Ideas

Ideas | Amitha Kalaichandran

Teaching empathy via temporary tattoos

Matt Rourke/Associated Press/File

Medical school, studies indicate, is where altruistic students lose some of the empathy that drew them into the healing profession in the first place. But if being jaded is a learned behavior, the ability to share in patients’ feelings may be as well.

In a recent study, a group led by Dr. Gerard Gormley from Queen’s University in Belfast, Northern Ireland, provided medical students with a temporary tattoo of a melanoma, a malignant skin cancer, for a full day. Then the students listened to a patient describe their experience with melanoma.

The students reported that they felt stigmatized, and that their friends and family had expressed worries upon seeing the tattoos. In follow-up interviews three months later, some felt they were better able to empathize with their patients.

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“Here we have a group of medical students who are young, [with] the majority having had no experience with ill health,” Gormley says. “We introduced them into a situation where they could experience what a patient with skin cancer might be going through.” He adds, “It gave them a sense of ‘patienthood,’ or the person behind the disease.”

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Just over a decade ago, a Boston University study found something striking: Empathy among students entering medical school dwindled dramatically by the time they graduated four years later. The new research in Belfast, along with similar studies around the world, raises the possibility that simple interventions that place medical students in a patient’s shoes might bring more empathy into medical practice.

“We need to think of empathy like a skill in much the same way as we think of athletic ability,” says Dr. Gary Rodin, the head of supportive care at Princess Margaret Hospital in Toronto and the coauthor of a seminal paper on how and why to teach empathy to aspiring clinicians. “We all have an innate capacity for empathic communication,” Rodin says, “but we all benefit from training.”

Just as there are good ways and bad ways of burning fat and building muscle, there likely are better and worse interventions for promoting empathy. But researchers are only beginning to figure out what that training should look like.

The University of New England College of Osteopathic Medicine in Maine recently tried to simulate aging so that students can better understand the issues facing older patients. Last year the University of Edinburgh in Scotland pursued a similar initiative, in which six medical students were offered aging suits involving a weighted vest, soft collar, special shoes, glasses with distorted lenses, and earplugs. To re-create an elderly patient’s experience with the health care system, researchers asked the students to carry out tasks such as reading medication information and hearing another person speak. But in both studies, the conclusions were iffy: The researchers couldn’t strongly conclude that it was actually effective at teaching empathy to would-be doctors.

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Nursing educators are exploring similar initiatives. In a project at the University of Technology in Sydney, Australia, published in December, half of the students were assigned the role of the “patient” and had to wear an acquired brain injury suit that rendered their dominant side paralyzed. The other half played the “rehabilitation nurse,” who was responsible for leaving their patient in crowded areas and observing from a distance, where they often witnessed indifference on the part of passers-by towards their patient.

Yet while both participants had higher empathy survey scores after the simulation, those in the nursing role had higher post-simulation empathy scores than their partners.

“This was surprising,” recounts Tracy Levett-Jones, one of the senior authors. “But we think witnessing their partner being treated so callously triggered a stronger empathic response.”

So far, though, there are few data to either support or refute the long-lasting impact of these efforts. Levett-Jones adds that, while the effects may decline over time, empathy doesn’t seem to return to the pre-simulation level. To explore this further, her group is planning to follow students over a longer period of time.

While role-playing and temporary tattoos can only teach so much, educators may see longer-lasting effects if they consistently coach students about empathy when they’re learning how to interact with real patients. One way to do this, Rodin suggests, might be to ask more senior physicians to model more empathetic behavior at the bedside.

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“As a resident doctor, for instance, an attending may ask you to list a differential diagnosis for the patient, but not necessarily ask about the patient’s emotional experience or suffering,” Rodin says, “This should be addressed as much as the physical effects of a disease.”

Dr. Amitha Kalaichandran is a resident physician and a health journalist based in Ottawa, Canada. Follow her on Twitter @DrAmithaK.