Learn about a unique training program helping medical students learn bedside manner using horses as the ultimate teachers.Remember, a horse doesnt speak English.The professor at Rutgers Robert Wood Johnson Medical School (RWJMS) was instructing students. The class is designed to teach how horses non-verbal communication can improve the doctor-patient relationship. Both horse and patient respondsimilarly toa quiet, focused, peaceful approach.Studying how a horse responds tothe manner, tone, touch, and eye contact of a humanhelps future doctors become sensitized to what contributes to rapport. The approach to the patient can improve their willingness to provide information, confidence in the doctor, patient satisfaction, and even their health outcome.All of those factors are important for patient-centered care.Barnyard to BedsideThe course connecting the medical student to the horse fornon-verbalskills was originally called From Barnyard to Bedside Manner, and began with Allan Hamilton, M.D., at the University of Arizona in 2000.The unique courses incorporating equine training to help medical students learn better bedside manner have expanded across the country. Photo courtesy Rutgers UniversityThe inspirationstruckduring a medical round. Hamilton, a horse trainer, neurosurgeon, and professor at the University of Arizona had medical residents following him at thehospital whenthey rushed into apatientsroom following a series of stressful emergencyconditionsthat had put them behind schedule.The patient bolted out of her chair and shrieked. The atmosphere calmed with a smile from students and a handshake.But what if this had been a horse in a stall and we had stormed in without warning, like we had just done with this poor woman? says Hamilton. That horse would probably have kicked someone.Adaptations of thistraining have also been used at Stanford University and other healthcare colleges in the United States.Hamilton considered what a horse needs when youre approaching him to gain confidence and reduce fear; this issimilar towhat the patient needs. A human may be polite, but a horse will show you exactly how you affect his environmental sphere.A horseneedsto gain confidence and reduce fear when youre approaching him; this is similar towhat a patient needs. Photo courtesy Rutgers UniversityBeverley Kane, M.D., program director for Stanford University, expanded the Barnyard course foundation into training called Medicine and Horsemanship, an equine-assisted course for doctor-patient relationship. Its dual purpose is teaching a physician how to approach and communicate with a patient while also preserving the medical students well-being, since the stress of medical education with its long hours, urgent demands, and time pressures can affect patient care and the physician-patient relationship.Part of the training is to set aside concerns anddistractions before approaching the patient, the same state of mind needed to work with a horse.Hands-On HorsesMaria Katsamanis, Psy.D., is a horse trainer, psychologist, scientist, and Clinical Assistant Professor of Psychiatry at RWJMS. She suggested a program similar to Hamiltons to the department.Rutgers formed a credit elective version of the Barnyard course in 2011, called HorsesforHealers: Improving Bedside Manners. A new dimension wasadded,integrating psychiatry so medical students could hone theirnon-verbalskills, including gestures, touch, empathy, tone, attitude, and eye contact.Psychiatry principles and horses help med students hone theirnon-verbalskills, including gestures, touch, empathy, tone, attitude, and eye contact. Photo courtesy Rutgers UniversityThe two-week experiential course takes place at Spring Reins of Hope & Growth, an equine-assisted therapy program in Three Bridges, N.J. The lecture (didactic) section was eventually removed from thetwo-weekcourse and more in-person equine education was added, a change based on student course evaluations requesting morehands-ontime with the horses.Katsamanis collected data to measure non-verbal skill for medical education both before and after instructive exercise in the course. On the value of non-verbal communication, shesays, Withoutit, understanding is like an iceberg floating onwater. You only see the surface ofit;you are only getting 10 percent of the information.Taking a PauseA course exercise called Meet Your Patient is basedon meetingyour patient where they are.At a session, athird-yearmedical surgery student approached a horse with what is called false confidence: braced, not breathing naturally,and with an assertive energy. The horse walked away. A psychiatry student, who was already well versed in clinicalexperience, went up to the horse, and the horse started following him. The third-year studentobserved others having success. He asked the psychiatry student, How did you do that? He learned that he should tryit a different way. Horses sense pressure and give feedback,and they can pullback and resist.Students are encouraged to be introspective, to ask: Did I really get there faster by pulling or pushing the horse? They learn how to gently encourage the horse forward.Students learn how to gently encourage a horse, taking a pause if needed to use a softer approach. Photo courtesy Rutgers UniversityPart of the method is learning to take a pause, a concept Hamilton promoted as a horsetrainer. The third-year student mentioned above took two or three minutes with the horse, in a softer approach, explaining to him, Heres what well do.Imgoing to be withyou. Themethod was the opposite of We need to get here and do this. Not An Intellectual ExerciseThe state of mind for gainingtrust inthe course applies to horse training as well. There is discussion about not approaching the horsethe patientas an intellectual exercise.Katsamanisexplains that doctors are taught a mindset of I am supposed to know everything. Psychologicalself-disclosureis encouraged in the way doctors are trained.Witnessingstudents successful solutions to working with horses and asking fellow students, How did that work? if they dontknow, is an important teaching tool in both the barnyard and the hospital environment.Trustworthy CommunicationThe stress isnt going to go away, Katsamanis says. But the students learn how to practice methods of reducing pressure. One way is called adaptive breathing behavior. Katsamanis instructs students to breathe like a horse. She asks them to whuffle, much like a horse when relaxed.Breath isa very importantnon-verbal biomarker because its the one that animals recognize, saysKatsamanis. The breath, like heartrate (another biomarker),signals to animals about danger or any shifts within the herd. Interestingly, patients at bedside act similarly to prey animals. They are less likely to believe your words. Breath will convey what emotion is truly occurring. Breathing also influences heart rate. Breath is the one variable that all mammals share as a common denominator when it comes to non-verbal communication. We teach students how to be aware of the influence of [breath] and other biomarkers so that what they say truly lines up with their body language. Doing so will help align their communication.In an exercise called billiards, a horse enters the arena from his stall, moving freely. The student in the center goes to connect with the horse, approaching slowly, with a gentle voice, as they would need to do for a human patient.During billiards, a group of students guide horses into makeshift chutes. Photo courtesy Rutgers UniversityThen he or she guides the horse towards the pocket, setup with a pole on the fence on one side and cones on the other side of the makeshift chute. There are groups of students that coordinate for this exercise, illustrating the team effect in a hospitalsetting. Forexample,if thereceptionist, anurse, or part of medical staffisnthelpful, the patient experience and satisfaction with their doctor is further affected. The exercise is analogous to contending with hospital-patient challenges. If somethingdoesntwork with a horse (patient) ora horse is nervous,the doctor can trydifferent or lesspressuring methods next time.The HorsesThe horses used for the medical program include aLipizzan, an Appaloosa, a former reining champion Quarter Horse, a Thoroughbred ex-racehorse, and a gray mule. The equines all live in a herd and are only used for emotional therapywork,notriding.Insights into personal relationships aredrawn; for instance, the Quarter Horse may try to resist the direction of the student. The teacher says, Where else in your life do you get pushed around? and You need to set boundaries.Authentic ResponseIn order toset up this kind of academic training, a college must have a person who is knowledgeable about horses and medical education. A psychology background is also important, and the school needs to have access to a horse herd for therapeutic education.Experiential training with the horse can provide sensitivity to an animal who is direct in his response andnotfiltering through a polite manner. Since medical students practice with patients who are actors, they may not get torealizethe breadth ofnecessary non-verbalskills. Future physicians learning from an authentic response discover how to respond both to humans and to the horse.This article about horses helping in the training of medical students appeared in the June 2024 issue of Horse Illustratedmagazine.Click here to subscribe!The post Horses Helping in the Training of Medical Students appeared first on Horse Illustrated Magazine.