From skillful to empathic: evaluating shifts in medical students' perceptions of surgeons through a combined patient as teacher and arts-based reflection program
Introduction: The purpose of this study was to identify whether the incorporation of a combined Patient as teacher (PAT) and arts-based reflection (ABR) program during a surgical clerkship rotation could influence more humanistic perceptions of surgeons, using an innovative evaluation approach.
Methods: A novel, single question evaluation tool was created. Third year medical-students were asked to “list the top 5 attributes of a surgeon, in order of perceived importance” both before and after their surgical clerkship rotations and participation in the PAT/ABR program. Attributes identified by students were coded as either “humanistic” or “non-humanistic,” which were then analyzed using generalized linear regression models under a Bayesian framework.
Results: After participation in the PAT/ABR program, the predicted probability of students ranking a humanistic characteristic as the most important attribute of a surgeon had increased by 17%, and the predicted probability of students ranking a humanistic characteristic amongst their top three attributes for a surgeon had increased by 21%.
Conclusion: This innovative evaluative method suggested the success of a combined PAT/ABR program in encouraging a humanistic perspective of surgery and this approach could potentially be explored to evaluate other humanistic education initiatives.
Kumagai AK, Richardson L, Khan S, Kuper A. Dialogues on the threshold: dialogical learning for humanism and justice. Acad Med. Dec 2018;93(12):1778-1783. https://doi.org/10.1097/ACM.0000000000002327 DOI: https://doi.org/10.1097/ACM.0000000000002327
Brady-Amoon P. Humanism, feminism, and multiculturalism: essential elements of social justice in counseling, education, and advocacy. J Humanistic COUNSELING. 2011;50 DOI: https://doi.org/10.1002/j.2161-1939.2011.tb00113.x
Baker L, Shing LK, Wright S, Mylopoulos M, Kulasegaram K, Ng S. Aligning and applying the paradigms and practices of education. Acad Med. Jul 2019;94(7):1060. https://doi.org/10.1097/ACM.0000000000002693 DOI: https://doi.org/10.1097/ACM.0000000000002693
Baker LR, Phelan S, Woods NN, Boyd VA, Rowland P, Ng SL. Re-envisioning paradigms of education: towards awareness, alignment, and pluralism. Adv Health Sci Educ Theory Pract. Mar 2021; https://doi.org/10.1007/s10459-021-10036-z
Kumagai AK. From competencies to human interests: ways of knowing and understanding in medical education. Acad Med. Jul 2014;89(7):978-83. https://doi.org/10.1097/ACM.0000000000000234 DOI: https://doi.org/10.1097/ACM.0000000000000234
Dijk SW, Duijzer EJ, Wienold M. Role of active patient involvement in undergraduate medical education: a systematic review. BMJ Open. Jul 27 2020;10(7):e037217. https://doi.org/10.1136/bmjopen-2020-037217 DOI: https://doi.org/10.1136/bmjopen-2020-037217
Rowland P, Kumagai AK. Dilemmas of Representation: Patient Engagement in Health Professions Education. Acad Med. Jun 2018;93(6):869-873. https://doi.org/10.1097/ACM.0000000000001971 DOI: https://doi.org/10.1097/ACM.0000000000001971
Towle A, Bainbridge L, Godolphin W, et al. Active patient involvement in the education of health professionals. Med Educ. Jan 2010;44(1):64-74. https://doi.org/10.1111/j.1365-2923.2009.03530.x DOI: https://doi.org/10.1111/j.1365-2923.2009.03530.x
Kumagai AK, Wear D. "Making strange": a role for the humanities in medical education. Acad Med. Jul 2014;89(7):973-7. https://doi.org/10.1097/ACM.0000000000000269 DOI: https://doi.org/10.1097/ACM.0000000000000269
Moniz T, Golafshani M, Gaspar CM, et al. How are the arts and humanities used in medical education? results of a scoping review. Acad Med. Aug 01 2021;96(8):1213-1222. https://doi.org/10.1097/ACM.0000000000004118 DOI: https://doi.org/10.1097/ACM.0000000000004118
Haidet P, Jarecke J, Adams NE, et al. A guiding framework to maximise the power of the arts in medical education: a systematic review and metasynthesis. Med Educ. Mar 2016;50(3):320-31. https://doi.org/10.1111/medu.12925 DOI: https://doi.org/10.1111/medu.12925
Kinsella EA, Bidinosti S. 'I now have a visual image in my mind and it is something I will never forget': an analysis of an arts-informed approach to health professions ethics education. Adv Health Sci Educ Theory Pract. May 2016;21(2):303-22. https://doi.org/10.1007/s10459-015-9628-7 DOI: https://doi.org/10.1007/s10459-015-9628-7
de Groot E, Schönrock-Adema J, Zwart D, et al. Learning from patients about patient-centredness: A realist review: BEME Guide No. 60. Med Teach. Apr 2020;42(4):380-392. https://doi.org/10.1080/0142159X.2019.1695767 DOI: https://doi.org/10.1080/0142159X.2019.1695767
Charon R, Hermann N, Devlin MJ. Close reading and creative writing in clinical education: teaching attention, representation, and affiliation. Acad Med. Mar 2016;91(3):345-50. https://doi.org/10.1097/ACM.0000000000000827 DOI: https://doi.org/10.1097/ACM.0000000000000827
George DR, Stuckey HL, Whitehead MM. An arts-based intervention at a nursing home to improve medical students' attitudes toward persons with dementia. Acad Med. Jun 2013;88(6):837-42. https://doi.org/10.1097/ACM.0b013e31828fa773 DOI: https://doi.org/10.1097/ACM.0b013e31828fa773
Timpani S, Sweet L, Sivertsen N. Storytelling: One arts-based learning strategy to reflect on clinical placement. an integrative review. Nurse Educ Pract. Mar 2021;52:103005. https://doi.org/10.1016/j.nepr.2021.103005 DOI: https://doi.org/10.1016/j.nepr.2021.103005
Lindsay R. Baker SP, Nicole N. et al. Re-envisioning paradigms of education: towards awareness, alignment, and pluralism. 2021;26:1045-1058. https://doi.org/10.1007/s10459-021-10036-z DOI: https://doi.org/10.1007/s10459-021-10036-z
Tremblay MC, Richard L, Brousselle A, Beaudet N. Learning reflexively from a health promotion professional development program in Canada. Health Promot Int. Sep 2014;29(3):538-48. https://doi.org/10.1093/heapro/dat062 DOI: https://doi.org/10.1093/heapro/dat062
Vogel BA LR, Helmes AW. Communication matters: the impact of communication and participation in decision making on breast cancer patients' depression and quality of life. Patient Educ Couns. 2009;77(3):391-397. DOI: https://doi.org/10.1016/j.pec.2009.09.005
Menendez ME, Chen NC, Mudgal CS, Jupiter JB, Ring D. Physician empathy as a driver of hand surgery patient satisfaction. J Hand Surg Am. Sep 2015;40(9):1860-5.e2. https://doi.org/10.1016/j.jhsa.2015.06.105 DOI: https://doi.org/10.1016/j.jhsa.2015.06.105
O’Rorke EV, Mauch JT, Liu Y, Friedrich JB. Essential elements of surgeon communication impacting patient satisfaction: a systematic review. J Comm Healthc. 2022. p. 90-101. DOI: https://doi.org/10.1080/17538068.2021.1994826
Gehenne L, Lelorain S, Eveno C, et al. Associations between the severity of medical and surgical complications and perception of surgeon empathy in esophageal and gastric cancer patients. Support Care Cancer. Dec 2021;29(12):7551-7561. https://doi.org/10.1007/s00520-021-06257-y DOI: https://doi.org/10.1007/s00520-021-06257-y
Steinhausen S, Ommen O, Antoine SL, Koehler T, Pfaff H, Neugebauer E. Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy. Patient Prefer Adherence. 2014;8:1239-53. https://doi.org/10.2147/PPA.S62925 DOI: https://doi.org/10.2147/PPA.S62925
Patel P, Martimianakis MA, Zilbert NR, et al. Fake it 'til you make it: pressures to measure up in surgical training. Acad Med. May 2018;93(5):769-774. https://doi.org/10.1097/ACM.0000000000002113 DOI: https://doi.org/10.1097/ACM.0000000000002113
Sadati L, Yazdani S, Heidarpoor P. Surgical residents' challenges with the acquisition of surgical skills in operating rooms: a qualitative study. J Adv Med Educ Prof. Jan 2021;9(1):34-43. https://doi.org/10.30476/jamp.2020.87464.1308
Khan S, Jung F, Kirubarajan A, Karim K, Scheer A, Simpson J. A systematic review of interventions to improve humanism in surgical practice. J Surg Educ. 2021;78(2):548-560. https://doi.org/10.1016/j.jsurg.2020.07.032 DOI: https://doi.org/10.1016/j.jsurg.2020.07.032
Simpson JS, Ng S, Kangasjarvi E, et al. Humanistic education in surgery: a "patient as teacher" program for surgical clerkship. Can J Surg. May 13 2020;63(3):E257-E260. https://doi.org/10.1503/cjs.005319 DOI: https://doi.org/10.1503/cjs.005319
Kangasjarvi E, Ng SL, Friesen F, Simpson JS. Patients as teachers and arts-based reflection in surgical clerkship: A preliminary exploration. Med Teach. 12 2020;42(12):1362-1368. https://doi.org/10.1080/0142159X.2020.1807482 DOI: https://doi.org/10.1080/0142159X.2020.1807482
Kruschke JK, Liddell TM. The Bayesian New Statistics: hypothesis testing, estimation, meta-analysis, and power analysis from a Bayesian perspective. Psychon Bull Rev. 02 2018;25(1):178-206. https://doi.org/10.3758/s13423-016-1221-4 DOI: https://doi.org/10.3758/s13423-016-1221-4
Osman M, Eacott B, Willson S. Arts-based interventions in healthcare education. Med Humanit. Mar 2018;44(1):28-33. https://doi.org/10.1136/medhum-2017-011233 DOI: https://doi.org/10.1136/medhum-2017-011233
Buck E, Holden M, Szauter K. A methodological review of the assessment of humanism in medical students. Acad Med. Nov 2015;90(11 Suppl):S14-23. https://doi.org/10.1097/ACM.0000000000000910 DOI: https://doi.org/10.1097/ACM.0000000000000910
Logghe HJ, Rouse T, Beekley A, Aggarwal R. The evolving surgeon image. AMA J Ethics. May 1 2018;20(5):492-500. https://doi.org/10.1001/journalofethics.2018.20.5.mhst1-1805 DOI: https://doi.org/10.1001/journalofethics.2018.20.5.mhst1-1805
Braun HJ, Dusch MN, Park SH, et al. Medical students' perceptions of surgeons: implications for teaching and Recruitment. J Surg Educ. Nov-Dec 2015;72(6):1195-9. https://doi.org/10.1016/j.jsurg.2015.05.014 DOI: https://doi.org/10.1016/j.jsurg.2015.05.014
Kumagai AK. A conceptual framework for the use of illness narratives in medical education. Acad Med. Jul 2008;83(7):653-8. https://doi.org/10.1097/ACM.0b013e3181782e17 DOI: https://doi.org/10.1097/ACM.0b013e3181782e17
Charise A. Site, sector, scope: mapping the epistemological landscape of health humanities. J Med Humanit. Dec 2017;38(4):431-444. https://doi.org/10.1007/s10912-017-9445-5 DOI: https://doi.org/10.1007/s10912-017-9445-5
Kumagai AK. Beyond "dr. feel-good": a role for the humanities in medical education. Acad Med. Dec 2017;92(12):1659-1660. https://doi.org/10.1097/ACM.0000000000001957 DOI: https://doi.org/10.1097/ACM.0000000000001957
Rosenthal S, Howard B, Schlussel YR, et al. Humanism at heart: preserving empathy in third-year medical students. Acad Med. Mar 2011;86(3):350-8. https://doi.org/10.1097/ACM.0b013e318209897f DOI: https://doi.org/10.1097/ACM.0b013e318209897f
Yang KT, Yang JH. A study of the effect of a visual arts-based program on the scores of Jefferson Scale for physician empathy. BMC Med Educ. Oct 2013;13:142. https://doi.org/10.1186/1472-6920-13-142 DOI: https://doi.org/10.1186/1472-6920-13-142
Leppink J, O'Sullivan P, Winston K. Evidence against vs. in favour of a null hypothesis. Perspect Med Educ. Apr 2017;6(2):115-118. https://doi.org/10.1007/s40037-017-0332-6 DOI: https://doi.org/10.1007/S40037-017-0332-6
Young M, Varpio L, Uijtdehaage S, Paradis E. The spectrum of inductive and deductive research approaches using quantitative and qualitative data. Acad Med. Jul 2020;95(7):1122. https://doi.org/10.1097/ACM.0000000000003101 DOI: https://doi.org/10.1097/ACM.0000000000003101
Cochran A, Paukert JL, Neumayer LA. Does a general surgery clerkship influence student perceptions of surgeons and surgical careers? Surgery. Aug 2003;134(2):153-7. https://doi.org/10.1067/msy.2003.216 DOI: https://doi.org/10.1067/msy.2003.216
Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: an updated, systematic review. Acad Med. Aug 2013;88(8):1171-7. https://doi.org/10.1097/ACM.0b013e318299f3e3 DOI: https://doi.org/10.1097/ACM.0b013e318299f3e3
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