Background: While empathy is often a large focus at the undergraduate medical education (UME) level, it unfortunately loses priority at many residency training programs due to lack of a formal curriculum. Residents are at high risk for burnout, emotional exhaustion, and loss of meaning in their work, all of which can negatively impact their empathy. Empathically communicating physicians can elicit important clinical information from patients which in turn increases compliance, reduces emotional distress, improves quality of life and quality of care. As such, renewing feelings of empathy should be an important part of all Internal Medicine training programs.
Purpose: This innovative and interdisciplinary curriculum for residents aims to increase empathy and improve communication skills in medicine as a primary goal. A secondary goal is to enhance confidence and comfort level with procedural skills with point of care ultrasound being chosen as the focused skill as it brings the provider “back to the bedside.” Integration of a humanities curriculum with a specific focus on empathy and communication can serve to promote wellness and encourage interconnectedness within interdisciplinary teams as well as build emotional intelligence and reinvigorate the empathic feelings which led them to pursue medicine as a career.
Description: Our curriculum focuses on three important themes: Empathy, communication and the patient experience, and procedural skills. This curriculum integrates various resources in the hospital and community setting, including the arts, improvisation, patient experience exercises, interdisciplinary experience with community partners, and simulations with both anatomic models and standardized patients. Experiences focused on empathy include a longitudinal medication compliance exercise, a simulation of “one month living at the poverty line,” motivational interviewing and a book club discussion on a novel chosen for it’s focus on empathy. The communication aspect of our curriculum teaches both verbal and nonverbal skills using an improvisational theatre workshop, acting classes with a local theatre company, an exercise in narrative medicine, as well as a half day “shadowing” a bedside nurse to improve communication (both verbal and written) between healthcare providers. Our procedural skills curriculum includes half day experiences in procedural ultrasound using anatomic models, diagnostic ultrasound using standardized patients, and code simulations using a state of the art simulation mannequin. As part of our code simulation, we also discuss how to communicate with families following a code and how to debrief with your code team to prevent emotional exhaustion after these events.
Conclusions: Burnout scores were measured at the start and end of our curriculum using the Maslach Burnout Inventory. We noted an increase in sense of personal achievement and decrease in sense of depersonalization with no significant impact in burnout. Empathy was measured using the Toronto Empathy Questionnaire, with an average increase of empathy scores through the three groups participating in the curriculum of 1.69 points. While these are small changes, through evaluation comments received after completion, we believe the curriculum has a large impact on residents’ sense of wellness and leave the curriculum ready to tackle the challenges of medical training with renewed enthusiasm and sense of purpose. We hope to expand aspects of this curriculum to upper level medical residents in the future.