Preserving third year medical students' empathy and enhancing

self-reflection using small group "virtual hangout" technology

     In order to preserve student’s empathy, Duke et al. (2014) took into consideration that there have been many studies that indicate that in the third year of medical school students’ empathy declines. Their study on enhancing self-reflection used “virtual hangout” technology utilizing small group sessions that include a faculty facilitator, Duke et al. (2014) launched, “a new course for third year students in 2012 built around stable, longitudinal peer small groups that span all four years” (p. 567) at Drexel University College of Medicine. The school includes 259 students across three states in 23 clinical sites. The researchers, “created virtual classrooms for 31 faculty-facilitated small groups using Google+ Hangout social networking technology (Google, Mountain View, CA), coupled with the online Blackboard learning management system (Blackboard, Washington, DC) on which to post course information and assignments” (Duke et al., 2014, p. 567). The student groups met online every 8-12 weeks.

      In these small groups, students would have their own private blog where they would be required to respond to triggering questions. Students were instructed to write important and meaningful experiences to their classmates and the facilitator. “These brief self-reflections are read by students and faculty beforehand and are then discussed during the 75-minute group session, providing an opportunity to explore and integrate these experiences in a safe learning environment” (Duke et al., 2014, p. 567). It is very important to remember that, "negatively perceived medical school learning environments may adversely impact empathy, professionalism, academic success, and quality of life" (Dunham et al., 2017  p. 2), which is why I believe Duke et al. stress the need for a safe environment for students to share their narratives. The topics of discussion included, “adaptation and stress; witnessing unethical or unprofessional behaviour; burnout and resilience; and death, dying and personal meaning” (Duke et al., 2014, p. 567).

The methods of the study included all 259 students being enrolled in the beginning of 2012.

      In order to protect students’ anonymity, the students were assigned numbers instead of using their names and only a staff member who was not engaged in the course knew this information. Students completed informed consent forms and questionnaires prior to the beginning of the course. The data collection included the tool, The Jefferson Scale of Empathy, which has been found to be the most popular scale throughout my research. “To assess self-reflection [they] used the Groningen Reflection Ability Scale (GRAS), which is a one-dimensional scale measuring ability for personal reflection” (Duke et al., 2014, p. 568). Student feedback also included anonymous online feedback at the end of the course. A pass/fail model was used and students were assessed by attendance and reflection exercises.

       The majority of students provided online feedback on the course. This included, “70% agreed or strongly agreed that the small group enhanced their understanding of the challenges they and their peers face during medical training. 66% of small group participants noted that the group was a source of social support and 48% stated that it contributed strongly to their ability to anticipate and respond to challenges of medical training” (Duke et al, 2014, p. 569). Unfortunately, only 6% of the students commented that the narrative/blogs were a useful exercise. Additional negative feedback included technology issues and the elimination of written reflection. There were many limitations in this study including the fact that it took place at only one academic institution; there was poor response rates that may have been due to collection and administration error; there was no subgroup analysis; and there was no control group. The authors indication that they, “hope to look more carefully at students’ perspectives and to add more self-assessment questions about which aspects students perceived helped them to preserve their empathy and improve their resilience skills” (Duke et al., 2014, p. 570).

      The results of the Duke et al., 2014 study was disappointing as the narrative method sounded effective and the technology used seemed to be an innovative solution to reach a variety of students across campuses. However, the students found the small groups useful and it was a new venue for social support that could lead to a decrease in stress as well as a platform to openly discuss their concerns. Hopefully, similar studies take place that address the limitations and lead to more positive results for the narrative approach as these types of courses would be greatly beneficial for students, especially if there was a team of well trained, passionate faculty members to facilitate the sessions.