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Chapter 8: Humanism Within Pediatrics

Chapter Authors: Jennifer C. Kesselheim, MD & Janet R. Serwint, MD

The concept of humanism has been a cornerstone of medicine throughout history.  Beginning from the time of Hippocrates and the development of the Hippocratic oath, doctors have been dedicated to the physician’s duty to benefit the sick and protect them from injustice.1  In 1902, Sir William Osler’s commitment to humanism was exemplified by his famous quote, “It is much more important to know what sort of person has a disease, than know what sort of disease a person has.”2 In 1927 Dr. Frances Peabody wrote an article on “the Care of the Patient” that emphasizes the importance of both the science and the art of medicine.3

While humanism has been defined in multiple ways, two definitions stand out.  One definition by physician and ethicist Edward Pellegrino includes “a set of deep-seated personal convictions about one’s obligations to others, especially those in need; encompassing a spirit of sincere concern for the centrality of human values in every aspect of professional activity.”4)   Similarly, Dr. William S. Branch defines humanism as “The physician’s attitudes and actions that demonstrate interest in and respect for the patient that addresses the patient’s concerns and values.  This generally relates to patients’ psychological, social and spiritual domains.”5

While some contend that humanism and professionalism are similar, Dr. Jordan Cohen has distinguished the two as separate concepts.  He defines professionalism as the way of acting, observable behaviors that meet the expectations of patients.  Some examples include competency, confidentiality, and fulfilling responsibilities.  In contrast, humanism is a way of being, including a set of deep seated convictions of others, especially those in need.  Examples include altruism, compassion and respect for others.  In summary, Dr. Cohen states that “Humanism is the passion that animates professionalism.”6

Humanism has many components that are central to the Professionalism Charter.  These include the principles of primacy of patient welfare that embrace altruism and trust, core concepts to the relationship between pediatricians and patients.  The pediatrician’s role in social justice, such as eliminating discrimination within pediatric care is also key to humanism. And the commitment to honesty with patients and enhancing the communication with patients is critical in our role as healers.

The Pediatric Competencies that are most relevant to the concept of humanism include:

  • Patient Care
    • Interview patients/families about the particulars of the medical condition for which they seek care, with specific attention to behavioral, psychosocial, environmental, and family-unit correlates of disease
    • Counsel patients and families
  • Practice-based Learning and Improvement
    • Participate in the education of patients, families, students, residents, and other health professionals
  • Interpersonal and Communication Skills
    • Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds
    • Demonstrate the insight and understanding into emotion and human response to emotion that allow one to appropriately develop and manage human interactions
  • Professionalism
    • Humanism:  Humanism, compassion, integrity and respect for others based on the characteristics of an empathetic practitioner
    • Professionalization: A sense of duty and accountability to patients, society and the profession
    • Professional Conduct: High standards of ethical behavior which includes maintaining appropriate professional boundaries
    • Self- awareness of one’s own knowledge, skill and emotional limitations that leads to appropriate help seeking behaviors
  • Personal and Professional Development
    • Develop the ability to use self-awareness of one’s own knowledge, skills, and emotional limitations that leads to appropriate help-seeking behaviors
    • Use healthy coping mechanisms to respond to stress
    • Practice flexibility and maturity in adjusting to change with the capacity to alter behavior
    • Trustworthiness that makes colleagues feel secure when one is responsible for the care of patients

Behavioral Statements

The components of humanistic practice by physician colleagues and other health professionals listed above provide general goals. It is important to identify specific behaviors or practices that indicate exemplary behavior and those that represent lapses in humanism.

Examples of Exemplary Humanism:

  • Makes humanism into a habit by consistently embracing humanistic practices and values
  • Demonstrates altruism by choosing to prioritize patient needs above his or her own
  • Expresses genuine compassion and empathy during interactions with patients and their families
  • Serves as a role model of integrity and honesty in everyday practice
  • Recognizes and celebrates ways in which each patient is unique, whether due to race, ethnicity, culture, or values
  • Respects the individual needs, preferences, and goals of each patient and family
  • Identifies and validates the perspectives of others in any group dynamic or conflict
  • Accepts his or her own limitations or flaws, viewing them as opportunities for reflection and ongoing improvement
  • Utilizes healthy coping mechanisms to avoid burnout and depression
  • Chooses optimal personal wellness techniques in order to maintain a healthy balance of mind, body, and spirit and to bolster resilience

Examples of Lapses in Humanism:

  • Prioritizes his or her own needs above those of patients
  • Does not offer therapeutic messages or other expressions of empathy or sympathy when the opportunity arises
  • Misses opportunities to provide optimal care/service to patients (e.g. leaving work undone; not following through on new issues; failure to communicate details when transferring care; omissions in documentation)
  • Does not explicitly acknowledge or address important unique aspects of patients, such as race, ethnicity, culture, or values
  • Avoids or poorly manages conflict
  • Makes assumptions, sometimes incorrectly, about the individual needs, preferences, and goals of each patient and family based on previous experiences, stereotypes or other bias (conscious or not)
  • Avoids or does not prioritize reflection such that opportunities for self-improvement are missed
  • Emotionally distances self from patients and their families as evidenced by becoming less responsive to patient and family needs and requests even if continuing to manage some aspects of the patient adequately
  • Treats patients, families or colleagues in a disrespectful, judgemental, inattentive or non-inclusive manner
  • Demonstrates a lapse in forming a therapeutic relationship with a patient or family
  • Does not demonstrate behaviors that sustain personal wellness
  • Demonstrates signs and symptoms consistent with burnout including emotional exhaustion, physical exhaustion and/or depersonalization
  • Demonstrates signs of medical or mental health illness
  • Demonstrates signs and symptoms consistent with depression

Teaching Humanism

The teaching of humanism in medicine is a multi-faceted endeavor.  During medical practice, a trainee engages in human-to-human interactions with a myriad of groups including patients, parents, other family members, physician colleagues, and inter-professional colleagues, to name a few.  Training in humanism enhances the quality of each of these relationships.  Deliberate integration of humanistic principles into the training experience will allow trainees to bring integrity, empathy, altruism, and respect to these interactions.  Ultimately, the trainee’s perspective on him or herself is among the most crucial.  Training in humanism must explicitly address a physician’s self-image to ensure that physicians, in training and beyond, learn to care for themselves as human beings even as they work humanistically with patients and team members.

Several strategies for teaching humanism have been developed and we present two here. Drs. Steve Miller and Hillary Schmidt, suggest that humanism can be taught. In their article, “The Habit of Humanism,” they propose that humanism can be learned and become a reflex or habit.7 They clarify the importance of 3 steps:

  1. Identify multiple perspectives, those of the patient, the patient’s loved ones, and those of the health care provider
  2. Reflect on whether these perspectives converge or conflict
  3. Choose to act altruistically, a choice we have every day

This framework can serve as a road map to enhance pediatricians’ humanism through deliberate reflection on the perspectives of all the stakeholders in an encounter. 

A second model was proposed by Dr. William Branch and this colleagues.5 They emphasize three specific teaching methods to enhance humanism: 

  1. Focus on addressing seminal events
  2. Effective and deliberate role modeling by faculty members
  3. Use of active learning methods

Utilizing a seminal event as a teaching strategy ensures recognition of the event and provides opportunity for debriefing. Debriefing was first developed by the military after soldiers returned from battle.  This allows a forum to discuss the components of the event; review of the decisions that were made while also addressing the emotional response that the event may have triggered.  (Debriefing may be a helpful strategy for Case D below, for example.)  Role modeling is a key concept within humanism.  A quote by Daniel Tosteson best exemplifies this concept: “When I ask an educated person….’What is the most significant experience in your education?’   I almost never get back an idea, but almost always a person”.8

Dr. Branch and colleagues also recommend infusing humanism into the overall learning environment by using active learning methods.  He and his colleagues address the importance of establishing a climate of humanism by helping teams and units to develop a group mission statement, gain skills in communicating bad news, and continue focus on recognizing the patient and his/her perspectives and that of their loved ones. The recognition of perspectives is consonant with Miller and Schmidt’s work.7 The humanistic learning climate ensures that all are treated with respect, work within an atmosphere of trust, and confirms the needs of patients, learners and other disciplines are being met.   The modeling of these behaviors is key to reinforcing the importance of these values and empowering others to emulate them.5

Learning Objectives for the Trainees:

  • Trainees will be able to identify the key elements of humanistic doctoring and describe how humanism relates to professionalism
  • Trainees will articulate the relationship between personal wellness and humanism and will develop strategies to maintain and augment their own wellness during training and beyond
  • Trainees will be able to identify challenges to humanism that arise in the training environment and will develop mechanisms for addressing these challenges.
  • Trainees will develop an individualized wellness plan that will promote resilience in their everyday practice of pediatrics

Vignettes

Reflecting on humanism as it applies to our interactions with colleagues, as distinct from patient care endeavors, is also an essential component of training.  Our duties to our team members are summarized well by the quotation “We have an obligation as educators to share with [colleagues] how we have coped with feelings of anger, anguish, shame or uncertainty in caring for patients.”9 In the natural ebb and flow of one’s career in medicine, each of us will undoubtedly encounter low periods in which we lose hold of the meaning and purpose in our work.  Such situations can lead to burnout or even depression so we must all develop skills in reaching out to colleagues in need or who are suffering.  Below are several cases that can trigger reflection and discussion about our duties to one another.

Chapter 8 Vignettes - Humanism Within Pediatrics

Vignette 1 - Granny knows best?

You’re in the midst of your weekly primary care clinic session.  Your next patient is Alex, a 4 year-old boy with spastic quadriplegia who has struggled with a long series of pneumonias. A recent feeding evaluation indicated a high risk of aspiration with any kind of oral feeding. Upon entering the exam room, you see Alex’s grandmother feeding him pudding.  You tactfully bring up the results of the feeding evaluation to assess the family’s comprehension of the results.  “We understand why the doctors say he’s not supposed to eat,” his grandmother says.  “But Alex loves his food and it makes us happy to feed him.”  As you again explain the risks of feeding Alex by mouth, his grandmother interrupts you and says “Feeding a child is never wrong.”  

Questions for discussion:

  • What might be motivating the different people in this case?  What are the goals of the mother?  Grandmother?  Trainee?  
  • How do these goals come into conflict and how do they complement each other?
  • What, if any, role does culture play in this case?

Vignette 2 - Untruthful subintern

As the attending of record on the inpatient service you decide to observe the evening sign out. The subintern is handing over one of your patients to the resident on call. The resident asks about the drug level sent earlier in the day as the student neglects to pass on those results and they may be important in managing the patient overnight. The student pauses and then says they were normal. You happened to check for that drug level yourself just a few minutes earlier so you could discuss plans for the evening with the team but were told by the lab tech it would not be ready for another half hour. 

Questions for discussion:

  • What factors could be driving the medical student’s behavior?  While this behavior is not acceptable, might there be underlying causes that would influence the team’s reaction to the behavior?
  • How would you approach the medical student?
  • Can you identify characteristics of the training environment that could put strain on a student such that integrity may be compromised?
  • How can we, as supervisors and role models, help students to make the right choices when faced with these dilemmas?  Is simply instructing them to “be honest” going to be sufficient?

Vignette 3 - Privileged intern 

Robert is a PGY-1 intern with whom you are working in continuity clinic.  He was born and raised in a very homogenous, suburban community, which consisted of primarily higher income, white families.  He is now working in a continuity clinic which provides service to mostly low income, minority patients.  Robert frequently will leave the exam room to precept with you, and states that he doesn’t understand why the parent can’t do a better job, whether it is adherence with medications, or being on time for appointments. 

Questions for discussion:

  • What might be an explanation behind Robert’s behavior?  How do his life experiences seem to influence his doctoring?
  • How can you help Robert to have insight into how his attitude is perceived by others?

Vignette 4 - Angry intern

It‘s Monday morning, although you arrived well-rested and refreshed this morning, by the end of rounds your to-do list for the day seems insurmountable, your pager has been incessant, and the familiar feeling of exhaustion returns.  Late that afternoon, you admit a 3 year-old ex-preemie with chronic lung disease who presents with wheezing.  As you take the history, he is screaming and ripping off his oxygen mask, causing his O2 saturation to drop to the high 80’s.  When you approach him, he pushes you away and you are unable to do much of an exam.  You feel absolute fury towards this child.  You truly wish he would shut-up and cooperate so that you wouldn’t have to deal with him.  You also want to yell at the mother to get out of her chair and restrain her son.  Instead, you exit the room as your pager is beeping once again.  

Questions for discussion:

  • How should we respond to patients/families who bring out negative reactions or emotions within us?  What emotions might this trainee be experiencing?
  • How might negative emotions influence our doctoring?  How do we maintain our ability to doctor as we know we should?
  • Why do our relationships with some patients become difficult?

Vignette 5 - Depressed doctor

It is February and you are post-call. Overnight you had a few admissions and transferred one patient to the ICU.  It was not so busy that dinner was impossible, but when other residents invited you to meet them in the cafeteria, you declined.  You were not hungry or interested in being around others.  Rounds are done and you are finishing up your work so that you can go home and sleep.  Your team and attending seem to think you have done a good job overnight, but you think that you could have done better and that your performance was generally mediocre.  This constant sense of mediocrity creates a feeling of sadness in you.  Sometimes you are tearful, especially when sleep-deprived. Even at home, sleep is difficult, and sometimes you’ve been using Ambien that a fellow resident prescribed for you. 

Questions for discussion:

  • Is the trainee in this vignette experiencing depression, burnout, or just the normal stress of training?
  • If this was a trainee in your program, how could you support him or her best?
  • How can this trainee regain a sense of wellness?

Either of the cases above could also be used to stimulate discussion about how we view ourselves as physicians.  Sulmasy writes “All health care professionals are wounded healers.  They cannot escape suffering themselves.  Moments of pain, loneliness, fatigue and sacrifice are intrinsic to the human condition.  The physician or nurse’s own suffering can become the source of compassion in the healer’s art.10 Trainees are so often worried about whether they are performing optimally.  Am I as smart as the others?  As efficient?  As caring?  Do I really have what it takes to be here?  Am I managing my patients well?  Did I make the right decision the other night on call?  This pattern of self-doubt affects many of our most talented trainees and may lurk below a veneer of confidence. 

When trainees are alone, tired, and stressed their negative self-image may dominate unless they are given opportunities to reflect on these emotions and identify skills with which to cope.  Education in humanism can be utilized to develop strategies to preserve a sense of self-efficacy, to help trainees give themselves a break and recognize their good work as doctors.  Sessions dedicated to the trainee as human being allow trainees to realize that their colleagues, whom they deeply respect, are experiencing similar feelings. This realization can be extremely therapeutic.  In addition, through discussion of case vignettes, strategies for confronting self-doubt can be articulated as a group exercise. This additional vignette can also be used to stimulate similar discussion.

Vignette 6 - Dealing with an error

You are beginning your oncology rotation and assuming care for Jordan, a 12 year-old boy status post renal transplant, complicated by chronic rejection and post-transplant lymphoproliferative disease (PTLD).  His course has been complicated and, sadly, he is not expected to live much longer.  He was admitted with febrile neutropenia and has been on ceftazidime.  Today he will be discharged but his antibiotic course must continue at home.  On the day of discharge, you assemble the patient’s discharge paperwork and prescriptions, including the ceftazidime order, before going to clinic.  Your co-resident agrees to discharge Jordan in the afternoon.  A few days later you hear that Jordan was readmitted to the ICU with renal failure and encephalopathy.  It was discovered that his antibiotic was not “renally-dosed.”  Jordan required a couple of needless days in the ICU during his end-of-life period, which was very distressing and frustrating for his family. 

Questions for discussion:

  • How does the clinician integrate this experience?  What strategies might be helpful to “forgive” oneself and to learn from this experience?
  • What factors may contribute to errors beyond the individual trainee?  In the face of an error, should we focus more on “systems issues” or on individual accountability?
  • What is the cumulative effect of medical errors on our doctoring?

Vignette 7 - Complaining colleague

Finally, we present a case that demonstrates an example of how a trainee may be perceived in a certain environment to have strong professionalism attributes, but in other venues may demonstrate depleted humanism. 

It is April and you are serving as a co-supervisory resident with a colleague on the general pediatric inpatient team.  Your colleague is always well dressed, poised, leads rounds effectively and is a role model for communication with patients.  However, in the work room, in the presence of medical students, interns and other residents, she publicly complains.  She ventilates her frustration about patients, their parents, their inability to understand instructions, and tends to make assumptions about parents while stating derogatory stereotypical comments.  Her behavior makes you uncomfortable and you also worry about the impact on the interns, medical students and team morale. 

Questions for discussion:

  • Do you feel it is your responsibility to address this issue?  If you believe so, why?
  • How would you approach the discussion with your co-supervisory resident? 
  • What circumstances might contribute to your colleague reacting in this manner?

Strategies to Maintain Wellness

To maintain a humanistic attitude and demonstrate humanistic behaviors, clinicians across the educational continuum must remain nurtured and resilient.  Teaching humanism, therefore, should entail explicit teaching of wellness strategies for practitioners.  Wellness includes a healthy balance of mind, body and spirit that results in an overall feeling of thriving.  Components of wellness include physical, intellectual, emotional, relationship enhancing and spiritual components.

While rewarding, a career in pediatrics can be stressful. Pediatricians confront emotionally challenging situations such as medical errors, sudden patient decompensation, medical uncertainty and patient death. Over time, the cumulative effect of these stressors take their toll on pediatricians. The rates for depression and burnout are higher in physicians than the general population and the onset often occurs early in training, even as early as medical school.11,12 The rates for depressive symptoms for pediatric residents have been noted to be as high as 20% of residents, while rates of burn out, based on the Maslach scale, range from 25-75%.13,14,15 The components of burn-out which include emotional exhaustion, depersonalization and decreased feelings of personal accomplishment16 can develop due to fatigue, long hours, timing in training, perceived loss of control and other personal factors. Burnout is a critical problem because it affects both pediatric health care providers themselves and the patients for whom they provide care. Burnout can dramatically affect relationships with patients by resulting in a loss of empathy and distancing from patients. This distancing can lead to a vicious cycle: patients experience a sense of abandonment and dissatisfaction with the health care provider’s care juxtaposed with the health care provider feeling a sense of failure by not making the connections with patients which had been one of the most rewarding benefits of their profession. As a result, burnout can lead to career dissatisfaction, social isolation and eventual departure from the career. Those who are burned out may have heightened levels of self- blame from negative outcomes and experience inadequate attention to their personal medical and mental health needs, depression and substance abuse, and most concerning suicide.17, 18, 19, 20

Negative drivers of humanism may prevent the development or maintenance of humanistic behaviors. These include, but are not limited to, poor communication skills, fatigue and exhaustion, inattention or neglect by colleagues or supervisors, a personal sense of isolation, practice in a toxic environment, guilt, repetitive exposure to grief responses, and lack of control over one’s personal or professional life.

To maintain humanistic behaviors and values, the focus must be on the positive drivers of humanism.   These include a deliberate attention and curriculum to enhance communication skills, creation of a nurturing environment that supports colleagues, positive role modeling by colleagues, opportunities for debriefing following sentinel events, time for self reflection and creating a community of caring.

To achieve wellness, identification and implementation of resilience strategies must be deliberate.  Resilience, as noted by Epstein, is to respond to stress in a healthy way, achieving desired professional goals at minimal psychological costs.  Enhancement of resilience empowers individuals to rebound quickly and grow stronger in their approach to emotionally challenging situations.21 This entails a personal and individual journey where one size does not fit all.  A strategy that may work for one individual may not work for someone else.  Trainees should be encouraged to develop an individualized wellness learning plan, a deliberate strategy to commit to wellness strategies that are important to them.   These can be developed and implemented in a similar way to their individualized learning plans. 

The following table summarizes both short term or “in the moment” strategies along with long term resilience strategies to maintain wellness.   Short term strategies include those that can be implemented immediately when faced with a challenging or frustrating encounter and one is striving to maintain humanistic behaviors.  The development of strong personal insight in understanding your own reactions and ways to adapt to the situation quickly are paramount.  Strategies to help you think on your feet and de-escalate situations allows you to remain present during the encounter or know when it is prudent to excuse yourself. (See Table 1) 

Table 1: Short-term and long-term strategies to preserve trainee wellness

Short-Term Strategies Long-Term Strategies
  • Take deep breaths and refocus
  • Remain present and listen well
  • De-escalate the situation
  • Excuse yourself, step away from the situation
  • Splash water on your face
  • Share the experience with a trusted friend of colleague
  • Gather opinions of others about how to respond to the stressor
  • Get fresh air
  • Listen to music
  • Mindfulness meditation
  • Occupational
    • Develop self-awareness of how you respond to strong emotions
    • Maintain healthy professional boundaries
    • Cultivate the ability to say “no”
    • Reflect on the meaning of one’s work and continually seek out reminders of that meaning
    • Ask reflective questions like “What surprised you today? What inspired you today?”
    • Celebrate the successes in work
    • Maintain a sense of humor
    • Create rituals to release the tension of the day (eg: listening to music on the way home, taking a shower after work, exercise)
  • Emotional/Cognitive strategies
    • Take time to grieve losses
    • Allow emotional “process” time using mediation, journaling, debriefing
    • Regularly self-assess for signs of stress or frustration
    • Mindfulness meditation
  • Relationships with others
    • Develop a family within the workplace
    • Acknowledge that colleagues may be suffering
    • Have your “go to” person to share experiences
    • Work towards a community of caring
  • Spiritual strategies
    • Religious beliefs and faith may provide comfort for some
    • Take solace in the medical field as an endeavor greater or more important than any one individual
  • Attention to self-care
    • See a physician to attend to medical needs
    • Ensure access to mental health professionals as needed
    • Encourage sleep hygiene, nutrition, exercise
    • Take time for vacation/spend time in nature
    • Pursue hobbies, activities outside of work to clear the mind

 

We suggest that learners across the educational continuum take an active role in developing their individualized wellness learning plan. This is relevant whether you are just starting out in your training in medical school or have practiced for decades. By identifying your individual resilience strategies you can make a deliberate effort to adapt them and thrive within your career.

Assessment Tools

Another way to focus on humanism during the training experience is to include humanism during trainee assessment.  The Pediatric Milestone Project, to emphasize humanism, created a Professionalism sub-competency labeled “Humanism, compassion, integrity, and respect for others.”22 As a trainee matures into an independent practitioner, he or she develops from the novice stage, characterized by “[Seeing] the patients in a ‘we versus they’ framework... detached and not sensitive to the human needs of the patient and family” to more advanced performance which includes altruistically going “beyond responding to expressed needs of patients and families” and engaging in advocacy.22Values and characteristics inherent to humanistic practice may also be assessed using a variety of established and published scales (Table 2).  Educators interested in including these scales into their program’s system of assessment should do so with formative intent.  None of these instruments are intended for high-stakes evaluation.  They can, on the other hand, be valuable sources of data to identify trainees in need of additional support, whose demonstration of humanistic behavior is challenging for them.

Table 2: Examples of Established Instruments Measuring Component of Humanism

Instrument Name Definition
Maslach Burnout Inventory The most widely used research measure in the burnout field.  Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment which can include negative, cynical attitudes and dehumanized perception of others.  A short version of the scale, including 7 items, was published in 2005.23
Resilience Scale The Resilience Scale is a self report measure of an individual’s ability to respond to adversity. The 26 item version reflects five core characteristics of resilience: perseverance, equanimity, meaningfulness, self reliance and existential aloneness.24
Jefferson Scale of Physician Empathy A 20-item self-assessment with well-established psychometric properties.The scale has demonstrated reliability and validity and all items are relevant to the measure of empathy, a key component of humanism.  An alternate version exists for patients to complete about their provider.25,26
 
Tolerance of Ambiguity Scale Ambiguity can derive from novelty, complexity, and confronting problems which are difficult to solve.  The construct speaks to an individual’s ability to cope with uncertainty and risk. Individuals vary in their tolerance for ambiguity which may influence both cognitive and emotional functioning.  Numerous scales exist to measure tolerance of ambiguity.27
Patient-Practitioner Orientation Scale

An 18-item scale that distinguishes physicians focused primarily on the provider’s needs and the medical problem or condition at hand from those focused on the patient and cultivating a relationship in which the patient shares in decision-making.28

 

Summary

Cultivating humanism is an inherent part of our profession and an integral aspect of pediatric residency training.  The Pediatric Milestone Project has highlighted sub-competencies relevant to humanism.  While included under the umbrella of professionalism, humanism encompasses some distinct concepts such as a focus on altruism, compassion and respect for others.    Strategies for teaching and enhancing humanism exist and programmatic adoption is key along with supporting trainee reflection on experiences.  Creation by trainees of an individualized wellness plan allows them to identify and prioritize the wellness strategies most valuable to their personal and professional lives.  Validated measures of humanism exist and can be implemented in a formative way into training programs.

References

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  27. Furnham A and Marks J. Tolerance of Ambiguity: A Review of the Recent Literature.  Psychology. 2013; 4(9): 717-28.
  28. Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction.  Patient Educ Couns. 2000 Jan; 39(1):49-59.

Additional Resources

  • Jones SH.  A self-care plan for hospice workers. Am J of Hospice and Palliative Medicine. 2005;22:125-128.
  • Kesselheim J , Garvey K, Sectish T, Vinci R. Fostering humanism and professionalism in pediatric residency training. MedEdPORTAL; 2010. Available from: http://services.aamc.org/30/mededportal/servlet/s/segment/mededportal/? subid=7906
  • Ludwig S. The Joseph W. St. Geme Jr. Lecture: Striving for Polygamy”. Pediatrics. 2011;127:358-362.
  • Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Intern Med. 1990; 150:1857-1861.Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. The Am J Med. 2003;14:513-519.
  • Wagnild GW. 2009. The resilience scale user’s guide. Worden, MT: The Resilience Centre.
  • Weiner EL, Swain GR, Wolf B, Gottlieb M. A qualitative study of physicians’ own wellness-promotion practices. West J Med. 2001;174:19-23.

 

Index of Pediatric Competencies addressed by learning activities:

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