Learning from the Master: Fostering Humanistic Learning Environments and Reducing Burnout

by Elizabeth Rider, MSW, MD, Director of Academic Programs at the Institute for Professionalism and Ethical Practice

Learning environments and organizational cultures strongly influence the professional identity formation of trainees, the well-being of faculty members, ways in which healthcare professionals relate to one another and to their patients and, ultimately, the quality of care they can provide. Organizational culture also significantly impacts patients’ and families’ experience of care, patient safety, medical error, patient and physician satisfaction, and clinician burnout.1

Dr. William Branch with Faculty Fellows
Dr. Branch with Faculty Fellows

Currently, over half of US physicians now experience professional burnout,2 and burnout is almost twice as prevalent in US physicians compared to workers in other fields.  A high prevalence of burnout and depression also exists in medical students and residents. Similarly, studies of nurses show a high frequency of burnout and depression.

Research shows that organizational aspects play an important role in the development of burnout among clinicians which, in turn, impacts healthcare professionals’ capacity to practice humanistically. This then can affect patient experience and quality of care.1 Disparate personal and health system values along with work overload contribute significantly to physician burnout. Similarly, moral distress is a significant factor in burnout in nurses. Humanistic practice may help to mitigate burnout.

At the Institute for Professionalism and Ethical Practice at Boston Children’s Hospital (BCH), we have developed and implemented two faculty fellowships: (1) the Faculty Education Fellowship in Medical Humanism and Professionalism3 and (2) the Faculty Fellowship for Leaders in Collaborative and Humanistic Interprofessional Education.4  The fellowships aim to improve faculty teaching effectiveness and role modeling in humanism and professionalism; to enhance reflective capacities; and to nurture those physicians and clinicians who already use humanistic practices to serve as positive influences on learning environments and organizational culture in these areas. In addition, the second faculty fellowship is designed to build enduring, trusting relationships among interprofessional education (IPE) faculty leaders, and to enhance their capacity to serve as collaborative role models to educate others about IPE and interprofessional practice. To date, thirty-two faculty have participated in the fellowships.

At BCH—part of a multi-institutional national project to develop curricula for the teaching of humanism and professionalism—we also created the faculty fellowships, adapted curricula for pediatrics, and created new curricula on values based on the International Charter for Human Values in Healthcare.5

“Our values are like roots. They hold us upright when they are present and can cause us to fall when they are absent or decay.” – Faculty Fellow

IPEP Visiting Professor for the Fellowships

William T. Branch, Jr., MD, MACP

William T. Branch, Jr., MD, MACP, Carter Smith, Sr. Professor of Medicine at Emory University School of Medicine, and Director and PI of the national “Passing the Torch: Fostering Medical Humanism Through Faculty Role Models” faculty development project, recently came to Boston Children’s Hospital as a visiting professor for the faculty fellowships. Dr. Branch is an internationally recognized expert on medical humanism and professionalism, and a leader and innovator in medical education.

Before moving to Emory University School of Medicine where he was the Director of the Division of General Internal Medicine for many years, Dr. Branch founded the Primary Care Residency at the Brigham and Women’s Hospital in 1974, among the first primary care residency programs, was a key leader of the New Pathway project at Harvard Medical School, and was instrumental in creating the Patient-Doctor III course at Harvard Medical School.

Hosted by IPEP, Dr. Branch spoke with enthusiastic audiences during several special events detailed below.

  1. Words Create Worlds: Appreciative Inquiry Narratives of Highly Humanistic Clinicians
    [Special session for Faculty Education and Faculty Interprofessional Education Leadership Fellows with Dr. Branch]

Dr. Branch and the Interprofessional Education fellows had a lively discussion about how professional growth occurs and how to facilitate reflection as a means for professional formation. They explored the 3-step process of reflection-in-action, action, and reflection-on-action, and the use of these to gain wisdom. They also considered learning environments that foster such reflection and how the fellows can establish such environments.

  1. Fostering Humanistic Culture
    [Department of Medical Education lunch and discussion]

An interprofessional group comprised of BCH Academy leadership and members, program directors, and other education leaders considered ways to encourage and foster more humanistic organizational culture and interprofessional, safe learning environments.

Discussion topics included moral development and enhancing values, the creation of good learning environments where learners can reach their full potential, role modeling, reflection, and feedback. The hope is that continued teaching of “the human side of medicine” in small groups, using a longitudinal curriculum that develops the small group process, will eventually lead to a critical mass of faculty members, administrators, staff and trainees committed to humanistic values and to demonstrating these in learning and clinical care environments.

  1. Healthcare at the Crossroads: Maintaining Values, Meaning, and Resilience in Today’s Healthcare Environment
    [BCH community-wide event; also included Faculty Fellows, Harvard Medical School faculty, graduate students and others.]

“There is nothing to replace the human interaction.”  –William Branch, Jr, MD, MACP

This lively event served as the launch of the Faculty Fellows Humanism Series–Cultivating Humanism: Nurturing a Culture for Safe, Compassionate Healthcare.

Dr. Branch presented findings from our national multi-site research study on promoters and barriers of humanistic practice,6,7 organizational culture, burnout, and resilience. The audience learned about stages of professional identity formation, ethics embedded in clinical practice, and the approaching crisis in the organizational culture of humanistic teaching and practice in today’s healthcare environment.

Dr. Branch noted that we have before us a “tremendous opportunity to change the culture by relating to each other as human beings.”

Faculty Fellows Humanism Series

The Faculty Fellows Humanism Series is designed to nurture values and to foster humanistic organizational cultures and learning environments. It is a project of the Boston Children’s Hospital Institute for Professionalism & Ethical Practice/ Harvard Faculty Education Fellowships.  Join us for our Humanism Series of seminars and workshops designed to teach broad aspects of humanism and values.1 Find out more here.

Applications for the next cohort of Faculty Interprofessional Education Leadership Fellows will be available soon. Preliminary information can be found here.

Faculty fellowships are supported, in part, by a multi-institutional grant from the Josiah Macy, Jr. Foundation (Dr. Branch as PI; Dr. Rider as site PI.).

© 2017 Elizabeth A. Rider, MSW, MD

Fellowship sponsors include The Institute for Professionalism and Ethical Practice and Boston Children’s Hospital Department of Medical Education; co-sponsors include BCH’s Academy for Teaching and Educational Innovation and Scholarship, Office of Faculty Development, Office of Graduate Medical Education, Nursing/Patient Care at BCH, BCH Department of Social Work, MGH Institute of Health Professions, and The International Charter for Human Values in Healthcare.

For further reading: 

  1. Montgomery A, Todorova I, Baban A, Panagopoulou E. Improving quality and safety in the hospital: The link between organizational culture, burnout, and quality of care. British Journal of Health Psychology 2013;18:656-662. DOI:10.1111/bjhp.12045.
  2. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proc. 2015;90 (12):1600-1613.
  3. Faculty Education Fellowship in Medical Humanism and Professionalism website. 2014. Available at: http://instituteforprofessionalisme-20171215-174349.qsandbox.com/the-faculty-education-fellowship-in-medical-humanism-and-professionalism/
  4. Faculty Fellowship for Leaders in Collaborative and Humanistic Interprofessional Education website. 2016. Available at: http://instituteforprofessionalisme-20171215-174349.qsandbox.com/faculty-fellowship-interprofessional/
  5. Rider EA, Kurtz S, Slade D, Longmaid III HE, Ho M-J, Pun JKH, Eggins S, Branch Jr WT. The International Charter for Human Values in Healthcare: An interprofessional global collaboration to enhance values and communication in healthcare. Patient Educ Couns 2014;96:273-280. Also available at: http://dx.doi.org/10.1016/j.pec.2014.06.017
  6. Branch WT Jr, Weil AB, Gilligan MC, Litzelman DK, Hafler JP, Plews-Ogan M, Rider EA, Osterberg LG, Dunne D, Derse AR, Pittman JR, Frankel RM. How physicians draw satisfaction and overcome barriers in their practices: “It sustains me”, Patient Educ Couns. 2017 Jun 8. http://dx.doi.org/10.1016/j.pec.2017.06.004  [Epub ahead of print]
  7. Branch WT Jr, Frankel RM, Hafler JP, Weil AB, Gilligan MC, Litzelman DK, Plews-Ogan M, Rider EA, Osterberg LG, Dunne D, Derse AR, May NB. A Multi-Institutional Longitudinal Faculty Development Program in Humanism Supports the Professional Development of Faculty Teachers. Academic Medicine In press.