‘Involve me and I learn’: an experiential teaching approach to improve dyspnea awareness in medical residents

Figures & data

Figure 1. Course sequence. The design of the course was based on the four-stage process of Kolb’s experiential learning cycle [17], the students’ knowledge about dyspnea being enriched through personal experience of dyspnea. After being engaged in an actual dyspnea experience (step 1: concrete experience), students were invited to reflect on what happened to them during this experience (step 2: reflection/observation). A theoretical course then intended to help the students amalgamate their personal experience and theoretical concepts (step 3: conceptualization/explanation). Finally, immediate, and delayed evaluations assessed the change in the students’ beliefs and attitudes about dyspnea (step 4: active experimentation/projection).

Table 1. Data collected at the different time points of the dyspnea course.

Before the beginning of the dyspnea course
Generic student questionnaire (electronic supplement ES1)
Age, gender, personal medical history
Personal experience of pain	• yes/no; if yes 0–10 NRS
Personal experience of ‘pathological breathlessness’	• yes/no; if yes 0–10 NRS
Self-perceived degree of empathy	• 0–10 NRS ^(1)
Dyspnea teaching received during medical studies	• number of courses • 0–10 NRS rating of overall satisfaction • 0–10 NRS rating of desire for more teaching
Self-perceived confidence in managing pain upon emergency room admission	• 0–10 NRS
Self-perceived confidence in managing dyspnea upon emergency room admission	• 0–10 NRS
Attitudes and habits regarding the management of dyspnea and pain in clinical practice	See details in ES1
Psychophysiological reactions to the teacher’s dyspnea (electronic supplement ES2)
Intensity of the teacher’s dyspnea?	• 0–10 NRS
Did you experience dyspnea yourself while watching the teacher’s dyspnea?	• yes/no • if yes, 0–10 NRS
Psychophysiological reactions to experimental dyspnea (electronic supplement ES3)
Intensity of your dyspnea ?	• 0–10 NRS
Multidimensional Dyspnea Profile ^(2) (French version) ^35	• see details in ES3
Verbatim (write two sentences summarizing your experience)	• lexicometric analysis
At the end of the teaching session (electronic supplement ES4)
To what extent did your personal experience of dyspnea make you better understand what dyspneic patients feel?	• 0–10 NRS
Grade the course in general	• 0–20 mark
One year after the teaching session (electronic supplement ES5)
Online 4 questions survey	• see details in ES5
Three-word verbatim to describe the impact of the course

NRS, numerical rating scale

⁽¹) participants who rated their self-perceived level of empathy 7 or more were allocated to a ‘high empathy’ group, those who gave a rating of 6 or less to a ‘low empathy’ group.

⁽²⁾a multidimensional instrument measuring the intensity of dyspnea unpleasantness (A1) and the sensory (SQ) and affective (A2) dimensions of dyspnea; (electronic supplement, ES3).

Table 2. Participant characteristics.

Variables	Whole n = 55	Low-empathyn = 13	High-empathyn = 42	P
General characteristics
Age, years	26 (26–27)	26 (26–28)	26 (25–27)	0.113
Gender (male), n (%)	26 (47)	9 (69)	17 (40)	0.069
Level of self-reported empathy, NRS	7 (7–8)	4 (4–5)	7 (7–8)	<0.001
Personal experience of pain*, n (%)	47 (85)	10 (77)	37 (88)	0.318
Rating of past experience of pain, NRS	8 (7–8)	8 (7–8)	7 (7–8)	0.713
Personal history of dyspnea* (pathological breathlessness), n (%) • asthma attacks, n (%) • fear of drowning, n (%) • miscellaneous, n (%)	17 (31) 11 (20) 3 (6) 3 (27)	2 (15) 2 (15) 0 (0) 1 (8)	15 (36) 9 (21) 3 (7) 2 (5)	0.303 1.000 1.000 0.562
Personal history of healthy breathlessness (sport), n (%)	4 (7)	2 (15)	2 (5)	0.234
Rating of past experience of pathological breathlessness, NRS	6 (5–6)	6 (6–8)	6 (4–6)	0.232

Continuous variables are expressed as median (interquartile range) and categorical variables are expressed as number (%).

NRS, numerical rating scale (from 0 minimal value to 10 maximal value)

* Participants who answered ‘yes’ to the ‘did you previously experience pain or dyspnea’, and provided both a description of the associated circumstance and a NRS rating.

‘Pathological breathlessness’[14] is defined as an experience of anxiogenic breathing difficulties due to a constraint that cannot be controlled, and correspond to the medical term ‘dyspnea’. ‘Healthy breathlessness’ is the non-threatening sensation that occurs in response to intense activities in normal individuals (e.g., sports, or sexual intercourse).

Table 3. Attitudes and beliefs toward pain and dyspnea management in patients on emergency room admission.

Variables	Pain	Dyspnea	P
Confidence with the management of the considered symptom, NRS	7 [5–8]	6 [5–7]	0.445
Propensity to systematically look for the symptom in patients on emergency room admission, NRS	9 [8–10]	8 [7–9]	0.016
How often do you prescribe morphine for symptom relief? Never Very rarely (1/year) Sometimes (1/month) More than sometimes (>1/month)	0 (0) 1 (2) 9 (16) 45 (82)	10 (18) 24 (44) 16 (29) 5 (9)	<0.001
The right to symptom relief is part of the public health code*, n (%)	55 (100)	29 (53)	<0.001
Notion that a clinically important threshold exists for the considered symptom, n (%)	48 (87)	11 (20)	<0.001
What is the proposed clinically important threshold for the considered symptom ^$	5 (3–6)	4 (3–5)	0.090
A symptom intensity rated ≥8 on NRS required immediate symptomatic relief, n (%)	52 (100)	50 (96)	0.879
Propensity to use morphine if symptom intensity ≥8, NRS	8 [7–9]	4 [2–6]	<0.001

Continuous variables are expressed as median (interquartile range) and categorical variables are expressed as number (%).

NRS, numerical rating scale (from 0 minimal value to 10 maximal value)

* The 2016 version of the French public health code (article L1110-5) states that everyone has the right to the relief of his/her ‘suffering’. This term replaces the word ‘pain’ that appeared in the 2002 version.

^$ The cut-off for clinically important pain that required prompt initiation of analgesic is 4 on a numerical rating scale ³⁶

^$ There are no guidelines on the clinically important threshold of dyspnea. A cutoff of 4 has been proposed ³⁷, but there is evidence that at least one third of patient rating their dyspnea ‘3’ consider this clinically intolerable ³⁸.

Kolb DA, Fry R. Toward an applied theory of experiential learning. In: Dans Cooper C, editor. Theories of group process. London: John Wiley; 1975;32–57.

 Google Scholar

Ashar YK, Andrews-Hanna JR, Dimidjian S, Wager TD. Empathic Care and. Distress: predictive brain markers and dissociable brain systems. Neuron. 2017;94(1263–1273):e1264.

 Google Scholar