Humanistic medicine in anaesthesiology: development and assessment of a curriculum in humanism for postgraduate anaesthesiology trainees

Abstract

Background: An unintended consequence of medical technologies is loss of personal interactions and humanism between patients and their healthcare providers, leading to depersonalisation of medicine. As humanism is not integrated as part of formal postgraduate anaesthesiology education curricula, our goal was to design, introduce, and evaluate a comprehensive humanism curriculum into anaesthesiology training. Methods: Subject-matter experts developed and delivered the humanism curriculum, which included interactive workshops, simulation sessions, formal feedback, and patient immersion experience. The effectiveness of the programme was evaluated using pre-and post-curriculum assessments in first-year postgraduate trainee doctors (residents). Results: The anaesthesiology residents reported high satisfaction scores. Pre-/post-Jefferson Scale of Patient Perceptions of Physician Empathy showed an increase in empathy ratings with a median improvement of 12 points (range; P¼0.013).After training, patients rated the residents as more empathetic ( 31[4] vs 22 [5]; P<0.001; 95% confidence interval [CI]: 7e12) and professional (47 [3] vs 35 [8]; P<0.001; 95% CI: 9e16). Patient overall satisfaction with their anaesthesia provider improved after training (51 [6] vs 37 [10]; P<0.001; 95% CI: 10e18). Patients rated their anxiety lower in the post-training period compared with pretraining (1.8 [2.3] vs 3.6 [1.6]; P¼0.001; 95% CI: 0.8e2.9). Patient-reported pain scores decreased after training (2.3 [2.5] vs 3.8 [2.1]; P¼0.010; 95% CI: 0.4e2.8). Conclusions: Implementation of a humanism curriculum during postgraduate anaesthesiology training was well accepted, and can result in increased physician empathy and professionalism. This may improve patient pain, anxiety, and overall satisfaction with perioperative care.

A systematic scoping review of approaches to teaching and assessing empathy in medicine

“…Role play has been found to boost participants’ confidence in communication [ 44 , 118 , 142 , 144 ]. The use of the arts and humanities including poetry and literature [ 49 , 57 , 83 , 136 , 139 ], drawings and paintings [ 16 , 43 , 59 , 83 , 136 , 139 ], reflective writing [ 49 , 83 , 136 , 139 ], cultural studies and history [ 16 ], film [ 16 ], photography [ 59 ], and comics [ 5 ] have also shown to increase self-awareness and reflection [ 59 ].…”

Can we go too far with empathy? Shifting from empathy to compassion

“…This quote epitomises empathy, which is perhaps, as Canales and colleagues 1 propose, an antidote to depersonalisation in healthcare and risk of physician burnout. Krasner and colleagues 3 have shown that increasing physician empathy (through well-being training) can reduce burnout.…”

“…Canales and colleagues 1 have undertaken an important study because it tells us that humanism is important for high quality patient-centred care and for satisfaction by both patients and carers. The extent to which each element of their curriculum is important to this improvement remains to be tested, but we suggest revisiting the purpose and outcomes of the 'doctor as patient' exercise.…”

“…But we can show compassion towards people in any situation, and research suggests that patients appreciate it when we do. 1,16,17 At the core of clinical medicine is shared decision-making about tests and treatments based upon individual patients' riskebenefit calculus. Interventions are undertaken when benefit outweighs risk from a patient's perspective.…”

“…9,12 Canales and colleagues 1 introduced a humanistic curriculum for first-year anaesthesia residents with the aim of increasing resident compassion, communication, and empathetic care of their patients. 1 They found that resident ratings for empathy increased, and that patients were more satisfied with the interaction, and their scores for anxiety and pain scores decreased. An unexpected side benefit for the residents was a sense of more personalised patient interactions, improving their working experience.…”