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Walking a mile in their patients shoes: empathy and othering in medical students education

机译：在病人的鞋子上走一英里：在医学生教育中的同理心和其他

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One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for imperfection in self and others; and acceptance of shared emotional vulnerability and suffering while simultaneously honoring the existence of difference. Reducing the sense of anxiety and threat that are now reinforced by the dominant medical discourse in the presence of illness will enable trainees to learn to emotionally contain the suffering of their patients and themselves, thus providing a psychologically sound foundation for the development of true empathy.
机译：医学教育工作者的主要任务之一是帮助维持和增加患者对学员的同情心。然而，研究表明，在医学培训过程中，医学生和居民的同理心减少了。已经引入了各种练习和更全面的范例来促进同理心和其他人文价值，但没有取得成功。本文认为，医学教育促进同理心的潜力并不容易，原因有两个：a）医学生和居民对人类普遍患有的疾病，残障，衰弱和最终死亡的脆弱性具有复杂且大多无法解决的情感反应，他们必须这样做在提供患者护理的过程中面临挑战b）关于保护，控制和恢复能力的现代主义假设在主流生物医学的制度文化中根深蒂固，并可能为移情关系造成障碍。在没有适当的关于如何从情感上管理人的苦恼的方面的论述中，受训人员很可能会诉诸于导致距离和超脱的应对机制。本文提出了一种认识论范式的需求，该范式可以帮助受训者发展对自我和他人缺陷的容忍度。接受共同的情感脆弱性和痛苦，同时尊重差异的存在。减少因有病而在医学上占主导地位的焦虑和威胁感现在可以使受训者学会在情感上遏制患者及其自身的痛苦，从而为真正的共情发展提供心理上的良好基础。

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