Teaching empathy through poetry: a clinically based model (original) (raw)
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The problem of empathy: medicine and the humanities
New Literary History, 2007
H ealth care institutions and medical educators assert that empathy is essential to optimum patient care, yet medical education and the practice of medicine often neglect empathy in favor of biomedical approaches to disease and injury. This essay discusses the development in medical literature of the concept of "clinical empathy"-which attempts to reorient a biomedical, disease-centered approach to treating illness by accounting for an increasing fluency within the interpersonal relations between physician and patient-and examines arguments for supplementing medical training with the study of literature and the practice of reflective writing as a means of developing empathy in physicians. In order to interrogate the problems as well as the possibilities of clinical empathy, I turn to theories of sympathy produced in the eighteenth century, when innovations in medical technology and knowledge had only begun to create separate categories that would ultimately untwine the body from mind and culture. The eighteenth century was also a time when philosophy and literature, rather than being compartmentalized from medicine as distinct disciplines, informed medical understandings before medicine became specialized as a "science." A critical approach to the theory and literature of the eighteenth century can help to formulate a productive critique of clinical empathy in contemporary medicine and to suggest possibilities for a reconfigured and strengthened understanding of empathy within the larger social context of institutions, systems, and access to care.
Reconsidering Empathy: An Interpersonal Approach and Participatory Arts in the Medical Humanities
Springer eBooks, 2022
The decline of empathy among health professional students, highlighted in the literature on health education, is a concern for medical educators. The evidence suggests that empathy decline is likely to stem more from structural problems in the healthcare system rather than from individual deficits of empathy. In this paper, we argue that a focus on direct empathy development is not effective and possibly detrimental to justice-oriented aims. Drawing on critical and narrative theory, we propose an interpersonal approach to enhance empathic capacities that is centered on constructive and transformative interactions which integrates the participatory arts and involves both patients and health professional students. We describe and evaluate a program where patients and students create collaborative, original songs. Interviews and a focus group revealed interactional processes summarized in four themes: reciprocal relationships, interactions in the community, joint goal, and varied collaboration. There was a significant enhancement of positive attitudes about care post-program amongst health professional students. The interpersonal approach may be a preliminary framework for the medical humanities to shift away from a focus on direct empathy development and further towards participatory, co-creative, and justice-oriented approaches to enhance health and thereby empathic capabilities.
BMC Medical Education, 2014
Background: Art-based interventions are widely used in medical education. However, data on the potential effects of art-based interventions on medical students have been limited to small qualitative studies on students' evaluation of elective programs, and thus their findings may be difficult to generalize. The goal of this study is to examine, in an unselected students' population, the effect of students' gender, ethnicity and attitude towards poetry on their evaluation of a clinically-integrated poetry-based educational intervention. Methods: A required Clinically-Oriented Poetry-reading Experience (COPE) is integrated into the 4 th year internal medicine clerkship. We constructed a questionnaire regarding the program's effects on students. Students completed the questionnaire at the end of the clerkship. We performed a Confirmatory Factor Analysis, and examined the relationship between students' evaluation of the program and students' ethnicity, gender, attitude towards poetry-reading, and the timing of the program (early/late) during the fourth year. Results: 144 students participated in the program, of which 112 completed the questionnaires. We identified two effect factors: "student-patient" and "self and colleagues". The average score for "student-patient" factor was significantly higher as compared to the "self and colleagues" factor. Evaluation the "studentpatient" effect factor was higher among Arab and Druze as compared to Jewish students. Students' attitude towards poetry-reading did not correlate with the "student-patient" effect, but correlated with the "self and colleagues" effect. The evaluation of the "self and colleagues" effect was higher among students who participated in the program during their second as compared with the first clerkship. Students' gender was not associated with any of the effects identified. Students favored obligatory participation in COPE as compared with elective course format. Conclusions: According to students' evaluation, a format of integrated, obligatory poetry-based intervention may be suitable for enhancing "student-patient" aims in heterogeneous student populations. The higher evaluation of the "patient-student" effect among Arab and Druze as compared to Jewish students may be related to cultural differences in the perception of this component of medical professionalism. Further research can provide insight into the effect of cultural and ethnic differences on actual empathy of medical students in patient encounters.
International e-Journal of Science, Medicine & Education
A medical narrative is a physician-patient dialogue, where the physician listens carefully to fragments of the patient's story, while interpreting their hidden messages and word sequences, as well as observing their gestures and body language. This aspect of the therapeutic relationship contributes to deciphering symptoms which are not apparent in the conventional interview and contributes to a much broader perspective of illness and health. The arts and the humanities have always been inseparable from each other in medical education. In this biomedical revolution, the humanities are needed now more than ever before to bridge the divides that separate the physician from the patient, from self, from colleagues, and society. Narrative Medicine (NM) which aims to treat the whole person, and not just the illness, is an emerging patient-centred discipline in medical schools that can humanise medical care and promote empathy. NM helps medical students cope with the suffering of their patients as well as their own emotions by reducing the anxiety and threat that come with illness, thereby providing a psychologically-sound foundation for the development of self-reflection and empathy. NM facilitates medical students' adoption of patients' perspectives with the hope of ultimately leading to more humane, ethical and empathetic healthcare for their patients. The discipline of NM is critically examined in this review paper from the perspective of external and internal stakeholders.
Lindsay Holmgren's " Empathic Communications and Narrative Competence in Contemporary Medical Education " reviews the teaching of narrative competence in medical education, arguing that these practices must engage postclassical approaches to narrative studies while attending to the concept of empathy as it is deployed in various disciplines, including narratology, cognitive science, and psychology. With an emphasis on the formation of professional identity in medical practice, Holmgren explores the relationship between professional identity in a multi-ethnic, gender neutral , demographically and culturally diverse medical education context, and the complex arena of narrative empathy. Hinging on the reciprocal nature of identity that emerges at the intersections of various versions of the self and others, Holmgren's article aligns the empathy developed by reading fiction with that which develops in the clinical encounter. Finally, the article understands these various, evolving subject positions rhetorically, arguing that the comportments of medical educators in the humanities should be such that their students will want to emulate them. The practice of medicine is fundamentally prosocial. Upon this premise the present essay rests, and what follows is imbued with its significations. Moreover, medical educators and accreditation bodies, as they determine the practical and theoretical strengths of North American medical institutions, implicitly recognize that which underlies this prosocial premise: the importance, indeed the urgency, of recuperating the empathic dispositions to which so many medical students were given when they decided to become physicians. Rita Charon's pioneering work in what she first called " narrative medicine " at Columbia Uni-versity's Medical School, alongside various applications of the medical humanities and nar-ratologically driven medical education at such institutions as McGill University, The Ohio State University, Dartmouth, and the University of Toronto attest to the increasing relevance of narrative, and the medical humanities more broadly, not only to theoretical medical education, but also to clinical medical practice. 1 What continues to preoccupy narrative 1 Charon coined the term " narrative medicine " in her 2001 JAMA article, " Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. " There, she outlined some of the qualities and benefits of an approach to the practice of medicine that involved attending to the nuances of story produced both by patients and their physicians.