Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-04T21:01:21.378Z Has data issue: false hasContentIssue false
  • English
  • Français

Recognition, reflection, and role models: Critical elements in education about care in medicine

Published online by Cambridge University Press:  13 November 2008

Anna L. Janssen ,
Roderick D. MacLeod  and
Simon T. Walker
Anna L. Janssen*
Affiliation:
Faculty Education Unit, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
Roderick D. MacLeod
Affiliation:
District Palliative Care Medical Director, Waitemata District Health Board, Auckland, New Zealand Department of General and Primary Health Care, University of Auckland, Auckland, New Zealand
Simon T. Walker
Affiliation:
Bio-Ethics Centre, Dunedin School of Medicine, University of Otago, Otago, New Zealand
*
Address correspondence and reprint requests to: Anna Janssen, Faculty Education Unit, Faculty of Medical and Health Sciences, University of Auckland, 151 Park Road, Grafton, PO Box 92019, Auckland, New Zealand. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Medical education can be described as a socialization process that has a tendency to produce doctors who struggle to convey to patients that they care. Yet, for people who are suffering, to enjoy the quality of life they are entitled to, it is important that they feel cared for as people, rather than simply attended to as patients.

Method:

This article addresses how we teach medical students the art of caring for the person rather than simply treating the disease—a question particularly relevant to end-of-life care where, in addition to the physical needs, attention to the psychosocial, emotional, and spiritual needs of the patient is paramount. Following an overview of what it is to care and why it is important that patients feel cared for, we investigate how we learn to care and develop caring human relationships, describing the development and display of empathy in adulthood and the developmental impact of human interaction.

Results:

We outline evidence of situational barriers to effective education about care in medicine including role models, ward culture, and the socialization process.

Significance of results:

We then propose a model for medical education based on patient contact, reflection, self-care, role model development, and feedback that will see students learn the art of human care as well as the science of disease management.

Keywords

CareMedical educationEmpathyRole modelingSocialization
Type
Review Articles
Information
Palliative & Supportive Care , Volume 6 , Issue 4 , December 2008 , pp. 389 - 395
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Attree, M. (2001). Patients' and relatives' experiences and perspectives of “Good” and “Not so good” quality care. Journal of Advanced Nursing, 33, 456–466.CrossRefGoogle ScholarPubMed
Bassett, C. (2002). Nurses' perceptions of care and caring. International Journal of Nursing Practice, 8, 8–15.CrossRefGoogle ScholarPubMed
Bellini, L.M. & Shea, J.A. (2005). Mood change and empathy decline persist during three years of internal medicine training. Academic Medicine, 80, 164–167.CrossRefGoogle ScholarPubMed
Birnbaum, G.E., Orr, I., Mikulincer, M., et al. (1997). When marriage breaks up: Does attachment style contribute to coping and mental health? Journal of Social and Personal Relationships, 14, 643–654.CrossRefGoogle Scholar
Bliss, M. (1999). William Osler: A Life in Medicine. New York: Oxford University Press.Google Scholar
Branch, W.T. (2000). The ethics of caring and medical education. Academic Medicine, 75, 127–132.CrossRefGoogle ScholarPubMed
Brorsson, A., Hellquist, G., Bjorkelund, C. et al. (2002). Serious, frightening and interesting conditions: Differences in values and attitudes between first-year and final year medical students. Medical Education, 36, 555–560.CrossRefGoogle ScholarPubMed
Carter, H., MacLeod, R., Brander, P., et al. (2004). Living with a terminal illness: Patients' priorities. Journal of Advanced Nursing, 45, 611–620.CrossRefGoogle ScholarPubMed
Cohen, D., Rollnick, S., Smail, S., et al. (2005). Communication, stress, and distress: Evolution of an individual support programme (ISP) for medical students and doctors. Medical Education, 39, 476–481.CrossRefGoogle Scholar
Coulehan, J.L., Platt, F.W., Egener, B., et al. (2001). Words that help build empathy. Annals of Internal Medicine, 135, 221–227.CrossRefGoogle ScholarPubMed
Darwall, S. (1998). Empathy, sympathy, care. Philosophical Studies, 89, 261–282.CrossRefGoogle Scholar
Gillett, G. (1993). “Ought and well-being.” Inquiry, 36, 287–306.CrossRefGoogle Scholar
Glick, S.M. (1993). The empathic physician: Nature and nurture. In Empathy and the Practice of Medicine, Spiro, H., McCrea Curnen, M.G., Peschel, E. et al. (eds.), pp. 85–102. New Haven: Yale University Press.Google Scholar
Hafferty, F.W. (1991). Into the Valley: Death and the Socialisation of Medical Students. New Haven: Yale University Press.CrossRefGoogle Scholar
Haidet, P., Kelly, A., & Chou, C. (2005). Characterizing the patient-centredness of hidden curricula in medical schools: Development and validation of a new measure. Academic Medicine, 80, 44–49.CrossRefGoogle Scholar
Hojat, M., Gonnella, J.S., Nasca, T.J., et al. (2002). Physician empathy: Definition, components, measurement, and relationship to gender and specialty. American Journal of Psychiatry, 159, 1563–1569.CrossRefGoogle ScholarPubMed
Hunter, J.J. & Maunder, R.G. (2001). Using attachment theory to understand illness behaviour. General Hospital Psychiatry, 23, 177–182.CrossRefGoogle Scholar
James, C.R. & MacLeod, R.D. (1993). The problematic nature of palliative care education. Journal of Palliative Care, 9, 5–10.CrossRefGoogle Scholar
Jaye, C., Egan, T., & Parker, S. (2005). Learning to be a doctor: Medical educators talk about the hidden curriculum in medical education. Focus on Health Professional Education, 7, 1–17.Google Scholar
Larson, P.J. (1984). Important nursing behaviours perceived by patients with cancer. Oncology Nursing Forum, 11, 46–50.Google ScholarPubMed
Larson, P.J. (1986). Cancer nurses' perceptions of caring. Cancer Nursing, 9, 86–91.Google ScholarPubMed
MacLeod, R.D. (2000). Learning to care: A medical perspective. Palliative Medicine, 14, 209–216.CrossRefGoogle Scholar
MacLeod, R.D. (2001). On reflection: Doctors' learning to care for people who are dying. Social Science & Medicine, 52, 1719–1727.CrossRefGoogle ScholarPubMed
MacLeod, R.D. (2004). Challenges for education in palliative care. Progress in Palliative Care, 12, 117–121.CrossRefGoogle Scholar
MacLeod, R.D., Parkin, C., Pullon, S., et al. (2003). Early clinical exposure to people who are dying: Learning to care at the end of life. Medical Education, 37, 51–58.CrossRefGoogle ScholarPubMed
MacLeod, R.D. & Robertson, G. (1999). Teaching about living and dying. Education for Health, 12, 185–192.Google Scholar
Novack, D.H., Epstein, R.M., & Paulsen, R.H. (1999). Towards creating physician–healers. Fostering medical students' self-awareness, personal growth, and well-being. Academic Medicine, 74, 516–520.CrossRefGoogle Scholar
Perner, J., Ruffman, T., & Leekham, S.R. (1994). Theory of mind is contagious: You catch it from your sibs. Child Development, 65, 1228–1238.CrossRefGoogle Scholar
Petersen, Y. & Koehler, L. (2006). Application of attachment theory for psychological support in palliative medicine during the terminal phase. Gerontology, 52, 111–123.CrossRefGoogle ScholarPubMed
Plack, M.M. & Greenberg, L. (2002). The reflective practitioner: Reaching for excellence in practice. Paediatrics, 116, 1546–1552.CrossRefGoogle Scholar
Reynolds, W.J. & Scott, B. (2000). Do nurses and other professional helpers normally display much empathy? Journal of Advanced Nursing, 31, 226–234.CrossRefGoogle ScholarPubMed
Roter, D.L., Stewart, M., Putnam, S.M., et al. (1997). Communication patterns of primary care physicians. JAMA, 277, 350–356.CrossRefGoogle ScholarPubMed
Thompson, D. & Ciechanowski, P.S. (2003). Attaching a new understanding to the patient–physician relationship in family practice. Journal of the American Board of Family Practice, 16, 219–226.CrossRefGoogle Scholar
Turner, P., Sheldon, F., Coles, C., et al. (2000). Listening to and learning from the family carer's story: An innovative approach in interprofessional education. Journal of Interprofessional Care, 14, 387–395.Google Scholar
Watson, J. (1979). Nursing: The Philosophy and Science of Caring. Boston: Little, Brown and Company.Google Scholar
Weissman, F., Branch, W.T., Gracey, C.F., et al. (2006). Role modelling humanistic behaviour: Learning bedside manner from the experts. Academic Medicine, 81, 661–667.CrossRefGoogle Scholar
Wilkinson, T.J., Gill, D.J., Fitzjohn, J., et al. (2006). The impact on students of adverse experiences during medical school. Medical Teacher, 28, 129–135.CrossRefGoogle ScholarPubMed