Walking a Mile An Experiential Empathy Rejuvenation Curriculum

Walking a Mile: An Experiential Empathy Rejuvenation Curriculum for Medical Learners Samantha Pelican Monson, MA University of Colorado Family Medicine Residency

Overview • Clarification of the meaning and importance of “empathy” and “rejuvenation” • Description of the “Walk a Mile” curriculum • Experiential sampling of “Walk a Mile” curriculum • Discussion

Overview • Clarification of the meaning and importance of “empathy” and “rejuvenation” • Description of the “Walk a Mile” curriculum • Experiential sampling of “Walk a Mile” curriculum • Discussion

Empathy in the Medical Home “…each patient has an ongoing relationship with a personal physician [italics added] trained to provide first contact, continuous and comprehensive care. ” The Joint Principles of the Patient-Centered Medical Home created in 2007 by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association

Patient Benefits of Empathy • Increased satisfaction and compliance with treatment • Improved health consequences • Better general wellbeing • Expedited recovery from surgery Shapiro, Schwartz, & Bonner, 1998; Winefield & Chur-Hansen, 2000

Provider Benefits of Empathy • Higher supervisor ratings of clinical competence • Decreased malpractice litigation • Increased job satisfaction Hojat, Gonnella, Mangione, et al. , 2002; Lipkin, 1996; Suchman, Markakis, Beckman, & Frankel, 1997

Empathy in Danger! • Medical and nursing students • Medical residents • Registered nurses Bellini & Shea, 2005; Di. Lalla, Hull, & Dorsey, 2004; Hojat et al. , 2004; Holm, 1997

Can Empathy Be Taught? Basic Innate Instruction=no increase Fostering=longterm increase Trained Acquired Instruction=shortterm increase Fostering=no increase Alligood, 1992; Evans, Wilt, Alligood, & O’Neil, 1998; Hatcher, Nadeau, Walsh, & Reynols, 1994

Overview • Clarification of the meaning and importance of “empathy” and “rejuvenation” • Description of the “Walk a Mile” curriculum • Experiential sampling of “Walk a Mile” curriculum • Discussion

We Need A Feasible Empathy Curriculum! • Identified all the empirically supported methods for fostering basic empathy • Selected the methods that are brief and inexpensive • Combined these methods into a flexible structure

“Walking a Mile” Curriculum • Eight 50 -minute modules • Each module has a 10 -minute intro, 20 minute activity, and 20 -minute processing period • Complements communications teaching • Uniquely engaging (i. e. , no lecture, reliance upon small-group dynamics, and emphasis on self-awareness)

“Walking a Mile” Modules 1. Dramatic Performance Deloney & Graham, 2003; Lorenz et al. , 2004; Shapiro & Hunt, 2003; Shapiro and Rucker, 2004 2. Simulated Sensory and Functional Deficits Douglass et al. , 2008; Galanos et al. , 1993; Varkey et al. , 2006 3. Literature Analysis Lancaster et al. , 2002; Shapiro et al. , 2004; Shapiro, Orange, Prislin, Shapiro, & Lie, 2000

“Walking a Mile” Modules 4. A Patient Case Study Dammers et al. , 2001 5. A Real Patient Cohen et al. , 2000 6. Role-Play Jackson & Cunningham, 2002

“Walking a Mile” Modules 7. Loss-Learner Pairs Tulsky, 1998 8. Reflective Writing Das. Gupta & Charon, 2004

Overview • Clarification of the meaning and importance of “empathy” and “rejuvenation” • Description of the “Walk a Mile” curriculum • Experiential sampling of “Walk a Mile” curriculum • Discussion

Loss-Learner Pairs • Find a partner • Go to or create a semi-private space to talk quietly • While one member of the pair is discussing their loss, the other may only use nonverbal communication (i. e. , no questions or comments) • Everything is strictly confidential!

Reflective Writing • Write about a personal experience with illness or that of a family member or friend (for the latter, must be from a personal perspective) • Writing can be in any form • No part of the writing must be shared with the group • Everything is strictly confidential!

References Alligood, M. R. (1992). Empathy: The importance of recognizing two types. Journal of Psychosocial Nursing & Mental Health Services, 30, 14 -17. Bellini, L. M. , & Shea, J. A. (2005). Mood change and empathy decline persist during three years of internal medicine training. Academic Medicine, 80, 164 -167. Cohen, J. , Krackov, S. K. , Black, E. R. , & Holyst, M. (2000). Introduction to human health and illness: A series of patient-centered conferences based on the biopsychosocial model. Academic Medicine, 75, 390396.

Dammers, J. , Spencer, J. , & Thomas, M. (2001). Using real patients in problem-based learning: Students’ comments on the value of using real, as opposed to paper cases, in a problem-based learning module in general practice. Medical Education, 35, 27 -34. Das. Gupta, S. , & Charon, R. (2004). Personal illness narratives: Using reflective writing to teach empathy. Academic Medicine, 79, 351 -356. Deloney, L. A. , & Graham, C. J. (2003). Wit: Using drama to teach first-year medical students about empathy and compassion. Teaching and Learning in Medicine, 15, 247 -251. Di. Lalla, L. F. , Hull, S. K. , & Dorsey, J. K. (2004). Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teaching and Learning in Medicine, 165 -170.

Douglass, C. , Henry, B. W. , Kostiwa, I. M. (2008). An aging game simulation activity for allied health students. Educational Gerontology, 34, 124 -135. Evans, G. W. , Wilt. , D. L. , Alligood, M. R. , & O’Neil, M. (1998). Empathy: A study of two types. Issues in Mental Health Nursing, 19, 453 -461. Galanos, A. N. , Cohen, H. J. , Jackson, T. W. (1993). Medical education in geriatrics: The lasting impact of the aging game. Educational Gerontology, 19, 675682. Hatcher, S. L. , Nadeau, M. S. , Walsh, L. K. , & Reynols, M. (1994). The teaching of empathy for high school and college students: Testing Rogerian methods with the Interpersonal Reactivity Index. Adolescence, 29, 961974.

Hojat, M. , Gonnella, J. S. , Mangione, S. , Nasca, T. J. , Veloski, J. J. , Erdmann, J. B. , et al. (2002). Empathy in medical students as related to academic performance, clinical competence and gender. Medical Education, 36, 522 -527. Hojat, M. , Mangione, S. , Nasca, T. J. , Rattner, S. , Erdmann, J. B. , Gonnella, J. S. , et al. (2004). An empirical study of decline in empathy in medical school. Medical Education, 38, 934 -941. Holm, U. , & Aspegren, K. (1999). Pedagogical methods and affect tolerance in medical students. Medical Education, 33, 14 -18. Lancaster, T. , Hart, R. , & Gardner, S. (2002). Literature and medicine: Evaluating a special study module using the nominal group technique. Medical Education, 36, 1071 -1076.

Lipkin, M. (1996). Sisyphus or Pegasus? The physician interviewer in the era of corporatization of care. Annals of Internal Medicine, 124, 511 -513. Lorenz, K. A. , Steckart, M. J. , & Rosenfeld, K. E. (2004). End-of-life education using the dramatic arts: The Wit Educational Initiative. Academic Medicine, 79, 481486. Shapiro, J. , & Hunt, L. (2003). All the world’s a stage: The use of theatrical performance in medical education. Medical Education, 37, 922 -927. Shapiro, J. , Morrison, E. H. , & Boker, J. R. (2004). Teaching empathy to first year medical students: Evaluation of an elective literature and medicine course. Education for Health, 17, 73 -84.

Shapiro, J. , Orange, C. A. , Prislin, M. , Shapiro, D. H. , & Lie, D. (2000). Literary narratives examining control, loss of control and illness: Perspectives of patient, family and physician. Families, Systems & Health, 18, 441 -454. Shapiro, J. , & Rucker, L. (2004). The Don Quixote Effect: Why going to the movies can help develop empathy and altruism in medical students and residents. Families, Systems & Health, 22, 445 -452. Shapiro, S. L. , Schwartz, G. E. , & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21, 581 -599. Suchman, A. L. , Markakis, K. , Beckman, H. B. , & Frankel, R. (1997). A model of empathic communication in the medical interview. The Journal of the American Medical Association, 277, 678 -683.

Tulsky, J. A. (1998). Teaching physicians to deliver bad news: Some practical advice. Journal of Palliative Medicine, 1, 423 -426. Varkey, P. , Chutka, D. S. , Lesnick, T. G. (2006). The Aging Game: improving medical students' attitudes toward caring for the elderly. Journal of the American Medical Directors Association, 7, 224 -229. Winefield, H. R. , & Chur-Hansen, A. C. (2000). Evaluating the outcome of communication skill teaching for entry-level medical students: Does knowledge of empathy increase? Medical Education, 34, 90 -94.

Overview • Clarification of the meaning and importance of “empathy” and “rejuvenation” • Description of the “Walk a Mile” curriculum • Experiential sampling of “Walk a Mile” curriculum • Discussion

THANK YOU! Questions? Comments? samantha. monson@ucdenver. edu