A Community Service Organization Focused on the Arts to Develop Empathy in Pharmacy Students

INTRODUCTION

Historically, the primary function of pharmacy schools as well as other health care professions programs has been to establish professional competence in the designated field of study. To prepare clinicians for practice, the curriculums of health care professions programs follow a combination of didactic and experiential models to ensure students develop baseline clinical competence. While knowledge is integral to patient care, compassion has been shown to be equally important in establishing patient-provider trust and decreasing patient anxiety, which may ultimately lead to better patient outcomes.¹

Compassion is defined as “sensitivity shown in order to understand another person’s suffering, combined with a willingness to help and to promote the wellbeing of that person, in order to find a solution to their situation.”² The Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry was one of the first studies that demonstrated the need for humanization and compassion in medical care.³ Compassion has been used as an indicator of the quality of care a patient receives, such that it is included within the American Medical Association’s Code of Medical Ethics.⁴ Despite the beneficial outcomes associated with compassion in the health care setting, health care education has yet to standardize the integration of activities and/or organizations that promote compassion-based care within the curriculum. The same holds true for empathy, which may be considered the gateway to compassion.

Empathy is defined as the ability to “see the world as others see it, be nonjudgmental, understand another’s feelings, and communicate understanding,” and is often viewed as an important attribute for medical caregivers as well as students in the medical and health professions.^5-7 Research findings suggest that medical practitioners benefit greatly and empathy is increased when the arts are included in their clinical training.^8-11 The authors believe that this concept can be translated to pharmacy students in training as well. The inclusion of the arts in healthcare is being addressed increasingly more often, as can be seen in the work being done in groups like the National Organization for Arts in Health (NOAH) and Americans for the Arts.^12,13

Another such group, Pro Mé, came into being in early 2018 at the Appalachian College of Pharmacy in Oakwood, VA. The college is a fully accredited, private, three-year doctor of pharmacy program. The college’s mission is to improve the health outcomes of rural and underserved communities, particularly those in Central Appalachia, through education, service, and scholarship. The college has 14 organizations on campus, including pharmacy fraternities and honor societies, through which students can gain leadership experience and enjoy extracurricular activities.¹⁴ This study describes Pro Mé, a student volunteer organization that focuses on combining the arts and medicine, and is centered around expressing compassion and empathy to patients and the community at large.

METHODS

Pro Mé was started in 2018 by student pharmacist Kathleen Jean-Louis and Kris Bailey Preston, an assistant professor of pharmacy practice at the Appalachian College of Pharmacy. The initial intent of Pro Mé was to create opportunities for student pharmacists who possess talents in the arts (music, performance, painting, etc) to use their gifts in the form of volunteerism to promote emotional wellbeing and joy to patients in various healthcare settings (eg, hospitals, assisted living facilities, nursing homes). While it was expected that the recipients of such volunteerism would be positively impacted, a secondary result has been the appreciable empathy and compassion experienced and observed by students and faculty members who have volunteered in Pro Mé.

The name Pro Mé was inspired by a concept found in the writings of Dietrich Bonhoeffer, a German Protestant theologian, who declared that one should not just profess their faith but put it into practice.^15,16 He promoted the idea that everything a person does should be done “pro mé,” which literally means “in relationship to me,” but which translates to “being there for others.”¹⁷ Inspired by Bonhoeffer’s ability to not live in theory but by practice, Pro Mé members practice living for others by volunteering their time and talents.

In March 2018, our students were introduced to the organization via a short power-point presentation given prior to class time, and offered an invitation to join. Within two weeks, we had recruited students who were vocalists, musicians, dancers, visual artists, actors, poetry readers, storytellers, and deejays. While most of those who joined were artists, we made it clear from the beginning that the organization was open to all students. Indeed, many self-proclaimed “non-artistic” members joined for the unique volunteerism and community service opportunities.

During our first meeting, we established an organizational framework for Pro Mé. The officers (president; vice-president; secretary; and business, music, performance, art, and social media chairs) were referred to as the “cast,” while the general members were the “crew.” Meetings were held monthly. Outreach performance events were held at least twice per semester at assisted living and long-term care facilities, hospitals, mobile medical clinics, health fairs, and schools. During events, members gave musical performances, led sing-a-longs, and performed dances, or helped patients create artwork, crafts, or jewelry. A popular event was Super Hero Day, where costumed members of Pro Mé visited children in local schools. Student members effectuated health care advocacy through production of a smoking cessation music video and development of a comic strip for children highlighting healthy eating tips.

Pro Mé was significantly different from other healthcare associated volunteer organizations in that it afforded students opportunities to interact with patients in completely novel fashions. During the didactic portion of their education, when impressions and habits are often formed, Pro Mé members were exposed to patients in situations where establishing relationships rather than achieving clinical competence was promoted. We believed that students interacting with patients in these settings, without the pressures of clinical practice, favored development of true connections, which could potentially lead to an increase in their compassion. The key features associated with an increase in compassion included the types of interactions between Pro Mé members and patients (ie, performing and/or participating in various forms of art), the timeframe in which the interactions took place (ie, early in the students’ didactic experience), and the low-stress environment in which the interactions took place. We believed that students who participated in Pro Mé were given more opportunities to interact with patients in an enjoyable, relaxed environment, and that this would allow them to establish true patient connections and ultimately become more compassionate practitioners.

In April 2019, a brief survey was sent to active members of the organization. A 5-point Likert scale was used for students to assess various aspects of their experience including improvement in empathy level. Several questions were open ended, tapping deeper into the opinions of members regarding their attitudes concerning the organization: how they felt being a member of Pro Mé would affect their future pharmacy practice; how being a member of Pro Mé allowed them to express themselves creatively; what they liked most about the organization; their most memorable experiences; and important lessons learned as a result of membership.

RESULTS

In a little over a year’s time, Pro Mé grew from 27 initial members to 66 members, and became the largest student organization on campus. Members participated in three community service events in its first month. Two members of the organization’s leadership team received prestigious Community Service Awards from the college. The effect the organization has had on its members is validated in survey findings.

Thirty-five students completed the survey. Of these, 89% agreed that being a Pro Mé member had very positively influenced their time as a pharmacy student. When asked about their level of empathy after participating in Pro Mé, 100% agreed or strongly agreed that they would be a “more empathetic healthcare provider” as a result of the enhanced patient contact experiences they were afforded during Pro Mé events. Looking toward their professional futures, 80% reported that they were “very likely” to continue to perform community service activities like those performed in Pro Mé once they become practicing pharmacists (Table 1).

Samples of Pro Mé members’ answers to the open-ended survey questions clearly demonstrated the impact that membership in the organization had on them (Appendix 1). For example, one member stated “It gives me the opportunity to show patients that I am not just a ‘white coat.’” Another member affirmed “Being able to interact with patients ‘outside of medicine’ really gives you a type of compassion that can be translated into the work field once we begin (our practice).”

Pro Mé events were well received by those who scheduled and hosted the events at their sites (nursing homes, assisted living facilities, schools, hospitals, etc.). Professional healthcare personnel who have witnessed firsthand the positive impact on their patients or residents that a Pro Mé visit and event provided shared their thoughts with us. For example, “You can feel their caring and compassionate spirit as they take the time to uplift patients in our local hospitals and nursing homes.” “What they love the most is the multi-cultural benefits the group brings...music, dance, crafts, showing their talents outside of their future profession.”

DISCUSSION

Overall, the student survey results and comments reflected what active Pro Mé members and faculty advisors had already realized: that this organization had a positive effect on students, patients, and community members, both young and old. Through Pro Mé, participants began to learn how to become empathetic and compassionate future healthcare providers while finding a much-needed outlet for their creative side during an otherwise intense and challenging time in their academic careers. The core of the Pro Mé founder’s goal for starting this organization was to create a way to use and combine students’ talents in the arts with health care. Sharing artistic talents through community service projects proved to be an ideal way to fulfill this benchmark.

The beneficiaries of Pro Mé’s community service events have enjoyed and appreciated the experiences. Pro Mé events that begin with music and art often lead to hand-holding, hugs, laughter, and smiles. An unforeseen outcome, however, has been how much student members claim to have learned from the events, not only about themselves, but about the joy that can be gained from sincere service and charity to others. A common theme seen throughout the results of the member survey was the better understanding of empathy and compassion for others gained through time spent participating in Pro Mé events. Furthermore, members expressed a greater awareness of how they can be better future health care providers as a result of lessons learned in Pro Mé. Some future plans include expanding events into homeless shelters and addiction treatment facilities and writing and performing a theater piece.

Plans for expansion and growth of the organization include chartering future chapters within other schools of pharmacy as well as other collegiate professional healthcare programs throughout the United States, which could lead to advanced interprofessional education opportunities. A framework is set in place that can easily be followed by future chapters. The club leadership structure and officer duties are well defined. Further information regarding the organization can be found at www.pro-me.org. Non-profit status was recently approved for Pro Mé, which will hopefully enhance opportunities to obtain grant funding.

Compassion, empathy, and knowledge are fundamental pillars for the success of healthcare professionals and the outcomes of their patients. The organizational structure of Pro Mé can provide pharmacy students with unique opportunities for creative expression, education, community service and direct patient contact. Mapping to the current Accreditation Council for Pharmacy Education’s Standard 3 (patient advocacy, interprofessional collaboration, cultural sensitivity, communication) and Standard 4 (self-awareness, innovation) could also be achieved using this model.¹⁸ Pro Mé can inspire novel ways to promote positive public health care initiatives, and exploration and introspection with regard to becoming compassionate and empathetic health care providers.

CONCLUSION

We established a new student organization, Pro Mé, with a mission to promote various healthcare initiatives in the form of community service volunteerism using students’ talents in the visual, linguistic, and performing arts. This organization’s efforts have successfully brought joy to and improved the emotional well-being of patients and others in the community. Establishing a Pro Mé chapter on a pharmacy school campus may also provide an incentive during the recruitment process for talented students seeking to participate in the arts while they are enrolled in pharmacy school. Likewise, faculty members with artistic interests or backgrounds may be compelled to form or become faculty advisors for Pro Mé chapters at their respective colleges.