Letters to the Editor
Drs. Artino and Durning have made thoughtful observations regarding the role of emotions in educating medical students. Their first assertion—that little is known about the role played by emotions in medical education—is easily verified, as a literature search yields little that is helpful. They are also correct that well-designed studies are needed to explore this concept. It will probably take a series of studies, as the number of variables and confounders will be considerable.
The investigators in these studies will need to be very careful from a methodologic standpoint. One of the few things we know with some certainty is that all students learn differently, and what “activates” one learner may drive away another. If such studies are planned, they will need to be done with the full rigor of a clinical trial. By that, I mean they will need IRB approval and informed consent, as the potential for negative consequences is real.
I would prefer to see more research along the lines of optimizing learning climate. Why flirt with disaster by provoking negative emotions, whether activating or deactivating, when so much needs to be done in a positive direction? In clinical medicine, situations are so obviously stressful that we don't need to artificially add to them. Ask the students about their experiences in the emergency department, on an intensive care unit rotation, or in the operating room. One quickly learns that they're experiencing many first-time events. Indeed, we know that the majority of medical students experience traumatic events.1 Watch a simulator session on cardiopulmonary resuscitation and see if anyone is cavalier about the experience. Students and residents understand the stakes they are dealing with in clinical medicine.
In spite of recent changes, such as duty hours restrictions, medical students continue to experience burnout, fatigue, and depression at unacceptable rates. When I discussed these issues with my current students, they characterized several of their colleagues as “hanging by a thread.” We should use our resources to improve the learning climate as an approach to optimizing their learning. Let's push for rigorous studies of emotions and student learning, but our interventions should keep in mind the concept of Primum non nocere (First, do no harm).
D. Michael Elnicki, MD
Professor and chief, Section of General Internal Medicine, UPMC Shadyside, University of Pittsburgh, Pittsburgh, Pennsylvania; firstname.lastname@example.org.