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Training Physicians for Empathy

August 08, 2014

A pair of training programs exposes medical students to art and loss, teaches them about the emotional aspects of patient care, and helps them avoid burnout.


Stephen Klasko, MD, MBA
President and CEO of
Thomas Jefferson University
and TJUH System

The healthcare industry is rife with change, and how it trains new doctors is no exception.

Healthcare organizations, already challenged to meet the demands of a growing patient population are looking to develop fresh methods to teach young students how to care for segments of the patient population that may be neglected and underdeveloped.

One attribute providers are eager to teach is the importance of empathy and emotional intelligence.

"The Art of Attending"

Stephen Klasko, MD, MBA, looks at the way doctors are being selected and trained, and sees a structure that is rooted in the past, not the future.

Klasko, the President and CEO of Thomas Jefferson University and TJUH System in Philadelphia, sees the current criteria used to judge med students doesn't necessarily produce the best doctors. He believes that when it comes to selecting the right doctors, the process should go deeper than test scores.

"We still select doctors based on their science GPA, their MCATs, and their organic chemistry grades, and somehow we are amazed that doctors aren't more emphatic, communicative and creative," says Klasko.

He has sought to break through the GPA barrier to discover more relevant skill sets that doctors need in the 21st century.

"In the 70s, if I knew 19 reasons why somebody had jaundice, and you only knew 15, I was a better doctor," said Klasko. "Now the 19 are on my iPhone… so at the end of the day, it's much less important that I can memorize the 19, than it is that I can really understand what a patient is telling me or what their emotions are."

These factors are the motivation behind "The Art of Attending," a group of workshops focused around art, music, and theater. The goal of the workshops is to sharpen students' observation skills in order for them to become more aware of a patient's emotional needs.

One workshop exposes students to art, then having the students utilize visual thinking strategies in an art discussion format.

Med students are asked to react to a painting. If they say that a painting is strange, they are asked to describe why they think it's strange. After that, they're prompted to describe anything else they see. By following those three steps, the students discover 30 to 40% more about a painting than if they had brushed it off after their initial reaction.

Other workshops in the program include medical students sketching human bones as a way to develop observational skills. This module has been run by Salvatore Mangione, MD, an associate professor at Jefferson who has worked with Klasko on the programs.

Mangione says a pending grant would allow him to start a new workshop for medical students to write and stage plays as a way of continuing to develop their empathic skills.

These programs aren't only helpful with dealing with patients, but also dealing with burnout.

"They loved [the Art of Attending]. They all commented on how not only how they were able to see differently, but also how this much this helped them against burnout," said Mangione. "There's very disturbing data that one out of two students burns out during medical school, and 10% have suicidal ideations."

While Klasko feels like the resident selection process is a competitive "cult" that needs to be changed, he is pleased with what he has seen from his organization, and that his physicians will leave Jefferson as seasoned professionals.

"That's what we told our docs," said Klasko. "You are going to graduate from Jefferson not being a tourist in creativity. You are going to graduate from Jefferson feeling good because you will know the science, but you are also going to feel comfortable in your ability in an uncertain environment."

Learning from Grieving Parents

A program in Washington State has the same goal as Klasko's work at Thomas Jefferson, but takes a slightly different approach.

Improving Clinical Management of Stillbirth is an educational session sponsored by the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and the University of Washington. The program was created to give residents a better perspective of what parents go through during a traumatizing medical event.

Maureen Kelley, PhD, an associate professor for the department of pediatrics at the University of Washington, saw that students weren't properly prepared to handle the emotional repercussions of a stillbirth.

"We don't train our physicians very well to handle the emotional, psychological side of it, says Kelley, "There's a little bit of training on the recognition and the science and symptoms of distress and they're trained on how to medically manage a woman who is having a stillbirth. But there's a whole other side to it, the emotional and psychological side of losing a pregnancy and how parents suffer in that process."

Kelley taught and developed the one-day course with Michael Gravett, MD and Alyssa Stephenson-Famy, MD, both OB-Gyns at the University of Washington.

The first hour covers the medical management of stillbirth, including the skills needed to handle a stillbirth, how to identify the signs that a mother might go through a stillbirth, and how to talk with parents who fear another stillbirth.

The next two hours instruct how to psychologically support parents going through a stillbirth. This section details the various emotions parents experience, and offers doctors ways to help them through.

Kelley tells the residents stories about what parents have told her during interviews, and offers a frank discussion of grief triggers, and what should, and shouldn't be said in those situations.

Two parents from the group Stillborn, Still Loved, an advocacy group that supports and partially funds GAPPS, then told their stories to the audience. The effect was profound.

"It was very emotional, a lot of the students were crying," said Kelley. "I heard later from several of the residents that they will never forget it. To have that time to listen to parents tell their story really stuck with them."

Understanding Failure
Lessons learned from the lecture didn't just focus on the emotional handling of stillborn parents. With the parents discussing their anger and frustration with parts of their treatment, it taught physicians how to deal with the notion of failure.

"One of the hardest things to teach in medicine is how to handle not being perfect, that you can't always save patients," said Kelley. "These parents were very generously teaching that."

The success of last year's session has prompted Kelley to plan a second session with new parents in October.

The programs at Thomas Jefferson and GAPPS highlight a vital side of medicine that will only grow in importance as the industry continues to change.

"The more innovative we can be, the more we can try to adapt to the changes in the healthcare setting, which are becoming so demanding and difficult," says Kelley. "Trainees are under pressure to learn so much information that we are going uphill in terms of trying to round out their experiences to include the emotional and psychological aspects of care."

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