Jeffrey Silver Humanism in Healthcare Research Roundup – January-February 2024

The Jeffrey Silver Humanism in Healthcare Research Roundup features summaries of recently published studies on humanism in healthcare. To receive email notification of new studies once per month, enter your information here and select “Jeffrey Silver Research Roundup” from the checkboxes at the bottom. See previous posts in this series.

Striking fear into students’ hearts: unforeseen consequences of prescribing education Dornan T, Armour D, McCrory R, Kelly M, Speyer F, Gormley G, Maxwell P. Med Teach. 2024 Feb 1:1-11. doi: 10.1080/0142159X.2024.2308061. Epub ahead of print. PMID: 38301608. Drs.Timothy Dornan and Martina Kelly have been Gold Foundation grantees. Dr. Kelly is also a recipient of the AFMC-Gold Humanism Award.
A major goal of medical school is to prepare students for subsequent clinical practice, though about one-third of UK interns report feeling unprepared. Prescribing, which is a main practice for interns in the UK, “is an everyday, safety-critical task for which new doctors feel especially poorly prepared.” To gain insight into the gaps between education and patient care, Dr. Timothy Dornan and colleagues asked 40 final year medical students at Queen’s University in Belfast, Northern Ireland to draw “rich pictures” describing their experiences and perceptions of learning intravenous fluid therapy (IVFT) prescription. Through template analysis and follow-up written interpretation of exemplary pictures, they were able to identify four main themes: (1) the affective impact of preparation, (2) contradictions between taught principles and observed practices, (3) challenges in teaching and learning, and (4) the curriculum as a complex journey that does not fully equip students for the practical demands of prescribing IVFT. Altogether, these findings underscore the need for medical schools to bridge the gap between classroom knowledge and clinical application, emphasizing the importance of practical experience and the integration of affective, intellectual, and practical capabilities to better prepare medical students for the complexities of real-world medical practice.

The effect of practitioner empathy on patient satisfaction : a systematic review of randomized trials Keshtkar L, Madigan CD, Ward A, Ahmed S, Tanna V, Rahman I, Bostock J, Nockels K, Wang W, Gillies CL, Howick J. Ann Intern Med. 2024 Jan 30. doi: 10.7326/M23-2168. Epub ahead of print. PMID: 38285985.
Patient satisfaction is an important indicator of healthcare quality and is associated with better healthcare outcomes. It has been suggested that increased practitioner empathy through training may lead to increased patient satisfaction, but data has been conflicting. To synthesize this data, Dr. Leila Keshtkar and colleagues conducted a systematic review of 14 randomized controlled trials involving 80 practitioners and 1,986 patients. They discovered that there was an overall positive change in patient satisfaction with increased empathy, although significant heterogeneity in the interventions as well as the measurement of empathy and patient satisfaction, along with concerns of study bias, rendered it difficult to determine if empathy interventions are effective in improving patient satisfaction. The results point to an urgent need for higher quality studies that address sources of bias, including lack of blinding and protocols, and include more detailed reporting of empathy interventions and greater emphasis on standardizing outcomes.

The effects of immersive virtual reality-assisted experiential learning on enhancing empathy in undergraduate health care students toward older adults with cognitive impairment: multiple-methods study Liu JYW, Mak PY, Chan K, Cheung DSK, Cheung K, Fong KNK, Kor PPK, Lai TKH, Maximo T. JMIR Med Educ. 2024 Feb 15;10:e48566. doi: 10.2196/48566. PMID: 38358800. Free full text
Immersive virtual reality (IVR)–assisted experiential learning is an emerging tool that may help to enhance empathy toward older adults with cognitive impairment. After all, In IVR, there is a realistic but safe virtual clinical environment, allowing participants to gain insights into patient perspectives. To explore this potential, Justina Yat Wa Liu and colleagues conducted a mixed-methods study to assess the efficacy of IVR in improving empathy, learning experiences, and learning outcomes among undergraduate nursing and occupational therapy students at a Hong Kong university. The study combined surveys, focus groups, and group assignments to measure the impact. With a participant pool of 367 students, the research found a significant improvement in empathy scores following a 2-hour IVR tutorial, along with high satisfaction and self-confidence levels regarding the IVR learning experience. The Presence Questionnaire version 2.0 further validated students’ sense of presence within the IVR environment, indicating effective engagement. Focus groups among 23 nursing students revealed three major themes: (1) enhanced sympathy toward older adults, (2) improved engagement, and (3) boosted confidence in grasping key concepts. Moreover, the assessment of written assignments underscored students’ comprehension of challenges faced by the elderly, emphasizing the importance of person-centered care and advocating for an age-friendly society. These findings underscore the potential of IVR as a transformative tool in professional healthcare education, suggesting its effectiveness in fostering empathetic understanding and reinforcing key educational outcomes. The authors concluded that IVR-assisted experiential learning significantly advances students’ empathy and knowledge in caring for older adults with cognitive impairment.

Forming physicians: evaluating the opportunities and benefits of structured integration of humanities and ethics into medical education Eno C, Piemonte N, Michalec B, Adams CA, Budesheim T, Felix K, Hack J, Jensen G, Leavelle T, Smith J. J Med Humanit. 2023 Dec;44(4):503-531. doi: 10.1007/s10912-023-09812-2. Epub 2023 Aug 1. PMID: 37526858; PMCID: PMC10733221. Dr. Barret Michalec has been a Gold Foundation grantee. Free full text
The integration of the arts and humanities into medical education has gained attention for its potential to enhance the development of empathy, critical thinking, and a humanistic approach in healthcare professionals. Despite nearly 95% of medical schools offering courses in medical humanities, the assessment methods remain varied and often lack standardization. The Creighton School of Medicine implemented a revised curriculum, “New ERA,” which, among other elements, included a longitudinal integration of humanities and ethics, termed the “Gold Track.” Dr. Cassie Eno and colleagues detailed this curriculum, which aims to foster students’ development through experiential learning, reflection, and application of humanities to clinical practice. The program’s evaluation employed a multi-method approach, including student essays, surveys, and interviews, to assess its impact on 168 first-year medical students. Semi-structured interviews with 27 students identified two major themes: Opportunity and Structure & Format. Qualitative analysis of 42 essays also identified several of the curriculum’s learning objectives, especially sociocultural components of illness, illness & suffering, and medicine & medical education in the context of healthcare policy and systems. The year-end survey corroborated qualitative data, with 45% describing their identity as changing during their first year of medical school. Based on these data, the authors conclude that “(1) students are open to engaging with humanities and ethics content during the pre-clerkship phase and that this engagement affords them an opportunity to engage in reflection and connect with their classmates, (2) stated learning objectives for the ethics and humanities sessions are being met, and learning expands beyond the stated objectives, and (3) students’ perceptions of medicine and what it means to be a physician are expanding, suggesting personal and professional growth.”

How does a junior faculty development program affect burnout? A mixed methods assessment Riley TD, Parascando JA, VanDyke E, Stuckey HL, Dong H, Pasha-Razzak O, Kass LE, McCall-Hosenfeld J, Bronson SK. J Med Educ Curric Dev. 2024 Feb 4;11:23821205231223294. doi: 10.1177/23821205231223294. PMID: 38322705; PMCID: PMC10846043. Dr. Heather Stuckey has been a Gold Foundation grantee. Free full text
Burnout is highly prevalent among academic health center (AHC) junior faculty members and is associated with a number of poor personal and professional outcomes. Faculty development programs have been proposed as a means to reduce such burnout. Dr. Timothy D. Riley and colleagues described an evaluation of the Junior Faculty Development Program (JFDP) at Penn State College of Medicine to better understand the challenges and opportunities faced by junior faculty in AHCs. They conducted a sequential explanatory mixed methods study across three cohorts (2018/19, 2019/20, 2020/21) involving 84 participants initially, with 75 completing end-of-course surveys. The study utilized surveys, focus groups, and thematic analysis of interviews to explore changes in burnout, job satisfaction, work–home conflict, and quality of life. Despite the program’s aim to foster self-reflection and dialogue on burnout, findings indicated a significant increase in burnout (from 9.5% to 28%, p=0.005) and a decrease in quality of life (1.88% to 1.92%%, p=0.02) among participants. Thematic analysis from 19 interviews identified four key themes: (1) personal growth, (2) networking opportunities, (3) competing program requirements, and (4) program characteristics contributing to burnout and frustration. These findings highlight the complex interplay between the benefits of professional development programs and their potential to exacerbate burnout among participants. The authors concluded by emphasizing the importance of considering the well-being of junior faculty in the design, evaluation, and refinement of such programs to ensure they provide the intended support without adding undue burden.

Vacation days taken, work during vacation, and burnout among US physicians Sinsky CA, Trockel MT, Dyrbye LN, Wang H, Carlasare LE, West CP, Shanafelt TD. JAMA Netw Open. 2024 Jan 2;7(1):e2351635. doi: 10.1001/jamanetworkopen.2023.51635. PMID: 38214928; PMCID: PMC10787314. Drs. Liselotte Dyrbye, Colin P. West, and Tait D. Shanafelt have been a Gold Foundation grantee. Free full text
Vacation is essential for physicians’ well-being, yet the vacation behaviors of U.S. physicians and the impact of these behaviors on burnout and professional fulfillment have been underexplored. To fill this knowledge gap, Dr. Christine A. Sinsky and colleagues analyzed the results of a survey of 3,024 physicians in the United States conducted between November 2020 and March 2021. The study revealed that over half of the physicians (59.6%) took 15 days or fewer of vacation annually and a fifth (19.9%) taking 5 days of vacation or fewer. 70.4% engaged in work-related tasks during vacation days, with a considerable portion working beyond 30 minutes daily. This study also identified barriers to taking vacation, including coverage for clinical responsibilities and financial impacts. A significant finding was that vacation practices, including the number of vacation days taken and work performed during vacation, correlated with levels of burnout and professional fulfillment among physicians. Less than half (49.1%) of physicians reported having full coverage for electronic health record (EHR) inbox tasks during vacation. Having full EHR coverage or taking more than 3 weeks of vacation a year was associated with lower burnout and higher professional fulfillment. Based on these results, the authors highlight the need for institutional policies that support physicians taking adequate vacation time and fully detaching from work to mitigate burnout and enhance professional fulfillment.

Using the skill of noticing to support empathy for third-Year medical students in family medicine Blalock AE, Tluczek M, Pylman S. Fam Med. 2024 Feb;56(2):120-125. doi: 10.22454/FamMed.2024.190695. PMID: 38335939.
Multiple lines of evidence suggest that there is an empathy decline among third-year medical students marked by diminishing interest in practicing empathy and reduced opportunities to develop empathic communication skills. To address this, Dr. A. Emiko Blalock and colleagues introduced a “noticing” intervention among third-year medical students during their 4-week family medicine clerkship rotations at Michigan State University’s College of Human Medicine. Specifically, they piloted the Social Emotional Noticing Tool (SENT), a reflective and qualitative tool to enhance observational skills. Through a focus group of 8 medical students, the authors found that SENT facilitated deeper connections with patients by enabling students to notice subtle cues and reflect on their emotional responses, albeit also highlighting the friction between aspiring for empathetic engagement and the reality of clinical pressures and cultural norms within medical education. The influence of positive role models and the environment on students’ empathetic development was underscored, pointing to the need for a supportive educational ecosystem that nurtures empathy. However, the low participant turnout and the tool’s potential as an added task rather than a transformative learning experience were noted as limitations, suggesting a complex interplay between individual initiative and systemic support in cultivating empathy among medical students.

Impact of mental health boarding on clinicians at a children’s hospital: a qualitative analysis Worsley D, Bowden C, Keating C, Cassidy K, Doupnik SK. J Hosp Med. 2024 Feb 10. doi: 10.1002/jhm.13300. Epub ahead of print. PMID: 38340351. Dr. Stephanie K. Doupnik has been a Gold Foundation grantee.
Around 20% of children and adolescents in the United States have a mental or behavioral health diagnosis, for whom there is often a significant gap between the need for mental health services and the availability of community mental health resources. This gap has led to increased pediatric mental health “boarding” — treating children in need of mental health care in emergency departments or other non-psychiatric departments until space becomes available in a psychiatric unit. Diana Worsley and colleagues examined the emotional and physical toll of mental health boarding on clinicians through interviews with 48 clinicians at a children’s hospital that lacks a psychiatric unit. Clinicians reported frustrations with the mental healthcare system, feeling unprepared due to lack of training in mental healthcare skills, feelings of helplessness, and the ineffectiveness of the medical model in addressing mental health boarding. Resilience and support from colleagues were identified as key factors in managing the emotional and physical toll of caring for these patients. The findings underscored the urgent need for enhanced clinician education, professional development and wellness programs to address the significant workplace stress associated with the mental health crisis in pediatric settings.

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Bharat Kumar, MD

Humanism in Research Assistant Editor

Updates the staff, databases, and social media about new studies around humanism in healthcare; curates and compiles the monthly Jeffrey Silver Humanism in Healthcare Research Roundup.