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Graphic Stories as Cultivators of Empathy in Medical Clerkship Education

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Abstract

Background

Physician empathy is an integral component of the patient-physician relationship and contributes to positive health outcomes. However, the direction of empathy change in medical trainees remains unclear. The aims of this study were (1) to qualitatively assess factors associated with empathy change in clerkship medical training and (2) to investigate the effect of graphic stories about diabetes self-management on affecting empathy and learning processes in medical trainees.

Methods

Third and fourth year medical students (clerks) were recruited. Participants viewed two online comics, responded to empathy-exploring surveys, and were interviewed individually. Interviews were coded following an inductive thematic approach, and emergent themes were developed using the constant-comparison method.

Results

Sixteen medical students participated. Qualitative analysis revealed five themes: (1) conceptualization and perceived value of empathy, (2) barriers and facilitators of empathy, (3) empathy and burnout, (4) strategies to promote empathy and prevent burnout, and (5) comics in medical education. Empathy was highly valued by clerks; however, a spectrum of empathy change occurs in clerkship. Major barriers included the hidden curriculum, physiological stressors, and burnout. Positive role models and peer support were key strategies to maintaining empathy. Clerks perceived the comics to be an innovative, quick, and effective reminder of the value empathy.

Conclusions

Graphic stories can be used as a medical education tool to simulate reflective practice and promote empathy retention during clerkship. Further strategies aimed at reducing burnout, improving student wellness, and fostering teaching of empathy by clinical faculty may enhance the retention of empathy by clerks.

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Acknowledgments

We would like to thank Susan Hall and Marc Settino for their administrative help during focus groups. We would also like to acknowledge Dr. Pamela Tsao and Julie Mann.

Funding

Dr. Wang was funded in part by a Charles Hollenberg Summer Studentship 2014 from the Banting & Best Diabetes Centre, University of Toronto.

Author information

Authors and Affiliations

  1. Department of Paediatrics, Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada

    Rebecca Wang

  2. Division of Endocrinology and Metabolism, Department of Medicine, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada

    Robyn L. Houlden

  3. Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada

    Catherine H. Yu

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  1. Rebecca Wang
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  2. Robyn L. Houlden
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  3. Catherine H. Yu
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Corresponding author

Correspondence to Catherine H. Yu.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the University of Toronto Research Ethics Board, reference number 30314, and Queen’s University Research Ethics Board, reference number 6013058. This research involved only human participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Wang, R., Houlden, R.L. & Yu, C.H. Graphic Stories as Cultivators of Empathy in Medical Clerkship Education. Med.Sci.Educ. 28, 609–617 (2018). https://doi.org/10.1007/s40670-018-0590-x

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