There is a cautionary adage that medical school takes a quarter of your soul, and the first year of residency takes another half. It is vital that we reform a system that gives some credence to these words, but equipping students with tools to navigate that system is a useful strategy as well. One way that we can do this is by fostering humanism, which is a part of professional identity formation.
Can we teach medical students to evolve into more humanistic physicians? We’re certainly trying, but we also have to ask ourselves how we will know whether or not we are successful in this endeavor. Obviously, an assessment tool is necessary, but how can measure a construct as complex as humanism?
With support from the Gold Foundation Research Institute, Drs. Era Buck, Mark Holden, and Karen Szauter from the University of Texas Medical Branch are evaluating how we teach humanism in medical schools. Much of their initial impetus came from professional development in undergraduate medical education, which has a longstanding cultural focus in academic medicine. They saw that professional behavior can be typified and recorded, but underlying humanistic qualities are much more difficult to observe. An even trickier problem is how to aggregate and analyze data on humanistic qualities.
A Mapping the Landscape Literature Review Grant from the Gold Foundation Research Institute helped the team conduct a meta-analysis of how humanism is measured in medical students. The team used the IECARES framework, which teases apart the core concepts of humanism into Integrity, Excellence, Compassion, Altruism, Respect, Empathy, and Service. Dr. Buck remarked that this particular framework was useful because it “allowed us to examine the complexity of humanism by looking at the pieces. However, one of the limitations here is how you put those pieces back together. It leaves the question of humanism as a global concept.” Dr. Szauter noted that despite some drawbacks, the framework was useful in opening up a broad area of literature for examination.
“One of the most striking things we found in our literature search was how infrequently multiple measures were used, and how often we have snapshot cross-sectional studies,” Dr. Szauter recounts, “but humanism as a developmental piece has not been well-studied.” The other researchers agreed that the ideal study would include multiple instruments for measuring humanism, where specific instruments could be tailored to specific questions that are made clear a priori. They also emphasized the need for longitudinal studies, as humanism is a construct that evolves over time.
The researchers are now putting their knowledge of how we teach humanism into a practical arena. “With our whole body of work, we’ve started with a broad range and are looking at how to move the discussion towards a direction that is supported by the best evidence,” Dr. Holden states. A second Mapping the Landscape Literature Review Grant is supporting their review of longitudinal studies to determine whether components of humanism (in the IECARES framework) respond to intervention. A Mapping the Landscape Discovery Grant is allowing them to study whether these humanistic qualities can be assessed using videotapes of medical students and standardized patients during clinical exams. This exciting work will contribute to an understanding of how best to intervene during the critical years of undergraduate medical education.
In addition to the financial support and structure that the Mapping the Landscape Grants provided, Dr. Buck commented that “there is a community that has been built around the Gold Foundation’s Research Institute which has been supportive and collaborative. It highlights the importance of the work that we do.” Dr. Holden mentioned that this community has been a source of new research collaborations, furthering our common goal of cultivating humanism in medicine.
The impact of the team’s work is important not only for medical students who will benefit from emotional learning that they can apply to other aspects of their lives, but also to patient care. We know that physicians who are burned out have worse patient outcomes. Encouraging developing physicians to be more humanistic and resilient – and making sure we have tools to demonstrate success – is a step in the direction of better care.