Teaching Empathy in Medical School

As medical educators, the most important message that we can send to our students is this: "Keep the patient at the center of everything you do." Patients visit doctors seeking help and hope. They are looking for guidance during difficult times, and they need to be treated with compassion and sensitivity.
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Technology is becoming increasingly integrated in our every activity, including the practice of medicine. Nowadays, robots are capable of providing assistance in surgical procedures, they enable doctors to visit with patients remotely, and some are even starting to make diagnoses and treatment decisions. Such space age innovations raise the question: are actual doctors still necessary? As the current and former deans of Weill Cornell Medical College, we feel that the answer is a resounding yes. Nothing can replace the human interaction between a doctor and a patient.

Still, recent reports in the media have described a widespread problem of physician burnout. Faced with the complexities of our healthcare system, doctors are working longer hours, seeing more patients, and being overwhelmed with administrative paperwork. Emotionally and physically exhausted, they may not be able to empathize and provide the best care to each and every patient. Physician burnout is a serious issue that not only affects the medical care that people receive today, but it also contributes to an ongoing shortage of doctors that could have adverse consequences long into the future.

At Weill Cornell, we want our students to develop lifelong habits of empathy that will stay with them throughout their medical careers. Our goal is to produce doctors who are highly proficient in both the scientific and the humanistic aspects of medical practice, so that they remain focused on treating the whole person, not just the outward signs of their diseases.

In our experience, most young people aspire to become doctors because they truly want to help others. When students first start medical school, they are often very empathetic. They are idealistic and desire to become healers, caring for rich and poor alike. Sometimes, however, the ability to connect emotionally with patients decreases during medical school, residency, and on into a doctor's career. One study has shown that empathy significantly declines in the third year of medical school, when extensive exposure to clinical settings typically first occurs.

Being able to connect emotionally with patients makes them feel supported and understood during what are often very stressful times in their lives. Having a compassionate doctor can also positively affect a person's health. A recent study looked at diabetic patients and found that those who had physicians with higher empathy scores were more likely to have blood sugar and cholesterol levels that were under control. One explanation for this finding is that patients may be more likely to follow instructions if they trust their doctors and feel personally cared for. In another study, patients with colds were seen either by doctors in a standard visit or by doctors who had received special training to make direct eye contact, touch patients, and spend more time with them. The people who rated their doctors as the most empathetic recovered from their colds sooner than the rest of the group.

Some institutions have begun to offer empathy training for their clinicians. At Weill Cornell, we have a number of initiatives that aim to cultivate empathy and humanistic values in our students. Last year, we launched an innovative pilot program that will eventually give students the opportunity to follow one or more patients over the course of their entire four years of medical school. Currently, one first-year and one second-year student are paired together under the supervision of a faculty mentor. Students build relationships with patients by attending doctor's appointments with them, contacting them regularly, and conducting an annual home visit to understand how their diseases impact their daily lives. Students are asked to keep a reflective journal about their experiences, and they participate in monthly mentoring sessions where they discuss psychosocial issues relevant to their patients. A major goal of the program is to prepare students to deliver empathetic, socially, and ethically responsible care by providing them with exposure to patients from the very beginning of their training.

Weill Cornell also has a longstanding Humanities and Medicine program that is designed to help students better understand patient experiences through literature, art, and music. We bring artists and writers to campus to speak to students, and we have electives that allow students to approach medicine through the study of art at a museum and by reading literary pieces. We recently introduced a third-year seminar on "Mindful Practice and the Art of Medicine" to encourage self-reflection. In addition, a group of medical students launched a journal last fall, called Ascensus, which explores the humanistic side of medicine through poems, art, prose pieces, and even a musical number contributed by members of our community.

Similarly, our Music and Medicine Initiative gives students the opportunity to continue pursuing their passion for music during their medical training. Each year a group of students performs at our commencement exercises at Carnegie Hall. Music and Medicine participants also perform at various benefit concerts at the medical college and for patients and families at our affiliate, NewYork-Presbyterian Hospital. We have partnered with The Juilliard School, which provides musical mentors for our students, and in return we offer specialized medical care to their musicians and organize seminars on performing arts medicine.

Another way to teach students to be open, respectful, and engaged with patients of every kind is to encourage international experiences, which help to broaden their experience of the world. At Weill Cornell, we have a very strong global health program, particularly in Qatar, Tanzania, and Haiti, where many of our students, faculty, and residents participate in educational exchange programs. Almost half of our students take international electives during the summer and have rich experiences seeing very different kinds of patients and health care facilities than they would normally be exposed to.

Our students have also started initiatives of their own, such as the Weill Cornell Community Clinic, which has provided free or low-cost primary medical care to uninsured patients since 2006. Under the supervision of an attending physician, students handle all medical and administrative responsibilities for about 350 patients each year. Another example is the Weill Cornell Center for Human Rights, which provides forensic medical evaluations to survivors of persecution seeking asylum in the United States. Founded in 2010, it is the first student-run asylum clinic at a US medical school. So far, 30 clients have gained asylum or another form of legal protection, and 187 students and physicians have been trained to conduct evaluations for people seeking asylum.

Educational programs and initiatives such as these underscore the fact that a person's health is affected by a myriad of socioeconomic, cultural, and behavioral factors, in addition to biological ones. An increased awareness of the human and social components of health characterizes the current field of medical education in general. For example, the Medical College Admission Test (MCAT) is being revised so that the humanistic aspects of medicine will be addressed more directly. Beginning in 2015, students will have to answer questions in the behavioral and social sciences and the humanities. Major aims of the revised MCAT are to promote a more holistic understanding of health and to ensure that future doctors will be able to empathize with patients from a diversity of backgrounds. This approach represents a major shift in the test, which has traditionally focused almost exclusively on the physical and biological sciences.

As medical educators, the most important message that we can send to our students is this: "Keep the patient at the center of everything you do." Patients visit doctors seeking help and hope. They are looking for guidance during difficult times, and they need to be treated with compassion and sensitivity. Technology--whether a robot or a DNA sequencer--can provide a lot of information and make our jobs easier, but there is no substitute for a caring relationship between a physician and a patient.

In the fifth century BC, Hippocrates wrote: "Where there is love of humanity there is also love for the art of medicine." Our goal at Weill Cornell is to instill the art of medicine, not just the scientific method, in our students. We want our young physicians to be technically proficient, but perhaps more importantly, we want them to empathize and to heal.