Empathy, Burnout, and the Hidden Curriculum in Medical Training

Khan, Rabia; Martimianakis, Maria Athina

doi:10.1007/978-3-030-29876-0_15

Cited by 8 publications

(8 citation statements)

References 29 publications

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“…A wealth of teaching pedagogies has been used to develop empathy, compassion and respect for patients in medical students (30)(31)(32)(33) These include, but not limited to, patients' narratives and creative arts, drama workshops, communication skills, reflective writing, video-based learning and experiential learning (34)(35)(36)(37). Lastly, the impact of role modeling and hidden curriculum in teaching compassion and empathy is well-established (38)(39)(40). There is little evidence about how the learning contexts, including the structure and delivery of medical curricula, influence the understanding of medical students about empathy and compassion (41).…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Educational Interventions and Their Impact on Empathy and Compassion of Undergraduate Medical Students

Menezes

Guraya

2021

Front. Med.

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Introduction: A compassionate and patient-centered care leads to improved clinical outcomes. Promoting empathy and compassion of medical students is a forerunner of their well-being, emotional stability, and a patient-centered care. However, there is slender evidence about best educational interventions that can inculcate empathy and compassion skills. Our objective was to conduct a systematic review of research evaluating the associations between spectrum, effectiveness, frequency of teaching modalities and their outcomes on compassion and empathy to highlight best practices.Methods: We searched the Web of Science, PubMed, Scopus, and EBSCO Host on 22nd July 2020. We adapted our search strategy from a previously published systematic review on education for compassion and empathy. Selected studies were required to have used unique educational interventions for promoting empathy and compassion of medical students. The research questions were based on Participants (medical students), Intervention (empathy and/or compassion related teaching), Comparison, and Outcome.Results: We analyzed 24 articles from the initial yield of 2,861. Twenty-two were quantitative studies with a mean of 12.8 on MERSQI. Twelve were randomized controlled trials while 5 measured outcomes with single group pre- and post-tests. There was no association found between duration, frequency and complexity of an educational intervention and its effectiveness. Twenty used multimodality curricula, and of those 18 reported statistically significant positive improvement in empathy, while 3 of 4 single modality were effective. Only three studies looked for long-term effects of educational interventions. Fourteen studies evaluated Kirkpatrick's level one (self-reported knowledge), 2 level three (behavior), and 6 level four (patient outcomes). We identified six major educational constructs of teaching empathy and compassion; communication, mindfulness, early clinical exposure, technology-enhanced learning, comics and arts and culture.Discussion: Our review couldn't identify a standard teaching construct in place and highlighted that different teaching tools carry similar impact in promoting compassion and empathy and a sustainable program rather than a single training activity is essential.

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Section: Introductionmentioning

confidence: 99%

A Systematic Review of Educational Interventions and Their Impact on Empathy and Compassion of Undergraduate Medical Students

Menezes

Guraya

2021

Front. Med.

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“…From a broader systemic lens, we questioned why residents did not feel empowered to use the back-up system as intended and instead required faculty to validate legitimate activations; this reflects an organisational culture that emphasises 'resiliency' and being present even when illness or wellness concerns are apparent. 7,26,27 Conversely, non-IM residents were often seen as 'outsiders' of the inner circle of collegiality with less stake in image management, leading to higher perceptions of misuse by this group. This elicited negative feelings amongst residents, which threatens fairness within the workplace and exacerbates burnout.…”

Section: Anxiety Of the Unknownmentioning

confidence: 99%

“…We need then to focus not only on the individual but rather reconceptualise the very systems and policies that set people up for failure from the perspective of burnout. 6,7 When the frequency of call activations exceeds expectations, consideration should be given to exploring burnout-related issues as an impetus for using the back-up system rather than assuming misuse. This shift in view could guide programme directors and administrators to focus efforts on restructuring back-up call systems to offset downstream impacts and create models that are less primed to unintentionally promote burnout.…”

Section: Anxiety Of the Unknownmentioning

confidence: 99%

“…While this framework explores burnout from the lens of the individual, some scholars have emphasised the need to critically analyse burnout at a systemic level. 6,7 Future studies should explore back-up call systems from additional theoretical perspectives, if we wish to understand how the organisation of the system itself, and cultural attitudes through which these systems are designed, relate to experiences and perceptions of burnout. Lastly, future research could extend the reach of our study and explore downstream impacts of back-up call systems on various patient care metrics.…”

Section: Anxiety Of the Unknownmentioning

confidence: 99%

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Internal medicine trainee perspectives on back‐up call systems and relationships to burnout

Sheikh

Flett

et al. 2022

Medical Education

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Introduction: As burnout within medicine escalates, residency programmes should strive to understand how training structures may contribute. Back-up call systems that address gaps in overnight resident call coverage are one possible contributing structure. However, the intersection between back-up call policies and burnout remains unclear. The authors explored residents' decision-making process when deciding whether or not to activate a back-up resident for call coverage, perspectives surrounding the legitimacy of call activations and the impact of back-up call systems on education and experienced burnout.Methods: Internal medicine residents at the University of Toronto were recruited through email. Eighteen semi-structured one-on-one interviews were conducted with residents from September 2019 to February 2020. Interviews explored participants' experiences and perceptions with back-up call and call activations. A constructivist grounded theory approach was used to develop a conceptual understanding of the back-up system as it relates to residents' decisions underlying activations, downstream impacts and relationships to burnout.Results: Residents described a complex thought process when deciding whether to activate back-up. Decisions were coloured by inner conflicts including sense of collegiality, need to maintain an image and time of year balanced against self-reported burnout. Residents described how back-up calls can lead to burnout, usually in the form of exhaustion, lowering their threshold to trigger future back-up activations.Impacts included anxiety of not knowing whether an activation would occur, decreased educational productivity and the 'domino effect' of increased workload for colleagues.Discussion: Residents weigh inner tensions when deciding to activate back-up. Their collective experience suggests that burnout is both a trigger and consequence of back-up calls, creating a cyclical relationship. Escalating rates of call activations may signal that burnout amongst residents is high, warranting educational leads to assess for resident wellness and to critically evaluate the structure of such systems with respect to unintended consequences.

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“…22 We believe we need a comprehensive approach that also addresses the systems and structures in which the medical students live and learn. [22][23][24]…”

mentioning

confidence: 99%