Quand les patients enseignent l’empathie aux étudiants : une revue systématique des interventions visant à promouvoir l’empathie chez les étudiants en médecine

Background: Despite growing emphasis on empathic care, numerous studies demonstrate diminishing empathy in medical students. Involving patient educators in medical curricula may be a solution. Therefore, we conducted a systematic review to evaluate patient-involved interventions that promote empathy among medical students.  Method: A literature search of MEDLINE, Embase, PsycINFO, and ERIC databases was performed using the keywords “empathy,” “medical student,” and their synonyms. Results were independently screened in duplicate. Conflicts were resolved by group consensus. All English studies describing interventions that promote empathy in medical students engaging patient educators were included. Relevant data was extracted and summarized. Results: 1467 studies were screened. 14 studies were included, of which 10 were pilot studies. Studies included patient involved interventions such as storytelling (5/14), shadowing patients (3/14), recorded videos (3/14), or combinations of methods (3/14). Qualitative measurements of empathy included written feedback and group discussions. Quantitative measurements included validated scales measuring empathy. All studies demonstrated increase in empathy among medical students. Participants reported satisfaction with training and patients reported being proud of giving back by training future physicians. Conclusion: Interventions engaging patient educators were shown to have a positive impact on medical student empathy. Furthermore, patient-led education was shown to increase medical student understanding of subject and knowledge retention while empowering patients. Further implementation of patient-involved education is an important step forward in patient-partnered care and may identify additional advantages of patient engagement in medical education.Contexte : Malgré l’importance grandissante accordée à l’empathie dans les soins de santé, de nombreuses études démontrent une diminution de l’empathie chez les étudiants en médecine. La participation de patients éducateurs dans les programmes d’études médicales pourrait être une solution. Nous avons donc réalisé une revue systématique pour évaluer les interventions qui visent à promouvoir l’empathie chez les étudiants et qui font participer des patients. Méthode : Nous avons effectué une recherche dans les bases de données MEDLINE, Embase, PsycINFO et ERIC en utilisant les mots-clés « empathie », « étudiant en médecine » et leurs synonymes. Les résultats ont été examinés de manière indépendante et en double. Les conflits ont été résolus par consensus de groupe. Toutes les études en anglais décrivant des interventions visant à promouvoir l’empathie chez les étudiants en médecine avec la participation de patients éducateurs ont été incluses. Les données pertinentes ont été extraites et résumées. Résultats : Des 1467 études examinées, 14 ont été incluses, dont 10 études pilotes. Les interventions avec des patients mentionnées dans les études comprenaient des récits (5/14), l’observation des patients (3/14), des vidéos enregistrées (3/14) ou des combinaisons de méthodes (3/14). Les mesures qualitatives de l’empathie comprenaient des commentaires écrits et des discussions de groupe. Les mesures quantitatives étaient des échelles validées mesurant l’empathie. Toutes les études indiquent une augmentation de l’empathie chez les étudiants en médecine. Les participants se disent satisfaits de la formation et les patients déclarent être fiers de redonner aux soignants en contribuant à former les futurs médecins. Conclusion : Les interventions faisant appel à des patients éducateurs ont eu un effet positif sur le développement de l’empathie des étudiants en médecine. En outre, il a été démontré que la participation de patients dans la formation augmentait la compréhension du sujet et la rétention des connaissances par les étudiants en médecine tout en responsabilisant les patients. La généralisation de l’intervention des patients dans l’éducation constitue une avancée importante dans les soins en partenariat avec le patient et pourrait révéler d’autres avantages de la participation des patients dans l’éducation médicale

Medical student views of and responses to expectations of professionalism

Funding this study is part of the corresponding author's (EAS) doctoral programme of research funded by the University of Aberdeen, and supervised by EH and JC. Acknowledgements we thank all the students who took part in this project, and Professor Rona Patey, the Director of the Institute of Education for Medical and Dental Sciences, University of Aberdeen, for her support of this project.Peer reviewedPostprin

When patients teach students empathy: A systematic review of interventions for promoting medical student empathy

Background: Despite growing emphasis on empathic care, numerous studies demonstrate diminishing empathy in medical students. Involving patient educators in medical curricula may be a solution. Therefore, we conducted a systematic review to evaluate patient-involved interventions that promote empathy among medical students. Method: A literature search of MEDLINE, Embase, PsycINFO, and ERIC databases was performed using the keywords “empathy,” “medical student,” and their synonyms. Results were independently screened in duplicate. Conflicts were resolved by group consensus. All English studies describing interventions that promote empathy in medical students engaging patient educators were included. Relevant data was extracted and summarized.Results: 1467 studies were screened. 14 studies were included, of which 10 were pilot studies. Studies included patient involved interventions such as storytelling (5/14), shadowing patients (3/14), recorded videos (3/14), or combinations of methods (3/14). Qualitative measurements of empathy included written feedback and group discussions. Quantitative measurements included validated scales measuring empathy. All studies demonstrated increase in empathy among medical students. Participants reported satisfaction with training and patients reported being proud of giving back by training future physicians.Conclusion: Interventions engaging patient educators were shown to have a positive impact on medical student empathy. Furthermore, patient-led education was shown to increase medical student understanding of subject and knowledge retention while empowering patients. Further implementation of patient-involved education is an important step forward in patient-partnered care and may identify additional advantages of patient engagement in medical education.Contexte : Malgré l’importance grandissante accordée à l’empathie dans les soins de santé, de nombreuses études démontrent une diminution de l’empathie chez les étudiants en médecine. La participation de patients éducateurs dans les programmes d’études médicales pourrait être une solution. Nous avons donc réalisé une revue systématique pour évaluer les interventions qui visent à promouvoir l’empathie chez les étudiants et qui font participer des patients.Méthode : Nous avons effectué une recherche dans les bases de données MEDLINE, Embase, PsycINFO et ERIC en utilisant les mots-clés « empathie », « étudiant en médecine » et leurs synonymes. Les résultats ont été examinés de manière indépendante et en double. Les conflits ont été résolus par consensus de groupe. Toutes les études en anglais décrivant des interventions visant à promouvoir l’empathie chez les étudiants en médecine avec la participation de patients éducateurs ont été incluses. Les données pertinentes ont été extraites et résumées.Résultats : Des 1467 études examinées, 14 ont été incluses, dont 10 études pilotes. Les interventions avec des patients mentionnées dans les études comprenaient des récits (5/14), l’observation des patients (3/14), des vidéos enregistrées (3/14) ou des combinaisons de méthodes (3/14). Les mesures qualitatives de l’empathie comprenaient des commentaires écrits et des discussions de groupe. Les mesures quantitatives étaient des échelles validées mesurant l’empathie. Toutes les études indiquent une augmentation de l’empathie chez les étudiants en médecine. Les participants se disent satisfaits de la formation et les patients déclarent être fiers de redonner aux soignants en contribuant à former les futurs médecins.Conclusion : Les interventions faisant appel à des patients éducateurs ont eu un effet positif sur le développement de l’empathie des étudiants en médecine. En outre, il a été démontré que la participation de patients dans la formation augmentait la compréhension du sujet et la rétention des connaissances par les étudiants en médecine tout en responsabilisant les patients. La généralisation de l’intervention des patients dans l’éducation constitue une avancée importante dans les soins en partenariat avec le patient et pourrait révéler d’autres avantages de la participation des patients dans l’éducation médicale

Adaptive practices in heart failure care teams: implications for patient-centered care in the context of complexity

Glendon R Tait,1 Joanna Bates,2 Kori A LaDonna,3 Valerie N Schulz,4 Patricia H Strachan,5 Allan McDougall,3 Lorelei Lingard3 1Department of Psychiatry and Division of Medical Education, Dalhousie University, Halifax, NS, 2Centre for Health Education Scholarship, Vancouver General Hospital, Vancouver, BC, 3Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, 4Palliative Care, London Health Sciences Centre, University Hospital, London; 5School of Nursing, McMaster University, Hamilton, ON, Canada Background: Heart failure (HF), one of the three leading causes of death, is a chronic, progressive, incurable disease. There is growing support for integration of palliative care’s holistic approach to suffering, but insufficient understanding of how this would happen in the complex team context of HF care. This study examined how HF care teams, as defined by patients, work together to provide care to patients with advanced disease. Methods: Team members were identified by each participating patient, generating team sampling units (TSUs) for each patient. Drawn from five study sites in three Canadian provinces, our dataset consists of 209 interviews from 50 TSUs. Drawing on a theoretical framing of HF teams as complex adaptive systems (CAS), interviews were analyzed using the constant comparative method associated with constructivist grounded theory. Results: This paper centers on the dominant theme of system practices, how HF care delivery is reported to work organizationally, socially, and practically, and describes two subthemes: “the way things work around here”, which were commonplace, routine ways of doing things, and “the way we make things work around here”, which were more conscious, effortful adaptations to usual practice in response to emergent needs. An adaptive practice, often a small alteration to routine, could have amplified effects beyond those intended by the innovating team member and could extend to other settings. Conclusion: Adaptive practices emerged unpredictably and were variably experienced by team members. Our study offers an empirically grounded explanation of how HF care teams self-organize and how adaptive practices emerge from nonlinear interdependencies among diverse agents. We use these insights to reframe the question of palliative care integration, to ask how best to foster palliative care-aligned adaptive practices in HF care. This work has implications for health care’s growing challenge of providing care to those with chronic medical illness in complex, team-based settings. Keywords: palliative care, qualitative, complex adaptive system, multimorbidity, health care team

The paradox of teaching wellness: Lessons from a national obstetrics and gynaecology resident curriculum.

BACKGROUND: In response to high rates of burnout among trainees, educators in obstetrics and gynaecology introduced a six-session wellness curriculum that improved professional fulfilment and resident burnout in participants with greater attendance. The implementation of the curriculum varied based on local variables and contextual factors. OBJECTIVE: To analyse the reactions of participants and curriculum leaders across the diverse settings of the pilot experience in order to identify the best practices for implementation of a wellness curriculum. METHODS: Twenty-five US OBGYN residency programmes completed the curriculum in the 2017-2018 academic year. OBGYN residents in all the years of training participated. Faculty members and fellows were workshop facilitators and course leaders. All participants completed post-intervention surveys. A qualitative, descriptive thematic analysis explored free-text responses from residents and workshop facilitators. RESULTS: Among 592 eligible resident participants, 387 (65%) responded to the post-intervention survey. Workshop facilitators submitted 65 surveys (47% response) on curriculum elements, rating the activities as \u27good\u27 or \u27excellent\u27 in 90.8% of cases. Qualitative analysis of workshop facilitators\u27 and resident comments pointed to three themes, namely disagreement about the purpose of the curriculum, the social value of the curriculum in the residency programme and the need to open a broader discussion and take action to address structural barriers to wellness. CONCLUSIONS: Residents and faculty members involved in a wellness curriculum pilot had polarised reactions. While participants found value in learning skills and connecting to colleagues, efforts to promote wellness skills should be accompanied by communication and action to address drivers of burnout