Beyond surgical carpentry

The responsibility of physicians in alleviating human suffering goes far beyond routine surgical carpentry. Though eminently desirable, academic excellence alone cannot be the sole metric for defining a good doctor. Holding a patient’s hand to show empathy is as important, if not more important, than repairing a complex retinal detachment. The blending of art and science in ensuring the ultimate well-being of our patients should be the sole compass around which our profession is built. A vast majority of students join the medical profession not only for social recognition but also with an innate desire to serve society. Most of these young individuals clearly articulate this interest when they enter undergraduate training. Unfortunately, the system does not adequately encourage or emphasize the need for these graduates to “walk their talk.” In the present era, with an increasing emotional disconnect between healthcare providers and patients, it has become a pressing need to reemphasize the nonacademic responsibilities of the physician. Medical institutions must revisit designing the curriculum so as to reinvigorate the importance of soft skills and consciously integrate them within training programs. Ideally, such characters should be emphasized and given preference from the selection process itself. At present, in medical admissions for undergraduate and postgraduate programs, academic excellence is often the sole determinant of selection. Because fellowship selection is clearly at the realm of individual training programs, administrators have an opportunity to incorporate these considerations into their selection processes. The authors considered selected nonacademic attributes in addition to academic excellence in ophthalmology fellowship selection. The nonacademic attributes evaluated were the following: communication, collaboration, critical thinking, curiosity, and creativity, which were assessed using structured situational judgment tests. There was no direct correlation between academic excellence and higher scores in nonacademic attributes, leading the authors to conclude that these two assessments measure distinct domains. The authors further conclude that a combined evaluation incorporating both domains may more effectively identify well-rounded candidates for ophthalmology fellowships. It is natural for patients to expect compassion from their providers,[1] and a recent survey found that 85% of patients and 91% of doctors value compassion.[2] However, very little time during residency and fellowship training is dedicated to cultivating empathy and compassion among doctors.[3] Compassionomics has recently been defined as the branch of knowledge and scientific study focusing on the effects of compassionate care on patient health, healthcare providers, and the healthcare system.[4] Research data suggest that compassion in society has substantially declined over recent decades. A cross-temporal meta-analysis involving 13,737 American college students revealed a sharp and accelerating decline in empathetic concern from 1979 to 2009.[5] Self-centered attitudes in adults are readily perceived by children, and a recent survey of 10,000 middle- and high-school students found that 80% considered their parents to be more concerned about achievement or happiness than about caring for others.[6] While compassionate healthcare delivery is desirable, the reality is often starkly different. A study performed in 2010 reported that among 800 recently hospitalized patients, only 53% felt that the healthcare system provided compassionate care.[7] It is also noteworthy that this lack of empathy is recognized by physicians themselves. A 2017 survey found that 63% of responding physicians had witnessed a progressive decline in empathetic communication and support by healthcare professionals over time.[8] Anecdotal experiences reveal a concerning lack of trust between healthcare providers and patients. It is essential to integrate appropriate caregiving strategies into training curricula. Those of us who have accompanied our loved ones to a medical facility can understand and appreciate the importance of receiving healthcare with compassion, clarity, and dignity. This type of selection process, wherein certain nonacademic attributes are given preference alongside academic metrics, is a welcome beginning in helping medical professionals understand the significance of developing relevant soft skills. It will be interesting to follow these cohorts of fellows over two years and evaluate their capacity as “healers.” If the authors find that fellows who scored highly on nonacademic attributes were also significantly preferred and appreciated by patients, this could open a new model for selection criteria. This study is a welcome beginning, and we look forward to further insights from this group so that we may serve our patients in a more holistic manner.About the authorNamperumalsamy Venkatesh Prajna Dr. Venkatesh Prajna is the Academic Director at the Aravind Eye Care System for the past 2 decades. In this role, he has trained more than 300 residents and around 150 cornea fellows and has considerable experience in imparting the science and art of ophthalmology. Imparting soft skills in the training progamme in a relevant and sustained manner has been one of his continued passion.