If you’ve ever watched FOX television’s House, featuring seemingly unfeeling, uncaring, sarcastic, no-holds-barred Dr. Gregory House, you might think that having a purely diagnostic and analytical approach to medicine is the proper way to get things done.
The renowned Dr. House hardly ever chooses to talk to his patients, and when he does it’s patronizing.
However, poor communication is the root of about 70 percent of unfavorable patient outcomes, according to The Joint Commission, an independent, not-for-profit health care certifier and accreditor.
Evonne Kaplan-Liss, TCU and UNTHSC School of Medicine assistant dean of narrative reflection patient communication, examined this problem and potential solutions for it in her study “Teaching Medical Students to Communicate with Empathy and Clarity Using Improvisation.”
The study was published in American Medicine. Additional authors include Valeri Lantz-Gefroh, Elizabeth Bass, Deirdre Killebrew, Nicholas M. Ponzio, Christine Savi and Christine O’Connell.
Before joining the TCU and UNTHSC School of Medicine about a year ago, Kaplan-Liss was the founding medical director for the Alan Alda Center for Communicating Science at Stony Brook University in Stony Brook, New York.
“The goal was initially to train STEM scientists, but I came in right at the beginning to train [students] to be more effective communicators. It took me about nine years to realize what we did was very exciting, and we wanted to embed it in a medical school,” Kaplan-Liss said.
“I knew all the special ingredients needed to build a successful medical program the way I knew it needed to be: support from the top, valuing training doctors to be effective communicators, having faculty who also think that communication is important and embedding that training in the curriculum,” she said.
In the abstract for her article, Kaplan-Liss said it is widely accepted among medical educators that health care providers need strong communication skills. Yet, The Joint Commission's findings have shown that medical professionals can lack those skills.
Kaplan-Liss and her fellow authors decided to develop and test an elective course that would use theatrical improvisational skills and the help of communication professionals to teach medical students not only how to communicate effectively, but how to build empathy for the clients and patients they interact with.
These techniques are what Kaplan-Liss says set their elective apart from traditional communication training offered to health care students. The course consisted of six weekly three-hour sessions, which included interactive lectures, discussions, exercises, role-playing and on-camera interviews.
The elective was ultimately offered by the Alda Center from 2012-2016 and used verbal and nonverbal exercises including role-playing, storytelling and improvisation.
The course also encompassed the Alda Method, which is based on two components — Improvisation for Scientists and Distilling Your Message. Kaplan-Liss explained that both components required the students to shift their focus from themselves to the people with whom they were communicating.
Course evaluations of 76 students from 2012 and 2013 showed that 100 percent of the students would recommend the course to their peers, saw its relevance to their industry and careers, and wanted more of the course’s content offered in their academic curriculum.
As a result of the 2012-2013 feedback, 10 hours of coursework combining empathy and communication training were added to the Stony Brook School of Medicine’s preclinical curriculum from 2014 to 2016.
Kaplan-Liss also said in her study that instructors found the training was most effective when taught in teams of two, a physician collaborating with an improvisation instructor to bring in real-world examples.
At this point, Kaplan-Liss says, the next step is advocating for this training to be embedded throughout a four-year medical school program. That’s what she is planning to do in the new TCU and UNTHSC School of Medicine when it officially opens. Pending accreditation, the schools hopes to open in the fall of 2019.
The Fort Worth Business Press caught up with Kaplan-Liss to discuss the study and her work more in depth.
How did you and the other authors approach designing the elective?
We wanted to start teaching medical students at Stony Brook, and you never want to make anything mandatory or shove it down their throats, so I asked the medical students I was working with to survey their colleagues to see both do they think this is important and do they want the opportunity. And the results came back that they did want it, but they wanted it to be an elective. … We decided to put it together in a developmental way, so it starts with nonverbal communication and body language, and then verbal, and then the application [of the training] in the community.
How did the elective differ from the kinds of communication training already offered to med students?
I think it’s the way it’s packaged and the techniques it used. There are other medical schools that do improvisation techniques, but it’s the way that it’s packaged and the use of the journalism skills that makes it different.
In your own words, what are the major takeaways from the study?
You can’t transform medical students and doctors to be effective communicators in a three-hour workshop or even a 16-hour elective. It needs to be seamlessly embedded in their curriculum. … This is not a destination, it’s a journey. They need to learn the skills but then practice, practice, practice.
Will a course like this be implemented in the new med school’s curriculum and if so will it be mandatory or elective?
Aspects of the curriculum we will be incorporating, but we will be going much more in depth. We will have a framework called the “pathway to empathy.” It’s a framework for communication with empathy and clarity. We like to say we use it to make a communication diagnosis. It helps [medical students] determine how to communicate clearly with a particular audience.
We are going to have some workshops to teach the framework but it will be applied in all courses and clinical encounters regardless of what the material is. We aren’t just teaching them communication with patients, but interpersonal communication, team building and communication with media as well.
How do you plan to advocate for this type of training to be implemented in other med schools?
The obstacles I ran into in other institutions is the inability to get enough faculty to be trained to push this initiative. … Advocating for this is helping the medical schools address the obstacles to have this curriculum. …
Not only do they have to advocate to have their course directors free up some time in their established courses to teach this type of curriculum, but it’s money. It takes money to do this kind of work. … Nationally, there isn't a lot of money for this, so one of the efforts I'm hoping to achieve is a collaboration with like-minded individuals nationally to get this type of funding.
That’s why I’m here [at the TCU and UNTHSC School of Medicine]. I have the resources to make this work, and I hope to help other institutions do the same.
And it’s not just money, it’s a cultural thing. It’s getting seasoned faculty to think outside the box and be a little more creative. Change is great but it’s hard.
Do you have any other comments?
Besides this communication curriculum, because this is a blank slate and we’re starting from scratch, we are also doing a lot of new things in term of support and resilience for the medical students, including a wellness curriculum and physical development coaches.
The other unique thing is this is a joint partnership between two universities and it's a private partnership that brings a lot of resources and collaborations from a liberal arts college, and that influence is most important.
For more information about the TCU and UNTHSC School of Medicine, visit: unthsc.edu/mdschool