2020 Capstone Projects
Charlotte Adema - System Provider, Patient Influence on Birth Outcomes in the U.S.
The United States is ranked forty-six in maternal mortality rate, despite spending more on healthcare than any other country. The high rate of maternal mortality in the United States is a multi-factorial issue due to lack of access to proper medical care, structural shortcomings of the healthcare system, and racism. Major disparities exist in maternal mortality rate. Black women in the United States are 3-4 times more likely to die of pregnancy complications than their white counterparts. Even after taking into account factors such as education and income, these disparities are present. In order to combat this issue, many researchers have turned to the science of compassion for solutions. Compassion was once criticized as a “soft science” without any scientific basis. However, over the last two decades, revolutionary research has shown us that compassion is a “hard science” rooted in biology, neuroscience, and psychology. The science of compassion has laid the groundwork in studying racial implicit biases in the medical field. This paper will examine disparities in maternal mortality rate and describe possible solutions rooted in the science of compassion: mindfulness and the loving-kindness meditation.
Margaret Bielski - Attachment Theory in Children: an overview of the manifestation of the four attachment styles and how pediatricians can be compassionate to children experiencing each of these
First identified by Bowlby in 1988, Attachment theory is an area of psychology that describes the nature of emotional attachment between humans. It describes how the attachment style that people develop in their childhood can affect their comfort level around vulnerability. One important relationship affected by this is the physician-patient relationship. Physicians must be aware of both their own attachment style and that of their patients in order to provide the best possible care. It is important to know not only what attachment style a patient has, but also how, based on age and experience, that might manifest itself. This paper aimed to look at attachment theory through a pediatrician’s lens and make a statement about both how attachment styles manifest at different ages and how pediatricians can compassionately engage with these individuals so that they receive the best care.
Literature often distinguishes between the different attachment styles by noting the level of anxiety and avoidance that individuals experience. Anxiety here is defined as one’s fear of abandonment and insecurity in a relationship. One high in anxiety may often worry that their partner or parent will leave them. Avoidance is classified as one’s comfort with depending on others and becoming close with them. Those who are securely attached experience low anxiety and low avoidance. Individuals experiencing a preoccupied attachment style have high anxiety and low avoidance. Meanwhile, those with an avoidant attachment style score high in avoidance and low in anxiety, and those with a disorganized attachment style experience both high anxiety and avoidance.
Interacting with all of these patients first requires the establishment of trust between the physician and the patient. The manifestation and timeline of this, however, is what varies based on age and experience. For example, a young child with a preoccupied attachment may be older than most children before he/she feels comfortable interacting with his/her physician. Likewise, a teenager with avoidant attachment may be more likely to withhold vital information in an attempt to maintain independence. Being aware of these tendencies as well as the thoughts and experiences that form them can allow pediatricians to respond appropriately and interact more compassionately with patients. This combined with a personal understanding of one’s own attachment style can help the pediatrician to slowly build a trusting and secure relationship with patients. In the long term, this will help the physician better connect with patients and ultimately better both patient satisfaction and medical outcomes.
Ricardo Boshetti - Identifying and Addressing the Sources of Trauma and Stress in Physicians
Physicians worldwide are highly regarded for many reasons—not only does their work require an immense amount of dedication and training, but it also demands social skills and an ability to process and regulate emotions on a day-to-day basis. However, they are not immune to the stressors that come with the job. Physicians are often times barraged with grim scenes that the average person would normally not be exposed to: from first responders resuscitating a victim of a car crash on the scene, to an oncologist having to tell a family that their loved one passed away from cancer, or a surgeon practicing in an underserved area that might not be able to give the patient adequate care due to insufficient resources. Constant exposure to unordinary, shocking, and traumatic events like these can lead to physician burnout and Post-Traumatic Stress Disorder (PTSD). Validating emotions has wrongfully been forbidden in the medical culture for a long time now, and there are many unfortunate consequences as a result. Not only must we exhort our physicians and the wider community to validate the grief that occasionally comes with the job, but we must also teach them to practice with a balanced compassionate caring mindset—which will lead to far better emotional and physical outcomes for both the patient and the physician and can reduce the vicarious trauma that our doctors might experience on a day-to-day basis. Furthermore, we should invest in making sure that our doctors have the necessary skill set to adequately respond to the wide array of emotions that patients might throw at them, particularly those of anger. There are also multiple problems with the status quo of the U.S. healthcare system and its components, which might be aggravating the trauma and stress that physicians face. This research paper explores the modern-day culture surrounding emotional trauma and stress in the medical profession, the many ways in which PTSD and burnout can be triggered in a physician’s practice, and the ways in which our doctors can healthily respond to—and possibly even avoid—these stressors.
Brendan Fitzpatrick - The Compensation of Compassion: Building Models to Incentivize Compassionate Health Care
Physician compensation plays a large role in how health care is ultimately delivered to consumers, yet this relationship is still poorly understood. Financial incentives have become closely integrated with physician decision-making without a full ethical assessment of the potential consequences of such conflicts of interest. Evidence suggests that there is a significant correlation between clinician financial reimbursement and the volume of care provided. In the United States, compensation comes in two main forms: fee-for-service, the predominant method, and value-based compensation, the method of the future. There is an undeniable shift in the United States towards value-based reimbursement, however current measures of performance in these systems leave much to be desired. Any successful future method of physician compensation will align the provider’s internal motivation to relieve suffering in their patients with financial gain. Although this fact is obvious, this research will show why this has not been attained yet in the United States, and what future success may look like.
Noel FioRito - The Role of Compassionate Caring in Pediatrics
When clinicians practice medicine with a compassionate mindset they should center their efforts to help patients on a desire to relieve their biological, physical, and psychological suffering. Using the biopsychosocial model of health care clinicians can understand that biological disease to also include psychological and social suffering. All three of these areas interact to affect patient’s overall health thus necessitating a physician to respond compassionately to more than simply treating the patient’s illness. Empathetically responding to suffering is imperative in all areas of healthcare but in specialties such as pediatrics, the treatment of children and adolescents, there are special circumstances and considerations which clinicians must adapt to. When treating children medical professionals must navigate the needs of their patients with constantly changing development while simultaneously addressing the needs of the parents and guardians who serve as the advocates for their children. These factors can lead to emotions running high in clinics and medical professionals needing to be even more aware of the compassionate care they are providing. Here, providing effective compassionate care will involve a delicate balance between caring for children and caring for their families. By exploring a general understanding of compassionately building trusting relationships, discussing some of the specifics of pediatric care, and becoming aware of the barriers to compassionate care, readers can begin to understand the important role scientific compassionate care has in pediatric healthcare. By building a fundamental understanding clinician can learn and continually improve their compassion skills. In the end, healing children with a compassionate mindset will improve the healthcare experience for the patients, their families, and the clinicians who work in healthcare. Under such a model, everyone is united in a common goal of healing.
Erica Gerstbauer - Compassion in Working with the Incommunicable in the Healthcare Setting
Communication between a physician and his or her patient is an increasingly well-studied area of medicine as society begins to recognize its worth as a part of the healthcare system. While the progress being made in this field is significant, most of the research being done is only applicable to patients with a typical capacity for understanding, excluding those who lack this capacity, termed “incommunicable”, such as children, the intellectually disabled, and dementia patients. This paper seeks to gather information on how these groups of individuals communicate, unify this information, and apply it to a healthcare setting. The interaction between a typical patient and his or her physician is covered and contrasted with how a dialogue between a physician and an incommunicable patient should be formed. In this regard, the physician should pay particular attention to alleviating the stress and anxiety of the patients so that even when they are unaware of the details of their situation, they can still understand that they are safe. There will often naturally be some forms of resistance to the actions of the physician during the healthcare process, so methods of handling these situations while giving the patient proper respect are also covered. This includes methods for determining whether or not patients have the capacity to make medical decisions for themselves. Lastly, approaches for continuing this communication in a domestic setting are also included, since healthcare expands beyond the clinic or hospital and into the home. In addressing these topics, this paper hopes to fill in some of the gaps in healthcare communication until research of this nature can conducted explicitly for incommunicable patient populations.
Taylor Guth - Effective Physician Communication Styles and Techniques in Working with Eating Disorder Patients
Current literature has demonstrated that many primary care physicians are reluctant to work with psychiatric patients due to lack of confidence and competence with psychiatric skills, among other factors. It is crucial to equip primary care physicians with the techniques needed to deliver efficient care to patients with a mental component to their illness. This is particularly important when treating patients suffering from eating disorders, as they are multi-dimensional illnesses that have proven to be difficult to treat in clinical settings due to their intense psychological component. This paper provides a comprehensive overview of the anorexia and bulimia nervosa –two of the most prevalent eating disorders and explores several different communication techniques that physicians can utilize during treatment. Specific strategies analyzed by this paper include use of empathy and empathic response, use of a compassion mindset and compassion-based practices, and motivational interviewing. The paper demonstrates how empathic responding can be used to connect with patients on an emotional level and increase emotional awareness in those suffering from anorexia and bulimia. Additionally, use of a compassion mindset by a physician increases patient levels of self-compassion, which reduces eating-disorder behaviors and negative body image associated with anorexia. Finally, research on motivational interviewing shows its ability to enhance patient motivation to change, leading to increased patient adherence and completion of eating-disorder treatment programs.The benefit of these communication styles and counseling skills is that they do not require extensive training in order for physicians to use them effectively. Therefore, physicians at any level of medical education can adopt these techniques and incorporate them into their medical practice.In doing so, the aim is to increase confidence in physicians and decrease their reluctance to interacting with eating disorder patients. Ultimately, this will allow physicians to administer a high level of compassionate care.
Meaghan Hayes - Cultivating Compassion and Reducing it Fatigue: The Power of Mindfulness and Meditation
High quality healthcare requires the practice of medicine to be centered around compassion. It is beneficial to both the patient and clinician. Compassion satisfaction is the positive feelings one derives from being able to help others in an effective way and it serves as a buffer against compassion fatigue, which results from burnout in the workplace as well as secondary traumatic stress. Given the unique nature of the profession, nurses are particularly susceptible to compassion fatigue and within nursing, those who work in the field of oncology can be especially at risk. When an individual empathizes with another, this can lead to either empathic distress or compassion. Meditation improves an individual's ability to regulate emotional responses and decrease stress, which helps prevent the empathic distress response. Meditation training has been shown to change brain activity in a way that increases compassion satisfaction and reduces the symptoms of compassion fatigue. In nursing practice, mindfulness and compassion meditation training programs have reduced burnout, stress, depersonalization, over-identification and emotional exhaustion. These programs have simultaneously increased mindfulness, non-reacting, observing, and non-judging. Nurses have learned and implemented better self-care techniques into their daily lives and studies have shown that the impact of these programs is long-term. Compassionate care is crucial and trainable. Mindfulness and compassion meditation have proven to be effective techniques for helping prevent compassion fatigue while increasing compassion satisfaction. The healthcare field is in desperate need of solutions for the burnout and secondary traumatic stress that clinicians are experiencing at alarming rates. The implementation of meditation training programs is a potential solution to this critical issue.
Madeleine Heyn - Implementing the Science of Compassion in the Navigation of Pediatric Patient Death
A child’s death is an unnatural and emotionally distressing incident, yet it is an unfortunate reality for many. The incidence of life-threatening conditions and death in pediatric patients is still devastating for health care professionals (HCPs) that work with and treat children every day.Treating a terminally ill child requires knowledge on a multitude of tasks including palliative care processes, communication with the patient and family, and bereavement for HCPs and the family. Exploration of this topic has shown that the practices that have been used in healthcare in the past are not the most beneficial in navigating end-of-life events. The process of working with children who have a life-threatening illness is a contributor to HCP's burnout rates and grief reactions. Research demonstrates that there is inadequate training and information provided to HCPs that work in this field. This leaves the HCPs especially vulnerable to the negative emotional, cognitive, and physical reactions they may undergo. The science of compassion indicates possible ameliorations of this process as well as techniques to mitigate detrimental effects. This paper employs the science of compassion through the Model of Balanced Compassionate Caring, the Clinician Compassion Mindset Process, and information on self-compassion, spirituality, and teamwork. The science of compassion has been utilized in studies on pediatric death and training processes, even if the studies do not explicitly state its use due to the relatively recent growth of compassion science. The information that compassion science can provide should be combined into a formal or informal training program to better serve the HCPs in the navigation of pediatric patient death.
Ingrid Hirte - Shared Decision-Making: The Underlying Science of Compassion and its Impact on Healthcare
In the past twenty-five years,there has been a shift in healthcare away from a paternalistic style of medicine to a more patient-centered approach. This evolution into patient-centric care resulted in large part due to patient dissatisfaction with loss of autonomy and the ready access to online health and illness information. Shared decision-making is a relatively new approach being utilized in many areas of the healthcare field in order to work collaboratively with patients in their healthcare decisions. This approach recognizes that patients are individuals who, although they might not have the same level of medical knowledge as the clinicians, have the right to help make decisions regarding their care. Although this approach requires the clinician to spend more time upfront with the patient to understand the patient’s goals and values, it ultimately saves time in the long run because of proper communication from the beginning which can prevent later misunderstandings. In order for shared decision-making to be effective in practice, clinicians must successfully navigate through the Clinician Compassion Mindset Process and ought to have an understanding of the implications of the Polyvagal theory on their interactions. A large component of shared decision-making relies on the strength of communication between the clinician and patient such that the two can work together to resolve questions and concerns and decide on a course of treatment. Compassion is a crucial element of shared decision-making because the clinician must recognize and be moved by the patient’s potential suffering in order to respond in a compassionate manner. The very foundation of shared decision-making is built on compassion in that the clinician must put the needs of the patient first, desire the wellbeing of the patient and take the time to truly care about the patient’s situation.The benefits associated with shared decision-making include increased patient and clinician satisfaction, improved treatment outcomes and improved financial and operational efficiency.In an era of healthcare that is experiencing increased emphasis on patient autonomy, shared decision-making has become more prominent and will continue to do so because of its fundamental nature of placing the patient at the center of care.
Haley Kempf - A Biopsychosocial Approach to Intractible Epilepsy
Managing seizures for patients with intractable epilepsy is extremely complex. Thus, in order to provide effective treatments, it is important to understand the historical progression of the scientific community’s understanding of the etiology and proper management of epilepsy. With recent advances, the world has become infatuated with the possibility of addressing all health problems using the scientific biomedical approach. However, this approach fails to acknowledge the complex interplay of biology, psychology, and sociology which gives rise to many diseases including intractable epilepsy. It is evident that pharmacological, dietary, and surgical treatments appear to improve patient outcomes; however, with rising rates of comorbidities in epileptic patients such as mood disorders, it is clear that one dimensional interventions are not good enough. Exploration of the biopsychosocial model reveals that the best results are seen when patients receive attention in each of these areas. The biopsychosocial framework provides patients with more holistic care which ultimately leads to more lasting improvements in health and overall quality of life. Thus, greater attention should be given to holistic approaches such as mindfulness, relaxation techniques, and biofeedback.
Hannah Koechley - The Role of Cultural Competency, the Clinician Compassion Mindset, and the Polyvagal Theory in Providing Compassionate Care in Native American Patients
Native Americans are an often underrepresented and misunderstood minority in our society, and the resulting stigmatization and discrimination American Indians face often seeps into their medical interactions with non-Native physicians. As a result, non-Native physicians have a duty to learn how to provide compassionate care to these patients and to learn why compassionate care is vital for true healing to take place in the medical interaction. The purpose of this paper is to, firstly, explain the scientific basis and importance of compassionate care in medicine by providing a thorough description, analysis, and application of the Polyvagal Theory and Clinician Compassion Mindset to the patient-physician relationship. Additionally, the historical mistrust of white, non-Native physicians by Native American patients will be established through stories and explanations of the history of trauma Native peoples have faced, the resulting intergenerational trauma, and other common health issues faced by American Indians in modern society. Lastly, the relevance and importance of physicians’ cultural competency in compassionate care will be discussed, with a focused emphasis on understanding traditional healing and effective verbal and nonverbal communication skills. This research serves a dual purpose: to open the eyes of medical professionals to the discrimination against Native peoples that is sadly rampant in our Western medicine healthcare system, and to educate medical professionals so that they are better equipped to adopt thought processes and behaviors that promote compassionate care. The overall aim of this paper, then, is to enable non-Native American physicians to be better scientifically informed and culturally aware in order to provide compassionate care to Native American patients.
Kyla Kosidowski - The Clinician Compassion Mindset and Implications of Burnout in Pediatric Surgery
The clinician compassion mindset process is “a specific mental and motivational state which organizes the clinician’s thoughts, feelings, and actions in a particular manner” (Vachon, 106). Compassion, therefore, is central to all aspects of a clinician’s response to patients. The following capstone discusses each stage of the clinician compassion mindset process in detail, applying each stage to the duties of pediatric surgeons and highlighting key difficulties those in the specialty may encounter. I have included reflections on my time shadowing various pediatric surgeons both in the operating room and clinic. I have made observations of their interactions with patients, applying them to the clinician compassion mindset process. The clinician compassion mindset process begins with noticing the suffering or vulnerability of the patient. From this stage of the clinician compassion mindset process, one can progress through the bottom-up and top-down processing stages, both of which will be discussed in detail. If compassion mindset failure occurs at any stage, compassion reset and recovery is attainable. This capstone also discusses the factors contributing to burnout in pediatric surgery. These contributors to burnout are related to specific stages of compassion mindset failure. Furthermore, this capstone contains an explanation of various measures a clinician may pursue to sustain the compassion mindset in light of daily stressors, difficult cases, and burnout.
Madelyn LaBar - compassionate Caring and Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) impacts many children and families in the United States and around the world. Around 1 in 54 children in the U.S. are diagnosed with ASD, which has symptoms of social difficulties such as difficulty using facial expressions or voice tone as well as difficulty understanding the intentions and emotions of others. Since the prevalence of ASD is so high, likelihood of primary care physician contact with patients with ASD is also very high, although many of these physicians report having little training with this patient population. In this paper I discuss how physicians can express compassion toward patients with ASD and their caregivers. I describe the importance of physicians expressing compassion in a way their patients can understand, which for patients with ASD may including dimming bright lights, turning off loud sounds, motivating with treats, or thoroughly explaining medical procedures. I discuss possible changes to the curriculum of health care professionals which could expose these professionals to ASD early in training, so they are better equipped to provide compassionate health care for patients with ASD later in their practice. I also discuss difficulties of persons who act as caregivers for patients with autism, and how physicians may show compassion to caregivers by acknowledging the stigma and economic burden associated with ASD and providing emotional support to caregivers. Lastly, I discuss how a physician’s introduction of compassion-focused therapy for patients with autism (equine therapy, imitation dance, theory of mind training) is a way for physicians to show compassion to their patients by alleviating social difficulties associated with ASD.
Erin McBride - Surgical Culture and Its Influence on Surgeon Emotions and Coping Mechanisms
The surgical culture, developed and passed on over many generations, has a “hidden curriculum” on how a surgeon is expected to behave and display emotions. In this paper, I will explore how this culture influences a surgeons’ emotions, how they express their emotions, and the coping mechanisms for challenges and complications experienced. By using the zone of balanced compassionate caring, surgeons must extremely regulate their emotions, particularly during surgery, in order to focus on the very technical task that they are performing. This is a difficult task that surgeons develop over time through practice. In addition, surgeons experience burnout more than any other specialty. This high rate of burnout is largely due to this hidden curriculum, including working long hours, increased work-related stress and work-home issues, anxiety about complications, and many other stresses. Surgeon well-being can be improved by training surgeons to have stronger mental skills. For example, surgeons should be taught to use mental rehearsal and visualization. They should also be taught how to reach the optimal level of arousal during a procedure in order to achieve peak performance.Finally, surgeons should be taught coping mechanisms in order to handle the extreme stress of their career. Surgeons should be encouraged to get professional help from a therapist without feeling like this is a sign of weakness. By increasing social capital and building stronger relationship, surgeons can also create a network of support. In addition, there are many programs that institutions and hospitals can implement in order to ease the stress that physicians face in both their professionals and personal lives. Overall, this paper will analyze the surgical culture, how it impacts the emotions of surgeons, and how training and coping mechanisms can be used to improve their lives.
Libby Parsons - Applying the Clinician Compassion Mindset Process to Facilitate Optimal Treatment of Dementia and Alzheimer’s
Dementia and Alzheimer’s disease are two of the most widespread syndromes of the twenty first century. The rates of dementia and Alzheimer’s cases are rising with each year and it is believed that the rates and associated costs may also increase. Because of this rising prevalence, family members may need to take on the role as caregivers. This familial caregiving can have negative impacts on both the patient and family caregiver, resulting in a poor experience for both. This paper will discuss the various symptoms and components associated with dementia and Alzheimer’s disease, how these patients are diagnosed, the effects it can have on both the patient and the caregiver, the various treatment options available, the aspects of and prevalence of caregiver burnout, and how the clinician compassion mindset can be utilized to facilitate optimal treatment and to overall improve the experience of both the patient and family caregiver during this difficult process.
Emma Sheedy - Applying the Science of Compassion and Cultural Competency to Address Barriers to Patient Access
Physicians are increasingly being trained in how to provide compassionate care to their patients through incorporating a positive “bedside manner”, healthy attachment styles, and other various ways to display empathetic responses. However, a concern within the field of compassionate care is the patients’ access to healthcare. How can physicians provide compassionate care, the way they are trained, if the patient does not even visit the clinic or appointment? Healthcare providers often lack the opportunity to provide compassionate care due to barriers to healthcare access. This paper intends to address the challenges patients face in accessing healthcare, assuming the individual has the fiscal and geographic resources to receive care. Furthermore, the paper will explore how institutions and individual healthcare providers can work or learn ways to mitigate these barriers.
Alexandra Marie Tan - Physician Burnout - What It Is and How the Compassionate Care Mindset Can Fix It
Why do you want to be a doctor? Pre-medical college students spend the majority of their time answering and fleshing out this very question. They volunteer hundreds of hours at hospitals to familiarize themselves with patient care, shadow physicians of various specialties to learn about possible career paths as well as catch a glimpse of a doctor’s daily routine, engage in both local and international service to demonstrate their compassion for others, and study difficult subjects in an attempt to build the mental stamina that medical school necessitates. After all this time spent reflecting, volunteering, studying, and observing, one might think that these students would understand what their futures entail as future physicians, but that is not the case. The same situation happens time and time again: young adults enter medical school with a passion for helping and healing others, yet, somewhere along the way, these invigorated doctors-to-be transform into jaded, cynical physicians, who sometimes do not even like helping their own patients –this is the problem of physician burnout. In this paper I will explore this newfound epidemic in depth: its underlying causes, profound consequences, and how the clinician compassion mindset can be utilized to remedy the problem –or at least serve as the stepping stone in alleviating the widespread issue of burnout.