Interns Practice Empathy Skills Through Simulation
Hospitalist Christine Bryson, DO served as a liaison when her critically ill cousin was hospitalized. She was struck by what a difference empathy—the ability to understand and respond to another’s feelings and situation—can make when doctors talk about difficult and emotional issues with patients and their families.
Her experience reaffirmed the conviction that had led her to create, years earlier, a simulation exercise for interns to practice their empathy skills—doctors need training to better communicate and connect emotionally with their patients.
Doctors More Comfortable “Speaking Medical”
Discussions with patients about complex medical decisions are essential for helping physicians provide appropriate care and avoid unwanted interventions.
“I can’t over state how overwhelming it was for my cousin’s family when she was in the ICU,” Bryson says. But, listening to her cousin's doctors trying to explain what was happening, she noticed a remarkable variation in their ability, and willingness, to communicate with empathy.
Her cousin’s husband told her that “doctors looked more comfortable 'speaking medical' to her.”
Medical Training in Communication Skills Falls Short
Residents' duties in the hospital often call upon their communication skills. A common conversation that is particularly challenging is a code status discussion—talking to patients and families about life sustaining interventions and goals of care. But residents generally lack the knowledge and confidence to effectively facilitate these discussions.
Bryson notes that there isn't a standardized medical school curriculum for communicating with patients about code status or end-of-life care.
“I was trained to care competently for medical needs," she says. "But, I didn’t get a lot of training about
effective patient communication—what used to be called bedside manner.”
Dr. Bryson says she's changed her practice since her experience with her cousin. Now she makes a more conscious effort to connect to her patients on a personal level.
“I’ve never had anyone thank me for fixing their pneumonia," she stresses. "The most thanks I get is when I check in to see how they are doing or talk about their test results.”
Simulation Helps Interns Understand Patient Perspective
The simulation training, taken by all internal medicine and medicine-pediatric interns, is designed to help them understand not just how to have a code status discussion, but to hear from a volunteer patient how it makes them feel.
“Residents often have sheets of to-do tasks—check hemoglobin, start IV. It drives me crazy when they have DNR as a checkbox," says Bryson. "It’s important and you have to remember to do it, but it’s not a checkbox, you need to have the discussion in the context of patient goals and values.”
The simulation training is part of a program that also includes lectures and workshops. The program has interns think through what they are going to say, how they will say it, and walk through it ahead of time so they can go in with a thoughtful approach.
According to Bryson, other training programs do similar things, but Baystate's program is unusual because real patients from the Baystate Patient Family Advisory Committee are trained to participate.
PFAC volunteers learn about code status discussions and are trained to play a specific role, for example a 90 year old with congestive heart failure, as well as how to give feedback to the residents on their performance.
Each intern has an individualized simulated code status session that is recorded for them to reflect on later. They also get immediate feedback from the PFAC volunteer, such as, “I didn’t like the way you were sitting, you made me feel talked down to.” Or, “I really liked that you asked about my grand kids.”
Interns Report Greater Confidence After Training
Feedback from interns has been positive, reports Bryson. “Last year, I liked that the buzz in the intern residency room was that it was a good experience,” she says.
Interns especially valued the simulated case, noting that the one-on-one coaching was extremely helpful.
“For me it was more important to hear how she felt—listened to or ignored, treated with compassion or with indifference—than telling me how I did,” commented an intern in last year’s program.
Empathy Increases Satisfaction for Patients—and Physicians
Bryson has heard from other doctors who have been thinking about this aspect of patient care. She thinks most do try to be more empathic, but find that it’s sometimes hard to find time.
Studies have linked empathy to increased satisfaction for both patients and physicians, according to Bryson. So she hopes that finding will convince doctors that it is worth the time. She believes that fostering satisfying relationships with patients is why most doctors went into medicine.
“I believe when we can acquire empathy it allows us to help patients make better decisions about their health," she concludes. "It allows us to walk with them and their families to the end, realizing we haven’t lost our humanity after all.”