restore are all accepted synonyms for this word. In medical education, we are charged with the task of teaching students how to “heal,” but are we indeed fulfilling this charge? The cultivation of empathy is a learning objective recommended by the Association of American Medical Colleges,1 yet thousands of students graduate from medical school every year thinking that their central focus is to cure physical ailments. This can produce physicians who practice in a way that corrects a problem without actually restoring the patient. An approach to patient care that focuses on the complaint but is without empathy is incomplete and does a disservice to both the patient and the physician. At the Dr Kiran C. Patel College of Allopathic Medicine at Nova Southeastern University (NSU MD) we decided to construct our curriculum to put a central focus on the cultivation of empathy.

Physician empathy is on the decline. The Jefferson Scale of Physician Empathy, a validated questionnaire developed in an attempt to measure empathy among medical students, demonstrated a downward trend in empathy in medical students throughout medical school.2 It has been challenging to elucidate the cause of this decline due to difficulties in both defining and assessing empathy. Some suggest that this decline in empathy is largely due to the experience of an average American medical student, which includes “transient social relationships, hurried and fragmented patient-caregiver relationships, and avoidance of intimacy during medical training.”3 This would suggest that designing undergraduate medical education curricula that emphasize and demonstrate empathy may start to promote empathetic behaviors in medical students.  

In educating medical students, we often unintentionally teach that “fixing” a patient is our most important role as physicians. Students are encouraged to be right and exact in their treatment plan, without similar focus on empathy and thoughtfulness. Clinical skills are assessed without focus on their delivery and the patient experience. At NSU MD, we are dedicated to training physicians who provide high quality care that is both effective and empathetic. As a new medical school, we have the unique opportunity to design a curriculum that is innovative in its approach to teaching empathy. We have chosen to use our Practice of Medicine courses to expose our students to skills that go beyond the standard history and physical exam. Each NSU MD clinical skills faculty member takes part in faculty development specific to humanism in medicine. We have designed a clinical skills curriculum that encourages an approach to patient care that says, “How can I serve you?” instead of “How can I fix you?” This new curriculum supports a shift in focus from trying to assuage a physical ailment to trying to improve a patient’s overall quality of life. The students are assessed using a rubric that includes behavioral anchors allowing students to achieve higher scores based on the effort used to make a patient feel comfortable. For example, asking the patient how they would like to be addressed, encouraging the patient to tell their story without interruption, and forming a therapeutic alliance are all included in our assessment tools.

As part of our clinical skills course, students take part in an interactive activity called the Science of Clinical Practice (SCP). In these SCP sessions, students are asked to view a patient case from a different lens in order to help them to identify with the humanistic aspects of medicine; they then write a reflective essay. One example of this is our SCP on culinary medicine. In this session, the students assist a patient with hyperlipidemia in developing a healthy meal plan. For this, the students must consider that this person is of low socioeconomic status with a limited budget and difficulty with transportation. The objective of this activity is to teach students about food insecurity and dietary counseling while demonstrating the need to consider social aspects when counseling a patient. Chen, et al suggests that reflective writing in medical education had a positive correlation with improvement in student empathy.4 Involvement in projects dedicated to serving underserved populations also seem to have this positive effect on empathy, according to a 2014 study by Jones et al.5 For additional reinforcement, our students take part in an interprofessional service learning project collaborating with nurses and social workers to perform needs assessments for mothers and babies in underserved communities. Further down the line, we are looking forward to assessing our curriculum in relation to its impact on empathy

Fundamentally, the Dr Kiran C. Patel College of Allopathic Medicine is dedicated to creating a culture that promotes seeing patients as humans and not as their diagnoses. In the words of Dr Edward Trudeau, the goals for our students should be “to cure sometimes, to relieve often, to comfort always.”

References

1. Hojat M, Gonnella JS, Mangione S, et al. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002;36(6):522-527. https://doi.org/10.1046/j.1365-2923.2002.01234.x
2. Hojat M, Mangione S, Nasca TJ, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38(9):934-941. https://doi.org/10.1111/j.1365-2929.2004.01911.x
3. Spencer J. Decline in empathy in medical education: how can we stop the rot? Med Educ. 2004;38(9):916-918. https://doi.org/10.1111/j.1365-2929.2004.01965.x
4. Chen I, Forbes C. Reflective writing and its impact on empathy in medical education: systematic review. J Educ Eval Health Prof. 2014;11:20. https://doi.org/10.3352/jeehp.2014.11.20
5. Jones K, Blinkhorn LM, Schumann SA, Reddy ST. Promoting sustainable community service in the 4th year of medical school: a longitudinal service-learning elective. Teach Learn Med. 2014;26(3):296-303. https://doi.org/10.1080/10401334.2014.911698

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