Towards an empathic hidden curriculum in medical school: A roadmap.

communication curriculum empathy medical schools students

Journal

Journal of evaluation in clinical practice
ISSN: 1365-2753
Titre abrégé: J Eval Clin Pract
Pays: England
ID NLM: 9609066

Informations de publication

Date de publication:
08 Feb 2024
Historique:
received: 29 08 2023
accepted: 11 01 2024
medline: 9 2 2024
pubmed: 9 2 2024
entrez: 9 2 2024
Statut: aheadofprint

Résumé

The "hidden curriculum" in medical school includes a stressful work environment, un-empathic role models, and prioritisation of biomedical knowledge. It can provoke anxiety and cause medical students to adapt by becoming cynical, distanced and less empathic. Lower empathy, in turn, has been shown to harm patients as well as practitioners. Fortunately, evidence-based interventions can counteract the empathy dampening effects of the hidden curriculum. These include early exposure to real patients, providing students with real-world experiences, training role models, assessing empathy training, increasing the focus on the biopsychosocial model of disease, and enhanced wellbeing education. Here, we provide an overview of these interventions. Taken together, they can bring about an "empathic hidden curriculum" which can reverse the decline in medical student empathy.

Identifiants

pubmed: 38332641
doi: 10.1111/jep.13966
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Stoneygate Trust

Informations de copyright

© 2024 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.

Références

Howick J, Moscrop A, Mebius A, et al. Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. J R Soc Med. 2018;111(7):240-252.
Dambha-Miller H, Feldman AL, Kinmonth AL, Griffin SJ. Association between primary care practitioner empathy and risk of cardiovascular events and all-cause mortality among patients with type 2 diabetes: a population-based prospective cohort study. Ann Fam Med. 2019;17(4):311-318.
Thirioux B, Birault F, Jaafari N. Empathy is a protective factor of burnout in physicians: new neuro-phenomenological hypotheses regarding empathy and sympathy in care relationship. Front Psychol. 2016;7:763.
Gleichgerrcht E, Decety J. Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PLoS ONE. 2013;8(4):e61526.
Moore PJ. Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. West J Med. 2000;173(4):244-250.
Street, Jr. RL, Petrocelli JV, Amroze A, et al. How communication “failed” or “saved the day”: counterfactual accounts of medical errors. J Patient Exp. 2020;7(6):1247-1254.
Ockenden D, Ockendend Report: Findings, Conclusions and Essential Actions From the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust. 2022, House of Commons London.
Kirkup B, Maternity and neonatal services in East Kent: ‘Reading the signals’ report. 2022, GOV.UK.
Francis R, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: executive summary 2013, GOV.UK.
GMC. Our Strategy 2021-25. 2021 [cited 2023 26/7/23].
Decety J, Cowell JM. Friends or foes: is empathy necessary for moral behavior? Perspect Psychol Sci. 2014;9(5):525-537.
Albuquerque A, Howick J. The moral role of clinical empathy in patient healthcare. Int J Fam Community Med. 2023;7(1):11-14.
Howick J, Steinkopf L, Ulyte A, Roberts N, Meissner K. How empathic is your healthcare practitioner? A systematic review and meta-analysis of patient surveys. BMC Med Educ. 2017;17(1):136.
Ponnamperuma G, Yeo SP, Samarasekera DD. Is empathy change in medical school geo-socioculturally influenced? Med Educ. 2019;53(7):655-665.
Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69(11):861-871.
Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching. BMJ. 2004;329(7469):770-773.
Howick J, Dudko M, Feng SN, et al. Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies. BMC Med Educ. 2023;23(1):270.
Dornan T, Littlewood S, Margolis SA, Scherpbier A, Spencer J, Ypinazar V. How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Med Teach. 2006;28(1):3-18.
Granek L, Lazarev I, Birenstock-Cohen S, Geffen DB, Riesenberg K, Ariad S. Early exposure to a clinical oncology course during the preclinical second year of medical school. Acad Med. 2015;90(4):454-457.
Pethrick H, Nowell L, Paolucci EO, et al. Peer mentoring in medical residency education: a systematic review. Can Med Educ J. 2020;11(6):e128-e137.
Dalwood N, Bowles KA, Williams C, Morgan P, Pritchard S, Blackstock F. Students as patients: A systematic review of peer simulation in health care professional education. Med Educ. 2020;54(5):387-399.
Passi V, Johnson S, Peile E, Wright S, Hafferty F, Johnson N. Doctor role modelling in medical education: BEME guide no. 27. Med Teach. 2013;35(9):e1422-e1436.
Patel S, Pelletier-Bui A, Smith S, et al. Curricula for empathy and compassion training in medical education: a systematic review. PLoS One. 2019;14(8):e0221412.
Wasson LT, Cusmano A, Meli L, et al. Association between learning environment interventions and medical student well-being: a systematic review. JAMA. 2016;316(21):2237-2252.
Xiao X, Song H, Sang T, Wu Z, Xie Y, Yang Q. Analysis of real-world implementation of the biopsychosocial approach to healthcare: evidence from a combination of qualitative and quantitative methods. Front Psychiatry. 2021;12:725596.
Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129-136.
Jaini PA, Lee JSH. A review of 21st century utility of a biopsychosocial model in United States medical school education. J Lifestyle Med. 2015;5(2):49-59.
Upshur REG. Looking for rules in a world of exceptions: reflections on evidence-based practice. Perspect Biol Med. 2005;48(4):477-489.
Rice K, Ryu JE, Whitehead C, Katz J, Webster F. Medical trainees' experiences of treating people with chronic pain: a lost opportunity for medical education. Acad Med. 2018;93(5):775-780.
Steinauer JE, Teherani A, Preskill F, ten Cate O, O'Sullivan P. What do medical students do and want when caring for “difficult patients”? Teach Learn Med. 2019;31(3):238-249.
Government U, Good for you, good for us, good for everybody. A plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions, 2021. Online D.o.H.a.S. Care, Editor.
Denizard-Thompson N, Palakshappa D, Vallevand A, et al. Association of a health equity curriculum with medical students' knowledge of social determinants of health and confidence in working with underserved populations. JAMA Network Open. 2021;4(3):e210297.
Kang ES, Di Genova T, Howick J, Gottesman R. Adding a dose of empathy to healthcare: what can healthcare systems do? J Eval Clin Pract. 2022;28(3):475-482.
Howick J. The philosophy of evidence-based medicine. John Wiley & Sons; 2011.
Dickinson BL, Lackey W, Sheakley M, Miller L, Jevert S, Shattuck B. Involving a real patient in the design and implementation of case-based learning to engage learners. Adv Physiol Ed. 2018;42(1):118-122.
Quail M, Brundage SB, Spitalnick J, Allen PJ, Beilby J. Student self-reported communication skills, knowledge and confidence across standardised patient, virtual and traditional clinical learning environments. BMC Med Educ. 2016;16:73.
NICE. Back pain- low. 2022November 2022 [cited 2023 26/7/23].
Zhou J, Ke P, Qiu X, Huang M, Zhang J. ChatGPT: potential, prospects, and limitations. Front Inf Technol Electron. 2023:1-6.
Steinmetz D, Tabenkin H. The ‘difficult patient’ as perceived by family physicians. Fam Pract. 2001;18(5):495-500.
Shapiro J, Rakhra P, Wong A. The stories they tell: how third year medical students portray patients, family members, physicians, and themselves in difficult encounters. Med Teach. 2016;38(10):1033-1040.
Whitehead L, Jacob E, Towell A, Abu-qamar M, Cole-Heath A. The role of the family in supporting the self-management of chronic conditions: a qualitative systematic review. J Clin Nurs. 2018;27(1-2):22-30.
Dijk SW, Duijzer EJ, Wienold M. Role of active patient involvement in undergraduate medical education: a systematic review. BMJ Open. 2020;10(7):e037217.
Hardman D, Howick J. The friendly relationship between therapeutic empathy and person-centered care. Eur J Pers Cent Healthc. 2019;7(2):351-357.
Başak O, Yaphe J, Spiegel W, Wilm S, Carelli F, Metsemakers JFM. Early clinical exposure in medical curricula across Europe: an overview. Eur J Gen Pract. 2009;15(1):4-10.
Pottle J. Virtual reality and the transformation of medical education. Future Healthc J. 2019;6(3):181-185.
Samadbeik M, Yaaghobi D, Bastani P, Abhari S, Rezaee R, Garavand A. The applications of virtual reality technology in medical groups teaching. J Adv Med Educ Prof. 2018;6(3):123-129.
Jiang H, Vimalesvaran S, Wang JK, Lim KB, Mogali SR, Car LT. Virtual reality in medical students' education: scoping review. JMIR Med Educ. 2022;8(1):e34860.
Darnton R, Amey S, Brimicombe J. The nature and prevalence of threats to medical student placement capacity in primary care: a survey of east of england GP practices. BJGP Open. 2022;6(4):BJGPO.2022.0127.
Barrett J, Trumble SC, McColl G. Novice students navigating the clinical environment in an early medical clerkship. Med Educ. 2017;51(10):1014-1024.
Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182-1191.
Monrouxe LV, Bullock A, Tseng HM, Wells SE. Association of professional identity, gender, team understanding, anxiety and workplace learning alignment with burnout in junior doctors: a longitudinal cohort study. BMJ Open. 2017;7(12):e017942.
Poncelet A, O'Brien B. Preparing medical students for clerkships: a descriptive analysis of transition courses. Acad Med. 2008;83(5):444-451.
Ryan MS, Feldman M, Bodamer C, Browning J, Brock E, Grossman C. Closing the gap between preclinical and clinical training: impact of a transition-to-clerkship course on medical students' clerkship performance. Acad Med. 2020;95(2):221-225.
Atherley A, Dolmans D, Hu W, Hegazi I, Alexander S, Teunissen PW. Beyond the struggles: a scoping review on the transition to undergraduate clinical training. Med Educ. 2019;53(6):559-570.
Akinla O, Hagan P, Atiomo W. A systematic review of the literature describing the outcomes of near-peer mentoring programs for first year medical students. BMC Med Educ. 2018;18(1):98.
Lim S, Xin Min L, Chan CJW, Dong Y, Mikkonen K, Zhou W. Peer mentoring programs for nursing students: a mixed methods systematic review. Nurse Educ Today. 2022;119:105577.
Pethrick H, Nowell L, Oddone Paolucci E, et al. Psychosocial and career outcomes of peer mentorship in medical resident education: a systematic review protocol. Syst Rev. 2017;6(1):178.
Hill SEM, Ward WL, Seay A, Buzenski J. The nature and evolution of the mentoring relationship in academic health centers. J Clin Psychol Med Settings. 2022;29(3):557-569.
Moberly T. Five facts about privilege and Medicine in the UK. BMJ. 2016;352:i632.
Bosse HM, Schultz JH, Nickel M, et al. The effect of using standardized patients or peer role play on ratings of undergraduate communication training: a randomized controlled trial. Patient Educ Couns. 2012;87(3):300-306.
Shuja F, Ansari S, Babar T, et al. Empathy building in undergraduate medical students through an interaction with persons with disabilities in their natural home environment. Rawal Med J. 2014;39(2):208-211.
McClenon J. The experience of care project: students as participant observers in the hospital setting. Acad Med. 1996;71(8):923-929.
Beylefeld AA. They went, they saw, they learned: medical students' reflections on community clinic visits. Innov Educ Teach Int. 2014;51(2):118-129.
Preci C, Bonfatti M, Garuti C, et al. Continuity of care and chronicity in medical students' education: ‘adopt’ a chronic patient. Educ Prim Care. 2020;31(6):365-370.
Park J, Woodrow SI, Reznick RK, Beales J, MacRae HM. Observation, reflection, and reinforcement: surgery faculty members' and residents' perceptions of how they learned professionalism. Acad Med. 2010;85(1):134-139.
Bombeke K, Van Roosbroeck S, De Winter B, et al. Medical students trained in communication skills show a decline in patient-centred attitudes: an observational study comparing two cohorts during clinical clerkships. Patient Educ Couns. 2011;84(3):310-318.
Chhabra N, Chhabra S, Archer E. Medical students' perspectives on the factors affecting empathy development during their undergraduate training. Med Sci Educ. 2022;32(1):79-89.
Burgess A, Goulston K, Oates K. Role modelling of clinical tutors: a focus group study among medical students. BMC Med Educ. 2015;15:17.
Wenger E. Communities of practice: Learning, meaning, and identity. Cambridge university press; 1999.
Winter R, Issa E, Roberts N, Norman RI, Howick J. Assessing the effect of empathy-enhancing interventions in health education and training: a systematic review of randomised controlled trials. BMJ Open. 2020;10(9):e036471.
Jeremy Howick MG The oxford Empathy Programme. 2023; Available from: https://www.philosophy.ox.ac.uk/oxford-empathy-programme.
Jochemsen-van der Leeuw HGAR, van Dijk N, van Etten-Jamaludin FS, Wieringa-de Waard M. The attributes of the clinical trainer as a role model: a systematic review. Acad Med. 2013;88(1):26-34.
Cruess SR, Cruess RL, Steinert Y. Role modelling--making the most of a powerful teaching strategy. BMJ. 2008;336(7646):718-721.
Gibson DE. Role models in career development: new directions for theory and research. J Vocat Behav. 2004;65(1):134-156.
Slavin DH, Jeremy, Giving medical students the tools to tackle the hidden curriculum: An evaluation and pilot to enable students to identify empathic role models. TBC, 2023.
Howick J, Lyness E, Albury C, et al. Anatomy of positive messages in healthcare consultations: component analysis of messages within 22 randomised trials. Eur J Pers Cent Healthc. 2020;7(4):656.
Smith KA, Bishop FL, Dambha-Miller H, et al. Improving empathy in healthcare consultations-a secondary analysis of interventions. J Gen Intern Med. 2020;35(10):3007-3014.
Kordestani Moghaddam A, Khankeh HR, Shariati M, Norcini J, Jalili M. Educational impact of assessment on medical students' learning at Tehran university of medical sciences: a qualitative study. BMJ Open. 2019;9(7):e031014.
Learning objectives for medical student education--guidelines for medical schools: report I of the Medical School Objectives Project. J Assoc Am Med Coll. 1999;74(1):13-18.
Winter R, Ward A, Norman RI, Howick J. A survey of clinical empathy training at UK medical schools. BMC Med Educ. 2023;23(1):40.
Opoka R, Kiguli S, Ssemata A, Marjan G, Driessen E. Perceptions of postgraduate trainees on the impact of objective structured clinical examinations on their study behavior and clinical practice. Adv Med Educ Pract. 2015;6:431-437.
Mercer SW, Maxwell M, Heaney D, Watt GC. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004;21(6):699-705.
Rosales-Ricardo Y, et al. Prevalence of burnout syndrome in university students: a systematic review. 2021;2021 44(2):12.
Hassed C, Sierpina VS, Kreitzer MJ. The health enhancement program at monash university medical school. EXPLORE. 2008;4(6):394-397.
McConville J, McAleer R, Hahne A. Mindfulness training for health profession students-the effect of mindfulness training on psychological well-being, learning and clinical performance of health professional students: a systematic review of randomized and non-randomized controlled trials. EXPLORE. 2017;13(1):26-45.
Shapiro P, Lebeau R, Tobia A. Mindfulness meditation for medical students: a student-led initiative to expose medical students to mindfulness practices. Med Sci Educ. 2019;29(2):439-451.
Curry OS, Rowland LA, Van Lissa CJ, Zlotowitz S, McAlaney J, Whitehouse H. Happy to help? A systematic review and meta-analysis of the effects of performing acts of kindness on the well-being of the actor. J Exp Soc Psychol. 2018;76:320-329.
Barker ME, Crowfoot G, King J. Empathy development and volunteering for undergraduate healthcare students: a scoping review. Nurse Educ Today. 2022;116:105441.
Sin D, Chew T, Chia TK, Ser JS, Sayampanathan A, Koh G. Evaluation of constructing care collaboration - nurturing empathy and peer-to-peer learning in medical students who participate in voluntary structured service learning programmes for migrant workers. BMC Med Educ. 2019;19(1):304.
Hafferty FW. Beyond curriculum reform: confronting medicine's hidden curriculum. Acad Med. 1998;73(4):403-407.
Safari Y, Khatony A, Tohidnia MR. The hidden curriculum challenges in learning professional ethics among Iranian medical students: a qualitative study. Adv Med Educ Pract. 2020;11:673-681.

Auteurs

Jeremy Howick (J)

Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK.

Daniel Slavin (D)

Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK.

Sue Carr (S)

Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK.

Fiona Miall (F)

Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK.

Chandra Ohri (C)

Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK.

Steve Ennion (S)

Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK.

Simon Gay (S)

Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK.

Classifications MeSH