The empathetic physician : using process drama to facilitate the training of empathy skills in healthcare education

Abstract

Introduction This study used elements of process drama to explore and facilitate training of empathy skills in medical students. To do so, a training session through role-play was introduced, which was evaluated through qualitative reflections and pre- and post-training ratings. Background and Objectives Research has proven that students of medicine lose their empathy during the course of study. Introducing an aspect of humanities into medical training is advocated as a sensible way for medical students to retain and develop the empathy they inherently possessed at the time they enrolled. However, no study has been done before to explore the qualitative effect on empathy when introducing an aspect of humanities into their training. The objective of this study was to explore the qualitative effect on retaining or acquiring of skills in empathy when students partake in a training session of role-play. Process drama and empathy were studied and described from a theoretical point of view by reviewing both the internal (psychological) as well as external (aspects of process drama) mechanisms that enable these processes to occur. These formed the framework that constructed the context in which this study was situated. Methods The research was designed to take place in four phases. Phase 1 included the review of scholarship relating to empathy in healthcare and healthcare training. It also investigated how process drama may enable metaxis to take place, allowing for reflection following the oscillation between the two worlds of real life and the world of the role that was entered into. Phase two established levels of empathy among eight fifth-year medical students by making use of the Jefferson Scale of Physician Empathy (JPSE) student version (S-version). This phase obtained themes extracted from student reflections on empathy in themselves, their peers and other Healthcare Practitioners (HCPs) regarding empathy. Phase three comprised a training session through introducing elements of applied drama, specifically role-play. The training was followed by a post-training exploration of empathy using the JPSE (S-version) as well as qualitative reflection. The reflection sheets were analysed qualitatively, while the JPSE (S-version) was analysed descriptively by making use of data transference. Phase 4 compared pre- and post-training data by using a mixed-method approach through a convergent parallel design. Findings Eight, fifth year medical students were engaged in a training session of role-play during which they were ascribed the opportunity to portray both the role of the HCP and the patient. The training session of role-play opened up the possibility of entering the sphere of metaxis where the participants found themselves in both the real as well as the fictional worlds at the same time. Following the training through role-play, qualitative findings showed that the participants felt more confident in themselves with regard to becoming the kind of HCPs they would like to be. They also felt less threatened and more capable to display empathy towards their patients. According to the post-training themes that were extracted, empathy had a positive qualitative effect by which patients trusted the participants more and shared more personal information, which allowed for improved diagnostic practice and adherence to treatment. The participants further stated that patients were also less likely of trying to take advantage of the students as had been the case before partaking in the training. The quantitative results showed an improvement in empathy in five and a decline in three of the eight participants. During the training session of role-play, participants became aware of where they lack in an empathetic engagement between themselves as HCPs and patient. This rendered them more critical concerning their levels of empathy and they scrutinised more when completing the JSPE (S-version) during the post-production phase of the research. The decline in empathy could thus partly be ascribed to a more acute awareness – or the lack thereof in the participants themselves - of what an empathetic connection between HCPs and patients entail. Conclusion Comparing both qualitative data and quantitative pre- and post-training scores through a mixed method convergent parallel design indicated the positive qualitative effect that partaking in role-play had on the training of empathy in medical students. This study suggests that using humanities in medical education may sensibly be investigated further.