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Being Vulnerable: A Qualitative Inquiry of Physician Touch in Medical Education.
Acad Med. 2020 May 05 [Online ahead of print]AM

Abstract

PURPOSE

Effective nonverbal communication is associated with empathic behavior and improved patient outcomes. Touch, as a form of nonverbal communication, is relatively unexplored in medical education. This study sought to gain in-depth insights into physicians' experiences communicating with touch and to examine how these insights could inform communication skills curricula.

METHOD

Collaborative inquiry, a form of action research, was used. Six experienced physician-educators from the University of Calgary met 8 times between 2015 and 2018 to critically reflect on their experiences of touch in clinical practice, teaching, and learning. Data comprised meeting transcripts, individual narrative accounts, and digital recordings of role-plays. Interpretative phenomenology, the study of lived experience, guided analysis.

RESULTS

Two themes were identified-touch as presence and touch as risk. Participants used touch to demonstrate presence and a shared humanity with patients, to express "being with" a patient. Risk was not associated with the physical experience of touch but, rather, with its social meaning, interpreted through gender, culture, relationships, and context. Individual experiences were open to many interpretations. Participants expressed tension between their personal experience communicating with touch to express empathy and formal curricular structures. Reflection, role-modeling, and clinical debriefs were suggested as ways to encourage situational awareness and sensitive use of touch.

CONCLUSIONS

Touch is a powerful means to communicate with patients but is highly subjective. Rather than avoiding touch for fear of misinterpretation, encouraging dialogue about its complexity could promote a more balanced understanding of touch and its potential to convey empathy and help physicians more effectively manage risk when using touch.

Authors+Show Affiliations

M. Kelly is associate professor, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada. ORCID: http://orcid.org/0000-0002-8763-709. L. Nixon is assistant professor, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada. ORCID: https://orcid.org/0000-0002-3505-6587. T. Rosenal is associate professor emeritus, Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada. L. Crowshoe is associate professor, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada. A. Harvey is clinical associate professor, Departments of Surgery and Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada. W. Tink is assistant professor, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada. ORCID: https://orcid.org/0000-0001-5932-119X. T. Dornan is professor of medical education, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom, and Maastricht University, Maastricht, The Netherlands. ORCID: https://orcid.org/0000-0001-7830-0183.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32379142

Citation

Kelly, Martina, et al. "Being Vulnerable: a Qualitative Inquiry of Physician Touch in Medical Education." Academic Medicine : Journal of the Association of American Medical Colleges, 2020.
Kelly M, Nixon L, Rosenal T, et al. Being Vulnerable: A Qualitative Inquiry of Physician Touch in Medical Education. Acad Med. 2020.
Kelly, M., Nixon, L., Rosenal, T., Crowshoe, L., Harvey, A., Tink, W., & Dornan, T. (2020). Being Vulnerable: A Qualitative Inquiry of Physician Touch in Medical Education. Academic Medicine : Journal of the Association of American Medical Colleges. https://doi.org/10.1097/ACM.0000000000003488
Kelly M, et al. Being Vulnerable: a Qualitative Inquiry of Physician Touch in Medical Education. Acad Med. 2020 May 5; PubMed PMID: 32379142.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Being Vulnerable: A Qualitative Inquiry of Physician Touch in Medical Education. AU - Kelly,Martina, AU - Nixon,Lara, AU - Rosenal,Tom, AU - Crowshoe,Lindsay, AU - Harvey,Adrian, AU - Tink,Wendy, AU - Dornan,Tim, Y1 - 2020/05/05/ PY - 2020/5/8/entrez JF - Academic medicine : journal of the Association of American Medical Colleges JO - Acad Med N2 - PURPOSE: Effective nonverbal communication is associated with empathic behavior and improved patient outcomes. Touch, as a form of nonverbal communication, is relatively unexplored in medical education. This study sought to gain in-depth insights into physicians' experiences communicating with touch and to examine how these insights could inform communication skills curricula. METHOD: Collaborative inquiry, a form of action research, was used. Six experienced physician-educators from the University of Calgary met 8 times between 2015 and 2018 to critically reflect on their experiences of touch in clinical practice, teaching, and learning. Data comprised meeting transcripts, individual narrative accounts, and digital recordings of role-plays. Interpretative phenomenology, the study of lived experience, guided analysis. RESULTS: Two themes were identified-touch as presence and touch as risk. Participants used touch to demonstrate presence and a shared humanity with patients, to express "being with" a patient. Risk was not associated with the physical experience of touch but, rather, with its social meaning, interpreted through gender, culture, relationships, and context. Individual experiences were open to many interpretations. Participants expressed tension between their personal experience communicating with touch to express empathy and formal curricular structures. Reflection, role-modeling, and clinical debriefs were suggested as ways to encourage situational awareness and sensitive use of touch. CONCLUSIONS: Touch is a powerful means to communicate with patients but is highly subjective. Rather than avoiding touch for fear of misinterpretation, encouraging dialogue about its complexity could promote a more balanced understanding of touch and its potential to convey empathy and help physicians more effectively manage risk when using touch. SN - 1938-808X UR - https://www.unboundmedicine.com/medline/citation/32379142/Being_Vulnerable:_A_Qualitative_Inquiry_of_Physician_Touch_in_Medical_Education L2 - https://doi.org/10.1097/ACM.0000000000003488 DB - PRIME DP - Unbound Medicine ER -
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