Is Medical Education Failing Our Future Doctors?

Society places a huge amount of trust in medical educators to produce well-rounded doctors that are knowledgeable, empathetic and passionate about delivering quality healthcare.

There is a lot that medical education is getting right. We only have to look at the current COVID crisis to see how doctors are able to adapt readily to a rapidly changing, challenging medical situation while ensuring the patients in their care are treated with grace and dignity.

If anything, the rise of COVID has highlighted more markedly than ever before the role of empathy in the healthcare profession. Where patients are hospitalised and their family members are not able to be at their side, doctors are having to engage with patients at a much more personal and emotive level, all while shrouded in personal protective equipment (PPE).

And yet, there are many factors within the current medical education system that are in conflict with a traditional empathic approach:

• Textbook medicine: Exams in medical school assess specific knowledge in many areas. Students can rote learn in order to pass a test to progress through the degree, rather than learning with the aim of providing a high level of care for their patients. This may lead to excellent clinical knowledge but can fail to prepare students for the complexities, nuances and uncertainties of real-world clinical practice.
• Poor preparedness in communication: There is evidence that students’ communication skills deteriorate as they progress through medical school. Students can also get caught up in medical jargon and technical details leading to information being ‘lost in translation’ when they communicate with their patients.
• Neglecting the patient narrative: A focus solely on signs and symptoms and ‘methodical’ evidence-based medicine may also fail to take into account the patient narrative – the complex experience of the patient with their illness – leaving patients feeling dissatisfied and potential alternative diagnoses being missed. This is particularly relevant in the era of increasing technology and mobile health (mHealth) in medicine.
• The hidden curriculum: ‘The hidden curriculum’ refers to what students learn from their observations of senior colleagues. While most students work alongside positive role models, there are those that report a hierarchical and competitive atmosphere in which tuition can be haphazard and teaching by humiliation can occur. These experiences can influence the student’s approach to medicine further down the line.
• The concept of ‘the difficult patient’: The hidden curriculum can also extend to the care of patients, with students being taught early on in their medical career about ‘difficult patients’ and patients labelled as such. These are patients that can have emotionally complex needs, don’t follow the ‘doctor’s orders’, or simply ask a lot of questions. This concept of ‘the difficult patient’ can lead to doctors tending to avoid such patients, when what they really need is more time, attention and compassion.
• A lack of time: It comes as no surprise that medical students and qualified doctors alike lack time: time for students to gain experience across all medical specialities, time to teach students, and time with patients. In particular, a lack of time dedicated to hands-on experience with patients early on in medical training can be a major barrier to empathy for medical students.

HOW CAN EMPATHY BE RESTORED IN MEDICAL EDUCATION?

Several changes to the current medical education structure have been suggested to foster greater empathy among medical students (and our future doctors!):

• Patient contact early in the curriculum with hands-on experience and the opportunity to experience the patient’s point of view
• Communication training focusing on empathy and the handling of negative emotions
• Development of mentoring-relationships and self-reflection between students and teachers
• Formal evaluation of students’ empathic abilities throughout the curriculum (e.g. with simulated patients)
• The integration of narrative-based medicine principles alongside traditional evidence-based medicine

The role of empathy in medicine should not be underestimated. Empathy can be therapeutic in its own right by reducing patients’ anxiety and improving patient outcomes; it can improve treatment compliance and raises patient satisfaction. Ultimately, an empathetic experience can be humanising and tends to leave patients happier.