Assessing the benefits and usefulness of Schwartz Centre rounds in second-year medical students using clinical educator-facilitated group work session: not just \u201ca facilitated moan\u201d!

J Smith,M G Stewart,A Cooney,E Foggin,C J Stocker,P Thomas,J Harris,S Mathews

doi:10.1186/s12909-020-02199-x

Abstract

BackgroundAn experiential curriculum exposing medical students to the clinic early has many benefits but comes with the emotional stress this environment engenders. Schwartz rounds (SR) are an effective means to combat emotional stress and increasingly used in UK and USA hospitals. Recent studies show that the SR format may also provide benefits for medical students. This study aimed to investigate whether the guidance of SR in second year medical students provides the same benefits as to healthcare professionals.MethodsSR assessment involved 83 s year MBChB students in facilitated groupwork sessions. Topics discussed were “change and resilience” and “duty of candour”. Students completed a Likert Scale questionnaire evaluating outcomes proffered by the Point of Care Foundation in collaboration with the Schwartz Foundation, with freeform feedback.ResultsThere was an 86% completion rate with 25% providing written feedback. Participants were more likely to agree than disagree that SR were beneficial. SR effectiveness in enhancing students’ working relationship awareness and skills was strongly correlated with understanding the purpose of, and engagement with, the SR (P < 0.001). Similarly, engagement with the SR was strongly correlated with self-reporting of enhanced patient-centredness (P < 0.001). Freeform feedback could be grouped into five themes that revolved around understanding of the SR and engagement with the process. Many positive comments regarded the SR as a forum not only to “learn experientially” but to so in a “safe environment”. Many negative comments stemmed from students not seeing any benefits of engagement with the SR, in that sharing experiences was “unbeneficial”, “empathy is inherent and not learnt”, or that sharing emotional problems is simply “moaning”.ConclusionSRs are an effective way of fostering empathy and understanding towards patients and colleagues. However, for the students to benefit fully from the SR it is necessary for them to engage and understand the process. Therefore, for the successful implementation of SR into pre-clinical medical education, it is important to help students realise that SR are not merely a “facilitated whinge”.

Highlights

An experiential curriculum exposing medical students to the clinic early has many benefits but comes with the emotional stress this environment engenders
It offers an important role in the contextualisation of theory, it is important to remember that this high-pressure environment can result in increased levels of stress and emotional unrest, all of which can affect one’s ability to maintain excellent standards of patient care [2, 3]
73% of students agreed that the Schwartz rounds (SR) enabled a greater understanding of the importance of empathy with patients

Summary

Introduction

An experiential curriculum exposing medical students to the clinic early has many benefits but comes with the emotional stress this environment engenders. With the introduction of spiral curricula, medical education has evolved such that more medical students are being exposed to clinical environments at earlier stages in their training [1] It offers an important role in the contextualisation of theory, it is important to remember that this high-pressure environment can result in increased levels of stress and emotional unrest, all of which can affect one’s ability to maintain excellent standards of patient care [2, 3]. The General Medical Council (GMC) [6] recognises this and states that students should have insight into their own mental health and “develop healthy ways to cope with stress and challenges” [7] It should be considered how medical schools can best facilitate and promote effective coping mechanisms at the earliest opportunity, those that expose students to the clinical environment in the initial stages. Two domains that are likely to contribute to resilience are emotional intelligence and the ability to reflect [8]

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