Art of Doctoring (AoD)

"The practice of medicine is an art, based on science." William Osler MD

Teaching residents the “Art of Doctoring” lessons of professionalism, nuanced communication, or empathy, remains a challenge. We designed an integrated humanities-based curriculum that is married to scientific analysis. We adhered to three key principles:

  1. Link sessions to parallel curriculum.  As residents learn EBM and clinical skills, AoD sessions reinforce Professionalism, Risk, Prognosis, Diagnosis, and Treatment by offering an alternative “humanities-based” approach.
  2. Selected readings are linked, local, and concise. Each memoir, poem, or video assigned is married to a more “analytic” treatment of that same topic. Whenever possible we will use Georgia authors for the added value of the cultural content that their writings contain while keeping reading assignments short.
  3. Put readings into practice. Since the nature of assignments in humanities curricula fundamentally depart from basic science courses, a key component to success is to make the sessions inherently practical. Residents use humanities sources to solve authentic scenarios, i.e., how to deliver bad news. From this approach, we developed the course component with examples from each theme:
  • Professionalism: Explores the “virtues” that characterize exemplary physicians. In groups residents critique the professional virtues physician such as Dr. Paul Farmer and Dr. Sanjay Gupta from writings about them, among others.
  • Risk: While learning about risk ratios, residents explore the nature of risky behavior, read biographic narratives of physicians impaired by addiction and studies of predictors of such risky behaviors. Residents apply these readings and concepts to confronting an impaired colleague.
  • Prognosis: We explore both the patient and the physician experience of dealing with a poor prognosis and have residents then apply learned concepts by articulating how they would deliver bad news. Examples such as  Jerome Groopman’s Anatomy of Hope residents learn about an oncology fellow grappling with a patient’s grim prognosis. Poet James Dickey: a patient’s perspective with his challenging poem “Diabetes”, and “When Breath Become Air” by Dr. Paul Kalanithi about a neurosurgery resident is diagnosed with stage IV lung cancer .
  • Diagnosis: When exploring the nature of medical decision making, residents will examine medical errors through a closer look at safety practices in the airline industry. Selected readings and modules include NEJM Quality Series, and AMA Ethics modules.  After reading a scientific treatment of how errors are minimized in aviation, residents view the NOVA documentary “The Deadliest Plane Crash”. Lessons are put into practice by analyzing error scenarios in small groups during PSQI conferences.
  • Treatment: In an interactive large group session, residents will explore the nature of persuasive language and analyze pharmaceutical commercials against the framework of the classic “Message-learning Approach” of Hovland.  Review EBM studies on how communication affects patient behavior, such as improving adherence by using positive language and open-ended questions.

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