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Where Science Meets Instructional Design

The Empathy Factor in Medicine: A Novel Approach

By Andrew J. Jones, MD, Medical Writer

Taking care of patients requires a heavy toolbox. At the base level, the patient needs to feel confident that the expert knows the science behind what is making them sick and the steps that could be taken to treat the illness. The next skill to master is the ability to communicate this information to the patient and the patient’s family. At the peak of the mountain lies one of the most elusive and intangible concepts: the empathy factor.

Humans are conditioned to feel some inherent degree of empathy. After all, thousands of years of social conditioning has led us to the conclusion that there is strength in numbers, and empathy provides us with some of the necessary components to maintain a complex civilization. The empathy factor is, perhaps, no more pronounced than in the bright-eyed, first-year medical student who steps out the front door ready to change the world. Unfortunately, physicians demonstrate a pattern of degradation in empathy toward their patients that further deteriorates with each successive year of training. Several contributing factors to this loss of empathy have been identified, including idealism death and emotionally exhausting work hours. These are unsurprisingly the very same factors that contribute to moral injury, often less precisely referred to as “burnout.”

Medical schools and graduate medical education (GME) training (residency and fellowship programs) are aware of this phenomenon, and multiple strategies have been employed over the years to try and maintain the empathy factor throughout training and into clinical practice. A recent study by Sutherland et al., published in BMC Medical Education, examined a rather original idea for patient-centered empathy training in a GME program. The research team previously developed a series of animated graphic novels depicting a patient journey after the diagnosis of type 2 diabetes, and the graphic novels were added to the medical student curriculum at the University of Toronto. Following an overall positive response from medical students, the research team extended this training modality to fourth- and fifth-year residents of the Adult and Pediatric Endocrinology and Metabolism Residency Program at the University of Toronto. During a year-long training course, four animated graphic novels depicting different aspects of living with a chronic disease from the patient perspective were used by residents to gain a better understanding of the empathy factor. A facilitated group discussion was also included as part of the training program where the residents could discuss their perspectives on the graphic novels and their current difficulties in maintaining empathy.

Overall, the residents felt that the graphic novels were impactful in their roles as medical learners, teachers, and practitioners. They appreciated the group setting that allowed them to share negative experiences and provide support to one another. Four major themes were identified from the resident responses:

  1. The curriculum accurately reflected and addressed issues in real-world medical practice.
  2. The comics curriculum facilitated holistic development.
  3. Participants appreciated the comics as an educational medium.
  4. Participants felt that the group discussion facilitated reflective exercises and discussions.

This study is an interesting peek into the lives of residents. Frustrations abound during medical training, and residents often feel disconnected from their previous safety nets for a variety of reasons. While an attending physician may offer a listening ear, it can still be difficult for residents to truly express their feelings in an open environment without fear of retribution. By combining the graphic novel curriculum with a small group discussion, the residents who participated in this curriculum gained a twofold benefit. The innovative techniques used by this research team should be fully considered by medical educators going forward.

How can these concepts be incorporated into medical training content? Consider the patient journey as the focal point of medical education. When creating an educational medium, it must be kept in mind that there is life beyond the technical aspects of a specific pharmaceutical or medical device. The essence of physicians’ work lies in patient care. Experiencing the patient journey was the technique employed by this research team through the use of a visual medium that told the story of daily life of a person with a chronic disease. This team chose to use graphic novels as a visual medium to represent the patient journey, but the possibilities for incorporating the patient journey into education are as varied as the patients themselves. Maintaining the patient perspective helps the creators and users of educational content stay grounded in their work. The empathy factor is important because people are at the center of everything physicians do.

Open Access Citation:
Sutherland, T., Choi, D. & Yu, C. “Brought to life through imagery” – animated graphic novels to promote empathic, patient-centred care in postgraduate medical learners. BMC Med Educ 21, 66 (2021).
Published by BMC, Part of Springer Nature

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