Being vulnerable, a qualitative inquiry of physician touch in medical education

Martina Kelly*, Lara Nixon, Tom Rosenal, Lindsay Crowshoe, Adrian Harvey, Wendy Tink, Tim Dornan

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose
Effective nonverbal communication is associated with empathic behavior and improved patient outcomes. Touch, as a form of non-verbal 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 this 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 eight times between 2015-2018 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 engaged with 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 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-modelling 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, promoting dialogue about its complexity could promote a more balanced understanding of touch and its potential to convey empathy as well as more effectively manage risk.
Original languageEnglish
JournalAcademic Medicine
Publication statusAccepted - 08 Jan 2020

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physician
non-verbal communication
education
experience
empathy
phenomenology
role play
communication skills
teaching practice
action research
recording
dialogue
educator
anxiety
narrative
curriculum
interpretation
gender
learning

Cite this

Kelly, M., Nixon, L., Rosenal, T., Crowshoe, L., Harvey, A., Tink, W., & Dornan, T. (Accepted/In press). Being vulnerable, a qualitative inquiry of physician touch in medical education. Academic Medicine.
Kelly, Martina ; Nixon, Lara ; Rosenal, Tom ; Crowshoe, Lindsay ; Harvey, Adrian ; Tink, Wendy ; Dornan, Tim. / Being vulnerable, a qualitative inquiry of physician touch in medical education. In: Academic Medicine. 2020.
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abstract = "PurposeEffective nonverbal communication is associated with empathic behavior and improved patient outcomes. Touch, as a form of non-verbal 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 this could inform communication skills curricula.MethodCollaborative inquiry, a form of action research, was used. Six experienced physician educators from the University of Calgary met eight times between 2015-2018 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 engaged with 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 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-modelling and clinical debriefs were suggested as ways to encourage situational awareness and sensitive use of touch. ConclusionsTouch is a powerful means to communicate with patients but is highly subjective. Rather than avoiding touch for fear of misinterpretation, promoting dialogue about its complexity could promote a more balanced understanding of touch and its potential to convey empathy as well as more effectively manage risk.",
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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.

Being vulnerable, a qualitative inquiry of physician touch in medical education. / Kelly, Martina; Nixon, Lara; Rosenal, Tom; Crowshoe, Lindsay; Harvey, Adrian; Tink, Wendy; Dornan, Tim.

In: Academic Medicine, 08.01.2020.

Research output: Contribution to journalArticle

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T1 - Being vulnerable, a qualitative inquiry of physician touch in medical education

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AU - Nixon, Lara

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N2 - PurposeEffective nonverbal communication is associated with empathic behavior and improved patient outcomes. Touch, as a form of non-verbal 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 this could inform communication skills curricula.MethodCollaborative inquiry, a form of action research, was used. Six experienced physician educators from the University of Calgary met eight times between 2015-2018 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 engaged with 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 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-modelling and clinical debriefs were suggested as ways to encourage situational awareness and sensitive use of touch. ConclusionsTouch is a powerful means to communicate with patients but is highly subjective. Rather than avoiding touch for fear of misinterpretation, promoting dialogue about its complexity could promote a more balanced understanding of touch and its potential to convey empathy as well as more effectively manage risk.

AB - PurposeEffective nonverbal communication is associated with empathic behavior and improved patient outcomes. Touch, as a form of non-verbal 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 this could inform communication skills curricula.MethodCollaborative inquiry, a form of action research, was used. Six experienced physician educators from the University of Calgary met eight times between 2015-2018 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 engaged with 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 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-modelling and clinical debriefs were suggested as ways to encourage situational awareness and sensitive use of touch. ConclusionsTouch is a powerful means to communicate with patients but is highly subjective. Rather than avoiding touch for fear of misinterpretation, promoting dialogue about its complexity could promote a more balanced understanding of touch and its potential to convey empathy as well as more effectively manage risk.

M3 - Article

JO - Academic Medicine

JF - Academic Medicine

SN - 1040-2446

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Kelly M, Nixon L, Rosenal T, Crowshoe L, Harvey A, Tink W et al. Being vulnerable, a qualitative inquiry of physician touch in medical education. Academic Medicine. 2020 Jan 8.