Humanism in Healthcare Research Roundup — January 2016

booksThis post is part of our series of Research Roundups — a list of recently published studies on humanism in healthcare. If you would like to be notified each time a Research Roundup is published, send an email to with the subject line “Subscribe RR”.

Publications from Gold Foundation-Affiliated Authors

Integrating Compassionate, Collaborative Care (the “Triple C”) into health professional education to advance the Triple Aim of health care
Lown BA, McIntosh S, Gaines ME, McGuinn K, Hatem DS.    Acad Med. 2015 Dec 29.

Ms. McIntosh is Senior Vice President and Chief Program Officer at the Gold Foundation
Providing compassionate, collaborative care (Triple C) is critical to achieving the “triple aim” of improving patients’ health and experiences of care while reducing costs. In this Perspective, the authors describe how the Triple C framework can be integrated and enhance existing competency standards to advance CCC across the learning and practice continuum.

Shining a light on the dark side
Cohen J, Levin RI.   Ann Intern Med. 2016 Jan 5;164(1):69-70.
Dr. Cohen is the Chair of the Gold Foundation Board of Trustees; Dr. Levin is our President and CEO.
This letter was written in response to an Annals article about disrespectful actions observed in medicine. Drs. Cohen and Levin state that these behaviors in medicine are common and that the code of silence in medicine often trumps the moral courage required to speak up about safety concerns and unprofessional behavior. They emphasize that mutual respect, empathy, and excellent communication among all members of the medical team are critical.

Impact of electronic medical record use on the patient-doctor relationship and communication: A systematic review
Alkureishi MA, Lee WW, Lyons M, Press VG, Imam S, Nkansah-Amankra A, Werner D, Arora VM.   J Gen Intern Med. 2016 Jan 19.

This paper was supported by the Arnold P. Gold Foundation Research Institute’s Mapping the Landscape, Journeying Together initiative. 
This systematic literature review of 53 papers sought to understand the impact of EMR use on patient-doctor relationships and communication. Researchers founded that despite objective evidence that EMR use may negatively impact patient-doctor communication, studies examining patient perceptions found no change in patient satisfaction or patient-doctor communication.

Is reflective ability associated with professionalism lapses during medical school?
Hoffman LA, Shew RL, Vu TR, Brokaw JJ, Frankel RM.   Acad Med. 2016 Jan 12.
Dr. Frankel is a member of our Research Institute Strategic Planning Task Force
Researchers conducted a retrospective case-control study comparing students who had been cited for a professionalism lapse during medical school (n=70) to 230 students who had not been cited for a professionalism lapse. They found that reflection scores for students in the case group were significantly lower than those for students in the control group. A lower reflection score was associated with an increased likelihood that the student had been cited for a professionalism lapse.

Alternative framings, countervailing visions: Locating the “P” in professional identity formation
Hafferty FW, Michalec B, Martimianakis MA, Tilburt JC.    Acad Med. 2016 Feb;91(2):171-4. 

Drs. Hafferty, Michalec and Martimianakis are Mapping the Landscape, Journeying Together grant recipients
The authors introduce core concepts on professional identity formation from organizational sciences literature and military literature. They argue that medical educators must strive to identify the skills, knowledge, and attitudes necessary that will allow physicians-qua-professionals to function as a quasi-subversive work force and to disrupt the very system that helped to shape their identity, so that they may fulfill their mission to their patients.

Resident role modeling: “It just happens”
Sternszus R, Macdonald ME, Steinert Y.   Acad Med. 2015 Nov 17.
Dr. Steinert is a Mapping the Landscape, Journeying Together grant recipient
In this study of 14 residents, researchers found that while residents were aware that students and junior colleagues learned from their modeling, they were often not aware of role modeling as it was occurring. Helping residents view effective role modeling as a deliberate process may improve clinical teaching.

Insisting on the Healer’s Art: The implications of required participation in a medical school course on values and humanism
Rabow MW, Lapedis M, Feingold A, Thomas M, Remen RN.    Teach Learn Med. 2016 Jan-Mar;28(1):61-71.

Dr. Remen is a member of the Gold Foundation’s Medical & Professional Advisory Council
In 2012, all 1st-year students at a U.S. medical school were required to take the Healer’s Art, an elective on professional values and humanism. Researchers analyzed differences between those who would have elected to take the course and those who would not have elected to take it. At baseline, elective students reported feeling safer to talk openly, a greater sense of community, and higher levels of cynicism. Over time, there were no differences in course evaluations or outcomes between elective and required students.

Other Publications

Emergent core values: The student perspective
Lovell B.    Clin Teach. 2016 Jan 26.

24 final-year medical students participated in semi-structured interviews, which explored the values that they recognize in themselves and in their colleagues. Analysis showed that moral values that are constructed in undergraduates center around maintaining personal well-being, establishing an identity as a medical professional and delivering compassionate care as part of a team.

Physician wellbeing: A critical deficiency in resilience education and training
Beresin EV, Milligan TA, Balon R, Coverdale JH, Louie AK, Roberts LW.    
Acad Psychiatry. 2016 Feb;40(1):9-12.
Being a physician requires many sacrifices that result in high rates of burnout, depression, suicide, and emotional exhaustion. Self-care has not been routinely and systematically taught in medical schools. The authors argue that resilience training should be integrated into all stages of medical education so that caring for oneself, maintaining cognitive and emotional acuity, and seeking fulfillment are considered professional obligations and preconditions for optimal patient outcomes.

BrandyKing-150x150This post was written by Brandy King, Head of Information Services at The Arnold P. Gold Foundation Research Institute