Cultivating Empathy By Embedding Humanities in PT Education

Purpose: This presentation is endorsed by the ACAPT Consortium for the Humanities, Ethics, and Professionalism (CHEP). In order for health care professionals to truly meet the needs of our patients, we need deep empathy. This requires more than an academic understanding of the impairments and functional limitations associated with a diagnosis; we must understand the emotions associated with them, as well.1,2 What writers, actors, musicians, and other artists have in common is the ability to evoke emotion when reading, watching, or listening to their work. This emotion is what drives growth in the affective domain and cultivates empathy.1–3 The humanities create mediums through which individuals can experience a small portion of the reality of having a life-altering injury or illness in order to better meet patient/clients’ needs.3–5 The purpose of this session is to discuss the importance of empathy in the health professions, then describe three practical classroom activities that help students understand the lived experience of the patients and clients who need them. Participants will leave this session with ideas than can be implemented in their classes right away. Methods and/or Description of Project: In a problem-based learning DPT curriculum, the humanities are incorporated into a series of professional topics courses that utilize a blended online and face-to-face format. Patients with Spinal Cord Injury (SCI): In the module that facilitates psychosocial issues in individuals with spinal cord injuries, students are required to watch the movie The Waterdance,written by Neal Jimenez and starring Eric Stoltz, Helen Hunt, and Wesley Snipes, is loosely based on Jimenez’s own experience with a spinal cord injury.6 The plot of The Waterdance centers around three men in an acute inpatient rehabilitation facility after spinal cord injuries. The movie allows the viewer to see the stages of grief associated with a major change in abilities, and these emotions are complicated by the support systems available to each of the men and the nature of the accident that resulted in the SCI. The movie depicts changes in sexual function, intimate relationships, and self-image, and these struggles are interwoven with substance abuse and institutional isolation due to a long inpatient rehabilitation stay. Students take notes on a worksheet created by the faculty member that asks students to consider their feelings and take notice of patients’ emotions and behaviors during the movie, and they complete an anonymous blog assignment in which they reflect on their own values and beliefs surrounding sexuality. The worksheet is then used as a prompt for a large-group discussion during the face-to-face portion of the class. This class session is associated with learning communication tools to give patients permission to discuss their questions or concerns about sex and sexuality associated with their injury or illness.7 Patients with Terminal Conditions: Students complete a module on end of life issues that helps students understand the physical therapist’s role in the care of patients with terminal conditions, and they explore the ethical questions related to the patient’s right to self-determination. In the online portion of this module, students read an excerpt from The Death of Ivan Ilyich by Leo Tolstoy8 and “Letting Go” by Atul Gawande9, and they reflect on their own values and beliefs surrounding death and dying in an anonymous blog writing assignment. When the class meets, students discuss the readings and reflect on the author’s intentions as well as their own feelings during the readings. Students are asked to consider the experiences of various characters in the story, including Ivan, his wife, his peers and his butler, and how Ivan’s progressive condition and death affect each of them. When discussing “Letting Go,” students are prompted to consider the costs and benefits of curative treatment and palliative care, and the struggles that health-care providers have with honestly communicating the likelihood that attempts at curative treatment will be effective. Students discuss palliative care, hospice, provider assisted death, and euthanasia, as well as the ethical considerations surrounding each. They also discuss their role on the interprofessional team and the impact of end-of-life decisions on the physical therapy plan of care and patient and/or family’s goals for physical therapy. After the face-to-face class session, students complete a written reflection that this shared only with the faculty member. Patients with Chronic Pain: During the online portion of the course module on patients with chronic pain, students complete the Implicit Association Test (IAT) about individuals with disabilities. The IAT has been shown to reliable predict behavior based on bias.10. There is not a specific IAT regarding chronic pain, so the test related to people with disabilities is used. The IAT results for people with disabilities has also been shown to correlate to the Jefferson Scale of Empathy-Student Version. The more empathy the student has, the lower their bias towards able-bodied people is.11 The students are able to see that many of them have an unconscious bias toward able-bodied individuals, and students reflect on this in the context of their development as a healthcare professional. Students are then asked to find artwork that is created by an individual with chronic pain or with a disability with the purpose of representing their pain or disability. The artwork can be music, poetry, sculpture, painting, or a variety of other media. When students find the art, they post an image, audio file, video link, etc. into a discussion post in the learning management software along with a description of the art and why the feel it meets the requirements of the assignment. Then, during class, they peruse the gallery that they have created and comment on each other’s posts. The IAT is again administered and the students are shown differences in the before and after scores since participating in the assignment. Results/Outcomes: Patients with SCI: After viewing The Waterdance, students are able to understand the complexities of community reintegration and discharge planning after a spinal cord injury. They are able to identify a variety of healthy and unhealthy coping strategies, and they are able to demonstrate the use of bridge statements and the Permission, Limited Information, Specific Suggestions, and Intensive Therapy (PLISSIT) model to give patients permission to ask questions, express concern or other feelings associated with their sexuality after SCI as well as other diagnoses. For example, student responses about a scene in the movie depicting change in sexual function identify feelings such as embarrassment, uncertainty, anger, loss, and frustration. Their responses about the effects of SCI on the patient’s family include feelings such as helplessness, heartbreak, loss, sadness, and uncertainty. Without prompting, many students went on to identify the clinical relevance of this worksheet item, stating they will be certain to focus on the patient’s abilities, rather than disabilities, and they will involve the whole family in the plan of care. Patients with Terminal Illness: Students’ written reflections on caring for patients with terminal conditions illustrate their understanding of the right to self-determination and the understanding the the definition of quality of life is highly individualized. They learn to respect beliefs that are different from their own, and they understand how to ask appropriate subjective questions and offer various physical therapy treatment approaches in order to find what best meets the needs of the patient and their family. Common phrases in student reflections included, “ see different perspectives,” “more than one right decision,” “more open to ideas other than my own.” Patients with Chronic Pain: Students are often surprised by the results of the IAT, and some experience disbelief. They share a variety of artwork and link it to the lived experience of the artist, and after this activity most students show a statistically significant decrease in their bias towards able-bodied people.11 This indicates a reduction in bias for people with disabilities, and plausibly for people in chronic pain. Conclusions/Relevance to the conference theme: Deep empathy is required to meet the needs of our patients and clients, and one way deep empathy is obtained by experiencing the struggles of the individual with a spinal cord injury, a terminal illness, chronic pain, or any number of other diagnoses. This does not mean merely experiencing the physical limitations that come with the diagnosis, but it is experiencing the emotion associated with struggling to do the things that bring joy and independence. The art and chronic pain activity has the most objective outcome data which increases confidence in its efficacy for reducing implicit bias and increasing empathy. The Waterdance and the Tolstoy and Gawande readings give life to information in their textbooks by providing case studies or detailed depictions of the patients’ lived experiences, and while there is not objective information associated with the efficacy of increasing empathy in their associated patient populations, they provide rich context for class discussion. Students are able to practice more targeted subjective questions to elicit the patient’s goals for therapy. Providing physical therapist students with a glimpse into the patients’ lived experiences helps them develop deeper empathy, which results in a better patient-practitioner alliance and ultimately, better outcomes.

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  • Control #: 3055
  • Type: Education Session
  • Event/Year: ELC 2019
  • Authors: Sarah Luna
  • Keywords:

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