{"id":341,"date":"2018-05-17T14:05:01","date_gmt":"2018-05-17T14:05:01","guid":{"rendered":"https:\/\/www.critical-stages.org\/17\/?p=341"},"modified":"2023-03-19T10:34:07","modified_gmt":"2023-03-19T10:34:07","slug":"teaching-empathy-implementing-theatre-pedagogy-in-the-medical-school-curriculum","status":"publish","type":"post","link":"https:\/\/www.critical-stages.org\/17\/teaching-empathy-implementing-theatre-pedagogy-in-the-medical-school-curriculum\/","title":{"rendered":"Teaching Empathy? Implementing Theatre Pedagogy in the Medical School Curriculum"},"content":{"rendered":"

Elisabeth Hostetter<\/strong>*<\/a> and Melanie Stewart<\/strong>**<\/a><\/p>\n

Abstract: <\/strong>The US Medical Licensing Examination requires future doctors to examine actors in simulated, improvisational scenarios to test students\u2019 ability to empathetically collect medical histories, perform basic examinations and diagnose an illness. To better prepare for this clinical testing and improve upon patient complaints related to doctors\u2019 insensitivity, medical schools increasingly turn to university theatre programs to help develop interpersonal aspects of doctor\/patient interactions. Based on four years of devising and delivering successful theatre-based programs at two Philadelphia area medical schools, this essay details benefits, challenges and curricular implementation of empathy-building programs that emphasize the embodied nature of theatre and medicine.<\/p>\n

Keywords:<\/strong> Empathy-building, Medical Schools, Theatre Pedagogy, Standard-Patient.<\/p><\/blockquote>\n

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Second year students at Rowan School of Osteopathic Medicine in Stratford, New Jersey practice social interaction using theatre pedagogy. Photo: David Cimetta<\/figcaption><\/figure>\n

The United States Medical Licensing Examination, sponsored by the Federation of State Medical Boards and the National Board of Medical Examiners, requires all future doctors to physically examine paid actors portraying patients in simulated, improvisational scenarios to \u201c[assess] whether [students] can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine, with emphasis on patient management in ambulatory settings.\u201d<\/p>\n

A fundamental portion of the examination replicates general practice encounters where medical students collect a fictionalized medical history, perform basic physical examinations, and complete diagnostic interview\/observations of a simulated illness. A board of licensed physicians observes and evaluates the procedural and diagnostic aspects of the scenarios but \u201cstandard patient\u201d actors often grade would-be physicians on \u201cempathetic response\u201d and \u201cprofessional demeanor\u201d (http:\/\/www.usmle.org\/step-3\/<\/a>).<\/p>\n

To prepare for this heavily weighted clinical testing and address growing patient complaints related to doctors\u2019 emotional insensitivity, medical schools have increasingly turned to university and professional theatre programs to design curriculum to prepare students for the physical, vocal and emotional aspects of interpersonal doctor\/patient interactions.[1]<\/sup><\/a> Based on four years of devising and delivering successful theatre-based curricular programs at two medical schools in the Philadelphia area, this essay details the philosophical considerations and curricular creation, delivery and assessment of empathy-building pedagogy that emphasizes the embodied nature of theatre and medical practice.<\/p>\n

Imbedding humanities coursework in medical curriculum is becoming more and more commonplace, because, according to Johanna Shapiro and Lynn Hunt, \u201cthe inclusion of the humanities in medical school curricula emphasize their ability to help students access the patient\u2019s subjective experience of illness as well as to provide a psychological space for students to reflect on their own professional development.\u201d[2]<\/sup><\/a> Or, as another published M.D. notes, \u201cFor whatever reason\u2014economics, efficiency, increased demands on physicians for documentation, technology, or the separation of education from patient care\u2014curiosity in physicians is at risk. I believe it is our duty, as those who now teach young physicians, to identify medical students with a gift for curiosity and take infinite pains not to suppress but to encourage that gift.\u201d[3]<\/sup><\/a><\/p>\n

Finally, Dr. Kathy A. Stepien explains in her article Educating for Empathy<\/em>, \u201cThe Association of American Medical Colleges states in their Learning Objectives for Medical School Education, \u2018physicians must be compassionate and empathetic in caring for patients,\u201d because, \u201cEffective communication and a \u2018warm, empathetic\u2019 style have been shown to improve clinical outcomes.\u201d Nevertheless, after reviewing thirteen peer-reviewed articles related to qualitative and quantitative studies on pedagogy designed to teach empathy, she also notes that, \u201ccurrent studies are challenged by varying definitions of empathy, small sample sizes, lack of adequate control groups and inadequacy of existing empathy measurement instruments.\u201d[4]<\/sup><\/a><\/p>\n

Although quantifying if\/how arts education actually helps teach empathy is challenging, Kate Rossiter counters this concern in Bearing Response-Ability: Theater, Ethics and Medical Education<\/em>:<\/p>\n

Art forms such as theatre elude and truncate straightforward, instrumental, factual analyses. Further they are open to multiple interpretations and impact each learner differently. These qualities make the arts epistemologically disturbing to an educational system that values instrumental skill development and the transfer of objective knowledge. However . . . this slippery, unpredictable quality of art\u2019s impact is precisely what allows the possibility for ethical encounter to occur. That art cannot be solely reduced to its function as a vehicle for knowledge transfer creates fertile ground upon which to build an ethics of inter-relationality [i.e. the author\u2019s definition of empathetic response] that transcends knowledge.[5]<\/sup><\/a><\/p><\/blockquote>\n

Like Rossiter, many theatre educators intuitively and experientially understand that the direct human interaction of theatre performance provides a strong foundation for students to interpret, simulate, practice, discuss and clinically evaluate how bodies and voices manifest empathy in imaginary circumstances. Therefore, using established theatre-based pedagogy in a studio space, outside of a traditional testing laboratory and\/or actual patient interaction, often allows doctors to more easily discuss, practice and interpret empathetic response.<\/p>\n

Activity focused theatre pedagogy also offers potential side-benefits of allowing medical students to physically explore their emotional range, discuss how they culturally interpret\/read emotional responses and interact with peers in a more direct, non-competitive and personal way.<\/p>\n

While evolving studies point to the benefits of infusing theatrical pedagogy into medical training, little research has been published from the perspective of theatre practitioners called upon to provide these services. University theatre programs face both positive and negative implications when choosing to collaborate with medical programs. Primary advantages can include increased agency in the eyes of university administration, potential interdisciplinary discovery, new academic dialogue, enhanced areas of research, fruitful avenues for arts-education application and increased access to ripe funding of STEM based grants.<\/p>\n

It can also offer theatre students and\/or faculty new career options as specialized performers and\/or arts educators. Finally, it can cultivate deeper appreciation of the value of arts education, foster future patronage and build audiences. Ideally, theatre-based medical education can demonstratively impact and improve medical training, which results in better, more responsive and compassionate doctors.<\/p>\n

Nevertheless, pitfalls can inhibit productive partnerships between medical and theatre programs. In some cases, serving the rarefied needs of another discipline can divert valuable faculty and departmental resources away from art making, professional actor training, and mainstage production. This shift can inadvertently reinforce a subordinate and undervalued status of theatre pedagogy as an \u201cextra-curricular\u201d activity. Science-minded faculty and students could view the experiential nature of theatre study as a distraction from, rather than a reinforcement of, traditional book-based medical training.<\/p>\n

Given the strenuous task of delivering crucial disciplinary content knowledge, justifying the value and time of empathy-focused education could appear low priority for medical students and faculty. Meanwhile, theatre work that requires medical students to physically and vocally engage can suffer if even one reluctant participant undermines the open communication and collaboration needed to make this work happen.<\/p>\n

It is also common to face conflicting expectations of the two academic units. Faculty members building these programs generally do not have extensive practical experience in both areas of study. Theatre faculty can lack needed clinical and content knowledge to communicate with authority, while medical faculty can underestimate the time and expertise needed to design and deliver empathy-building curriculum. Logistical concerns regarding the availability of qualified instructors, time, studio space, funding sources, assessment, ongoing communication and program accountability need to be carefully negotiated at the start of any project. Despite these challenges, the potential rewards offer powerful incentives that can benefit both departments.<\/p>\n

In 2013, Rowan University in Glassboro, New Jersey, became one of two universities in the US to offer D.O. and M.D. degree-granting programs by acquiring the Rowan School of Osteopathic Medicine (formerly University of Medicine and Dentistry of New Jersey) and simultaneously establishing Cooper Medical School of Rowan University. The massive expansion and accompanying state funding to implement and maintain these satellite programs quickly transformed Rowan from a liberal arts university into a budding Research Institution.<\/p>\n

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Rowan University Campus, Glassboro, New Jersey. Via www.rowan.edu<\/a><\/figcaption><\/figure>\n

To better fulfill the missions of all three institutions and to utilize common resources, medical faculty soon reached out to the main campus to address the national call to prepare students for doctor\/patient interactions. The M.D (Allopathic) granting program at Cooper Medical School in Camden, New Jersey prides itself on forward-thinking work in this area and notes in the core mission:<\/p>\n

Being a new school afforded us with the unique opportunities to create a culture centered on teamwork, professionalism and empathy. We\u2019ve had the advantage of being able to develop a curriculum that offers dynamic teaching methods that support learning, including a focus on active learning, simulation and early and frequent exposure to patient care. (http<\/a>:\/\/www.rowan.edu\/coopermed\/about<\/a>\/<\/a>)<\/p><\/blockquote>\n

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Cooper Medical School, Camden, New Jersey. Via www.rowan.edu<\/a><\/figcaption><\/figure>\n

To address this claim, Cooper Medical requires second and third year students to complete one \u201cSelective\u201d humanities course each year that generally requires twelve contact hours divided in two-hour blocks on six Fridays of an academic semester. The University website describes the goal of this coursework as:<\/p>\n

The Selectives in the Medical Humanities are intended to create a well-rounded physician with a background in the arts as well as the sciences and to foster the development of creative, empathic, and intellectually adaptable physicians who are capable of using their right hemisphere as well as their left. The compilation of courses is meant to provide students with various perspectives and thereby facilitate problem-solving and creativity in multiple arenas.<\/p>\n

Course options include: \u201cDance and Medicine,\u201d \u201cObservational Drawing for Future Physicians,\u201d \u201cOpera and Medicine\u201d and \u201cArt of Observation.\u201d Two courses designed and regularly taught by theatre faculty from the Rowan main campus are \u201cMedical Improvisation,\u201d and \u201cTheatre, Role-playing and Medicine.\u201d Intensive discussions between Melanie Stewart (Associate Dean of Performing Arts), Dr. Dyanne P. Westerberg (DO, FAAFP and former Chair of Family and Community Medicine) and Elisabeth Hostetter, PhD (Chair of Theatre and Dance), led to the following overarching goal to, \u201cexplore the humanistic side of patient and health care using physical and vocal theatre techniques to interpret patient\/character emotion and general motivation.\u201d The role-playing course requires students to:<\/p>\n