Teaching Human Side Of Patient Care Is Best Done At The Bedside, Say Medical Educators

The authors were members of the Ad Hoc Group on Teaching Humanism at the Bedside created at a meeting of the American Academy on Physician and Patient in June, 1998. In addition to Dr. Branch, the group included David Kern, M.D., Johns Hopkins University School of Medicine and Bayview Medical Center; Paul Haidet, M.D., M.P.H., Baylor College of Medicine and Houston Veterans Affairs Medical Center; Peter Weissmann, M.D., University of Minnesota Medical School; Catherine F. Gracey, M.D., University of Rochester School of Medicine; Gary Mitchell, M.D., Indiana University School of Medicine; and Thomas Inui, M.D., The Fetzer Institute.

The primary question the surveyors asked was: "What can we do in the patient’s presence to improve and teach the human dimensions of care?" They defined humanism as "the physician’s attitudes and actions that demonstrate interest in and respect for the patient, and that address the patient’s concerns and values."

As a result of their informal survey, the authors found that the established medical school curriculum of formal courses and seminars has failed to foster humanism in physicians-in-training. They discovered that barriers to teaching humanism are created informally, within the "hidden curricula" in medical schools. Through an institution’s "hidden curriculum," medical trainees are socialized into the culture of medicine by integrating the institution’s values and attitudes into their knowledge and skills of medical practice.

Using suggestions gathered from their teaching peers and their own experience, the authors recommended solutions ranging from broad changes in attitudes within medical schools to specific teaching methodologies. The broad changes included addressing the overall climate of medical education within institutions — a climate that often has more of an impact on students than any formal lesson, they noted.

The authors suggested three teaching methods that integrate humanism into medical education directly at the patient’s bedside. These included taking advantage of "seminal" events (teachable moments); role-modeling; and utilizing active learning skills.

"It is not possible to teach the human side of medicine away from the patients themselves," Dr. Branch said. "The methods we suggest are useful even within the fast-paced setting of clinical rounds. The goal of humanistic education is to create a learning environment that treats the students and residents with respect, establishes an atmosphere of trust and collaboration, and addresses the human needs of the learners, who also are under a great deal of stress." he pointed out.

Results of the survey found that attending physicians may exert a powerful influence on the attitudes of their students and encourage positive, caring attitudes through the personal interest they show in patients, in they way they respond to crises, and by modeling effective listening skills. In bedside teaching, medical educators should discourage dehumanizing language, integrate the medical with psychosocial aspects of care, emphasize teamwork and provide timely feedback, the authors suggested.

"One of the most effective ways to learn any skill is through actual practice," Dr. Branch said. "This principle also applies to positive physician-patient interactions. We believe that physicians-in-training should be practicing and receiving feedback on their humanistic skills at the same time they are learning the technical, scientific skills of medical practice."