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Med students learn empathy through improv

Med students learn empathy through improv

September 12th, 2018 by Helen Wilbers in Local News

Gina Shannon, associate director at Emory University's Clinical Skills Center, talked Tuesday about the value of improv in training medical students. At the Clinical Skills Center, 'simulated patients' act out various conditions and help trainee doctors improve their communication skills.

Photo by Helen Wilbers /Fulton Sun.

The connection happened when the medical student put her hand on Gina Shannon's shoulder. 

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Shannon had serious pain in her stomach. In the exam room, the student had rattled off questions so fast Shannon wasn't sure her answers were being registered. Then the student reached out and said she'd do whatever she could to help ease Shannon's pain.

"It was then that a wash of reassurance came over me," Shannon said.

Before long, a voice over the intercom announced the simulation was over. Shannon could stop feigning her stomach ache and congratulate the student on a job well done.

Shannon, who spoke at Westminster College's Hancock Symposium Tuesday, is the associated director at the Emory University School of Medicine's Clinical Skills Center. She and her trainees act as simulated patients, also called standardized patients, for doctors-in-training.

The purpose is two-fold. First, doctors need to be able to assess and diagnose a wide variety of potential ailments. While memorizing symptom lists is part of that, students also need hands-on experience. But there isn't always a person with Crohn's disease on hand.

The need for hands-on experience drove the development of simulated patients in 1963 by Dr. Howard S. Barrows, who taught neurology at the University of Southern California.

"There was much controversy," Shannon said.

Today, however, medical students interact with simulated patients during their education, and must pass a test involving a dozen simulated medical conditions to become a licensed doctor.

Other areas of medical education use simulated patients as well, according to one audience member. Cassidy Hill, a WC sophomore from Vienna, recently completed emergency medical technician training.

"We did simulations extensively," she said. "You learn how to look at the symptoms individually and put them together as a whole."

The second reason for simulated patients is to teach doctors to empathize and communicate with patients, Shannon said.

"If a health care provider is with a patient and they aren't in agreement, where can that relationship go?" she queried.

Drawing on her seven years of teaching theatre, she applies principals of improv to the exam room.

Improv puts a heavy emphasis on "yes, and."

"If we're in a scene together the only way we can elevate the scene and keep it going is by agreeing," Shannon said.

In theatre, that could look like following your scene partner's lead in a goofy improv exercise. In the exam room, "yes, and" involves listening to the patient and building and showing empathy with them. Empathy can be a gift, Shannon said.

"It can be a way of connecting with someone," she added.

Here's why that's important. Shannon described one study in which patients and providers were surveyed after consultations. Both 55 percent of patients and 60 percent of providers thought the patients didn't receive enough information about their diagnosis.

After providers received training in communication, patient and provider satisfaction increased — and patients did a 15 percent better job at sticking to their treatment plan.

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While finding a diagnosis is important, so is building trust, Shannon said.

"It's okay if you don't have an end result," she said. "What matters more is if you make that connection. I think there has to be some recognition that (the patient) is going through something."

Students at the Clinical Skills Center learn to forge those corrections in the short time they have with each patient.

"Building rapport in 15 minutes is a challenge," she said.

Following the talk, Hill said she found Shannon's perspective valuable.

"It's interesting to learn how the simulated patients are trained," she said.