Search

Background: Changes in the organization of medical practice have impeded humanistic practice and resulted in widespread physician burnout and dissatisfaction., Objective: To identify organizational factors that promote or inhibit humanistic practice of medicine by faculty physicians., Design: From January 1, 2015, through December 31, 2016, faculty from eight US medical schools were asked to write reflectively on two open-ended questions regarding institutional-level motivators and impediments to humanistic practice and teaching within their organizations., Participants: Sixty eight of the 92 (74%) study participants who received the survey provided written responses. All subjects who were sent the survey had participated in a year-long small-group faculty development program to enhance humanistic practice and teaching. As humanistic leaders, subjects should have insights into motivating and inhibiting factors., Approach: Participants' responses were analyzed using the constant comparative method., Key Results: Motivators included an organizational culture that enhances humanism, which we judged to be the overarching theme. Related themes included leadership supportive of humanistic practice, responsibility to role model humanism, organized activities that promote humanism, and practice structures that facilitate humanism. Impediments included top down organizational culture that inhibits humanism, along with related themes of non-supportive leadership, time and bureaucratic pressures, and non-facilitative practice structures., Conclusions: While healthcare has evolved rapidly, efforts to counteract the negative effects of changes in organizational and practice environments have largely focused on cultivating humanistic attributes in individuals. Our findings suggest that change at the organizational level is at least equally important. Physicians in our study described the characteristics of an organizational culture that supports and embraces humanism. We offer suggestions for organizational change that keep humanistic and compassionate patient care as its central focus.

One way practitioners learn ethics is by reflecting on experience. They may reflect in the moment (reflection-in-action) or afterwards (reflection-on-action). We illustrate how a teaching clinician may transform relationships with patients and teach person-centered care through reflective learning. We discuss reflective learning pedagogies and present two case examples of our preferred method, guided group reflection using narratives. This method fosters moral development alongside professional identity formation in students and advanced learners. Our method for reflective learning addresses and enables processing of the most pressing ethical issues that learners encounter in practice., (© 2017 American Medical Association. All Rights Reserved.)

Objectives: This study was designed to investigate the roles, characteristics and contributions to the educational process of highly influential teachers described retrospectively by faculty members who were former medical students and trainees., Methods: The authors collected 20 appreciative inquiry narratives from a convenience sample of 22 faculty members (91% collection rate) at three medical schools that had volunteered to participate in a year-long programme of faculty development in humanism in medicine. The faculty members wrote narratives in response to the prompt: 'Write about your most influential teacher.' The four authors performed qualitative analysis of the 20 narratives using the constant comparison method to identify the characteristics of influential teachers., Results: Particular relational features with their learners explain the profound influences of these teachers on the professional development of their learners. All influential teachers shared qualities of excellence in teaching and nearly all were described as caring, generous and selfless in their relationships with learners., Conclusions: Highly influential teachers have no official roles, yet appear to profoundly influence the professional development of many learners at various stages of the educational process., (© 2015 John Wiley & Sons Ltd.)

Purpose: To describe the development and psychometric properties of the Humanistic Teaching Practices Effectiveness Questionnaire (HTPE), an instrument that measures the humanistic skills of attending physicians within an academic health center (AHC) department of medicine., Method: From August 2005 through March 2007, the authors distributed the HTPE, along with other standard faculty evaluations, to internal medicine and medicine/pediatrics residents at a single midwestern AHC (the Indiana University School of Medicine), in an effort to assess the instrument's validity and reliability., Results: The data set included 886 completed HTPE questionnaires, representing 73% of the 1,212 administered. Exploratory factor analysis demonstrated a single major factor with high internal consistency reliability. The correlation between the HTPE and routine teaching evaluation tools was low. Interrater reliability was only fair (0.17). Total HTPE scores were not significantly different between female and male attending physicians., Conclusions: The 10-item HTPE provides reliable and valid information on the humanistic teaching practices of internal medicine faculty at a single AHC. The ability to reliably measure these practices provides a framework for understanding and promoting the skills to effectively demonstrate humanism at the bedside and in the clinic. The low correlation between the HTPE and other faculty evaluations suggests that the former measures a unique domain in attending physicians' performance. The HTPE items cluster together as a single construct allowing educators to choose fewer items without compromising reliability; however, moderate interrater reliability indicates that multiple raters are required to produce reliable scores.

Purpose: To successfully design and implement longitudinal faculty development programs at five medical schools, and to determine whether faculty participants were perceived to be more effective humanistic teachers., Method: Promising teachers were chosen from volunteers to participate in groups at each of the medical schools. Between September 2004 and September 2006, the facilitators jointly designed and implemented a curriculum for enhancing humanistic teaching using previously defined learning goals that combined experiential learning of skills with reflective exploration of values. Twenty-nine participants who completed 18 months of faculty development at the five medical schools were compared with 47 controls drawn from the same schools in the final six months of the two-year project. For comparison, the authors developed a 10-item questionnaire, the Humanistic Teaching Practices Effectiveness Questionnaire (HTPE), to be filled out by medical students and residents taught by participants or control faculty. Items were designed to measure previously identified themes and domains of humanism. Control faculty were similar to participants by gender, specialty, and years of experience., Results: Thirty-four (75%) of the original 45 enrollees completed the programs at the five schools. Faculty participants outperformed their peer controls on all 10 items of the HTPE questionnaire. Results were statistically significant (P < .05) and sufficiently robust (8%-13% differences) to suggest practical importance., Conclusions: A longitudinal faculty development process that combines experiential learning of skills and reflective exploration of values in the setting of a supportive group process was successfully accomplished and had a positive impact on participants' humanistic teaching.

Respect is a core value of medical professionalism. Respect for patients often manifests itself as an attitude, of which the physician is only partially self-aware. To teach respect means bringing it fully into consciousness. Physicians then should strive to make respect an inner quality, beyond being a behavior. The author illustrates the depth of feeling involved in respecting another person by citing passages from Let Us Now Praise Famous Men, James Agee's classic book that describes Depression-era tenant farmers. However, major barriers inhibit teaching of respect in clinical settings. The author proposes that synergies can be achieved that overcome the barriers by combining the effective modeling of respect in bedside teaching with formal teaching exercises involving patients and deep critical reflection using narratives wherein learners describe their experiences in patient care.

Objective: To determine the prevalence, topics, methods, and intensity of ongoing faculty development (FD) in teaching skills., Design: Mailed survey., Participants: Two hundred and seventy-seven of the 386 (72%) U.S. teaching hospitals with internal medicine residency programs., Measurements: Prevalence and characteristics of ongoing FD., Results: One hundred and eight teaching hospitals (39%) reported ongoing FD. Hospitals with a primary medical school affiliation (university hospitals) were more likely to have ongoing FD than non-university hospitals. For non-university hospitals, funding from the Health Resources Services Administration and >50 house staff were associated with ongoing FD. For university hospitals, >100 department of medicine faculty was associated. Ongoing programs included a mean of 10.4 topics (standard deviation, 5.4). Most offered half-day workshops (80%), but 22% offered > or =1-month programs. Evaluations were predominantly limited to postcourse evaluations forms. Only 14% of the hospitals with ongoing FD (5% of all hospitals) had "advanced" programs, defined as offering > or =10 topics, lasting >2 days, and using > or =3 experiential teaching methods. These were significantly more likely to be university hospitals and to offer salary support and/or protected time to their FD instructors. Generalists and hospital-based faculty were more likely to receive training than subspecialist and community-based faculty. Factors facilitating participation in FD activities were supervisor attitudes, FD expertise, and institutional culture., Conclusions: A minority of U.S. teaching hospitals offer ongoing faculty development in teaching skills. Continued progress will likely require increased institutional commitment, improved evaluations, and adequate resources, particularly FD instructors and funding.

Feedback and reflection are two basic teaching methods used in clinical settings. In this article, the authors explore the distinctions between, and the potential impact of, feedback and reflection in clinical teaching. Feedback is the heart of medical education; different teaching encounters call for different types of feedback. Although most clinicians are familiar with the principles of giving feedback, many clinicians probably do not recognize the many opportunities presented to them for using feedback as a teaching tool. Reflection in medicine-the consideration of the larger context, the meaning, and the implications of an experience and action-allows the assimilation and reordering of concepts, skills, knowledge, and values into pre-existing knowledge structures. When used well, reflection will promote the growth of the individual. While feedback is not used often enough, reflection is probably used even less.

Background: We sought to identity the choices and the methods used by ambulatory teachers in a qualitative study, using teacher-intern-patient role plays to improve ambulatory teaching., Methods: We used repeated performances of a scripted role play; during each iteration, field notes were taken by the authors. Insights garnered at each iteration were incorporated into the next version of the role play. After 9 iterations, no further insights into outpatient teaching were forthcoming, and our observations were included into a qualitative study., Results: The sequence of steps and major choices to be made in an outpatient teaching encounter were delineated. The goals of the initial opening phase were defined as setting a learning climate, gathering information about the case, and assessing the learner's level of knowledge. Alternatives posed for setting up the second phase of the interaction with the patient included the choice of being a role model or being a "coach." Three-way conversations between patient, learner, and teacher were described in this phase of the encounter. In the final or summary phase of the encounter, we described the choices between giving a "general rule" for learning, and/or exploring higher-level issues, such as patient-doctor communication skills, medical ethics, or feedback for the learner., Conclusions: The sequence of steps involved in an outpatient teaching encounter, were defined, and the major choices to be made in the encounter were described.

Despite repeated calls to emphasize the humanistic dimensions of care during medical education, these are few known techniques for effective teaching of humanism. We describe the barriers that inhibit humanistic teaching and suggest pragmatic teaching methods to overcome such barriers and teach humanistic care in clinical settings. We began by asking participants at a conference on patient-physician communications sponsored by the American Academy on Physician and Patient in June 1998, "What can we do in the patient's presence to improve and teach the human dimensions of care? Please provide one or more examples of approaches you found to be effective." We augmented this information with suggestions from a number of colleagues in other settings. In a series of iterations, we analyzed all their suggestions to identify key teaching methods. We found that barriers to teaching humanism largely consist of elements of the informal and hidden curricula in medical schools. We then defined methods to help teachers overcome these barriers. Specific methods fall into the 3 categories of taking advantage of seminal events, role modeling, and using active learning skills. We believe that formal courses and other well-motivated endeavors that take place away from patients fail to foster humanistic care. In contrast, we present pragmatic teaching methods that can be used in the fast-paced setting of the clinical environment.

Ambulatory care training is increasingly important in internal medicine. Such training centers on the practice where residents and faculty see their patients; thus, features of the practice model influence what residents learn. A resident-faculty group practice affiliated with a division of general internal medicine has many advantages. In such a practice, learning centers on resident-patient interactions, around which a comprehensive teaching program must be built. Major features of such a program include the mentoring of residents by faculty who work with them longitudinally and the presence of a well-balanced structured curriculum addressing clinical and nonclinical topics related to patient care. Teaching residents to interact and communicate with patients is crucial; approaches include role-modeling by faculty, use of videotaping, and role-playing and other innovative methods. Feedback is integral to learning and helps shape the attitudes and values that permeate residents' practices.

Patients want to be treated humanely and as individuals by their care-providers. Many curricula, usually written by university faculty, have been developed to teach physicians such skills. Rarely are patients' actual preferences taken into account when designing curricula. This study was undertaken to identify what hospitalized patients most valued about their encounters with attending faculty physicians. In this study, medical residents (post-graduate medical trainees) identified faculty physicians as outstanding teachers of humanistic care. Patients receiving care from these outstanding physicians were interviewed, as were the students and residents on the care team and the study physicians. Using qualitative techniques, patients' comments were analyzed and common themes were identified. These findings were compared with qualities identified by medical residents and students and by the attending physicians themselves. Patients identified the following specific behaviors as those they most valued in their physicians: direct communication, understanding, direct involvement in care, adequate explanation, and overt expressions of respect, as highly valued. Outstanding teachers of humane care exhibited several discrete behaviors that patients described as valuable. Since these behaviors can be discretely identified, they can be taught as part of medical curricula. The content of medical education in communication and doctor-patient relationships should incorporate goals informed by the perspectives of patients. [ABSTRACT FROM AUTHOR]

Focuses on techniques for teaching humanism during medical education. Definition of humanism in medicine; Educational strategies; How to approach active learning of humanism.

Presents a summary of a study which determined the barriers that inhibit humanistic teaching during medical education. Methodology; Results; Discussion.