How do you define compassion, how do you best teach it, and how do you practice it as a doctor-in-training? Khushboo Jhala ('16) has been exploring these questions through a project funded by the Schwartz Center for Compassionate Healthcare. She is part of a group of five other Geisel students awarded Schwartz Fellowships to work with faculty to design and implement projects that introduce compassion-centered care into the Geisel curriculum.
At their first meeting, she and the other Schwartz Fellows started reading literature on how best to teach compassion at a medical school. Based on her research, she came up with two ideas to describe compassion: passive and active empathetic avenues. Passive avenues are where students learn about compassion through readings and seminars in a classroom. Geisel does this through the Profession of Medicine course with Hearts and Minds Grand Rounds where a patient and their caregivers come into a classroom and students learn from the patient what the disease process is like.
"If a medical school wants to be at the forefront of modern medicine and changing the medical paradigm from one that's lab based to patient based, having students understand what it's like to be a patient is really important."
Khushboo Jhala )'16)
For her Schwartz Fellowship, Jhala wanted to create a project where you "actually take on a patient's situation as if it were your own. So you go through the experience yourself," she says, which she coins as "active empathetic avenues." Hunger is a major issue nationally and locally in the Upper Valley. So Jhala thought it would be fascinating to do a study on hunger, having students directly experience what it is like to live on a limited food budget.
She then recruited 14 Geisel students and split them into two groups of seven students each. One group lived on a typical Supplemental Nutrition Assistance Program (SNAP) budget of $3 per day for five days. The other group—a control group—did not participate. Jhala herself participated in the food challenge (eating "mainly staple foods—beans, rice, and homemade tortillas," also "quick tomato and mayonnaise sandwiches"). At the end of the week, both groups filled out surveys where they commented on their experience and answered specific questions.
Jhala found the results surprising. One of the survey questions was: If a diabetic patient comes to your clinic and you find out they are not taking their insulin, what do you say to them? The responses, Jhala found, were quite different between the two groups. The group who did not go through the food challenge approached the question as an education problem or compliance problem and suggested ways of making sure the patient understands how insulin is given and what the correct doses are. The group who did go through the food challenge answered the question very differently. They did talk about helping educate the patient but also would ask "'Why isn't the patient taking their insulin? Is there a food shortage going on? Is there access to resources that needs to be considered?' And discussed other socioeconomic problems that the patient might face," says Jhala. Students in the food group were "more open to understanding the patient's story," she adds.
Students in both groups were also asked to offer solutions for the diabetic patient. The group who did not do the challenge tended to propose writing down guidelines for the patient for insulin compliance. Students in the food group thought more broadly, suggesting having in their clinics a list of the nearest grocery stores that sell less expensive fruits and vegetables, or that offer cooking lessons. These students also commented it is important to understand a patient's situation—for example, a mom with five kids who works two shifts and may have access to fresh vegetables but very limited time to cook.
Students were also asked about their ability to "relate to the perspective of a patient from a low socioeconomic background." The food challenge students reported that they had a greater ability to empathize with such a patient compared to the control group. Students, then, who lived on a $3/day food budget could relate more. "That refutes a lot of the current studies that talk about how people are born compassionate or are not compassionate," says Jhala. "If compassion is pliable based on experience, which this study highlights, then there is a place for medical education to put compassion-centered avenues in the curriculum."
Sympathy, says Jhala, is important for bedside manner. "But I think empathy is important for innovation. . . . If a medical school wants to be at the forefront of modern medicine and changing the medical paradigm from one that's lab based to patient based, having students understand what it's like to be a patient is really important," she says. "We have to start taking compassion seriously and defining it and understanding what it means to take measures in an educational curriculum to foster it."
Jhala, who is an accomplished painter, also likes to explore how painting and medicine both involve empathy. See here for an example.