Teaching empathy through poetry: a clinically based model (2010)

This programme is conducted during the clinical rotation of Year 4 medical students in three medical wards at a teaching hospital in Israel. The rotation did not previously include any activity designed to increase students’ capacity for empathy and awareness of patients’ narratives. The medical humanities are considered to increase medical students’ capacity for empathy. However, the medical humanities have been criticised for being far removed from the clinical setting and for insufficient doctor participation and role-modelling, thus emphasising a dichotomy between doctors’ emotional and intellectual competencies. In addition, elective courses may address only students who are interested in art. Our aim was to develop a clinically based medical humanities model to overcome these challenges. Based on our model we developed a programme consisting of five 1-hour meetings, held immediately following a teaching round, of seven to nine students with a facilitator-doctor. At each meeting a poem reflecting the patient–caregiver relationship is discussed in order to encourage students to share their experiences. For example, the poem ‘When the Woman’, by Zelda, describes an encounter at a hospital between the speaker and a stranger, a ‘brown-faced woman’, who is mopping the floor. Later, this woman is described as an unexpected new friend, after she has overheard the ‘doctor’s words’ and said: ‘I will pray for you.’ A key topic for discussion is the function of the woman compared with that of the doctor: the woman hears and responds, although it is not her role to do so. By contrast, the doctor is absent. Only the ‘doctor’s words’ are mentioned. The question of why the woman’s dark skin is mentioned stimulates discussion regarding the ethnic differences that students inevitably face in their encounters with the heterogeneous Israeli patient population. The woman may be of a different ethnicity to the speaker, but empathy can break such boundaries. To reflect on events in the ward, students are asked to describe an experience that they feel is associated with the poem and to discuss what they would do differently if they were the doctor. The ensuing discussion has yielded insights, such as that for a patient it is imperative to feel that the doctor is empathic and responsive. Six groups (44 students; 24 male; 33 Jews, 10 Arabs, one Druze) participated in the programme facilitated by three clinicians. Students evaluated the programme using a questionnaire consisting of statements to which they could respond using a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree). Students felt that the programme increased their ‘understanding of what it is like to be a patient’ (Empathy) (mean ± standard deviation 5.70 ± 1.40) and did not agree with the statement ‘Time should have been used better’ (2.07 ± 1.40). Students favoured clinician facilitation (6.23 ± 1.14) and obligatory student participation (4.98 ± 1.99). Students’ prior attitudes towards poetry did not correlate with impacts on Empathy (Spearman’s coefficient − 0.096, P = 0.535). The model described is applicable to clinical settings and is perceived by students as increasing their capacity for empathy. Its clinical orientation is reflected in its content, timing and facilitation. By modelling the continuum of doctor professionalism, this model places medical humanities at the core of the clinical setting.