Teaching Communication and Compassionate Care Skills: An Innovative Curriculum for Medical Students

A journalist and an actor walk into a room full of white coats. No, this is not the opening line of a joke; it’s a typical day in the lives of Evonne Kaplan-Liss, MD, and Valeri Lantz-Gefroh.

Their task? To focus their talents and assemble a full cast of characters in developing a new communication curriculum model to support the revolutionary mission of the new Texas Christian University (TCU) and University of North Texas Health Science Center (UNTHSC) School of Medicine.  

As stated by the school’s founding dean, Stuart Flynn, MD, “Physicians graduate from this school as empathetic scholars, exhibiting the qualities you and your family expect and value. These physicians will embrace and lead the rapid advance of technology in empowering health and delivering care, but will also be skilled in communication and empathy — the ability to stand in a patient’s shoes and convey an understanding of their situation.”

During the past 10 years, Kaplan-Liss and Lantz-Gefroh have been partners, drawing on their multidisciplinary perspectives to create ways for doctors to connect with their patients — and to nontraditional audiences such as the media, donors, and policymakers — with empathy and clarity.  

Kaplan-Liss credits her background as a childhood actress, a professional journalist, and a chronic patient with providing her with the important communication lessons necessary for becoming a physician. She and Lantz-Gefroh, an acting teacher, were founding faculty members of the Alan Alda Center for Communicating Science, created to empower “scientists and health professionals to communicate complex topics in clear, vivid, and engaging ways,” according to the center’s website. 

Together, they built an improvisational curriculum that was piloted by the medical school at Stony Brook University and shared with an affiliate network of medical schools. All those involved agreed: The desired result was to ensure that doctors become empathetic, that they can learn to listen to people and reflect an understanding of those voices in the care they provide. 

Despite the importance of physician empathy in patient care, empirical research into the topic is scarce. How do you teach it? How do you measure it beyond knowing it when you see it? In a decade of work in this area, Kaplan-Liss and Lantz-Gefroh found that everyone faced the same questions and predictable obstacles: entrenched curricular hurdles, budget constraints, and a lack of time for faculty to teach and for students to devote to learning how to listen and communicate empathetically.          

Then, one day, Flynn approached Kaplan-Liss with a challenge to fix these issues. He also offered her a job as the nation’s first dean-level position in a medical school dedicated to narrative reflection and patient communication. She asked Lantz-Gefroh to join her as the medical school’s artistic director; they also work with Chase Crossno, assistant artistic director, whose background is in theater and public health. Together, they are creating a new model of communication training called the Compassionate Practice.    

This model is a highly interdisciplinary curriculum that, when complete, will meld aspects of many disciplines into something completely new. In its pilot phase, theater training has taken a front seat. Why start with theater? Many people assume that acting is about “faking it” or pretending. In reality, actors are trained in an immersive form of empathy-based, intrapersonal pedagogy with the sole purpose of causing an audience to feel something. They are taught to emotionally and psychologically understand another person, to justify their actions, to speak in their voice and stand in their shoes.  

After 10 years of working in medical improv, Lantz-Gefroh and Kaplan-Liss discovered that medical professionals and scientists run into the same issue actors face: Learning improvisation is transformative and builds new perspective in the moment but requires longitudinal integration as well as a repeatable process to instill lasting behavioral change. The Compassionate Practice changes the pedagogical approach. To teach doctors to become comfortable with uncertainty, the training incorporates improvisational elements but moves quickly to the method created by Russian actor, director, and teacher Constantin Stanislavski and taught in the U.S. by Uta Hagen. 

This method introduces simple technical tools related to the character’s objective, life circumstances, and conflict. To portray and honor the behavior of the character, actors must begin with an understanding of the self. As they study, they learn to identify psychological, physical, vocal, and emotional attributes they share with the character. Thus, they build an empathetic understanding to authentically portray that character.  

This process is not about pretending you are someone else, but about connecting on the most fundamental human level possible, according to Kaplan-Liss and Lantz-Gefroh. The rehearsals allow actors to dissect moment-to-moment behavior, stepping in and out of the world of the play. This gives them the power to connect in the moment when the job and audience demand it and to disconnect when it’s over and rejoin life, unencumbered by the character’s drama. Imagine the emotional and psychological difficulty of playing Hamlet, grieving the death of your father and asking if life is worth living for four hours each performance, eight times a week. No actor can successfully sustain this type of emotional grind and move an audience to feel something without a process that keeps them safe. 

Actors do not face the real-world drama medical professionals encounter, so theater training in medical school needs to be supported by multidisciplinary perspectives. Journalism and narrative medicine will teach important lessons about inquiry, finding the story, and reflecting on its meaning; diversity, public health, and social justice will reinforce the need to find compassion for other’s needs and perspectives; psychology and contemplative practice will bolster physician wellness; and communication studies will result in important research. Each of these areas shares common ground with theater practices and can collaboratively be built into a new method for doctors to help foster resiliency and compassion for patients and communities. 

Such an innovative curriculum will also prepare and empower medical students to promote health equity and wellness as well as reduce disparities in health and healthcare.  

The Compassionate Practice is still being developed, but in early workshops, Kaplan-Liss and Lantz-Gefroh indicated that feedback from physicians had been overwhelmingly positive. Following a recent two-day Boot Camp, faculty members enthusiastically reported applying the lessons learned immediately with good results, including deeper listening, stronger patient interactions, a clear process to build understanding, and improved marital communication.

As far back as 2002, a group of physician leaders met to discuss the state of communication training in healthcare. From their assessment, the Kalamazoo Report II, they determined it was imperative for students to focus on interpersonal skills to generate more successful patient outcomes. The Compassionate Practice takes it one step further by understanding that doctors can’t give what they don’t have. Therefore, adding intrapersonal training is an important first step on this path. Just as an actor needs technique to both connect in emotional settings and disconnect when the job is complete, this kind of intrapersonal, empathy-based training can provide much needed support for physicians struggling with resiliency.

When fully developed, the training will be assimilated into medical students’ coursework so that compassionate communication is embedded in their understanding of medicine. Empathetic scholars will learn that practicing compassion is like practicing medicine.— a lifelong endeavor.●

Lisa McBride, PhD, is assistant dean of diversity and inclusion and a professor of medical education at the TCU and UNTHSC School of Medicine. She is also a member of the INSIGHT Into Diversity Editorial Board. Valeri Lantz-Gefroh is artistic director and an associate professor at the TCU and UNTHSC School of Medicine. Evonne Kaplan-Liss, MD, is assistant dean of narrative reflection and patient communication and a professor of medical education at the TCU and UNTHSC School of Medicine. This article was published in our December 2018 issue.