“Brought to Life through Imagery” – Animated Graphic Novels to Promote Empathic, Patient-Centred Care in Postgraduate Medical Learners

Abstract

Background: Empathy levels decline through medical training. This has been associated with poor patient and physician outcomes, and strategies to combat this decline are increasingly recognized as critical aspects of medical education. The aim of this study was to qualitatively determine factors associated with empathy decline, and to assess the impact of a comics/graphic novel-based curriculum on enhancing empathy and a patient-centered approach to care in post-graduate medical learners. Methods: Fourth and fifth year residents in the Adult and Pediatric Endocrinology and Metabolism Program at the University of Toronto were recruited from the 2017 cohort of the Empathy, Humanism & Comics course. Participants completed a 12-month curriculum, viewing a total of four animated graphic novels over six sessions. At the end of the course participants were interviewed either individually or in a focus group. A coding framework of emerging themes was developed based on consensus between the three authors using a qualitative descriptive approach and the constant-comparison method.Results: Analysis of coded interview data revealed four themes. 1. The curriculum accurately reflected and addressed issues in real world medical practice; 2. The comics curriculum facilitated holistic development; 3. Participants appreciated the comics as an educational medium; 4. Participant feedback on the curriculum. The importance of empathy was noted, while participants acknowledged their own empathy decline and increased burnout. Stressors included increasing responsibility, long work hours, and competing work-life responsibilities. They felt the sessions developed resilience, an appreciation for the patient perspective, and communication skills. They appreciated the comics as a novel and engaging educational modality. Feedback on the effectiveness and relevancy of the curriculum was variable.Conclusions: Residents appreciated sharing difficult experiences and seeking support. They acknowledged the curriculum as a commitment to wellness and felt it reduced burnout and improved empathy. The comics were viewed as an effective reminder of the patient perspective. Variable curriculum feedback highlights the challenge in designing a course for adult learners. Future investigations may include the development and incorporation of similar curricula in other post-graduate residency training programs.

Empathy in health professions education: What works, gaps and areas for improvement

“…Upon further scrutiny, we found that different interventions were being implemented either as a one‐off intervention or over a span of time (refer to Table 1). There were four articles which did not mention the duration of implementation 47–49,81 . Of these four articles, the results showed no significant change in empathy for two quantitative articles 47,48 and the other two were qualitative research 49,81 .…”

“…A total of 44 articles (38 undergraduate and six postgraduate) 11,37,38,47–87 were reviewed. Interventions related to empathy have placed a higher emphasis on undergraduate as compared with postgraduate education.…”

“…There were four articles which did not mention the duration of implementation 47–49,81 . Of these four articles, the results showed no significant change in empathy for two quantitative articles 47,48 and the other two were qualitative research 49,81 . A majority of the interventions (60%; n = 26) were implemented over a span of time 37,60–80,83–86 as compared with studies that suggested a one‐off intervention (30%; n = 12) 38,50–59,82 .…”

“…Although most of the studies conformed to the rigour of research, we noticed that some studies had limitations in the research methodology which might affect the outcome of the studies. There were four studies utilising qualitative research design 49,71,80,81 but did not discuss the components of empathy being nurtured in the results. Empathy was briefly mentioned by the interviewees as one of the themes of the outcome of the interventions.…”

Intervention Effects in Using an Application Compared with a Module with Pictures on Knowledge, Attitude, and Practice of the Pregnant Women in North Sumatra, Indonesia

“…Meanwhile, the development of the era and technology demands the health sector to adapt and adjust when education is carried out [8], [9]. At present, technology has developed so rapidly that every mother in an urban area has a mobile phone and has been exposed to various shows on TV which make them have ideal figures that directly and indirectly influence their imagination [10], [11]. Moreover, in this pandemic era, the education service for pregnant women should be carried out still, without any socio-economic or location limitation because we still do not know when this pandemic will be over [12], [13].…”