INNOVATIONS IN INTEGRATIVE HEALTHCARE EDUCATION

BRIDGING THE COMPASSION AND EMPATHY GAP IN

MEDICAL SCHOOL: THE PHYSICIAN HEALER TRACKAT UTMB-HEALTH

| Cara Geary, MD, PhD, Julie McKee, MD, Catalina Triana, MD,Era Buck, PhD, Scott Walton, BS, MS2, David Valdez, BS, MS2,

Victor Sierpina, MD, and Mary Jo Kreitzer, RN, PhD|

In

“We are what we repeatedly do.Excellence, then, is not an act, buta habit.” —Aristotle

Excellence in compassion and empa-thy require repeated practice. Instead ofproviding this practice, medical schoolcurriculums emphasize data acquisitionand regurgitation, test performance, andcompetition. Medical students oftenstart their training with a passion to carefor and be of service to others. Theirtraining will often acknowledge theimportance of humanistic skills but timeand energy is rarely within the medicalschool curriculum to become compas-sionate and empathic by becoming “whatthey repeatedly do.” In addition to thelack of attention and actual practice inthis realm, a lack of self-care in exchangefor test performance is encouragedwithin the culture. This further erodescompassion and empathy for others aspoor self-care contributes to stress andburn-out. As faculty role models trainedwithin this system, it is challenging torediscover our own empathy and com-passion, much less figure out how tochange the training for the future.This degradation of compassion and

empathy skills is well documented inacademic medicine.1–13 While notentirely understood, contributing factorsmay include any or all of the following:focus on grades and evaluation, compe-tition for residency, long hours, anddecreased time and effort for self-care.Other potential culprits are poor facultyrole models, medical technology, shortoffice and hospital visits, and lack oflong-term relationships with patients.

novations in Integrative Healthcare Edu

To address these problems and hope-fully prevent so-called “empathy burn-out” in students, UTMB-Health (Uni-versity of Texas Medical Branch, Galves-ton, TX) has initiated a new track, ThePhysician Healer Track, for a limitednumber of students. It is intentionallyand mindfully designed to help studentsmaintain their innate compassion andhumanity and to grow these personalskills in relation to clinical care.The syllabus description of this new

program is as follows: “The PhysicianHealer Track is designed to mentorstudents as they develop their professio-nal identity as doctors. The trainingfocuses on self-awareness, self-reflection,interpersonal communication skills, self-care, and work-life balance. Being asource of healing for the suffering ofanother is both a responsibility and aprivilege. In addition to our technicalknowledge and skills, being a healerrequires training in equanimity, wisdomand compassion.” (See The PhysicianHealer Track website for furtherdetails.14)UTMB-Health has established a num-

ber of “Tracks” in the medical school toprovide interested students opportuni-ties to receive expanded learning experi-ences in areas of interest. Other Tracksinclude Aerospace Medicine, BilingualHealth, Global Health, Geriatrics, PublicHealth, Rural Healthcare, and Transla-tional Research.15

Tracks entail five to six months ofelective and selective experiences. Avariety of configurations with regard totiming are possible. Flexibility allowsstudents to enter a track at multiplepoints. Programs require a substantial

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scholarly project and product (e.g.,manuscript or oral presentation) forsuccessful completion. Students com-pleting this Physician Healer Track arerecognized for their extra commitmentin their Dean's letter and at graduationas “Physician Healer” Scholars. Othertracks offer similar recognition.The Physician Healer Track is meant

to be highly experiential, fostering mind-fulness and self-awareness. To fosterthese, a variety of small-group, self-study,and clinical experiences are included.Some examples from early sessions inthe first year of medical school includeself-assessments using the enneagram andself-compassion tests,16 viewing TEDand YouTube presentations,17 journal-ing exercises, selected articles, books,18,19

and other readings.While this is the first year of the

program, and it is too early to evaluateits impact, student enthusiasm has beenhigh. We anticipated nine to10 studentswould sign up for the track and nearly40 did so. We ultimately limited it to 24students for the first year (10% of theclass).Two second-year students, Scott Wal-

ton and David Valdez are integral asactively contributing committee mem-bers who are helping guide The Physi-cian Healer Track's planning,implementation, and leadership. Theirreflections on the value of this curriculartrack are as follows:

Upon entering medical school, myspirits were high and I was anxiousto learn from the professionals inthe medical field and perform wellin my classes. However, I quickly

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learned that gaining the ability totruly heal as a physician requiredmore than a wealth of medicalknowledge and A's on all of mytests. I needed to learn how to bepresent with my patients in order tobetter alleviate their suffering, espe-cially the suffering that extendsbeyond the physical. Unfortu-nately, the stress and rigid structureof medical school curriculumsallows too many students to merelypass through without acquiring thisskill and their patients sufferbecause of it.

With so much of our medical train-ing focused on the science of med-icine, I learned from firsthandexperience that too many students,residents, and physicians lack theability and training necessary toprovide a complete healing pres-ence in their clinics. Our first sonwas diagnosed with an illness thatcarried with it a poor prognosis.The news turned our lives upsidedown and the stark contrastbetween those doctors equipped toprovide complete care and thosemerely there to fill out a chart orcomplete a task became blatantlyobvious. Following this experience,I was introduced to the PhysicianHealer Track and I am finallyreceiving the experience and train-ing necessary to learn to fully pro-vide for my patients.

The healing aspect of my training isso important to my future and I amgrateful that UTMB is beginning toincorporate it actively for all stu-dents. Undoubtedly, medical stu-dents will confront situations thatwill pull at their heart strings. ThePhysician Healer Track will ensurethat when students hit the wards,they will be empowered to confrontthese encounters with confidenceand not hide behind the fancymedical jargon that leaves patientsto fend for themselves in theirvulnerable states. This track willconfirm in the hearts and mindsof its students that a task to beperformed or case to be solved isnever more important than apatient to be cared for. (S.W.)

I remember being 2 months intothe first year of medical school andnot being able to keep myself fromwondering: where are all the peopleI was supposed to be helping, whohave I helped since I have been

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here, and when was the last time Ithought about anything other thanscheduling my day around lectures,labs, problem-based learning, andassigned readings. I found that mypersonality and empathy werebecoming calloused, and that theflame that once burned so strong tomake a difference in people's liveshad been redirected toward justlearning a massive amount of infor-mation and performing on anexam. This continued through thefirst half of second year and, Iadmit, although it seemed like thecurriculum did try to implementsome sort of empathy exposure, itwas always minimal and unable toget past the daily strife of being amedical student. Then I heard of aprogram that was starting whichfocused on bringing humanity andcompassion to medical school.

The Physician Healer Track focuseson the elements of being a caregiverthat the current medical curriculumfails to adequately address. It notonly provides the opportunity formedical students to be engaged inactivities focused on combatingempathy burn-out but also nurturesstudents to become well-roundedcaregivers trained in more completepatient care. As we all have enteredthe medical profession to helpothers, this track acts as a bridgeover the traps of a demandingcurriculum to help medical stu-dents maintain the mindfulnesstoward care for others that theyinitially entered with. This trackalso provides students with theopportunity to learn from passion-ate physicians who are motivated toserve students by facilitating themin small groups as well as being avisual representation and model ofwhat being a physician healer is allabout. Currently the track is onlyopened to a limited amount ofstudents, but we hope it will soonbe available to everyone. Everymedical student needs the opportu-nity to be a physician healer. (D.L.)

A number of challenges remain to theimplementation of this program. Facultydevelopment is key to expanding ourgoal of having the key elements of thetrack available to more students andperhaps the entire class. This will requirefunding for travel and conferences onmindfulness, mind–body therapies,

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communication, and empathy skilldevelopment. Food expenses for eveningdinner meetings with students has so farbeen provided from discretionary andendowment funds of generous facultybut eventually need to be budgetedfrom the School of Medicine. Providingadministrative staff support as well astime and effort to lead faculty is crucialto the program's long-term success. Weare just starting to realize the need forthese structural elements to sustain andgrow what promises to be a majorinnovation in healthcare education.Our success in early recruitment of bothstudents and faculty encourage us toaddress these challenges and others thatinevitably will arise.Stay tuned as we grow and evaluate

this program. In the meantime, considerstarting one at your own medical orother health professional school. Feelfree to adapt our evolving model andso you do not have to reinvent thewheel.14

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2. Grewal D, Davidson HA. Emotionalintelligence and graduate medical educa-tion. J Am Med Assoc. 2008;300:1200–1202.

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burnout: a prospective, multi-instit-utional study of US medical students.Med Educ 2010.

11. Dyrbye LN, et al. Relationship betweenburnout and professional conduct andattitudes among US medical students. JAm Med Assoc 2010.

12. Thomas MR, et al. How do distress andwell-being related to medical studentempathy? J Gen Intern Med 2007.

13. Shapiro J. Does medical education pro-mote professional alexithymia? A call forattending to the emotions of patients andself in medical training Acad Med.2011;86:326–332.

14. http://www.utmb.edu/pedi_ed/PHT/default.asp.

15. http://www.utmb.edu/oce/Tracks.htm/.16. http://www.self-compassion.org/tes

t-your-self-compassion-level.htmlhttp://www.enneagraminstitute.com/.

17. http://www.ted.com/talks/abraham_verghese_a_doctor_s_touch.html http://www.ted.com/talks/brene_brown_on_vulnerability.html.

18. http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=shameless%20guide%20to%20happiness.

Innovations in Integrative Healthcare Edu

19. MacGregor B. In: Awe of Being Human—A Doctor's Stories From the Edge of Life andDeath. Greenbank, WA: AbidingNowhere Press; 2013.

Cara Geary, MD, PhD, is an AssociateProfessor of Pediatrics in the Division ofNeonatology at the University of TexasMedical Branch in Galveston, Texas.

Julie McKee, MD, is a Family MedicinePhysician in University of Texas MedicalBranch's Department of Family Medicine.

Catalina Triana, MD, is a FamilyMedicine Physician in University of TexasMedical Branch's Department of FamilyMedicine.

Era Buck, PhD, is faculty at the Universityof Texas Medical Branch in Galveston,Texas.

Scott Walton, BS, and David Valdez,BS, are second-year medical students at theUniversity of Texas Medical Branch inGalveston, Texas.

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Victor S. Sierpina, MD, is the W.D. andLaura Nell Nicholson Professor ofIntegrative Medicine, Professor FamilyMedicine, Director of Medical StudentEducation, at the University of TexasMedical Branch in Galveston, Texas. Heis an associate editor for EXPLORE.

Mary Jo Kreitzer, PhD, RN, is thefounder and director the Center forSpirituality and Healing and a professor inthe School of Nursing at the University ofMinnesota, Minneapolis, Minnesota.

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