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A Few Good Doctors: An Examination of Humanistic Outliers in Medical Education

  • Author(s): Soh, Michael
  • Advisor(s): Chang, Mitchell J
  • et al.
Abstract

Medical education literature has indicated that, on average, the humanistic orientation of medical school students declines from matriculation to graduation. This humanistic orientation, or humanism, commonly is referred to as attitudes and behaviors that are “sensitive to the values and the cultural and ethnic backgrounds of others” and characterize “a respectful and compassionate relationship between physicians, as well as all other members of the healthcare team, and their patients.” Although a stronger humanistic orientation can lead to better and more positive patient outcomes, the deterioration of humanistic behaviors and attitudes such as integrity, compassion, empathy, and professionalism can largely be traced back to clerkship rotation experiences during the third year of medical school. Because clerkship rotations take place outside the “traditional” classroom at the bedside of real-life patients, medical students rely on the actions and conduct of their clinical instructors to help inform their own patient care principles. In other words, clinical faculty who teach in clerkships play a pivotal role in shaping the humanistic orientations of medical students.

This study examines how highly humanistic clinical faculty guide, teach, and advance their humanism amongst their students, colleagues, and specialty. These highly humanistic physicians were selected from specialties representing opposite ends of the humanism spectrum, e.g. surgery, internal medicine, and pediatrics. Using Bandura’s social learning theory and Spreitzer and Sonenshein’s positive deviance framework, this study employed observational fieldwork and semi-structured interviews to explore the teaching practices of fifteen Teaching Humanism Award (THA) winners within the UCLA Health System. Over the course of nine months, this qualitative data drew from the knowledge, attitudes, and behaviors of clinical faculty members who had been recognized for their exemplary humanistic teaching practices.

Findings point to the critical impact that role models had on the development and expression of the humanistic orientation of THA faculty. In addition to role modeling, THA faculty pointed to the relationship between clinical expertise, confidence, and comfort within their specialty as primary guides for their humanistic orientations. Observational fieldwork revealed five typologies of THA faculty with regards to teaching humanism – storytellers, active listeners, sensors, communicators, and guardians. Though humanism was readily apparent amongst trainee interactions, advancing humanism within the specialty and the hospital seemed to incur challenges – both philosophically and institutionally. As such, this study concludes with several recommendations revolving around improving the expression, protection, and adaption of one’s humanistic orientation to different audiences and context. Implications for medical education speak to future research into the relationship between humanism and leadership and the longitudinal impact of THA faculty.

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