Graphic Stories as Cultivators of Empathy in Medical Clerkship Education

Abstract

Physician empathy is an integral component of the patient-physician relationship and contributes to positive health outcomes. However, the direction of empathy change in medical trainees remains unclear. The aims of this study were (1) to qualitatively assess factors associated with empathy change in clerkship medical training and (2) to investigate the effect of graphic stories about diabetes self-management on affecting empathy and learning processes in medical trainees. Third and fourth year medical students (clerks) were recruited. Participants viewed two online comics, responded to empathy-exploring surveys, and were interviewed individually. Interviews were coded following an inductive thematic approach, and emergent themes were developed using the constant-comparison method. Sixteen medical students participated. Qualitative analysis revealed five themes: (1) conceptualization and perceived value of empathy, (2) barriers and facilitators of empathy, (3) empathy and burnout, (4) strategies to promote empathy and prevent burnout, and (5) comics in medical education. Empathy was highly valued by clerks; however, a spectrum of empathy change occurs in clerkship. Major barriers included the hidden curriculum, physiological stressors, and burnout. Positive role models and peer support were key strategies to maintaining empathy. Clerks perceived the comics to be an innovative, quick, and effective reminder of the value empathy. Graphic stories can be used as a medical education tool to simulate reflective practice and promote empathy retention during clerkship. Further strategies aimed at reducing burnout, improving student wellness, and fostering teaching of empathy by clinical faculty may enhance the retention of empathy by clerks.