Johanna Shapiro

Teaching empathy to first year medical students: evaluation of an elective literature and medicine course.

BACKGROUND Empathy is critical to the development of professionalism in medical students, and the humanities-particularly literature-have been touted as an effective tool for increasing student empathy. This quantitative/qualitative study was undertaken to assess whether reading and discussing poetry and prose related to patients and doctors could significantly increase medical student empathy and appreciation of the relevance of the humanities for their own professional development. METHOD In 2000-2001, first year students (n=22) volunteered for an eight-session literature and medicine elective and were randomly assigned to either immediate participation in the class or a wait-list group, who participated in the same class 6 months later. Complete pre- and post-intervention data for 16 students from both groups were obtained for two quantitative measures of empathy and an attitudes-toward-the-humanities scale. Students also participated in a qualitative group interview pre- and post-intervention. RESULTS Empathy and attitudes toward the humanities improved significantly (p<0.01) after participation in the class when both groups of students were combined. The scaled treatment effect size was in the moderate range (> or =0.60 standard deviation units) for both measures that had statistically significant pre-to-post changes. Furthermore, student understanding of the patients perspective became more detailed and complex after the intervention. Students were also more likely post-intervention to note ways reading literature could help them cope with training-related stress. CONCLUSION A brief literature-based course can contribute to greater student empathy and appreciation for the value of humanities in medical education.

Family reactions and coping strategies in response to the physically ill or handicapped child: A review

This article reviews a broad range of clinical and research material investigating the coping processes of individuals and families, particularly in response to a serious illness or handicapping condition in a child family member. The interactive effects of family and illness are established; then several theoretical, descriptive and empirical theories of coping are presented. Coping responses of family members and the family unit as a whole to minor illness, to chronic illness and handicapping conditions, to childhood cancer, and to death in childhood are all discussed. The article concludes with a discussion of the implications and benefits for the physician and other health care professionals in adopting a family-oriented treatment approach.

Walking a mile in their patients' shoes: empathy and othering in medical students' education.

One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for imperfection in self and others; and acceptance of shared emotional vulnerability and suffering while simultaneously honoring the existence of difference. Reducing the sense of anxiety and threat that are now reinforced by the dominant medical discourse in the presence of illness will enable trainees to learn to emotionally contain the suffering of their patients and themselves, thus providing a psychologically sound foundation for the development of true empathy.

Training the clinical eye and mind: using the arts to develop medical students' observational and pattern recognition skills

Introduction  Observation, including identification of key pieces of data, pattern recognition, and interpretation of significance and meaning, is a key element in medical decision making. Clinical observation is taught primarily through preceptor modelling during the all‐important clinical years. No single method exists for communicating these skills, and medical educators have periodically experimented with using arts‐based training to hone observational acuity. The purpose of this qualitative study was to better understand the similarities and differences between arts‐based and clinical teaching approaches to convey observation and pattern recognition skills.

How Do Physicians Teach Empathy in the Primary Care Setting

To explore how primary care clinician—teachers actually attempt to convey empathy to medical students and residents, the author carried out a qualitative study in 1999-2000 in which 12 primary care physicians reflected on their views of empathy, how they demonstrated empathy to patients, and how they went about teaching empathy to learners. Interview data were triangulated with observations of actual teaching sessions and informal questioning of students and residents who had been taught by the faculty participants. Grounded theory was used to interpret the data. The faculty had clear conceptualizations of what empathy meant in clinical practice, but differed as to whether it was primarily a measurable, behavioral skill or a global attitude. Respondents stressed the centrality of role modeling in teaching, and most used debriefing strategies, as well as both learner- and patient-centered approaches, in instructing learners about empathy. Findings suggest that limiting the teaching of empathy to a skill-based approach does not reflect the richness of what actually occurs in the clinical setting, and that it is important to teach empathy comprehensively, acknowledging both behavioral and attitudinal tools.

Contributions to Depression in Latina Mothers with and without Children with Retardation: Implications for Caregiving

Contributions to depression in 148 Latina mothers with and 101 without children with mental retardation were investigated. Depressive symptomatology was assessed using the Center for Epidemiologie Studies-Depression scale (CES-D) (Radloff, 1977). Depression was elevated in both Latina samples relative to a normative group. Furthermore, Latina mothers who had children with mental retardation showed significantly higher levels of depressive symptomatology relative to controls. Depression was predicted by low family cohesion, poor health of the mother, absence of spouse or partner, less use of passive appraisal as a coping strategy, and presence of a child with mental retardation.

All the world's a stage: the use of theatrical performance in medical education.

Purpose  Student exposure to illness‐related theatrical performances holds intriguing educational possibilities. This project explored uses of theatrical performance within the context of medical education.

Cultural Models of Transition: Latina Mothers of Young Adults with Developmental Disabilities:

This study used several focus groups to examine culturally based variation in attitudes, beliefs, and meanings of transition. Sixteen Latina mothers of young adults with disabilities participated in the study, recruited from an agency serving low-income, predominantly Spanish-speaking communities. Data analysis identified five primary themes: (a) basic life skills and social adaptation, (b) the importance of the family and home rather than individualism and independence, (c) the importance of the mothers role and expertise in decision making, (d) access to information; and (e) dangers of the outside world. The overarching theme was a view of transition as home-centered, sheltered adaptation as opposed to a model emphasizing independent productivity. The findings and the implications for future research and practice are discussed.

Can Poetry Make Better Doctors? Teaching the Humanities and Arts to Medical Students and Residents at the University of California, Irvine, College of Medicine

The Program in Medical Humanities & Arts at the University of California, Irvine, College of Medicine has been in existence for five years. The program was implemented to enhance aspects of professionalism including empathy, altruism, compassion, and caring toward patients, as well as to hone clinical communication and observational skills. It contains elective or required curriculum across all four years of medical school and required curriculum in two residency programs, organized according to structural principles of horizontal coherence, vertical complexity, and patient care applications. The program emphasizes small-group, interdisciplinary teaching and faculty development, and is notable for learners’ use of creative projects to reflect on patients and themselves. Evaluation of the program indicates a positive response among learners. More systematic studies point to increases in empathy and positive attitudes toward the humanities as tools for professional development as a result of exposure to the program curriculum. Future directions include closer collaboration with the University of California, Irvine, Schools of the Arts and Humanities, involvement of local artists and writers, and development of a graduation with distinction in humanities for medical students.

Alienated advocacy: Perspectives of Latina mothers of young adults with developmental disabilities on service systems

Although collaborative partnership between parents and professionals is a cornerstone of the special education and service systems, this relationship exists more as an ideal, especially when low-income, culturally diverse families are involved. Through three focus groups, we examined the beliefs of 16 low-income Latina mothers of young adults with developmental disabilities about their relationships with the educational and service delivery systems. Primary concerns identified were (a) poor communication, (b) low effort in providing services, (c) negative attitudes of professionals toward the client-children, (d) negative treatment of parents by professionals, and (e) the mothers role as central to the well-being of her child. Mothers tended to adopt a posture of alienated advocacy in relation to their childs educational and service needs.