September 27, 2016
By Darrell G. Kirch We face a crisis of well-being in medicine. From the acceleration of science to the implementation of the Affordable Care Act, rapid change has become the “new normal” for our profession. While many of the changes have the potential to revolutionize health care, they also create stress and uncertainty within our […]
August 24, 2016
By Patricia Stubenberg “No words are ofterner on our lips than thinking and thought.” – John Dewey The teaching physician has opportunities for personal and professional growth through reflection and revisiting not only their own experiences in training and practice, but also their role as clinical teachers with medical students and residents. Studies on reflection in […]
August 2, 2016
By Wessam Ibrahim Learning Anatomy is a journey. All medical students have some memories about their anatomy courses; some have good memories and some don’t. It’s October 1995. I was a first-year medical student at my medical school in Egypt. I had never seen a corpse except in horror movies. I was so scared and […]
July 26, 2016
By Josh Hopps It is the end of the USMLE Step 1 exam season in undergraduate medical education. If UME is a solar system, Step 1 is the sun, irradiating and superheating some, leaving others cold and frozen out, and supporting life for those who thrive in intense and constrained circumstances. Its enormous gravity pulls […]
July 18, 2016
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
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
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
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
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 , 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
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 ,
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
 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
 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
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 […]