Chapter 14: Teaching about Emotions in Healthcare

INTRODUCTION

Clinicians often partake in patients’ most vulnerable moments, such as receiving difficult news or coping with how an illness affects “patients’ lives”. Therefore, clinicians carry the responsibility of both recognizing and handling the emotions elicited by those experiences, skills that we typically do not learn explicitly and that do not always come naturally. Teaching these skills effectively requires expertise and patience, in addition to self-awareness.

Research shows that clinicians often deprioritize responding to emotion in favor of more concrete skills such as history taking or venipuncture.¹ Educators must consider recognizing and responding to emotion as critical communication skills similar in importance to traditional technical skills. We will first describe some of the core educational theories that support successful skill development in recognizing and handling emotions, and then we will enumerate effective teaching techniques. We have included both guidance from evidence-based approaches to education, as well as our collective experience teaching communication skills to health professions learners for more than 40 years.

OVERVIEW OF LEARNING THEORY

Why do medical students balk at the notion of mandatory attendance to lectures they could watch on YouTube? Why do smartphone apps and other social media videos resonate so much with so many? How can one learn from these various experiences? Andragogy, or adult learning theory, stresses the importance of tapping into prior experiences in order for learning to be achieved.² It is through these experiences that learners determine whether content is meaningful or irrelevant. Effective training must not only be learner-centered but also skills-focused, oriented to one’s own practice.³ In addition, efficacy of communication skills training depends on the degree of active and interactive strategies, namely, role-play, feedback, and small group discussions that provide and build off learner experiences, rather than didactic sessions.⁴ Moreover, “learner-centered” instructional techniques value formation of learner–educator relationships, address unique learner needs, and parallel what occurs in patient–clinician relationships.^2,5,6 In order to learn effectively from experiences, one must trust the support of others and have a sense of confidence in one’s abilities. Otherwise, fear, manifesting through behaviors and emotions such as perfectionism or anger, can block learning.⁷

In addition to positive perceptions of learning, situated learning posits that learners learn more effectively if they can envision application to relevant practice settings.⁸ A common example of situated learning is case-based learning, where familiar materials and presentation structures lend accessible context. If groups of participants share a learning experience, this situated learning can generalize to interactions in a social network. Social Cognitive Theory, developed by psychologist Albert Bandura, affirms that humans learn most behaviors through observation, imitation, and/or modeling of social interactions.⁹ Particularly relevant in adult learning, social cognitive theory takes into account both the learner and the environment in which they operate, stressing the importance of context as well as how learners interface in their environments.¹⁰