The Culturally Humble Care Curriculum: An Approach to Address Empathy in Resident Education

Background: Empathy aims to shift focus from problem solving to understanding and has been shown to give way to building a stronger patient doctor relationship, and ultimately better individualized patient care. It is understood by many physician organizations to be a central tenet of medical practice. Various studies have demonstrated the benefits of physician empathy for both patients and physicians, including higher level of patient satisfaction, improved clinical outcomes, higher physician well-being, and clinical competence. Despite this, data has shown that the practice of empathy in medicine is low, and that empathy declines throughout medical training. Different forms of curricula have attempted to address empathy building in residency education. We aim to utilize an approach which centralizes the patient perspective to increase resident empathy with the communities we serve.

Methods: The Culturally Humble Care (CHC) curriculum was created within the pediatric residency program at The Children’s Hospital at Montefiore in The Bronx, NY. Investigating residents identified patient populations within the community who had significant interactions with the medical system but with which providers were likely less familiar with their cultural values, lifestyle practices, motivations, and needs. Once identified, residents collaborated with faculty content experts as well as specified patients and families to develop the curricular sessions. For each focus population, an interactive didactic conference and patient/parent panel were designed with educational goals focused on both the clinical and socioemotional considerations integral to providing care to each group. The series was launched during resident education, to capture 85 residents throughout the academic year. Quantitative and qualitative pre and post-surveys were and will be completed to assess levels of comfort, understanding, and empathy, amongst participating residents.

Results: Four populations were identified as focus areas for CHC: 1) transgender & non-binary communities, 2) patients with medical complexity and technology-dependence, 3) the Muslim population, and 4) the different Latin American communities within the Bronx. To date, sessions addressing two of these populations have been conducted. Preliminary data from the post survey reveals favorable qualitative feedback including comments such as the curriculum “raises important issues that are necessary to address in holistic patient care” and the panel method “brings in different perspectives, resources, [and] community voices.” The additional sessions are scheduled to be completed by winter 2021.

Conclusion: Preliminary outcomes demonstrate acceptance of the CHC as a method to centralize the patient and their community in an effort to address the decline in empathy throughout training. The CHC framework can be easily adapted for use in other training programs once selected patient populations have been identified. Future directions include completing the additional sessions and addressing the sustainability of this approach throughout residency training.