Humanistic education in surgery: a "patient as teacher" program for surgical clerkship

Abstract

Surgeons are frequently perceived by medical students to be uncompassionate, resolute and individualistic. Surgical education often prioritizes teaching and learning approaches that perpetuate these perceptions. In other specialties, engaging patients in education has shown promise in refocusing attention from the technical and procedural aspects of care toward the humanistic and social aspects. Despite proven favourable outcomes for both patients and students in many clinical areas, a "patient as teacher" approach to surgical education has yet to be adopted widely in Canada. A patient as teacher program was developed for surgical clerks at the University of Toronto with the goal of emphasizing the humanity of the patient, the psychosocial impact of a surgical diagnosis of breast cancer on patients and their families, and the social and humanistic roles for surgeons in providing patient-centred care. We report on the program's development process and pilot session.

Fig. 1

Patient as teacher program timeline vis-à-vis the structure of the 8-week surgical clerkship.

Fig. 2

Student-generated arts-based reflection piece: Loss, by Shawn Khan. The painting depicts the left hand of a patient following amputation. Despite the detail in the hand, there are no other background features or sense of who the patient is. This was meant to represent the initial tunnel vision the artist felt when focusing on the clinical hand examination itself as opposed to who the hand belonged to. In the background, the hand is surrounded by dark hues, contrasted with warm yellow hues shifting in from the corner. This symbolizes the artist’s shift in perception and interpretation of the patient’s experience as he came to learn about the patient’s newfound optimism after ridding themselves of chronic pain. The “Artist’s Statement” is available in Appendix 1 at canjsurg.ca/005319-a1.