Learning to cure, but learning to care?

Abstract

Utilizing interviews with students and a key administrator, analyses of academic schedules, and observations of courses, labs, and small groups, this study examines if and how elements of the explicit preclinical curriculum may have deleterious effects on medical students’ humanitarian attributes, namely empathy. Findings from this case-study of a medical school in the United States suggest that the lack of frequent formal testing in the psycho-social aspects of patient care during the preclinical years, as well as a general reduction in curriculum hours devoted to teaching the social aspects of medicine, may serve as mechanisms behind the diminution of medical students’ levels of empathy and other positive attributes as found by previous research. Following the basic tenets of the Testing Effect and the assumption that assessment drives learning, it is argued that a feasible way to maintain and potentially cultivate these traits among medical students, without saturating an overwhelmed medical curriculum, would be to install periodic, formally graded exams into preclinical curriculums that evaluate empathy and the psycho-social aspects of care.

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Fig. 1

Notes

  1. 1.

    County SOM, County University, and all names presented in this work are pseudonyms.

  2. 2.

    The alterations and new emphases of the curriculum will be explained in the pages to follow.

  3. 3.

    The argument presented in this paper does not state that current curriculum of County SOM, or other medical education institutions, is wrong or lacking, it is understood that clinical knowledge is imperative. Rather, this argument focuses on the structure of assessment of students’ skills as it currently exists in formal medical education.

References

  1. Becker, H., Geer, B., Hughs, E., & Strauss, A. (1961). Boys in white. New Brunswick, NJ: Transaction Books.

    Google Scholar 

  2. Cantillon, P. (2008). Do not adjust your set: The benefits and challenges of test-enhanced learning. Medical Education, 42, 954–956.

    Article  Google Scholar 

  3. Case, G., & Brauner, D. (2010). The doctor as performer: A proposal for change based on a performance studies program. Academic Medicine, 85, 159–163.

    Article  Google Scholar 

  4. Colliver, J., Conlee, M., Verhulst, S., & Dorsey, K. (2010). Reports of the decline of empathy during medical education are greatly exaggerate: A reexamination of the research. Academic Medicine, 85(4), 588–593.

    Article  Google Scholar 

  5. Colliver, J., & Swartz, M. (1997). Assessing clinical performance with standardized patients. JAMA, 278(9), 790–791.

    Article  Google Scholar 

  6. Conrad, P. (1988). Learning to doctor: Reflections on recent accounts of the medical school years. Journal of Health and Social Behavior, 29, 323–332.

    Article  Google Scholar 

  7. Coombs, R. (1978). Mastering medicine. New York, NY: The Free Press.

    Google Scholar 

  8. Course Bulletins are not included in the reference section to protect the anonymity of the medical school studied.

  9. DasGupta, S., & Charon, R. (2004). Personal illness narratives: Using reflective writing to teach empathy. Academic Medicine, 79(4), 351–356.

    Article  Google Scholar 

  10. Davis, M. (1996). Empathy: A social psychological approach. New York, NY: Westview Press, Inc.

    Google Scholar 

  11. Diseker, R., & Michielutte, R. (1981). An analysis of empathy in medical students before and following clinical experience. Journal of Medical Education, 56, 1004–1010.

    Google Scholar 

  12. Epstein, R., & Hundert, E. (2002). Defining and assessing professional competence. JAMA, 287(2), 226–235.

    Article  Google Scholar 

  13. Frederiksen, N. (1984). The real test bias: Influences of testing on teaching and learning. American Psychologist, 39(3), 193–202.

    Article  Google Scholar 

  14. Glick, S. (1993). The empathic physician: Nature and nuture. In H. Spiro, M. G. McCrea-Curnen, E. Peschel, & D. St. James (Eds.), Empathy and the practice of medicine (pp. 85–102). New Haven, CT: Yale University Press.

    Google Scholar 

  15. Hafferty, F. (1988). Cadaver stories and the emotional socialization of medical students. Journal of Health and Social Behavior, 29, 344–356.

    Article  Google Scholar 

  16. Hafferty, F., & Franks, R. (1994). The hidden curriculum, ethics, teaching, and the structure of medical education. Academic Medicine, 69(11), 861–871.

    Article  Google Scholar 

  17. Haidet, P., Dains, J., Paterniti, D., Chang, T., Tsang, E., & Rogers, J. (2001). Medical students’ attitudes toward patient-centered care and standardized patients’ perceptions of humanism: A link between attitudes and outcomes. Academic Medicine, 76(10), S42–S44.

    Article  Google Scholar 

  18. Halpern, J. (2003). What is clinical empathy? Journal of General Internal Medicine, 18, 670–674.

    Article  Google Scholar 

  19. Hanna, M., & Fins, J. (2006). Power and communication: Why simulation training ought to be complemented by experiential and humanistic learning. Academic Medicine, 81(3), 265–270.

    Article  Google Scholar 

  20. Hochberg, M., Kalet, A., Zabar, S., Kachur, E., Gillespie, C., & Berman, (2010). Can professionalism be taught? Encouraging evidence. American Journal of Surgery, 199(1), 86–93.

    Article  Google Scholar 

  21. Hojat, M., Gonnella, J., Mangione, S., Nasca, T., & Magee, M. (2003). Physician empathy in medical education and practice: Experience with the jefferson scale of physician empathy. Seminars in Integrative Medicine, 1(1), 25–41.

    Article  Google Scholar 

  22. Hojat, M., Mangione, S., Nasca, T., Rattner, S., Erdmann, J., Gonnella, J., et al. (2004). An empirical study of decline in empathy in medical students. Medical Education, 38, 934–941.

    Article  Google Scholar 

  23. Hojat, M., Vergare, M., Maxwell, K., Brainard, G., Herrine, S., Isenberg, G., et al. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine, 84(9), 1182–1191.

    Article  Google Scholar 

  24. Hornblow, A., Kidson, M., & Ironsides, W. (1988). Empathic process: Perception by medical students of patients’ anxiety and depression. Medical Education, 22, 15–18.

    Article  Google Scholar 

  25. Horowitz, C., Suchman, A., Branch, W., & Frankel, R. (2003). What do doctors find meaningful about their work? Annals of Internal Medicine, 138(9), 772–776.

    Google Scholar 

  26. Klass, P. (1987). A not entirely benign procedure. New York, NY: G. P. Putnam’s Sons.

    Google Scholar 

  27. Konner, M. (1987). Becoming a doctor. New York, NY: Penguin Books.

    Google Scholar 

  28. Kramer, D., Ber, R., & Moore, M. (1989). Increasing empathy among medical students. Medical Education, 23, 168–173.

    Article  Google Scholar 

  29. Kumagai, A. (2008). A conceptual framework for the use of illness narratives in medical education. Academic Medicine, 83(7), 653–658.

    Article  Google Scholar 

  30. Kvale, S., & Brickman, S. (2009). Interviews (2nd ed.). Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  31. Lancaster, T., Hart, R., & Gardner, S. (2002). Literature and medicine: Evaluating a special study module using the nominal group technique. Medical Education, 36, 1071–1076.

    Article  Google Scholar 

  32. Larsen, D., Butler, A., & Roediger, H., I. I. I. (2008). Test-enhanced learning in medical education. Medical Education, 42, 959–966.

    Article  Google Scholar 

  33. Larson, E., & Yao, H. (2005). Clinical empathy as emotional labor in the patient-physician relationship. JAMA, 293(9), 1100–1106.

    Article  Google Scholar 

  34. Le, T., Bhushan, V., Rao, D., & Grimm, L. (2008). First aid for the USMLE Step 1 2008. New York, NY: McGraw Hill.

    Google Scholar 

  35. LeBaron, C. (1981). Gentle vengeance. New York, NY: Richard Marek Publishers.

    Google Scholar 

  36. Lofland, J., Snow, D., Anderson, L., & Lofland, L. (2006). Analyzing social settings: A guide to qualitative observation and analysis. Belmont, CA: Thomson-Wadsworth.

    Google Scholar 

  37. Marcus, E. (1999). Empathy, humanism, and the professionalization process of medical education. Academic Medicine, 74(11), 1211–1215.

    Article  Google Scholar 

  38. McDaniel, M., Anderson, J., Derbish, M., & Morrisette, N. (2007). Testing the testing effect in the classroom. European Journal of Cognitive Psychology, 19(4/5), 494–513.

    Article  Google Scholar 

  39. Mehrabian, A. (2000). Manual for the Balanced Emotional Empathy Scale (BEES). Available from Albert Mehrabian, 1130 Alta Mesa Road, Monterey, CA 93940.

  40. Merton, R. (1957). Some preliminaries to a sociology of medical education. In R. K. Merton, G. G. Reader, & P. L. Kendall (Eds.), The student-physician: Introductory studies in the sociology of medical education (pp. 3–79). Cambridge, MA: Harvard University Press.

    Google Scholar 

  41. Michalec, B. (2010). An assessment of medical school stressors on preclinical students’ levels of clinical empathy. Current Psychology, 29(3), 210–221.

    Google Scholar 

  42. Plano-Clark, V., & Creswell, J. (2008). The mixed methods reader. Los Angeles, CA: Sage Publications.

    Google Scholar 

  43. Robbins, J., Bertakis, K., Helms, J., Azari, R., Callahan, E., & Creten, D. (1993). The influence of physician practice behaviors on patient satisfaction. Family Medicine, 25(1), 17–20.

    Google Scholar 

  44. Roberts, W., & Strayer, J. (1996). Empathy, emotional expressiveness, and prosocial behavior. Child Development, 67, 449–470.

    Article  Google Scholar 

  45. Saunders, P., Tractenberg, R., Chateriji, R., Amri, H., Harazduk, N., Gordon, J., et al. (2007). Promoting self-awareness and reflection through an experiential Mind-Body Skills course for first year medical students. Medical Teacher, 29, 778–784.

    Article  Google Scholar 

  46. Spiro, H. (1993). What is empathy and can it be taught? In H. Spiro, M. G. McCrea-Curnen, E. Peschel, & D. St. James (Eds.), Empathy and the practice of medicine (pp. 7–14). New Haven, CT: Yale University Press.

    Google Scholar 

  47. Szmuilowicz, E., el-Jawahri, A., Chiapetta, L., Kamdar, M., & Block, S. (2010). Improving residents’ end-of-life communication skills with a short retreat: A randomized controlled trial. Journal of Palliative Medicine, 13(4), 439–452.

    Article  Google Scholar 

  48. Teherani, A., Hauer, K., & O’Sullivan, P. (2008). Can simulations measure empathy? Considerations on how to assess behavioral empathy via simulations. Patient Education and Counseling, 71, 148–152.

    Article  Google Scholar 

  49. Wear, D. (1998). On white coats and professional development: The formal and the hidden curricula. Annals of Internal Medicine, 129, 734–737.

    Google Scholar 

  50. Wear, D., & Castellani, B. (2000). The development of professionalism: Curriculum matters. Academic Medicine, 75(6), 602–611.

    Article  Google Scholar 

  51. Wear, D., & Varley, J. (2008). Rituals of verification: The role of simulation in developing and evaluating empathic communication. Patient Education and Counseling, 71, 153–156.

    Article  Google Scholar 

  52. Whitemore, P., Burstein, A., Loucks, S., & Schoenfeld, L. (1985). A longitudinal study of personality changes in medical students. Journal of Medical Education, 60, 404–405.

    Google Scholar 

  53. Wolf, T., Balson, P., Faucett, J., & Randall, H. (1989). A retrospective study of attitude change during medical education. Medical Education, 23, 19–23.

    Article  Google Scholar 

  54. Wood, T. (2009). Assessment not only drives learning, it may also help learning. Medical Education, 43, 5–6.

    Article  Google Scholar 

  55. Zillman, D., & Cantor, J. (1977). Affective responses to the emotions of protagonist. Journal of Experimental Social Psychology, 13, 155–165.

    Article  Google Scholar 

  56. Zraick, R., Allen, R., & Johnson, S. (2003). The use of standardized patients to teach and test interpersonal and communication skills with students in speech-language pathology. Advances in Health Sciences Education, 8, 237–248.

    Article  Google Scholar 

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Acknowledgments

The author would like to thank all students, faculty, and staff at County SOM for their participation in this study.

Conflict of interests

The author declared no conflicts of interest with respect to the authorship and/or publication of this article.

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Correspondence to Barret Michalec.

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Michalec, B. Learning to cure, but learning to care?. Adv in Health Sci Educ 16, 109–130 (2011). https://doi.org/10.1007/s10459-010-9249-0

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Keywords

  • Medical education
  • Explicit curriculum
  • Preclinical students
  • Psycho-social issues
  • Empathy