Conjuring compassion and courage through Schwartz Rounds
Schwartz Rounds have been utilised within the NHS, since their introduction by the Point of Care Foundation in 2009, as an opportunity for staff working across different healthcare settings to come together to discuss and reflect on the emotional challenges associated with their work. The University of Liverpool was the UK’s first to introduce the forum across its 9 different healthcare programmes when it began running Schwartz Rounds on campus in February 2016.
Since then, 32 rounds have taken place on a monthly basis – including 6 virtual rounds during the pandemic. For Schwartz Round Project Lead Dr. Laura Golding, they provide a meaningful, facilitated safe space for students in recognition of the emotional impact of providing healthcare. “The rounds are important in normalising strong emotions that arise from our work. Students tell us how much they value the space to reflect and process thoughts and feelings, as well as ponder the human connections they form in patient care.”
Schwartz Rounds are built around different themes including ‘A patient I will never forget', ‘Accepting that we cannot fix everything’ and ‘Speaking up or keeping quiet’. Each follows a similar format, with 3 panellists opening up the discussion by sharing a personal experience in relation to the theme, followed by a discussion driven by two facilitators who invite participants to reflect on what they have heard, what resonates with them and contribute their own experiences.
Dr. Golding is struck by how the rounds can help students feel more courageous once they grasp the understanding of what they are feeling and why, and harness that for the future. “Students appreciate the chance to reflect on their own emotions and how they relate to others, as well as finding comfort in realising they are not alone in thinking or feeling a certain way.” One student shared,
I kind of think ok, if people who’ve been practising for years and years are experiencing these things that I’m experiencing as a student then that’s kind of ok.
Feedback such as the following points to the impact opportunities like this provide in developing as well-rounded healthcare professionals, “I can think of one particular patient who’d just been given a diagnosis of pancreatic cancer, and I asked him how he was doing; I just said ‘can I ask, how are you coping with this, because it’s a big diagnosis’. And he said ‘do you know what, no-one has asked me that yet’. And I don’t think I would have done that a year ago. So, I think it’s a combination of me maturing and also going to the Rounds has made me much more emotionally aware; I don’t think I would have asked that question”.
Year 3 Student Doctor Sana Kalathil is a fan of the format and was delighted to be part of the panel for February’s Round on the theme ‘When principles and reality conflict’.
“I talked about an experience I had while on placement where I could have improved the way I carried out the consent process for bedside teaching. It was a sensitive topic for me as I felt a range of emotions including guilt and frustration that I could not deliver the best patient care.
Processing these thoughts was challenging but I was supported well by facilitators Professor Gabbay and Helen Orton. Although talking openly about a time you made a mistake can put you in a vulnerable position, I was surprised at how many participants related with my story.
As healthcare professionals we all want to deliver the best care to our patients while respecting their autonomy and dignity. Concepts such as consent and implied consent, while clear cut on paper, can become blurry in practice especially when considering human factors like stress and time shortages. After the discussion, I understood that obtaining proper consent is a universal skill that all healthcare professionals get better at with time.
I was able to look at the situation with more compassion towards myself and most importantly learn from it.
I recommend everyone to try joining a Schwartz Round session! It is a non-judgemental space to debrief and learn from our experiences as healthcare professionals.”
Community Clinical Tutor Lead Dr Helen Rawsthorne also highly recommends this type of multidisciplinary reflection to medics and health care professionals as a way of improving both their own perspective and the care of future patients.
"The Schwartz Round format enabled me to share a difficult professional experience as a GP in the context of more than 30 years clinical practice. As a panel member, telling your story in 5 minutes is an art, and takes away the detachment of the clinical case presentation.
Deeply ingrained emotion seemed to tumble out of me as I recounted my transforming patient experience and helped me re-evaluate it.
I found the presence of 60 healthcare professional students extremely supportive.”
Richard Latten, Deputy Director of Wellbeing for the School of Medicine is a facilitator for Schwartz Rounds at both the University and hospital in his role as Palliative Care Consultant.
“All of us involved in healthcare will at times encounter complex situations which have the potential to affect our own emotions and feelings. For example, in my palliative care role I’m often involved in supporting patients and families who are experiencing incredibly difficult circumstances.
It’s only human to feel the emotional impact of exposure to the often-challenging circumstances we encounter.
Especially as we all navigate the additional demands and complications of studying and working during a global pandemic. It's important to develop ways of processing the emotional impact on ourselves, and each person will find their own strategy in doing so.
One method designed to help do this are Schwartz Rounds. My involvement in the rounds as a facilitator has become a part of my job I particularly enjoy and look forward to. It’s a privilege to gain insight into the experiences of others through hearing stories of how situations they’ve encountered have made them feel.
During the round itself, there’s often a crescendo effect from the sharing of stories from the panellists, not from a problem-solving perspective but rather how it felt on a human level to have experienced them, to the subsequent discussion with the audience, reflecting on the things we’ve heard.
Ultimately, the thing I like most about Schwartz Rounds is the way they help build connections through the process of listening to and sharing stories with each other in a facilitated ‘safe space’.
I believe this quote from Ken Schwartz himself, the health attorney whose legacy helps foster compassion in healthcare, says it best:
“I have learned that medicine is not merely about performing tests or surgeries, or administering drugs… For as skilled and knowledgeable as my caregivers are, what matters most is that they have empathized with me in a way that gives me hope and makes me feel like a human being, not just an illness.”
Discover more
- Schwartz Rounds run once a month and are open to Liverpool School of Medicine student doctors in years 3 to 5. Sign up for April’s round via eventbrite on the theme ‘A memory to treasure’, Thursday 29th April at 17.15.
- Find out more about Schwartz Rounds at the University of Liverpool on the website.
- Contact the UoL Schwartz Rounds team at schwartz@liverpool.ac.uk and follow them on Twitter.
- Explore the School’s Wellbeing services available to student doctors on the Wellbeing area of the Student Intranet.