30 May 2022

New doctors will face ethical dilemmas and have to deliver difficult medical news. By reading and discussing novels, films and poetry, medical students are well positioned to learn to manage emotional challenges when meeting with patients and family members, according to a new doctoral thesis at Linköping University.

Anja Rydén Gramner.
Anja Rydén Gramner, trained as an upper secondary teacher, recently completed her doctorate in education at Linköping University. Anna Nilsen

For many years, talking about literature has been considered an important complement to biomedical knowledge for professional training in healthcare. In medical schools, both in Sweden and abroad, literature is used to enhance students’ professional development when it comes to emotional awareness.

“One of the key learning goals for Swedish medical training is that the students develop a professional and empathetic attitude to their patients”, says Anja Rydén Gramner, who recently finished her doctorate in education at Linköping University.

Emotional engagement

In her doctoral thesis, Cold Heart, Warm Heart – On fiction, interaction and emotion in medical education, Anja Rydén Gramner studied the discussions among medical students and supervisors in the literature seminars.

“It’s very clear in my data that the medical students really get involved emotionally in the literature. This may seem obvious, but because the interaction between students and supervisors as they discuss literature has not been studied previously, we haven’t known whether it happens, and how it plays out.”

Contributes new knowledge

Literature is a relatively common component in medical training worldwide. However the processes that arise in the fiction seminars in medical training have not been researched previously – neither in Sweden nor abroad.

“The thesis contributes new knowledge. Previous studies are mainly based on international contexts, and have focussed either on students’ evaluation of literature components in their training, or on measurements of empathy by way of testing before and after the literature component”, says Anja Rydén Gramner.

Empathy decreases during training

The thesis can also provide a more nuanced picture of previous research, which shows that the empathy of medical students decreases during training, which however has been questioned in various contexts within academia, because these results vary between countries and between groups.

“The focus on fiction has probably come in part as a response to that, and as a response to the fact that doctors and researchers generally perceive that medical science has gradually become less human centred. It is considered to have become more clinical, and now, more about solving problems early, saving time and meeting efficiency requirements.”

The importance of supporting the students’ professional and emotional development is stressed by both educators and researchers, and the fiction talks can be a way to achieve this goal.“The students must be equipped so that they can manage emotionally in their future career, as burnout is a big problem among doctors”, says Anja Rydén Gramner.

Characters become patients

The results in her thesis are based on 58 hours of audio and video recordings from fiction seminars in two medical programmes in Sweden, where the interaction has been analysed in detail. The arrangement of the literature courses that she has filmed has differed. The number of participants has varied in the groups. Sometimes the students have read the same novel, and sometimes they have chosen the book themselves. Also the number of supervisors has varied, but they all have been doctors or academics in literature or interdisciplinary subjects.

The results showed that both students and supervisors often discuss characters or events in the novels or films as if they were case studies and fictitious patients. This can lead to discussions about how the students think they would have reacted or felt if the character was their patient.

“My study shows that conversations about literature can help the medical students understand the emotional work that the profession involves. And also how a doctor can manage in a professional way the emotional challenges inherent in the interaction with patients and family members.”


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