Medicine as a performing art: what we can learn about empathic communication from theater arts.

The authors describe how they came to the realization that theater arts techniques can be useful and effective tools for teaching interpersonal communication skills (ICS) in medical education. After recognizing the outstanding interpersonal skills demonstrated by two actors-turned-doctors, in 2010 the authors began to develop a technique called Facilitated Simulation Education and Evaluation (FSEE) to teach ICS. In FSEE, actors and residents are coached in empathic, and therefore effective, ICS using a novel technique based on lessons learned from theater arts education. Competence in ICS includes the ability to listen actively, observe acutely, and communicate clearly and compassionately, with the ultimate goal of improving medical outcomes. Resident, actor, and faculty perceptions after two years of experience with FSEE have been positive. After describing the FSEE approach, the authors suggest next steps for studying and expanding the role of theater arts in ICS training.

Humanism at heart: preserving empathy in third-year medical students.

PURPOSE: Research suggests that medical student empathy erodes during undergraduate medical education. The authors evaluated the Jefferson Scale of Physician Empathy Medical Student Version (JSPE-MS) scores of two consecutive medical school classes to assess the impact of an educational intervention on the preservation of empathy. METHOD: The authors conducted a before-and-after study of 209 Robert Wood Johnson Medical School (RWJMS) students enrolled in the classes of 2009 and 2010. Students' clerkships included a mandatory, longitudinal "Humanism and Professionalism" (H&P) component, which included blogging about clerkship experiences, debriefing after significant events, and discussing journal articles, fiction, and film. Students completed the JSPE-MS during their first and last clerkships. RESULTS: The results showed that (1) contrary to previous studies' findings, third-year students did not show significant decline in empathy as measured by the JSPE-MS (these students, from two consecutive RWJMS classes, experienced the H&P intervention), (2) students selected for the Gold Humanism Honor Society (GHHS) were significantly different from their peers in empathy scores as measured by JSPE-MS, and (3) knowledge of selection for the GHHS seems to positively influence students' JSPE-MS scores. CONCLUSIONS: Maintaining empathy during the third year of medical school is possible through educational intervention. A curriculum that includes safe, protected time for third-year students to discuss their reactions to patient care situations during clerkships may have contributed to the preservation of empathy. Programs designed to validate humanism in medicine (such as the GHHS) may reverse the decline in empathy as measured by the JSPE-MS.

Does medical student membership in the gold humanism honor society influence selection for residency?

OBJECTIVES: With the creation of the Gold Humanism Honor Society (GHHS) in 2002, the Arnold P. Gold Foundation established a mechanism for recognizing medical students who demonstrate exemplary humanism/professionalism/communication skills. Currently, 80 medical schools have GHHS chapters. Selection is based on peer nomination using a validated tool. The objective of this survey was to assess the percentage of residency program directors (PDs) who are aware of and are using GHHS membership as a residency selection tool. METHODS: Surgery (SURG) and internal medicine (IM) PDs in 4 United States regions were surveyed for familiarity with GHHS and perceived rank of GHHS membership relative to Alpha Omega Alpha (AOA) membership, class rank, medical student performance evaluation (MSPE), clerkship grade, and United States Medical Licensing Examination (USMLE) score, in evaluating an applicant's humanism/professionalism, service orientation, and fit with their program. Program demographics and familiarity with GHHS were also surveyed. RESULTS: The response rate was 56% (149 respondents). IM PDs rated GHHS membership higher than did SURG PDs when evaluating professionalism/humanism and service orientation. PDs familiar with GHHS ranked membership higher when considering professionalism/humanism (4.1 vs 3.2; p < 0.05) and service orientation (4.1 vs 2.9; p < 0.01). Familiarity with GHHS correlated with being an IM PD, residency based at teaching hospital, large residency program, knowledge of residents who were GHHS members, and having a GHHS chapter at their school (p < 0.01). Familiarity with GHHS was related to rankings of GHHS (professionalism/humanism F = 3.36; p < 0.05; service orientation F = 3.86; p < 0.05) more than the PDs' specialty was. In all, 157 GHHS students (from all 4 United States regions) were also surveyed about the 1197 interviews they had with residency PDs. They reported that although a few PDs were aware of GHHS, PDs of core medical specialties were more aware of GHHS than SURG PDs. CONCLUSIONS: IM PDs were more aware of GHHS (70%) than SURG PDs (30%). Awareness was related to the favorable ranking of GHHS as a selection criterion for humanism/professionalism/service orientation. PDs familiar with GHHS were from larger programs, were likely to know residents who were members, and were likely to think that GHHS membership predicted humanistic care. Membership in GHHS may set candidates apart from their peers and allow PDs to distinguish objectively the candidates who demonstrate compassionate medical care. Increased knowledge about the GHHS may therefore serve to be a useful adjunct for PDs when selecting medical students for their residency programs.

Temporal changes in anthropometric measurements of idealized females and young women in general.

This study examined the temporal anthropometric changes in idealized female body images in the media (i.e., Playboy magazine Playmates of the Year, Miss America Pageant winners, and fashion models) and young women in general across eight decades. Overall, all anthropometric measures differed significantly over time. BMI for all women in the idealized groups tended to decline significantly over time, while the BMI for YoungWomen increased significantly. Models tended to have the smallest bust and hips, Playmates the largest bust, and young women in general the largest waist and hips. The general trend for all groups was to move from a less curvaceous body shape in the early part of the twentieth century to a more curvaceous shape at mid-century and returning to a less curvaceous shape at the end of the century. Idealized women have a body size unlike that of Young Women and the chasm between the media- defined ideal and reality is continuing to diverge.

Assessing cardiovascular risk and stress-related blood pressure variability in young women employed in wage jobs.

This overview discusses how aspects of behavior and stressors inherent in the lifestyles of contemporary women affect their cardiovascular health. Three main issues are addressed. The first is the applicability of cardiovascular risk data collected on prior generations of working women in predicting the health outcomes of the current generation of women. It is argued that the earlier data may not adequately describe the health risk of the current generation because of changes in the nature of women's paid employment in recent decades, and because the compartmentalization of economic, leisure, and domestic activities may have affected how stress associated with each influences cardiovascular measures such as blood pressure. Second, the influence of the environment on lifestyle is briefly discussed in the context that differences in the results of studies examining lifestyle stressors may occur as a consequence of local physical and cultural environmental differences which influence lifestyle. Third, the effects of daily microenvironmental changes on blood pressure are discussed and it is argued that perceived socioeconomic roles may influence the cardiovascular response to the stressors inherent in each microenvironment. Because the lifestyles of women change over the lifespan, it is concluded that the impact of lifestyle on cardiovascular risk must be studied at all stages of life. © 1996 Wiley-Liss, Inc.