Tag: medical education

Blog Posts (32)

July 18, 2016

Medical Education Research and IRB Review

By Emily Anderson Medical school curricula now emphasize evidence-based medicine.  We also need to prioritize evidence-based educational strategies.  There are some great educational innovations happening at our medical school, but too few publications highlighting these.  Conducting research on medical education faces many barriers, not least of all, lack of funding.  Publication in any peer-reviewed academic […]
July 5, 2016

Social Scientists in Medical Education: Important Contributors to the Educational Mission

By Bobbie Ann Adair White and Leila Diaz When we began our careers in medical education in the early 2000s, our roles (Student Affairs and Admissions) were adjacent to those of educators but not truly intertwined in content development and delivery. We found there were opportunities to create and lobby for co-curricular social sciences content, but […]
June 14, 2016

Sacred and Profane: Balancing the sanctity of the human body with the mechanics of cadaver dissection

By Michael Dauzvardis Often heard on the first day of anatomy lab: “Oh— I’m so glad the cadaver doesn’t look real. It is gray and ashen.  The skin is wrinkled and the head is shaven. I can do this— I’ll make the first cut.” In fall, in medical schools across the country, students begin their […]
June 9, 2016

Landing the Role of a Lifetime

Hearing the Call:  A Feature on How Physicians and Medical Educators Came to Understand their Vocation By Kerensa Peterson Sometimes, a place just feels right, like home.  When I entered the Clinical Education Center for the first time, I immediately felt calm—an unusual feeling before an audition.  When I arrived, I made my way to […]
June 8, 2016

Is Being Nice Part of Being Ethical as a Healthcare Provider?

Being on the other side of the healthcare equation is always illuminating.  That is, last week I was a patient at our institution having major, elective, abdominal surgery.  Most of the care I received was kind and humane, but when it was not the negative effects were not small.  Before I “go negative” I would like to say that every nurse I encountered treated me with respect and empathy, and most did not know I was an attending physician.

But now to the negative.  An attending anesthesiologist came into my pre-operative cubicle to interview me prior to the surgery.  She started speaking very softly, and she asked me a question that I could not understand.  I told her I was hearing impaired, and that I needed her to speak up a bit, and she responded with a snort of derision.  I was shocked, and I looked over at my wife who seemed to have read the situation the same way.  She then proceeded to speak too loudly for the rest of the interview, and then stood there silently for several minutes filling out paperwork before just turning and walking out.  “Can you request another anesthesiologist,” my wife asked.  “Do you think you can trust her to take care of you while you’re asleep?’  I had no answer to these questions, and while it follows logically that her rude behavior does not directly impugn her clinical skills, she sowed a seed of doubt in my mind that even Versed (the pre-operative sedative given to patients) did not completely overcome.  Her rude behavior increased my fear and anxiety, and lessened my trust in her clinical skills.  This questioning of her abilities is emotionally justified, but it was also justified on clinical grounds as well.  My pre-operative history and physical, which she should have reviewed prior to speaking to me, documented my hearing loss, and the fact that I use hearing aids.  She came in unprepared, and then blamed me for her mistake.

Patients interviewed in a primary care setting responded that physician empathy and caring was even more important to them than physician knowledge and skill [1], but many of us have assumed that in a surgical setting patients would feel differently.  But how did I judge the skills of my surgeon except by his reputation, a warm bedside manner and thorough pre-operative informed consent discussion?  Being “nice” isn’t extra—it is the starting point of patient trust, and lack of trust undermines confidence and creates anxiety.  You would think that interpersonal skills would be less important as an anesthesiologist, but you would be wrong.  Any healthcare professional that interacts with patients needs to be well mannered, and preferably genuinely caring and compassionate.  The nursing assistant who patiently walked me around the unit at 1 am in the morning post-operatively could give lessons to the anesthesiologist. 

When it comes to medical education there has been some debate about whether we should screen for empathy or whether we can just teach it as part of the curriculum.  I think the answer is both.  Few physicians take roles that do not involve direct patient care, so rejecting applicants who have poor interpersonal skills seems both reasonable and appropriate to me.  But the “hidden curriculum” of the third and fourth year of medical school has been shown to reduce students’ empathy [2], and we as educators need to actively guard against this.  At AMC, the antidote is a longitudinal class “Health, Care, and Society (HCS).”  The course is taught over all four years of medical school, but combating the erosive effects of the clinical experience begins in the third-year.  We meet with students fifteen times during their last two years of medical school to “de-brief” them on their experiences, and help them sort out what they have witnessed.  Often we find them excusing the bad behavior of the residents and attendings, and when we challenge them on this their response is often genuine relief, because we have now allowed them to critique inappropriate behavior by their superiors.  Even more importantly, we look for positive examples of modeling that can be emulated, and fortunately students are quick to recognize these as well.  This “sorting” is critical, because at times the negative behaviors can be so commonplace as to become the norm, and students stop seeing them for what they really are. 

Last year a student told me during her Internal Medicine clerkship that she realized that many of the “nicest” residents had graduated from Albany Medical College.  It was her supposition, not mine, that the reason was HCS.  I have no idea how to test this, but if true it is the highest praise I could have received for the work we are doing.  Being “nice” isn’t extra—it is the essential starting point of patient care.

Reference:

[1] Mercer, S, Watt, G, Maxwell, M, et al. 2004.  The Development and Preliminary Validation of the Consultation and Relational Empathy (CARE) Measure:  An Empathy-Based Consultation Process Measure.  Family Practice 21(6):669-705.

[2] Neumann, M, Edelhauser, F, Tauschel, D, et al. 2011. Empathy Decline and Its Reasons: A Systematic Review of Studies With Medical Students and Residents.  Academic Medicine 86(8): 996-1009.

 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

June 2, 2016

What is the Future of Ethics Education in Medical Schools?

By Micah Hester In 2004, Lisa Lehman and colleagues noted that “Despite widespread agreement that ethics should be taught [in medical schools], there is little formal consensus concerning what, when, and how medical ethic is best taught” (2004, 682).  Eleven years later, the Project to Rebalance and Integrate Medical Education (PRIME) group in its Romanell […]
May 17, 2016

What’s Laremy Tunsil Got To Do With It? Professionalism, Social Media, and Medical Education

By Mark Kuczewski On April 28, 2016, ten minutes before the NFL draft of college players was to begin, the Twitter account of Laremy Tunsil of the University of Mississippi, displayed a video of him wearing a gas mask and smoking from a bong.  Mr. Tunsil was a talented prospect widely believed about to become […]
May 10, 2016

What is a Doctor and What is a Nurse? As Patients, We Have the Answer

By Aaron Michelfelder and Fran Vlasses As the health care professions struggle with defining a “doctor,” a “nurse,” and all of the other remarkable people comprising the health-care team, it is clear to us that the most important perspective is that of the patient.  Who better to contribute to the conversation than a physician and […]
May 3, 2016

Illness As An Opportunity for Reflection: Enabling the Unseen To Be Seen

By David Leach On March 1st my aortic valve was replaced. I received extraordinary care, was discharged on the third postoperative day, and am doing very well. When I arrived from the operating room to the intensive care unit I had an endotracheal tube, two chest tubes, an arterial line, a jugular vein Swan-Ganz catheter, […]
April 18, 2016

Awareness Creation in Healthcare Should be a Priority in the Developing World

By Calvince Owiti I was born about two decades ago in a small village in Western parts of Kenya.  I grew up in a humble background, learning all that was relevant that time.  My grandparents were herbal medical practitioners.  I lived with them most of my early life even though my parents were still alive. […]

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News (1)

July 10, 2012 4:28 pm

FDA unveils safety measures for opioid painkillers (Fox News)

Drugmakers that market powerful painkiller medications will be required to fund training programs to help U.S. doctors and other health professionals safely prescribe the drugs, which are blamed for thousands of fatal overdoses each year.  The safety plan released by the Food and Drug Administration on Monday is designed to reduce misuse and abuse of long-acting opioid pain relievers, which include forms of morphine, methadone and oxycodone. The agency’s plan mainly involves educating doctors and patients about appropriate use of the drugs.