The Art of Chronic Pain: Using Medical Humanities to Reduce Implicit Bias & Cultivate Empathy in Physical Therapy Students
Healthcare provider empathy is a trait highly valued by patients.1 Hojat defines empathy in a healthcare context as the ability to cognitively understand the perspective of a patient and then communicate that understanding effectively back to the patient.2 It has been reported that empathy decreases over time during the education of health care professionals.3 Lack of empathy combined with unconscious or implicit bias in health care professionals may influence care plan decisions and further contribute to health care disparities.4
Many healthcare professional programs are exploring the expanded inclusion of medical humanities in their curricula in an effort to enhance empathy and a broader understanding of the human experience.5–10 Furthermore, while studied in other health professions implicit bias has not yet been investigated in physical therapy.4
The purpose of this study is to: 1) determine the efficacy of exposing first-year Doctor of Physical Therapy (DPT) students to medical humanities to increase their empathy levels, as measured by the Jefferson Scale of Empathy-Health Professionals Student (JSE-HPS) version, towards patients with chronic pain 2) explore students’ implicit bias related to patients with disability 3) study the relationship between empathy and implicit bias.
Fifty-four first-year entry-level DPT students from a problem-based learning program were assessed using the JSE-HPS11 and an Implicit Association Test (IAT)12 for people with disabilities before and after an empathy-building artwork humanities assignment related to patients with chronic pain. Qualitative data of students’ perceptions was also collected. The cohort will be assessed again with the JSE-HPS and IAT 5 months after completion of their first professional practice experience to assess lasting effect of the assignments and changes in empathy and bias.
Early review of the IAT data at baseline showed a strong preference for individuals who are able-bodied before the art assignment. Re-test after the art assignment shows a cohort shift in IAT scores away from strong preference to a low preference for individuals who are able-bodied. Data for the JSE-HPS and student reflections has been collected but has not yet been analyzed.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
High self-reported levels of empathy have been previously reported in physical therapy students with the tendency to decline over the course of the curriculum.3,13 Preliminary findings of this study indicate a trend toward reducing bias against individuals with disabilities after exposure to medical humanities as demonstrated by IAT scores.
This study’s outcomes will guide educators in integrating the humanities into physical therapy education while strategically shaping curricula to promote and sustain empathic behavior, and reduce implicit bias in health care students.
1. Kelm Z, Womer J, Walter JK, Feudtner C. Interventions to cultivate physician empathy: a systematic review. BMC Med Educ. 2014;14:219.
2. Hojat M. Ten approaches for enhancing empathy in health and human services cultures. J Health Hum Serv Adm. 2009;31(4):412-450.
3. Neumann M, Edelhäuser F, Tauschel D, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996-1009.
4. Archambault DHSc M, Van Rhee MS PA-C JA, Marion PA-C GS, Crandall SJ. Utilizing Implicit Association Testing to Promote Awareness of Biases Regarding Age and Disability. The Journal of Physician Assistant Education. 2008;19(4):20-26.
5. Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: an updated, systematic review. Acad Med. 2013;88(8):1171-1177.
6. Macnaughton J. The humanities in medical education: context, outcomes and structures. Med Humanit. 2000;26(1):23-30.
7. Shapiro J, Rucker L, Boker J, Lie D. Point-of-view writing: A method for increasing medical students’ empathy, identification and expression of emotion, and insight. Educ Health . 2006;19(1):96-105.
8. Shapiro J, Morrison E, Boker J. Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. Educ Health . 2004;17(1):73-84.
9. Muszkat M, Yehuda AB, Moses S, Naparstek Y. Teaching empathy through poetry: a clinically based model. Med Educ. 2010;44(5):503.
10. Misch DA, Peloquin SM. Developing Empathy Through Confluent Education. Journal of Physical Therapy Education. 2005;19(3).
11. Fields SK, Mahan P, Tillman P, Harris J, Maxwell K, Hojat M. Measuring empathy in healthcare profession students using the Jefferson Scale of Physician Empathy: Health provider – student version. J Interprof Care. 2011;25(4):287-293.
12. Greenwald AG, McGhee DE, Schwartz JL. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464-1480.
13. Bayliss AJ, Strunk VA, Others. Measurement of Empathy Changes During a Physical Therapist’s Education and Beyond. Journal of Physical Therapy Education. 2015;29(2):6.