Compassionate Care Curriculum

Where is the Caring in Clinical Assessment?

Our AMS project started off with the premise: if assessment drives learning and we want to foster compassion in clinicians, then why don’t we assess compassionate care during medical school?  Inspired by our research project, this blog playfully explores different views on whether caring actually is in the current medical school curriculum, whether it can be taught or assessed and whether it belongs in the curriculum.

Caricatures (simplified and exaggerated versions) of viewpoints that are actually very complex are presented to open up a dialogue about caring in the curriculum by considering the underpinning views that inform the different positions.  Faculty members are unlikely to fit squarely into one of the four positions imagined below.

The (Imagined) Viewpoints

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So where do we go from here?

Arguably, Ardent Assessors are stuck in their traditional assessment ways. CanMEDS champions argue that Ardent Assessors have reduced caring and compassion down to checklist items, ignoring important elements of medical training, with potential undesirable effects. However, the strength of Ardent Assessors is in knowing exactly what they’re testing and ensuring that exams are reliable and valid. This makes psychometrician types feel all warm and fuzzy inside.

Conceivably, the CanMEDS Champions reassure themselves that most medical students are inherently caring and that caring permeates the curriculum. These assumptions could create a situation in which caring is assumed to be everywhere and ends up being nowhere, and that medical students do not need specific training in caring because they have been selected because they are caring. Ardent Assessors ask CanMEDS Champions, where exactly are we assessing caring in the curriculum?  Are we doing it reliably?

Nevertheless, the Nature Enthusiasts assume it’s a waste of time to teach and assess caring anyway, arguing that students are either born with a caring nature or they are not. No amount of training or assessment will change that, so why bother? All we can do is try to select the right people into the program and try to exclude the ones who are good at faking it.

The Transformers dream about radical changes to our model of medical education.  In their utopia, a behaviourist model of education where behaviours and actions are incentivised by a reward system are replaced by an inspiring education system in which students orientations are transformed through participation, dialogue and critical reflection. The Skills, Knowledge and Professionalism model upon which many assessment programs are based would be radically transformed. Ardent Assessors would be left bewildered at how such a system would be delivered and how it could ever ensure assessment standards. CanMEDS Champions would argue that their framework already incorporates caring, so why is such a radical change needed?  The Nature Enthusiasts would say, why bother?  Now, what do you say about it all?

About the author

Sarah Wright

Dr. Sarah Wright is a Research Scientist at Toronto East General Hospital an Assistant Professor, DFCM, University of Toronto and an Education Scientist, Centre for Ambulatory Care Education.

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