Various new methods have been conceptualised to attempt to teach medical students about empathy beyond classroom walls, including visiting art galleries and drawing comics. However, at the end of the day, while literature and art might help medical students gain understanding of empathy as a concept, actual practice of this concept is a whole other matter.

Live encounters with (simulated) patients is hoped to be able to help medical students with the actual practice component of empathy. In Singapore, this concept has been adapted in several schools of medicine such as the National University of Singapore (NUS), which has around 160 actors in their medicine programme, and the Lee Kong Chian School of Medicine at Nanyang Technological University (NTU) which has around 100.

Dr Tanya Tierney, Assistant Dean of Clinical Communication Training and Student Welfare at the NTU School of Medicine, believes sessions with actors will make students more aware of what they say and how they say it. "Whether you smile at the patient, whether you make eye contact, how you listen to someone - all these things can help develop trust and build rapport.”

Actors are trained by script

Realistically enacting a patient’s sentiments require some degree of self-awareness, which comes with acting experience. The actors in NUS and NTU also serve as live models for anatomy lessons, having been trained to teach students to carry out physical examinations, using their own bodies as a model.

These sessions are also recorded to bring attention to nervous habits that students may be unaware of, such as fidgeting or clicking their pens while interacting with patients.

However, simulated patients are asked to adhere strictly to a script – for example, to only reveal their family history of cancer when being asked a second time. Such artificial encounters, while meant for a specific training purpose, could prompt students to just understand the mechanics of the test to succeed, defeating the purpose of the whole activity.

“In a standardised encounter, empathy is a moot point. The medical student more or less knows the game and knows that the ability being tested is whether or not they know the right questions to ask, how to take a history, or when to press a patient for a particular piece of crucial information,” wrote George Pate and Libby Ricardo (University of South Carolina Beaufort) in The Journal of American Drama and Theatre.

Being more aware of their patients' mental and emotional needs

Pate and Ricardo, who are both currently developing simulated encounters for nursing students, suggest putting more pressure on the medical students to really engage with their patients and training them to be more aware of their patients' mental and emotional states, as well as to develop multiple strategies for building trust with and gaining access to patients.

This is what the Singapore of Institute of Technology (SIT) has been planning in a programme for its degree course in occupational therapy later this year. It pairs students with people who have disabilities, who will then provide feedback on how well students do, especially on technical proficiencies such as transferring them from the bed to a wheelchair.

The school is currently working with 21 people who have disabilities such as muscular dystrophy or visual impairment, and students follow them on three separate occasions to understand their daily life in order to develop understanding and empathy.

Associate Professor May Lim, programme director for occupational therapy at SIT, said, "We decided it's very important for students to learn from the people they will be treating, through interaction in the community and beyond a clinical setting." MIMS

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