TF-9 A Medical Humanities Curriculum for Emergency Medicine Residents

Abstract

Humanities curricula for medical students have been shown to improve observation skills, empathy, wellness, and tolerance of uncertainty. Such attributes are all the more important in residency training; however, formal implementation and evaluation of similar curricula are lacking in graduate medical education (GME), especially in emergency medicine (EM). EM residency training demands excellent observation and communication skills, ability to practice patient-centered care, and development of skills to cope with stress and uncertainty; humanities curricula may therefore be of specific value for EM residents. This multimodal medical humanities curriculum incorporates themes relevant to EM and comprises museum visits, self-instructional modules, and classroom discussions. The goal of this curriculum is to use visual thinking strategies and narrative medicine to enhance resident observation and communication skills, patient-centeredness, empathy, and wellness. Upon curriculum completion, residents will improve their ability to 1) evaluate impact of personal biases and develop a patient-centered, empathetic approach, 2) demonstrate comfort with ambiguity, 3) make and communicate thoughtful and thorough observations, and 4) develop strategies to mitigate burn-out and address challenging situations. This longitudinal curriculum for EM residents in any year of training is to be implemented over 6 months during weekly protected conference time. In session 1, residents will be introduced to visual thinking strategies at a local museum and assigned a “portrait patient” to follow longitudinally during the curriculum. Three subsequent sessions will be small-group discussions using relevant extracts of novels, short stories, and nonfiction articles and residents’ written responses to the readings to focus on themes of 1) the patient experience, 2) medical conundrums and the art of diagnosis, and 3) the role of the physician in disaster settings. An additional classroom session on the clinical gaze and its correlations in visual arts will serve as a point of synthesis for prior sessions. The curriculum will conclude with a case study-based discussion of ethical dilemmas, which will permit residents to synthesize themes from previous sessions and practice consensus-building and communication skills. A pre- and post-course evaluation will use validated scales to assess curriculum impact on empathy (Jefferson Scale of Empathy), patient-centeredness (Patient-Practitioner Orientation Scale), tolerance of ambiguity (Tolerance of Ambiguity Scale) and burnout (Shirom-Melamed Burnout Measure). Residents will also provide written observations of a set of images, which will be scored for complexity and length. The post-survey will include an evaluation of resident satisfaction with the course and free-text response about potential strategies to mitigate burnout that they may have gleaned from this course. Residents’ ability to analyze, interpret, and communicate observations about visual and written data will be assessed via discussion participation and written responses to readings. If demonstrated to be feasible and if shown to have a positive impact on key resident attributes, this portable and adaptable curriculum could serve as a model not only for other EM residency programs, but for other GME specialties.