CEimpact Podcast

Modeling Compassion and Empathy for Better Patient Care

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Can compassion and empathy be learned? Can it be taught? The evidence suggests that the answer to both of these questions is yes, and yet as preceptors, we interact with student pharmacists and pharmacy residents who are wide-ranging in their abilities and comfort-level when it comes to fostering impactful patient care interactions.

In this episode, explore the value (and challenges) of incorporating strategies that model and teach empathy and compassion - for your patients, your learners, and for you.
 
Host
Kathy Schott, PhD
Vice President, Education & Operations
CEimpact

Guest
Kate Cozart, Med, PharmD, BCPS, BCGP, BCACP
Clinical Pharmacist Practitioner, Primary Care
Residency Program Coordinator
VA Tennessee Valley Healthcare System (TVHS)
Clarksville, TN

Get CE: CLICK HERE TO CPE CREDIT FOR THE COURSE!

CPE Information
 
Learning Objectives
At the end of this course, preceptors will be able to:
1. Review evidence that compassionate and empathetic patient care positively impacts patients' healthcare experience.
2. Identify strategies preceptors can model to help pharmacy learners deliver more compassionate and empathetic care.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-191-H99-P
Initial release date: 6/19/2024
Expiration date: 6/19/2027
Additional CPE details can be found here.

The speakers have no relevant financial relationships with ineligible companies to disclose.

This program has been:
Approved by the Minnesota Board of Pharmacy as education for Minnesota pharmacy preceptors.

Reviewed by the Texas Consortium on Experiential Programs and has been designated as preceptor education and training for Texas preceptors.

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Speaker 1:

Hello. If you are a regular listener, welcome back. If you're new to Preceptor Practice, then welcome. We're glad you're here.

Speaker 1:

Ce Impact brings you this podcast on the third Wednesday of each month. Each episode engages insightful guests who share resources and ideas to help you improve your precepting practice, become a more effective teacher and mentor and balance your work with these additional but really important responsibilities. Can compassion and empathy be learned? Can it be taught? The evidence suggests that the answer to both of these questions is yes, and that it can be more effectively taught in the experiential environment versus in the classroom.

Speaker 1:

Yet, as preceptors, we interact with student pharmacists and pharmacy residents who are wide-ranging in their abilities and comfort level when it comes to fostering impactful patient care interactions. In this episode, we explore the value and the challenges of incorporating evidence-based strategies to model and teach empathy and compassion for your patients, for your learners and for you. Well, welcome, kate. I'm so glad that you're here and so excited to connect with you on this topic. Today we're talking about the importance of empathy and compassion in patient-centered care and, specifically, how we, as preceptors, can help our students demonstrate those characteristics for better patient outcomes. So thank you again, so much. Let's start by having you just tell. Share a little bit about yourself and why this topic has become important to you.

Speaker 2:

Thank you so much for having me on, kathy. I am so excited to be here to talk about this topic. So I practice in a primary care setting. As far as my pharmacy practice, I'm also the residency program coordinator for my health care system, so I do a lot with residents and then also precept for five different schools of pharmacy, so I have a lot of learner interactions. The reason that this has become something that I'm so passionate about is because several years ago I was on the other side. I was a patient and had some interactions that were very short of compassion, and so that led me to really start digging into how can we do things better for our patients and what does the data tell us? How do we do it and why is it important?

Speaker 1:

Yeah, yeah, so many of us have had interactions like that where we walk away thinking, boy, that could have been so much better and so much more helpful so, and certainly helped us be seen or feel seen. So I think that's really important to bring that personal experience to the conversation. Can you talk a little bit, just to sort of get us started? Talk a little bit about what those words mean empathy and compassion. I think they get lumped together a lot, but there's some nuance between them and why they're important for patients and their health.

Speaker 2:

That's a great question I'm going to answer in reverse. So why is it important? Because we know that there is a crisis of compassion right now in the healthcare systems. The fact is, 50% of patients say that they don't feel compassion from their healthcare providers, and most providers would admit that they are sometimes guilty of being inconsistent in their delivery of compassionate care. So it's definitely a problem that we see on both sides, and yet it's tied to all of the positive outcomes that we look for in healthcare.

Speaker 2:

We always think about that quintuple aim. Right. Compassion is tied to all of those. We know that there are better outcomes for the patients, outcomes for the healthcare system and cost savings of unnecessary testing. There are better patient experiences, better clinician experiences and better health equity if we are intentional with compassion. That's why it matters. So, digging a little deeper into the words and the terminology we use, you're right, most of us use empathy and compassion fairly interchangeably, because there is a lot of overlap in these constructs. But the main thing to think about is that empathy is how we understand and share the feelings of another person, but compassion takes it to another level, because compassion is that emotion that really binds us to the other person and makes us have a positive emotion about our social behaviors. We want to interact with them, we want to provide a good experience, but we also walk away feeling a positive emotion as a result of giving that compassionate care.

Speaker 1:

Got it, got it. That really helps, I think. Lay those two things out. Those statistics are really interesting and, I guess, not surprising, but I think it really. I don't know. It just stands out to me to have that, you know, be stated so starkly. And yet in the didactic portion of the PharmD curriculum we're not necessarily focusing on teaching skills specific to empathy and compassion. Why do you think that is and, and you know, why aren't we focused more on that in the curriculum?

Speaker 2:

I think one it's hard to teach.

Speaker 2:

Empathy and compassion are not always easy to teach or easy to assess.

Speaker 2:

There's not one specific tool that is consistently used throughout healthcare in terms of the way we evaluate the delivery of these things, and so that does decrease how much focus it gets in a curriculum, because we don't like to teach things we can't assess Right right.

Speaker 2:

But I do think that's also important to realize that there are studies, even though they're specific to medical education, I think they are very much things that overlap into the pharmacy world, where there is a downtrend in compassion that tends to be seen throughout school and into residency. So we need to be thinking more about how can we better incorporate this. I also want to make a statement, because I don't know if you're going to kind of go into this piece of it, but yes, it is absolutely important that we start building those skills in a didactic setting. But I also don't want to say that that's enough, because the fact is, studies looking at compassion training show that a purely didactic approach does not lead to consistent improvement in compassionate care. You have to start it in the didactic setting but then really move into that patient facing, experiential realm of teaching compassion in order for those outcomes to last.

Speaker 1:

Right, right, and that really makes sense. I mean, you're limited in you know, the curriculum really probably to things like role play and simulation and that sort of thing, versus when you get to the experiential portion of the curriculum or to residency. That's when you're having real patient interactions, you know that can set you up to practice some of these skills. Kate, are you seeing, you know, in the students and residents that you're working with? Are you seeing any differences among those learners and how they exhibit empathetic or compassionate behaviors when they're working with patients, compared to maybe what you've seen in the past? And, if so, any thoughts on what you know, the factors there might be?

Speaker 2:

I would say in the past few years, I have noticed that I share a lot more about how to come across with compassion when we interact with patients. But I also will say, maybe that's because I am becoming more and more in tune with that science than I was a decade ago when I started practicing myself. So is it because I'm paying attention to it or it's truly a different context for the learners? I can't be sure, but I do think there are a few things specific to today's learners that are relevant. One is the fact that these learners are mostly digital natives. Now, you know, these learners have had more screens in their lifetime than those that came before them. I was raised on a farm. I didn't have screens, and so I had a lot of face-to-face interaction with people my age and adults as a young, young kid just doing farm life, and today's learners may not get that as much because there are more distractions just as a result of technology. So I think that's one piece.

Speaker 2:

I also think that our pandemic learners didn't get a lot of early face-to-face time.

Speaker 2:

Even in a role-play setting, it wasn't the same, and so I think we need to be very conscious of that, because they were not given a lot of face-to-face interactions and truly they were just in survival mode.

Speaker 2:

You're trying to think about how to be a provider when you're, in a lot of ways, dealing with fear and anxiety, and so I do think that those things very much impacted their early part of their career and who they are as a pharmacist and who they are as a provider of patient care. The last thing that I think about, too, is that virtual visits do tend to add this extra layer of complexity, because the fact is, if we don't know how to be intentionally compassionate in the same physical room as someone, imagine how much harder it is when, all of a sudden, we're adding this layer of, and now we have to do it virtually. So I think it's kind of this combination of these learners are really used to technology and maybe didn't have some of the same life experiences. The pandemic was very, very hard on them and their training, and now we are starting a lot of newer things with virtual care. They are the guinea pigs in a lot of ways, and so I think that has made a difference.

Speaker 1:

Yeah, yeah, that makes sense. I always like to tap into sort of our experience as an organization. At CE Impact, we are 100% virtual company. We were that prior to the pandemic even and you know, building trust and understanding even for one another, and we all know each other. You know even that is difficult and so and more challenging than if we were in the same space. So it makes complete sense that you know, having grown up in, you know, in an era when virtual learning was certainly more common and sometimes necessary, you know some of that relationship building, some of those relationship building skills you know maybe have been missed or modified or you know whatever. So I think that that really is like an important thing to call out.

Speaker 1:

There's so many of these podcast episodes and these conversations we have that the pandemic has impacted these learners in so many ways, and this is just another one of them. I think you shared with me the article that you referenced earlier. That was so interesting and this is I'll put this in the show notes for listeners a link for show notes to review it. But it was an analysis of like 50 some odd studies focused on existing or previous empathy and compassionate training tools in medical education and it seemed like a million behaviors were studied and taught as part of those curricula. Can you kind of boil all that down for me into a few key behaviors, because I think at the end of the day, we're talking about developing skills around some behaviors that we can demonstrate or show empathy and also have the patient feel like there's compassion being extended to them. So can you boil those behaviors down into just a few that you think are critical to compassionate care that we should be focused on when we're talking to, you know, when we're working with learners?

Speaker 2:

So this article definitely fascinated me, so I'm glad you enjoyed it as much as I did. There were five key behaviors that were really found to be effective in the promotion of provider compassion as viewed by the patient. The first one was sitting, not standing, and that is one that I find myself telling students about on a regular basis, because I never thought that that could change the dynamic of how they perceive us as a provider. But now I am very intentional in my office space to always sit, lean in and really show them I'm present. The second is being able to detect the patient's nonverbal cues, which means you have to be looking at them and not the screen in front of you means you have to be looking at them and not the screen in front of you, and so that has been a very good, intentional practice for me and my learners.

Speaker 2:

The next is recognizing and responding to opportunities for compassion. So when a patient says they're going through something difficult, rather than trying to just get them back on track to the question you asked, rather than trying to just get them back on track to the question you asked, taking a moment to give them recognition of what's going on and show them that you care, instead of just trying to redirect to stay on time. The fourth that they recognized in the studies were the non-verbal communication, so that looked like eye contact, even body position. Don't point yourself toward the door. Point yourself toward the person in front of you. That makes a big difference in the way that you're perceived. And then the last was verbal statements of validation, of acknowledgement, of support for the things that the patients are going through. One of my favorite quotes from the article said that a possible common denominator among these interventions, so the five things that I just mentioned is that you are assuring the patient of true presence and focus and you're letting them know they're not going through their current condition alone.

Speaker 2:

That statement was something that I internalized immediately and have tried to really live out in my own practice and as I precept.

Speaker 1:

Right, right. No, that's great, that's a really great call out, shifting sort of to the precepting mindset you know and of the behaviors you know, I think most of us could be intentional about practicing the majority of them, certainly depending on your environment. If you're in a busy community pharmacy or something like that, sitting is not maybe an option, but you know, eye contact and some of the active listening things that you referenced you know would be. Talk a little bit about what our role as preceptors is in all of this. So we have students who have been focused on growing their knowledge base and passing their tests and getting through all the things. And now here they are, whether it's in experiential learning as a student or they're launched into residency. What's our role in encouraging teaching? You know this compassion and this empathy and everyday practice.

Speaker 2:

I think the most important thing is that we model compassion well. If we aren't doing the things, it's hard for learners to know how to do the things, so we need to be the models if we expect the next generation of learners to be truly compassionate providers. The second thing I would say is teach them that they can learn it. I think there's always been that kind of mindset of this is a soft skill that may not be easily learned, but I would disagree with that. I think we need to tell learners like this can be learned behavior, but intentionality is key. And then the last thing that I would say, for the preceptors specifically, is to remember that we are the most important place for them to learn this, because the actual patients are a crucial part of being successful in developing compassionate care for your patients.

Speaker 2:

100% of the studies that used real patients to teach these skills resulted in improvement in compassion by the providers. I don't think that's a coincidence. The real patients matter more than didactics and role play. Are the other pieces great to lead into being a preceptor and getting them on experiential rotations? Absolutely, I think it's something that we could definitely do a better job talking to our learners about, but let's not forget that the role of the preceptor is going to be to give them the chance to do this in real life, with real people.

Speaker 1:

Yeah, so true. So let's let's try to make it real practical here. Can you can give me an example or two of some specific strategies that you've used and maybe even go a little further into the feedback component? Like, how do you give feedback on stuff like this? You know, without telling somebody they're hard or not empathetic, you know how do you, how do you handle, you know developing that individual student.

Speaker 2:

Well, I think the first strategy that has been wildly successful for me how do you handle developing that individual student? Well, I think the first strategy that has been wildly successful for me is that at the beginning of most months, I go ahead and review these five key behaviors. I want them to know that there is actual literature supporting this and this is the type of care that we want to provide, and so when they have that kind of rubric in mind already, they're likely to be much more successful. In one of the months that I did not think to do that, I had a learner that decided that she wanted to change the desk position to stand, and so when we got a break in patients that day, I actually used that as my kind of hey. So I know that you, like the whole standing desk, get your burning extra calories, all of that in. But let's talk about the data for why maybe that's not the best position for you when you're the provider, and so it wasn't any kind of call out in a negative way, but it was a hey. I want you to know that the data shows that they're going to see you as more compassionate when you're on their level. So let's sit, even if you can see the benefit of standing. And if you want to stand while you write your notes, fine, but while you're seeing them, I want you to sit. I want you to sit.

Speaker 2:

And so I use things like that as a segue to go ahead and pull this article and say, hey, let's look at these five behaviors together.

Speaker 2:

And then I also try to talk to them about how does this translate to a virtual world, because my rotation is partially virtual. I am not on site. Every day we do video calls, and so we talk a lot about how the nonverbal cues really become even more crucial when you're on a virtual call with a patient, because one they see your eyes. If you're not looking at them and you're clearly checking other alerts, checking other alerts looking at your phone, looking down, they notice that, and so we need to make sure that they are invested in the patient care, that they are actually engaged with the patient. And I think there's a big difference in, you know, looking clearly, like at the patient chart while you're on a call with them, and like, yes, you may have two screens next to each other, but we've all been on a call where we were in a meeting with someone and they were clearly not in that meeting. Right Like.

Speaker 2:

I think we've all been there by now, because there's so much virtual happening.

Speaker 1:

And so.

Speaker 2:

I think that that's an important thing to make sure that they're really aware that patients are going to see, that they're going to see whether or not you notice their nonverbal cues and then they're going to respond to your nonverbal cues. So let's really try to be intentional in what we're putting off to the patients and so most of the time I haven't had to do a ton of corrective feedback. If I start the rotation by talking through this, I've noticed that most of the time they internalize it very well and really are great at being examples of compassionate care, because they know what to do and how to be intentional about it.

Speaker 1:

Right, right, Well, and it's one thing to do that in a teaching and learning environment, but then carrying it with you when you get into practice, when there's new stress, busy practice, no time, lots of expectations, you know, that's when the intentionality really becomes, really becomes important. You know, for for them, but also for us as as receptors, right, Well, this has been really helpful, Kate. Again, I'm going to post the that article in the show notes for anybody who wants to dig a little bit deeper. It just didn't wrap up. What is one thing that a preceptor listening today can start doing to help their students or residents be more intentional about their interactions with patients, to ensure that they're bringing that compassion and that empathy to the conversation?

Speaker 2:

I love this question and I think that the most important thing that we can do is prove over and over that it doesn't take a lot of extra time to do this. So there was a study and yes, it was from 1999, so it's a bit dated but a study in the Journal of Clinical Oncology where there were two arms and the intervention arm included an extra 40 seconds of enhanced compassion, and in that study those seconds of enhanced compassion calmed patient anxiety more and led the patients to a greater belief that the doctor cared about the patient, and so I think we can take that into patient care and realize that it doesn't take a lot. There was a specific script that was used, but the bulk of it boiled down to one key phrase I am here with you. If you let them know you're in it with them, they're going to see that compassion shine through.

Speaker 1:

Yeah, yeah. Well, that is a great way to wrap things up. So thank you so much for sharing that and, again, I think the most important thing we can do is be that model, even on a bad day. You know, whenever we can is to is to be that model and and be the be the practitioner that our learners want to become. Right, yeah?

Speaker 2:

exactly.

Speaker 1:

Awesome. Well, thank you so much. This is a lovely conversation. I really appreciate it.

Speaker 2:

Thank you so much for letting me come.

Speaker 1:

Take care, kate. So what is the one thing you can do today to start building more compassionate and empathetic practitioners? A couple of the easy ones I heard were first, incorporate a conversation about compassionate behaviors when you set expectations for your learners. Second, give constructive feedback on patient interactions that you observed. Is there body language that could be improved, better strategies for active listening, or does the learner just need to give each patient a little more of their time 40 seconds according to the study Dr Cozart mentioned and finally, always model the behaviors you want to see.

Speaker 1:

If you'd like a little more information, check out the show notes for a link to the study that Dr Cozart had based her own efforts on. I also found it helpful. If you have some effective strategies to share in this space, send me an email at kathy at cempactcom and I'll get them posted here for others, as always. Be sure to check out the full library of preceptor by design courses available for preceptors on the CE Impact website, and be sure to ask your experiential program director or residency program director if you're a member, so that you can access it all for free. If you do have access, thank your program director and be sure to log on to CE Impact and claim your CE for this episode. Thanks again and I'll see you next time on Preceptive Practice.