Humility: A Pathway to Restoring Trust and Coherence in Medical Practice
Benjamin Snyder, Indiana University School of Medicine, Indianapolis, IN
While efforts have been made over the last several decades to integrate humanism with education in scientific and technical excellence during medical training, character formation remains an overall weakness in current medical education paradigms. At a time when trust in both medical systems and physicians is declining, attention to character development is crucial to carrying out the aims of medicine.
Work to reform medical education in the realm of humanism and character formation have included re-imagined evaluation schema, adaptations of continuing education, bias training, and implementation of the medical humanities. However, these adaptations have not slowed the erosion of trust between patients and healthcare as evidence by a study commissioned by the American Board of Internal Medicine Foundation carried out by the NORC at the University of Chicago completed in late 2020-2021 (1). As far back as 2011, five articles were published concurrently in Medical Humanities questioning if the use of the humanities such as art and narrative medicine are adequately nuanced to cultivate cultural understanding or if these practices simply lead to personal reflection in the absence of well-formed character (2). These studies and reflections are cause for humility in considering what tools may serve as an ointment to the ails of medicine.
Part of the challenge in addressing character formation in medical training, is the difficulty in evaluation of character as a core competency. Inherent to the philosophy of modern medical practice is a drive for excellence in knowledge and skill on which patients depend. Competence-based education focuses on the six core areas developed by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Medical Specialties including Patient Care, Procedural Skills, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-based Practice. These competencies contain elements relating to character but primarily focus on knowledge acquisition or practical skills. However, society expects not only technical excellence but also strength of character from those to whom they are entrusting their lives (3).. In fact, Khullar and colleagues recently highlighted in analysis from the Healthy Workplace Trial that the factors contributing most to patients’ trust in their physicians are what occurs in the examination room including satisfaction with explanations, overall satisfaction with provider, learning about their medical conditions, and their clinician’s personal manner (4). The examination room factors as cited in this study are significantly tied to physician character and humanism.
Humility is a concept of both theological and philosophical significance. Humility as explained in Pauline theology, for example the kenosis of Christ described in Philippians 2, or Christ’s assertion that the “meek will inherit the earth” during the Sermon on the Mount in Matthew 5, elevate the importance of humility as a foundational character trait. Qualitative analysis of peer nominated excellent physicians has highlighted humility as a defining character trait for excellence in medical practice (5). While modern medicine seeks certainty by harnessing the powers of technology to control the natural world, humility speaks to ideographic realities of human experience that transform illness narrative (6). Medical students long for character formation (7), but competence-based education focused on nomothetic realities cannot drive this formation or assess the fruit of the content of one’s character. Developing a robust theology and philosophy of humility as a foundational character trait can restore the trust of society and create coherence in the practice of medicine when uncertainty abounds.
References
Work to reform medical education in the realm of humanism and character formation have included re-imagined evaluation schema, adaptations of continuing education, bias training, and implementation of the medical humanities. However, these adaptations have not slowed the erosion of trust between patients and healthcare as evidence by a study commissioned by the American Board of Internal Medicine Foundation carried out by the NORC at the University of Chicago completed in late 2020-2021 (1). As far back as 2011, five articles were published concurrently in Medical Humanities questioning if the use of the humanities such as art and narrative medicine are adequately nuanced to cultivate cultural understanding or if these practices simply lead to personal reflection in the absence of well-formed character (2). These studies and reflections are cause for humility in considering what tools may serve as an ointment to the ails of medicine.
Part of the challenge in addressing character formation in medical training, is the difficulty in evaluation of character as a core competency. Inherent to the philosophy of modern medical practice is a drive for excellence in knowledge and skill on which patients depend. Competence-based education focuses on the six core areas developed by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Medical Specialties including Patient Care, Procedural Skills, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-based Practice. These competencies contain elements relating to character but primarily focus on knowledge acquisition or practical skills. However, society expects not only technical excellence but also strength of character from those to whom they are entrusting their lives (3).. In fact, Khullar and colleagues recently highlighted in analysis from the Healthy Workplace Trial that the factors contributing most to patients’ trust in their physicians are what occurs in the examination room including satisfaction with explanations, overall satisfaction with provider, learning about their medical conditions, and their clinician’s personal manner (4). The examination room factors as cited in this study are significantly tied to physician character and humanism.
Humility is a concept of both theological and philosophical significance. Humility as explained in Pauline theology, for example the kenosis of Christ described in Philippians 2, or Christ’s assertion that the “meek will inherit the earth” during the Sermon on the Mount in Matthew 5, elevate the importance of humility as a foundational character trait. Qualitative analysis of peer nominated excellent physicians has highlighted humility as a defining character trait for excellence in medical practice (5). While modern medicine seeks certainty by harnessing the powers of technology to control the natural world, humility speaks to ideographic realities of human experience that transform illness narrative (6). Medical students long for character formation (7), but competence-based education focused on nomothetic realities cannot drive this formation or assess the fruit of the content of one’s character. Developing a robust theology and philosophy of humility as a foundational character trait can restore the trust of society and create coherence in the practice of medicine when uncertainty abounds.
References
- efaidnbmnnnibpcajpcglclefindmkaj/https://www.norc.org/content/dam/norc-org/pdfs/20210520_NORC_ABIM_Foundation_Trust%20in%20Healthcare_Part%201.pdf
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- Derse AR. Medical Training and Errors: Competence, Culture, Caring, and Character. Acad Med. 2020 Aug;95(8):1155-1158. doi: 10.1097/ACM.0000000000003118. PMID: 31833851.
- Khullar D, Prasad K, Neprash H, Poplau S, Brown RL, Williams ES, Audi C, Linzer M. Factors associated with patient trust in their clinicians: Results from the Healthy Work Place Study. Health Care Manage Rev. 2022 Oct-Dec 01;47(4):289-296. doi: 10.1097/HMR.0000000000000336. Epub 2022 Feb 17. PMID: 35170482.
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