Journal Club

Weissmann, P F, Branch, William T,; Gracey, C F, Haidet, P,Frankel, RM. Role Modeling Humanistic Behavior: Learning Bedside Manner from the Experts. Academic Medicine 2006. 81: 661-667

Reviewed by: Sherilyn Smith, University of Washington

This well designed qualitative study describes the behaviors humanistic physicians use during patient care as a method to identify best practices to teach this core topic in medicine. The researchers audio taped 12 faculty members from three institutions. These physicians were selected from nomination derived from a web based survey. Researchers used qualitative methods (audiotaped bedside teaching sessions, transcript reviews, field notes and structured interviews) to derive a structured abstract describing a best practice. These abstracts were then reviewed by the authors to generate a consensus.

The researchers found that the physicians taught humanism almost exclusively by role modeling. The faculty assumed that learners would recognize, learn and emulate what they saw. Occasionally there were reflective discussions followed by role modeling. The most commonly used humanistic techniques (and there was a wide variety of tools used) included nonverbal behaviors such as listening closely to the patient, demonstrating respect for patients (such as using appropriate introductions or including the patient within the discussion) and eliciting / addressing the patient's emotional response to the illness. The study is limited by the setting (inpatient hospital services) and may not be generalizable to specialties other than internal medicine (although I expect it is generalizable). Finally, there was no comparison group to determine if the behaviors identified in the humanistic physicians were also present in other physicians. However, this was a hypothesis generating study that others could build on and address the questions about what are the most effective techniques to use to teach these concepts.

This study provides specific observations about humanistic teaching that can become the foundation of faculty and learner development in this area. Many techniques are simple to recognize and emulate. The technique of role modeling (perhaps coupled with learner reflection) may be the most powerful manner of instilling these positive values without sounding "preachy". The effects of the "hidden curriculum" have been well established through similar qualitative studies.

(Editorial Comment: "Don't it always seem to go that you don't know what you've got till it's gone?" The faculty "assumed that learners would recognize…"? Here's a positive demonstration of the power of the hidden curriculum. Why not take that curriculum out of hiding and male it explicit? Like other teaching issues - especially feedback - there's also a faculty development issue. When someone is modeling humanistic practices, they need to be encouraged to highlight that activity, so the learners see it in action. Bruce Morgenstern)