CARING TO LEARN, BUT LEARING TO CARE?: THE ROLE OF EMPATHY INPRECLINICAL MEDICAL TRAINING Open Access
Michalec, Barret (2009)
Abstract
Abstract CARING TO LEARN, BUT LEARNING TO CARE?: THE ROLE OF EMPATHY IN PRECLINICAL MEDICAL TRAINING By Barret A. Michalec
This project examines the empathy levels of first and second year students at one particular medical training institution, and the potential mechanisms behind any changes in those empathy levels. Data was gathered from July of 2007 to May of 2008 employing surveys, observations of classes, labs, and small groups, and interviews with students and administrators. It was found that first and second year students decreased significantly in clinical empathy during the course of the academic year. Although the negative impact of stress was found to not be a significant predictor of the decrease in empathy, it was suggested that students shed empathy in order to become less vulnerable to medical school stressors. Furthermore, decreases in hours of first- and second-year curriculums devoted to the discussion and practice of patient-centered care, lack of formal evaluation in communication skills and connectivity, and a "knowledge gap" accentuated by the hidden curriculum, are each argued to have led to the decrease in clinical empathy among preclinical students. Researchers, physicians, instructors, and patients all argue that empathy is a valuable asset in medical care that provides positive mental and physical health outcomes for doctors and patients. This study suggests that in order for clinical empathy to be taken seriously by students, medical schools must integrate formally graded exams (standardized patient exercises, and vignettes) on the skills associated with empathy into the preclinical curriculum.
Table of Contents
TABLE OF CONTENTS
LIST OF TABLES...viii CHAPTER 1: DEFINITIONS AND CONCEPTUALIZATIONS...1
Conceptual Overview...5
What is Empathy?...5 What is the Function of Empathy: What is an Empathic Physician?...7 Empathy and Clinical Empathy: Conceptually Different?...12 Socialization...14
Research Questions...18 Hypotheses...19
CHAPTER 2: METHODOLOGY...24
Research Objectives...24 Research Design and Methods...24
Study Setting...26 Characteristics of Sample...27 The Survey...27 Observations...32 Interviews...40 Statistical Analyses and Interpretation of Qualitative Data...43
Conclusion...44
CHAPTER 3: THE "HAMBURGER MACHINE"...46
Introduction...46 The Stress and Stressors of Medical School...47 Recap of Methodology...48 Analyses...49 Results...50
Characteristics of Sample...50 Changes in Attributes...51 Regression Analyses...52 Bivariate Correlations...54 Other Notable Findings...58
Discussion...59
CHAPTER 4: THE "SHEDDING" OF EMPATHY...61
Introduction...61 Shedding Empathy to Adapt...61
Stress, Stressors, and Adaptation to Stress...61 Most Prominent Stressors of Medical School...65
Shedding Empathy to Diminish Vulnerability to Other Stressors...76 Shedding Empathy to Focus on What Needs to be Known Now...83 Shedding or Stripped?...86 Conclusion...87
CHAPTER 5: THE EXPLICIT CURRICULUM: ASSESSMENT DRIVES LEARNING...89
Introduction...89 The M1 and M2 Curriculum of County School of Medicine...92
Class of 2010: The "Traditional" Second Year Curriculum...92
The Nature of Step 1 of the USMLE and the Testing Effect...99
Class of 2011: The "New" Curriculum...105
Conclusion...114
CHAPTER 6: THE IMPLICIT CURRICULUM: ROLE MODELS & MODELS OF ROLES...115
Introduction...115 Role Models and Models of Roles...115 The Importance of Role Models and the Informal Curriculum of Medical Education...117 Role Models vs. Models of Roles: Conceptually Different...119 Small Group Leaders as Role Models for the Class of 2011...121 Role Modeling and the Modeling of Roles in OPEX and Clinical Methods...126
OPEX...126 Clinical Methods...130
Conclusion...136
CHAPTER7: THE "KNOWLEDGE GAP" AND THE HIDDEN CURRICULUM...137
Introduction...137 The Knowledge Gap and Its Effects...138
Difficulty Connecting with Those Outside of the Realm of Medicine...139
The Hidden Curriculum...140
An Element of the Hidden Curriculum: "Medical Knowledge is Power"...141
Evidence of the Hidden Curriculum at County SOM...145
The White Coat Ceremony...145 Instilling a Level of Superiority...148
Conclusion...151
CHAPTER 8: LEARNING TO CARE?...152
Introduction...152 Diagnoses...155
Chapter 3 - The "Hamburger Machine"...155 Chapter 4 - The "Shedding" of Empathy...156 Chapter 5 - The Explicit Curriculum: Assessment Drives Learning...156 Chapter 6 - The Implicit Curriculum: Role Models & Models of Roles...157 Chapter 7 - The "Knowledge Gap" and the Hidden Curriculum...158
Recommendations for Medical Training...159
Admissions and Recruitment...159 Courses...160 Illness Narrative Exercises...161 Faculty Development Programs...162
My Prescription for Preclinical Medical Education...165
Part I: Installation of Formal Standardized Patient Examinations...165 Part II: Installation of Formal Patient Centered Vignette Examinations...168
Limitations of the Study...171 Future Directions...172 Prognosis...175
REFERENCES...192 APPENDICES...205
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