Integrative course examines importance of empathy in health communication

DUNMORE, Pa. – Meaningful, compassionate communication can be challenging under the most mundane of circumstances. And, as many know all too well, it can be especially difficult during a health crisis.

Mindful of that disconnect, Penn State Scranton Associate Professor of English Kelley Wagers set out to create an innovative course that gives students across the academic spectrum the opportunity to explore and practice these vital exchanges.

During the fall semester Wagers taught, for the second time, Communicating Care, an integrative (i.e. multidisciplinary) general-education course she designed with input from a medical ethics expert at Penn State College of Medicine and some campus colleagues.

Essentially, Communicating Care is a medical humanities course, perfect for those going into nursing or another medical field, but also for anyone who wants to become a more effective and empathetic communicator, said Wagers. Students have the option of taking it as an english, sociology, or communication arts and sciences course.

Throughout the fall semester, students enrolled in the course studied literary texts and social science studies and theories that allowed them to think critically about what Wagers calls “performances of care.”

In addition, two guest speakers visited the class via Zoom – Michael Evans, assistant dean for undergraduate nursing education at the Commonwealth Campuses and associate teaching professor in nursing, and Susan J. Loeb, professor of nursing at Penn State College of Nursing and College of Medicine. And, for further perspective, Wagers gave students the opportunity to virtually attend Penn State Abington’s Health Humanities Symposium and Geisinger Commonwealth School of Medicine’s Webinar Series on Healthcare, Humanities and Social Justice.

Student response to the course has been very encouraging, said Wagers, noting it was a particularly good time to offer it given the wide-ranging effects of the COVID-19 pandemic.

“The idea is that everybody acts as a care provider and a care recipient in their lives, so we can study and improve our abilities to communicate in these encounters,” Wagers said. “I think we're used to seeing firm lines — not just between the humanities and sciences, but also between academic study and ‘real life,’ and between experts and students. Everything about this course is designed to help us see that those divisions are false and to find out how much more we can do when we see connection and overlap instead. I think creating opportunities for that kind of integration is really helpful for the students.”

Freshman adult learner Jessica Kehl signed up for the course with the hope that it would benefit her as she works to gain admittance to the campus nursing program.

“It sounded exactly like something a nurse would need,” Kehl said. “I enjoyed the course and love Dr. Wagers, and I absolutely do think that it has made me more empathetic. The readings that we did have opened my eyes to many different areas of health care that I hadn't necessarily thought of. I work for Geisinger CMC and when I see my patients now, I approach things differently than I had prior to this class.”

Sophomore Lexie DeWolfe enrolled in Communicating Care while still a pre-med major, but has since switched to business. Nonetheless, the course perfectly married her passion for medicine and literature.

“I think this course should be taken by anyone headed into the medical field,” DeWolfe said. “The objective of the course, in theory, is very simple — connect the concept of medicine in its very biological form with medicine in its very personal and emotional form. Yet, when you begin to unwrap the layers of complex connections, as we did in this course, the connections aren't as simple as they appear. I believe this course opens the eyes of future health care providers to elements of their care that they never even considered and how care extends beyond its traditional definition.”

Emphasis on empathy

Wagers first conceived the idea for Communicating Care in 2017, when she received a seed grant to bring an integrated general ed course to the campus. With encouragement from Professor Emerita of Education Patricia Hinchey, who was then facilitating general education changes on campus, Wagers decided to focus on the medical humanities, with a specific interest in empathetic communication.

With the grant money, Wagers was able to enlist the expertise of Rebecca Volpe, an associate professor in Penn State College of Medicine’s Humanities department. From there, she sought further assistance from two faculty members at Penn State Scranton — James Hart, lecturer in communication arts & sciences, and Raymond Petren, associate professor of human development and family studies.

“Becky was involved in every level of the course design and Ray and Jim both asked great, specific questions and had really good resources and ideas,” Wagers said. “For me personally, the course has been a great lesson in collaboration. I find myself asking more and more people more and more often, ‘What do you know about this?’ or ‘How would someone in your field get at this question?’”

Of course, Wagers has brought her own background in literature to the course, designing it in a way that reflects how the arts can help people develop deep reserves of empathy and compassion that will help them listen and express themselves better during medically related encounters, whether they’re health care professionals, patients or family members.

“The thought was, we can take this problem to a poet, or a sociologist, and see what they have to say about it in order to understand it better,” Wagers said.

As with any course, Wagers made several tweaks to Communicating Care for her second time teaching it. The goal, she said, was to offer students a broad range of learning opportunities.

Indeed, the students’ reading list last semester included an array of literary genres, everything from “When Breath Becomes Air,” neurosurgeon Paul Kalanithi’s acclaimed memoir about his battle with terminal lung cancer, and Margaret Edson’s Pulitzer Prize-winning play, “Wit," to the poetry of Maggie Nelson, and Brian Fies’ graphic novel, “Mom’s Cancer.”

And it wasn’t just literature on the syllabus — to give the class a more clinical perspective, Wagers assigned the students health care-themed sociological and communications studies. They read literature reviews, evaluated data collection, and learned about theoretical models to see how the same concerns about equality, expression and understanding in health communication are addressed in the social sciences too.

“What I found was the students were interested in seeing the same experience depicted in a graphic novel or a poem and then from a sociological perspective,” Wagers said. “The reading assignments became something they wanted to know about rather than something they were just being asked to read. And they were adding to the material, and seeing connections. Seeing themselves reflected in the texts was kind of a revelation to them.”

Meanwhile, the students’ assignments were a mix of “the academic and the creative,” Wagers said. In addition to the typical quizzes and analytical writing, they had to write a mini memoir about their own personal experiences with illness, as well as seek out and interview someone who had experienced a health crisis. In addition, they did a graphic novel-style drawing project depicting a health interaction, visited and analyzed a space where a health communication might take place (a pharmacy, a kitchen, etc.), and got in groups and collaborated on a skit dramatizing a health care scenario.

Sophomore pre-film major Jacob Rosenstein said the assignments left him with a genuine appreciation for the importance of good communication skills, both in the health care field and in general.

“As someone who is on the complete opposite spectrum of medical knowledge, I never understood the perspective of a health care worker, what they deal with daily, and even how they deal with it,” Rosenstein said. “I think this class really helped me understand communication in the health care setting and, beyond that, has also shaped the way I communicate with others in everyday life.”

Expert testimony

Because the course was delivered on Zoom, Wagers was able to bring Evans and Loeb into the virtual classroom to offer students the firsthand perspective of a health care professional.

Evans, who in addition to his academic positions works as a part-time RN for VNA (Visiting Nurse Association) Hospice & Home Health of Lackawanna County, discussed his experiences with telehealth as it’s become more prevalent in the wake of COVID-19.

“He was able to tell them stories and experiences related to being present for people and how challenging that is when you don’t have physical access to them,” Wagers said.

Loeb visited the class twice to discuss her extensive research on improving the quality of life of older incarcerated individuals who have chronic health conditions or are approaching death. Recently, Loeb received grant funding from the National Institutes of Health (NIH)/National Institute on Aging (NIA) to continue her team’s research on e-training for inmates serving as peer caregivers.

For her first visit to the class, Loeb told the story of the project’s development over many years. She talked about interdisciplinary collaborations and asked students to think about how to ethically recruit vulnerable subjects, such as older people and incarcerated individuals, to participate in research and training programs. When the students wanted to hear more, Loeb returned later in the semester to give further details about the kinds of people her peer caregiving program might serve and how, and to let the class read some words from people facing illness and death while incarcerated.

The students were highly engaged by Loeb’s talks, posing thoughtful, perceptive questions on both occasions, Wagers said.

“To hear Susan talk about her work and research made the concepts we’d studied so much more concrete for the students. It makes it real for them, and I think that’s great,” Wagers said. “The students were really hungry to hear the perspectives of both of our speakers. When you create a framework where they’re authorized to engage, they will do it.”  

“Dr. Loeb’s work is fascinating and very much related to our course objectives,” DeWolfe said. “Throughout the semester, we talked a lot about defining care, and by that I mean literally defining what is and what isn't care. What I think a lot of us discovered is that care goes far beyond the traditional ideals of hospitals, health care workers and medicine. I mean, care can be pictured as giving a popsicle to a sad patient or friend, to boost their mood. There are no needles or doctors involved in that interaction, yet it can still be considered care. I think Dr. Loeb's presentation really helped to reinforce this idea of care extending beyond the traditional setting.”

Wagers herself has learned plenty from teaching Communicating Care, and fully intends to continue offering and developing the course. She also has talked with faculty members at other Penn State campuses who are offering or plan to offer the class. This spring, the Abington campus is offering it.

“I think it’s had a good impact, and I’d like to think it helped in some way in the everyday conversations the students are having. Hopefully, it’s helping them talk and listen better to others,” Wagers said. “It can draw many different types of students, so I’m hopeful I can continue to fill it.”

DeWolfe said she wouldn’t hesitate to recommend the course to other students.

“Dr. Wagers really does a great job with this course and picks some of the most fantastic literature that opens and inspires all minds, not just those aspiring to be in the medical field,” she said. “Regardless of who you are or who you are aspiring to be, you will leave this class more humble, empathetic and inspired.”