Cheryl L Holmes1, Harry Miller2,3, Glenn Regehr4. 1. Department of Medicine, Division of Critical Care, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 2. UBC Southern Medical Program and Department of Psychology, University of British Columbia Okanagan, Kelowna, British Columbia. 3. Department of Psychiatry, University of British Columbia Faculty of Medicine, Vancouver, British Columbia. 4. Department of Surgery and Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
CONTEXT: The erosion of empathy in medical students is well documented. Both the hidden curriculum associated with poor role modelling and a sense of burnout have been proposed as key factors, but the precise mechanisms by which this loss of empathy occurs have not been elaborated. OBJECTIVES: In the context of a course designed to help students manage the hidden curriculum, we collected data that raised questions about current conceptualisations of the aspects of medical training that lead to loss of empathy. METHODS: We held nine sessions in the first year of clinical clerkship, in which we asked students to bring to the group their experiences of the hidden curriculum for reflection. Course sessions were recorded, transcribed and qualitatively analysed, and themes were generated for further exploration. RESULTS: We identified an identity developmental trajectory in early clerkship in which students started with feelings of excitement, transitioned quickly to 'shock and awe', progressed into 'survival mode' and then passed into a stage of 'recovery'. Interestingly, in the early stages, students' sense of empathic virtuosity was reinforced. It was not until later, when students were more comfortable in their clinical role, that they reported their tendency to connect with the patient only as an afterthought to the encounter, or not at all, and needed to remind themselves to care. CONCLUSIONS: We offer new data for consideration with regard to medical students' loss of empathy during early clinical training that suggest it is the process of making patient care routine that shifts the patient from the status of an individual with suffering to the object of the work of being a physician.
CONTEXT: The erosion of empathy in medical students is well documented. Both the hidden curriculum associated with poor role modelling and a sense of burnout have been proposed as key factors, but the precise mechanisms by which this loss of empathy occurs have not been elaborated. OBJECTIVES: In the context of a course designed to help students manage the hidden curriculum, we collected data that raised questions about current conceptualisations of the aspects of medical training that lead to loss of empathy. METHODS: We held nine sessions in the first year of clinical clerkship, in which we asked students to bring to the group their experiences of the hidden curriculum for reflection. Course sessions were recorded, transcribed and qualitatively analysed, and themes were generated for further exploration. RESULTS: We identified an identity developmental trajectory in early clerkship in which students started with feelings of excitement, transitioned quickly to 'shock and awe', progressed into 'survival mode' and then passed into a stage of 'recovery'. Interestingly, in the early stages, students' sense of empathic virtuosity was reinforced. It was not until later, when students were more comfortable in their clinical role, that they reported their tendency to connect with the patient only as an afterthought to the encounter, or not at all, and needed to remind themselves to care. CONCLUSIONS: We offer new data for consideration with regard to medical students' loss of empathy during early clinical training that suggest it is the process of making patient care routine that shifts the patient from the status of an individual with suffering to the object of the work of being a physician.