Abstract
BackgroundEmpathy levels decline through medical training. This has been associated with poor patient and physician outcomes, and strategies to combat this decline are increasingly recognized as critical aspects of medical education. The aim of this study was to qualitatively determine factors associated with empathy decline, and to assess the impact of a comics/graphic novel-based curriculum on enhancing empathy and a patient-centered approach to care in post-graduate medical learners.MethodsFourth and fifth year residents in the Adult and Pediatric Endocrinology and Metabolism Program at the University of Toronto were recruited from the 2017 cohort of the Empathy, Humanism & Comics course. Participants completed a 12-month curriculum, viewing a total of four animated graphic novels over six sessions. At the end of the course participants were interviewed either individually or in a focus group. A coding framework of emerging themes was developed based on consensus between the three authors using a qualitative descriptive approach and the constant-comparison method.ResultsAnalysis of coded interview data revealed four themes. 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. Participant feedback on the curriculum. The importance of empathy was noted, while participants acknowledged their own empathy decline and increased burnout. Stressors included increasing responsibility, long work hours, and competing work-life responsibilities. They felt the sessions developed resilience, an appreciation for the patient perspective, and communication skills. They appreciated the comics as a novel and engaging educational modality. Feedback on the effectiveness and relevancy of the curriculum was variable.ConclusionsResidents appreciated sharing difficult experiences and seeking support. They acknowledged the curriculum as a commitment to wellness and felt it reduced burnout and improved empathy. The comics were viewed as an effective reminder of the patient perspective. Variable curriculum feedback highlights the challenge in designing a course for adult learners. Future investigations may include the development and incorporation of similar curricula in other post-graduate residency training programs.
Highlights
The comics were viewed as an effective reminder of the patient perspective
The primary aim of our study was to qualitatively assess factors affecting empathy in postgraduate training and investigate the impact of educational animated comics on affecting empathy changes and learning processes. This qualitative study aimed to answer the research questions: What factors contribute to burnout in a cohort of fourth- and fifth-year endocrinology residents, and would an empathy training curriculum delivered with graphic novels affect empathy-based practice and burnout? Fourth- and fifth-year residents of the Adult and Paediatric Endocrinology and Metabolism Residency Program at the University of Toronto who had attended the 2017–2018 6-part comics curriculum were eligible to participate
We identified four major subthemes as follows: The curriculum accurately reflected and addressed issues in real world medical practice Participants were asked to describe their perspective on empathy in residency and beyond, as well as to outline previous empathy training
Summary
Empathic care has been linked to increased patient satisfaction and improved adherence to therapy [2, 3], improved clinical outcomes [2, 4], and lower malpractice liability [2] Given these benefits, many organizations in medical education, including the Association of American Medical Colleges and the American Board of Internal Medicine, recommend a focus on empathy in medical education [5, 6]. Empathy among medical students declines as they progress through training [6, 7] This decline continues into post-graduate education, significantly impacting the mental wellness and clinical performance of residents [7]. The long-term benefits of these studies are unclear and follow up studies in post-graduate medical learners have not been conducted
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