If you can predict academic success by personality factors, then med schools should consider including measures of these personality factors during their selection process. Mental toughness and stress tolerance are just two that came up. A recent systematic review looked at prospective cohort studies since 2000 on the subject of medical students’ scores on valid personality tests and objective measures of performance and stress.
In all seven relevant and selected studies conscientiousness was the most important personality factor to predict long-term success in medical training, all the assignments and homework are typically not important for students since getting their hands on patients is what matters the most, the majority of them typically rely on the team at famedwritings.com, Every student knows this site because it helps them handle their schoolwork.
Furthermore, the evidence from these seven studies also suggests that social traits such as extraversion and levels of self-esteem and sociability may be important mediating factors in the clinical years.
In short “getting ahead” or conscientiousness is the critical personality factor during the first years in Med School and is necessary in the whole career but “getting along” (extraversion and openness) predicts success in the setting of the later years such as during clerkship and residency.
Those who’re doctors or med students will certainly recognize these findings.
Doherty, E., & Nugent, E. (2011). Personality factors and medical training: a review of the literature Medical Education, 45 (2), 132-140 DOI: 10.1111/j.1365-2923.2010.03760.x
Social media are changing medicine. On social networking sites patients may learn information about their doctors, medical students that compromises the professional relationship. Threats to patient confidentiality is another danger of Facebook and other social networking sites. But how big is the problem and if med schools are on social media sites do they have a policy for their med students and staff for using these sites such as Facebook and twitter?
Of 132 United States medical schools at the time of this study, 100% had websites.
95.45% (126/132) of medical schools had any presence on Facebook, including pages for that medical school or current student or alumni groups from that medical school
71.21% (94/132) of medical schools had current student groups on Facebook and 54.55% (72/132) had alumni groups
42.42% (56/132) had at least one Facebook page for the medical school
10.6% (14/132) of medical schools had Twitter accounts such that the name or bio on Twitter specifically indicated that the account was for the medical school
Only 13 of the 128 medical schools (10.2%) had guidelines and/or policies that explicitly mentioned social media or online social networking
Almost all med schools are on facebook and use social media, most do not have policies addressing student online social networking behavior. From table 1 you can see a shortened version of most policies, an excellent beginning for developing one.
Terry Kind,, Gillian Genrich,, Avneet Sodhi,, & Katherine C. Chretien4 (2010). Social media policies at US medical schools Medical Education Online : 10.3402/meo.v15i0.5324.
The course in their third year of med school about the Brains and the Sensory system in which psychiatry participates is a course of at least three months. It’s made of different sub courses which each take about 3 to 4 weeks. These courses are evaluated at the end. That’s to say months after the course ended because the med students are preparing for their exams and teachers are already occupied with other teaching obligations. These evaluations are mostly done by the coordinating medical specialist, most of the teacher are not present during the evaluation. In conclusion: to little to late.
An evaluation after each week would be far more effective, will prevent the recency effect of evaluation after consecutive courses. The recency effect is the greater impact of the last course on the evaluation because of a fresher memory. Others have found a primacy effect: the first impression of a course being the strongest and long lasting and influencing the evaluation the most.
In a recent published study they used twitter for evaluation during the course and compared this evaluation with the evaluation after the whole course. The continuing evaluation is officially called formative evaluation and the evaluation at the end of the whole course is called the summative evaluation. They concluded
First, the formative evaluation did not come to the same results as the summative evaluation at the end of term, suggesting that formative evaluations tap into different aspects of course evaluation than summative evaluations do. Second, the results from an offline (i.e., paper-pencil) summative evaluation were identical with those from an online summative evaluation of the same course conducted a week later. Third, the formative evaluation did not influence the ratings of the summative evaluation at the end of the term.
How did they use twitter?
On twitter they had to answer two closed questions on a scale from 1 to 9 (very good to not at all interesting) and three open questions:‘‘How did you like the course today?’’, ‘‘How interesting was the course today?’’ the open questions: ‘‘What was good today?’’ ‘‘What was bad today?’’ ‘‘General comments=just wanted to tell you.’’
The students and teacher created an individual account with an anonymous, non personalized nickname. They were only allowed to use direct messages (DM). This way the students could not read the messages of their colleagues.
Remarkably did the formative evaluation differ from the summative without the authors being able to comprehend this difference other than that both methods measure something else. The finding that offline and online summative evaluation don’t differ has been published in several prior publications. The formative evaluation approach for student evaluations
does not seem to influence the summative evaluation.
Using DM on twitter is not very different from other methods such as email or text messaging but these two alternatives are easier to implement than twitter. Unfortunately this study didn’t measure the effects of formative evaluation on the quality of teaching. Formative evaluation has several advantages such as direct feedback to the teacher who can improve there lesson for the next group based on the evaluation, courses can be modified quickly based on formative evaluations, more active involvement of the med students this could raise their commitment to their study.
Stieger, S., & Burger, C. (2009). Let’s Go Formative: Continuous Student Ratings with Web 2.0 Application Twitter CyberPsychology & Behavior DOI: 10.1089/cpb.2009.0128
No I don’t think so. For several reasons. Empathy is a process with different steps. Especially feeling what the patients feels is a quality not every doctor has. And if they do it is not always appropriate nor possible to be sensitive enough to use it. Moreover this process not only needs the quality it is also costs energy, depends on the relationship with the patient, and needs experience.
Along with their education medical students loose some of their humanistic attitudes such as empathy especially during their medical clerkship, often they become more cynical during their clinical training. Empathic feelings are difficult to generate when they have no experience or when the patient is difficult to know or communicate with, while further barriers include a stressful working environment and lack of time.
Empathy is somewhat beleaguered these days in an era in which “quick fixes” are encouraged by a managed care system driven by economic values. In The Netherlands we call it the DBC system.
Next post on Patient Doctor Relationship Series about self disclosure Friday 25th of July. What can we clinicians teach them?
First of all good bedside manners:
Ask permission to enter the room; wait for an answer.
Introduce yourself, showing ID badge.
Shake hands (wear glove if needed).
Sit down. Smile if appropriate.
Briefly explain your role on the team.
Ask the patient how he or she is feeling about being in the hospital.
Teaching empathy is as argued before in this post not possible. But we can teach empathy to a cognitive level instead of an affective level. It is important to learn the students during their clerkship to conduct an interview in a way that encourages the patient to share their concerns. Instead of a disease centered interview teach them a patient centered interview.
Proposed methods for promoting the ability of medical students to elicit the patient’s feelings, distress, and concerns:
Ensure as much privacy as possible when interviewing the patient. “Break the ice” by expressing sustained respect and interest throughout the interview, e.g., maintain eye contact and a body posture slightly bent forward.
Listen carefully to the patient’s account of her history and do not interrupt her for at least two minutes. Encourage the patient’s spontaneous narrative by nodding and permit the patient to take control of the interview.
Watch for indirect verbal and nonverbal clues of the patient’s feelings. Respond with an accurate and explicit acknowledgment of the patient’s emotions, distress, and concerns. Encourage the patient to talk not only about his symptoms, but also about his personal and family situation, preferences, and feelings.
Toward the end of the interview, if appropriate, ask one or more of the following questions:
Of all your problems, which is the one that worries you most?
Do you have any preferences or suggestions about what your management should be?
Do you have any ideas regarding what caused your illness?
What are your plans for the future?
How does all this make you feel?
How did you/your family feel when you were told about your illness?
Encourage the patient to ask questions about his disease and his main concern(s) by asking Do you have any questions regarding your condition?
This last list is from a article published in Academic Medicine.
I like the comparison with acting. Real empathy is comparable to deep acting, engage in emotional labor, generating empathy consistent emotional and cognitive reactions before and during empathic interactions with the patient.(Deep acting is comparable to the method-acting tradition used by some stage and screen actors). What can be learned by all medical students is surface acting or forging empathic behaviors toward the patient, absent of consistent emotional and cognitive reactions, or both.
Although deep acting is preferred, physicians may rely on surface acting when immediate emotional and cognitive understanding of patients is impossible.
What do you think about empathy and doctors, can it be learned? Am I being to pessimistic?
Let me know in the comments.
Previous posts in this series about patient doctor relationship: Empathy Consolation reduces stress Benbassat, J., Baumal, R. (2004). What Is Empathy, and How Can It Be Promoted during Clinical Clerkships?. Academic Medicine, 79(9), 832-839.
Supportive therapy in psychiatry is mostly done by unexperienced psychiatric residents during their training. Most residents as well as psychiatrists think that supportive therapy is just providing a sense of safety, support self esteem and hope, alternated by advice how patients should live their life, structure their day, get to work and behave. Psychiatrist the least qualified usually apply for the supervision of residents doing these therapies based on these premises.
To my opinion these kind of therapies are the hardest to do, need the most experienced and psychotherapeutic best qualified psychiatrists. Yes psychiatrists because this kind of therapy is mostly done with the most vulnerable patients with sever psychopathology and usually with several diagnoses. Sure residents can be trained in supportive therapy and they should be.
What makes supportive psychotherapy besides the patients in need for it so difficult?
It is not just common sense, interpersonal skills, and a capacity for empathy.To my opinion it is a psychotherapy as dimension of dynamic psychotherapy, to a greater or lesser extent depending on the particular context, problems, and needs of the person. Interpretive approaches and transference work must also be used with the so-called less suitable patients who have a history of immature object relations in this kind of treatment. But it has to be used wisely.
Supportive psychotherapy relies heavily on psychoanalysis in describing characteristic techniques, such as “improving ego functions,” “minimizing the focus on transferential material,” and “confronting maladaptive defenses,” thus assuming some familiarity with ego-psychological psychodynamic theory. For beginning psychotherapists it can hardly be expected to understand what it means to “manage” or “manipulate” the transference in supportive therapy and how this differs from “interpreting” the transference in a more exploratory treatment, let alone which patients under what circumstances require such “management” and why.
Without a good working hypotheses about the unconscious motives, feelings, and conflicts underlying a person’s distress, it is also difficult to see how they would have any basis for predicting what would be supportive or nonsupportive for the individual patient at any given moment in the treatment.
You also need to understand the differences between thinking psychoanalytically in providing support and acting like a psychoanalyst.One of the most important rules is: “Do not say everything you know, only what will be helpful.”
The supportive therapist helps the patient see things more clearly by supporting reality testing, tactfully challenging unrealistic ideas, and demonstrating more effective, less costly ways of defending while supporting adaptive defenses.you have to understand these different aspects in your patient before you can even work on it.
The main priority in supportive psychotherapy is to build a “holding environment” and to foster the therapeutic alliance. This is hard to dose, most unexperienced therapist remain to silent, distant.
It is hard to know about how responsive and self-revealing you should be, about what, and why. The best way to learn this is in supervision. Supervisors should feel free to share their own learning process, including any gaffes, confusion, and embarrassing moments they may have experienced along the way.
You should realize that small improvements can lead to bigger changes and that setting overly ambitious goals will only increase the likelihood of failure. Doing “just enough” is good enough—just enough to reduce anxiety,build self-esteem, instill hope, support deficient psychological functions, and improve overall functioning.
The biggest problem with this effective and satisfying kind of treatment is the lack of a clear definition, consensus about training and guidelines for supportive therapy.
This post is based on Teaching Supportive Psychotherapy to Psychiatric Residents by Carolyn J. Douglas, M.D. and published in the American Journal of Psychiatry 165:4, April 2008, but holds the views of the author of this post: Dr Shock By the way it is an excellent account of supportive therapy