Impact of behavioral science curriculum in medical education
Background:
Humanization of health care is defined as a state of well-being, involving affection, dedication, respect for the other, that is, to consider the person as a complete and complex being (1). We applauded this insightful editorial and sincerely appreciated author’s call for building a more compassionate society (2). When we are sick, injured, or facing an existential life crisis, our greatest human need is loving kindness and compassion in response to our vulnerability and suffering (2).
Most commonly young generation medical graduates find it difficult to initiate respectful and compassionate dialogues with their patients while working in a crowded out-patient department. Many of them fail to maintain professional conduct in a stressful working environment. Some of them often feel sick due to burn out state of their mind after long hours of emergency ward duties.
It is most unfortunate that many of them did not get an opportunity to learn about behavioral science as a part of their curriculum during their medical school training program. They were never been exposed to the local community for a supervised health screening program with a mission to develop doctor-patient relationship and professional communication skills in real life scenario. Psychological state of our patients vary widely. Many of our patients expect kind and friendly approach before explaining their personal health problems.
In recent years behavioral science has created its own space in medical curriculum which is now taking care of building foundation of compassionate behavioral changes among new generation of medical professionals. Patient-centered care has been a focus of health care management for many years, with emphasis ranging from the policy and health system levels to individual care at the bedside.(3) We suggest that work environments that support caring and compassion, for patients as well as for care providers, best provide a foundation upon which high quality patient-centered care can flourish (2). One of the challenges that makes humanizing health care difficult is the lack of financial resources for improving the physical and material structure of the services (3). It is necessary to understand the patient as unique and irreplaceable, who deserves to be treated with dignity (4, 5).
In recent years, the outreach program of All American Institute of Medical Sciences, Jamaica is gaining popularity and our medical students are getting early exposure to local population and their cultural background, which may help them to understand the human need of loving kindness and compassion in response to their vulnerability and sufferings.
Concluding remark:
The routine class room teaching of doctor-patient-relationship and case history taking course work, remain incomplete till we expose our young medical students to interact in a real life scenario. Medical professionals need a supervised environment to develop compassionate relationship with unknown patients in a limited time period. A supervised and well-designed training course work on behavioral science may help to build up confidence and self-respect among young generation medical students. All patients want to be looked after by a good doctor. This is because they know instinctively that a doctor's decisions and advice about diagnosis and treatment can affect the outcome and possible consequences of illness and may make the difference between life and death (6)
Nothing tests our communication skills so much as breaking bad news. Such conversations can be extremely emotional for both doctor and patient. The right words said in the right way make a huge difference (7). Compassionate behavioral skills of medical practitioners often help to reduce anxiety and worries of patients and accompanying relatives.
We understand that behavioral science curricula may even include content that favors the students' humane education, however, curricula hinder such content being effectively appropriated by the students in a significant manner, which includes the possibility of the content being transformed in routine care actions. More integrative models, and especially those that permit students to gradually approximate content to professional practice, connecting it to theoretical references, may have a greater potential for improving critical-reflective learning committed to reality (1).
References:
1. Rev. esc. enferm. USP vol.46 no.1 São Paulo Feb. 2012 http://dx.doi.org/10.1590/S0080-62342012000100029
CRITICAL REVIEW: The humanization of care in the education of health professionals in undergraduate courses*
2. Editorials: Christmas 2016; Humanizing healthcare: BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6262 (Published 13 December 2016) Cite this as: BMJ 2016;355:i6262.
3. Re-humanizing Health Care: Facilitating “Caring” for Patient-centered Care
Cheryl Rathert, Timothy J. Vogus, and Laura McClelland
The Oxford Handbook of Health Care Management
Edited by Ewan Ferlie, Kathleen Montgomery, and Anne Reff Pedersen http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780198705109.001.0...
4. Rev Saude Publica. 2013 Dec; 47(6): 1186–1200. doi: 10.1590/S0034-8910.2013047004581: PMCID: PMC4206092 : Humanization policy in primary health care: a systematic review: Carlise Rigon Dalla NoraI and José Roque JungesII
5. Humanizing Health Care: Creating Cultures of Compassion With Nonviolent Communication (Nonviolent Communication Guides) Paperback – October 15, 2010: by Melanie Sears RN (Author)https://www.amazon.com/Humanizing-Health-Care-Compassion-Communication/d...
6. Education And Debate: GMC and the future of revalidation: Patients, professionalism, and revalidation: BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7502.1265 (Published 26 May 2005); Cite this as: BMJ 2005;330:1265
7. Breaking bad news: BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7500.1131 (Published 12 May 2005) Cite this as: BMJ 2005;330: 1131.
Competing interests:
1. The author is teaching Behavioral Science in different USMLE based medical schools since 2006.
2. The outreach community health screening program was organized under All American Institute of Medical Sciences in Jamaica on 17th March 2017.
30 April 2017
Tanu Pramanik
Associate Professor
All American Institute of Medical Sciences
66 High Street, Black River, St Elizabeth, Jamaica.
Rapid Response:
Re: Humanising healthcare
Impact of behavioral science curriculum in medical education
Background:
Humanization of health care is defined as a state of well-being, involving affection, dedication, respect for the other, that is, to consider the person as a complete and complex being (1). We applauded this insightful editorial and sincerely appreciated author’s call for building a more compassionate society (2). When we are sick, injured, or facing an existential life crisis, our greatest human need is loving kindness and compassion in response to our vulnerability and suffering (2).
Most commonly young generation medical graduates find it difficult to initiate respectful and compassionate dialogues with their patients while working in a crowded out-patient department. Many of them fail to maintain professional conduct in a stressful working environment. Some of them often feel sick due to burn out state of their mind after long hours of emergency ward duties.
It is most unfortunate that many of them did not get an opportunity to learn about behavioral science as a part of their curriculum during their medical school training program. They were never been exposed to the local community for a supervised health screening program with a mission to develop doctor-patient relationship and professional communication skills in real life scenario. Psychological state of our patients vary widely. Many of our patients expect kind and friendly approach before explaining their personal health problems.
In recent years behavioral science has created its own space in medical curriculum which is now taking care of building foundation of compassionate behavioral changes among new generation of medical professionals. Patient-centered care has been a focus of health care management for many years, with emphasis ranging from the policy and health system levels to individual care at the bedside.(3) We suggest that work environments that support caring and compassion, for patients as well as for care providers, best provide a foundation upon which high quality patient-centered care can flourish (2). One of the challenges that makes humanizing health care difficult is the lack of financial resources for improving the physical and material structure of the services (3). It is necessary to understand the patient as unique and irreplaceable, who deserves to be treated with dignity (4, 5).
In recent years, the outreach program of All American Institute of Medical Sciences, Jamaica is gaining popularity and our medical students are getting early exposure to local population and their cultural background, which may help them to understand the human need of loving kindness and compassion in response to their vulnerability and sufferings.
Concluding remark:
The routine class room teaching of doctor-patient-relationship and case history taking course work, remain incomplete till we expose our young medical students to interact in a real life scenario. Medical professionals need a supervised environment to develop compassionate relationship with unknown patients in a limited time period. A supervised and well-designed training course work on behavioral science may help to build up confidence and self-respect among young generation medical students. All patients want to be looked after by a good doctor. This is because they know instinctively that a doctor's decisions and advice about diagnosis and treatment can affect the outcome and possible consequences of illness and may make the difference between life and death (6)
Nothing tests our communication skills so much as breaking bad news. Such conversations can be extremely emotional for both doctor and patient. The right words said in the right way make a huge difference (7). Compassionate behavioral skills of medical practitioners often help to reduce anxiety and worries of patients and accompanying relatives.
We understand that behavioral science curricula may even include content that favors the students' humane education, however, curricula hinder such content being effectively appropriated by the students in a significant manner, which includes the possibility of the content being transformed in routine care actions. More integrative models, and especially those that permit students to gradually approximate content to professional practice, connecting it to theoretical references, may have a greater potential for improving critical-reflective learning committed to reality (1).
References:
1. Rev. esc. enferm. USP vol.46 no.1 São Paulo Feb. 2012 http://dx.doi.org/10.1590/S0080-62342012000100029
CRITICAL REVIEW: The humanization of care in the education of health professionals in undergraduate courses*
2. Editorials: Christmas 2016; Humanizing healthcare: BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6262 (Published 13 December 2016) Cite this as: BMJ 2016;355:i6262.
3. Re-humanizing Health Care: Facilitating “Caring” for Patient-centered Care
Cheryl Rathert, Timothy J. Vogus, and Laura McClelland
The Oxford Handbook of Health Care Management
Edited by Ewan Ferlie, Kathleen Montgomery, and Anne Reff Pedersen
http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780198705109.001.0...
4. Rev Saude Publica. 2013 Dec; 47(6): 1186–1200. doi: 10.1590/S0034-8910.2013047004581: PMCID: PMC4206092 : Humanization policy in primary health care: a systematic review: Carlise Rigon Dalla NoraI and José Roque JungesII
5. Humanizing Health Care: Creating Cultures of Compassion With Nonviolent Communication (Nonviolent Communication Guides) Paperback – October 15, 2010: by Melanie Sears RN (Author)https://www.amazon.com/Humanizing-Health-Care-Compassion-Communication/d...
6. Education And Debate: GMC and the future of revalidation: Patients, professionalism, and revalidation: BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7502.1265 (Published 26 May 2005); Cite this as: BMJ 2005;330:1265
7. Breaking bad news: BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7500.1131 (Published 12 May 2005) Cite this as: BMJ 2005;330: 1131.
Competing interests: 1. The author is teaching Behavioral Science in different USMLE based medical schools since 2006. 2. The outreach community health screening program was organized under All American Institute of Medical Sciences in Jamaica on 17th March 2017.