As theatre folk know well, sometimes the most meaningful creations are borne out of the fruit of circumstance. To wit, the Lantern Theater Company in Center City, Philadelphia, happens to be located around the corner from the Sidney Kimmel Medical College (SKMC) of Thomas Jefferson University. In 2012, Charles McMahon, artistic director of the Lantern, and Dr. Salvatore Mangione, pulmonologist and director of physical diagnosis and history of medicine at SKMC, started discussing a way to make the most of that physical proximity—and potentially change the course of modern medicine while they were at it.
Together, along with artistic colleagues Craig Getting and Kittson O’Neill, they developed a curriculum for what became the Empathy Project. According to Mangione, the project, launched in 2014, was created to “provide some sort of support, catharsis, and way to metabolize what [medical students were] dealing with.” He and the team believed that “in addition to preventing burnout, and giving [students] more comfort with empathy and ambiguity, it might give them a different brain and help them become a better physician.”
Largely thanks to Mangione’s insistence on the vital importance of humanities as part of the medical students’ curriculum, Jefferson University has developed an entire Humanities Selectives department, under whose umbrella the Empathy Project falls.
The project started as a fifteen-week theatremaking course at the university for two sections of about a dozen students each. Participants in the first year of the program were not only medical school students, but also occupational therapy students, professors, and nurse practitioners who wanted to take a break from their professional routine. In subsequent years, Empathy Project participants have been primarily med students.
When Getting and O’Neill created the curriculum, they divided it into three parts. The first section includes ensemble building, improv, playwriting prompts, and confronting implicit bias. Getting likes to end the first class by asking students when they feel like they’re performing. About half the class usually responds: “When I put on my white lab coat.” Learning the skills set out in this first portion of the course encourages the students to turn a critical artistic lens on their lives and helps them unpack the baggage they bring into the room as members of the medical field.
The second part of the program focuses on playwriting. This section asks students to not only learn the technical tools of dramatic storytelling, but also to make a personal investment in the work they are creating. It helps break students out of their comfort zones by encouraging them to write about a truth that goes unsaid in their community—be that scholastic, professional, or personal. Getting calls this notion of speaking an unspoken truth the “cornerstone” of the Empathy Project. L Feldman, a Philadelphia-based playwright who has taught with the Empathy Project for the past two years, says this particular prompt “always feels like a great gauntlet or invitation to start with,” since it tends to yield writing that takes risks.
During the final few weeks of the curriculum, students refine their plays and prepare them for a public sharing session with the SKMC community at the end of the class. This past year, the program switched to two eight-week sessions, which allowed more students to participate. Due to the shortened timeframe and students’ intensive schedules, the public presentation aspect was eliminated, turning the course into more of a playwriting intensive.
As models for their curriculum, Getting and O’Neill drew from Brooklyn-based writer and director Bryan Doerries’ company, Theater of War Productions, which looks at ways hierarchy can impede open and successful communication by re-staging Greek tragedies for military and civilian communities. By asking all Empathy Project participants to engage in the same theatre exercises, entrenched Jefferson University hierarchy was broken down in the classroom, opening up new lines of dialogue and, potentially, support. The Alan Alda Center for Communicating Science at Stony Brook University, as well as the Morchand Center at the Ichan School of Medicine at Mount Sinai, were additional resources in the course planning.
Many of the project’s exercises have roots in Meisner work, including improv technique to facilitate open listening and taking stock of one’s “baseline self.” This combination of listening and self-awareness supplies the building blocks of empathy, asking students to consider themselves and each other with perhaps more generosity and less competitiveness than is usually required.
To enable this exchange, Feldman incorporated a version of the Liz Lerman Critical Response Process into the playwriting feedback structure, which provides artists with useful information for the development of their work. By creating a language based in respect to talk about one another’s work and empower individual artists’ voices without prescription, students are required to leave their egos at the door.
According to Feldman, the students find it useful to receive feedback that is honest, gentle, and affirming. “It’s also a way they can give feedback to each other about things that are not artistic, medical or otherwise, [without it being] an attack or a power trip,” she says. Getting adds: “Not only does it champion each individual student artist’s voice, it challenges students to be restrained and purposeful in their feedback, and to think more rigorously about how they ask questions or pose suggestions.”
While Getting and O’Neill came up with the program’s structure, Mangione was busy drawing up a scientific test to measure the project’s success. Research has shown that among third-year medical students there is a significant decrease in empathy, which coincides with burnout. “Physicians are telling us with their behavior that they are hurting, that we are losing something fundamental to the art of medicine,” Mangione says. A devoted humanist, he devised a survey to measure students’ empathy, tolerance for ambiguity, wisdom, and tendency towards burnout, before and after participating in the Empathy Project, and found that all elements improved.
Mangione has since expanded this study to five medical schools in the United States and found a positive correlation between students’ engagement in the humanities (both “active” and “passive” exposure to the arts, including reading and writing for pleasure, singing, and attending concerts and museums) and the desirable qualities of a medical professional, like those listed above.
Mangione cites Dr. Bennett Lorber, a professor of microbiology and immunology at Temple University, as a shining example of a contemporary humanist physician. Lorber, who is seventy-five years old, is not only a high-caliber infectious disease specialist, but also a lifelong guitar player and oil painter. Practicing what he preaches, Lorber has always encouraged his students to cultivate other interests outside of their scientific practice. Like the best writing and television, Lorber believes theatre has tremendous potential to nourish doctors’ professional lives, and that, in taking care of themselves, they will be better able to take care of others. “Theatre shows us who we are,” he says. “It presents our humanity to us, it makes us think about what matters, and where we want to go, and where we are, and how we can be better.”
Plays written by students for the Empathy Project have dealt with wide-ranging topics such as immigrant experience, class issues, what it feels like to be a Muslim in America, the recent death of a parent, ethics of patient privacy, and doctors confronting cadavers. O’Neill avows she has learned more about the Muslim American experience in her class at Jefferson than she has anywhere else in her life.
Getting believes some of the most fundamental questions playwrights ask during their writing process can easily be applied to doctors working with patients. These include: What are the given circumstances of this person? Who is supporting them or not supporting them? How do you get your audience to feel the emotions you want them to feel? How do you structure the telling of information that is at the right pace and is clear? As a result, students taking part in the Empathy Project reported seeing their patients in the hospital the way a playwright would see them.
“By studying theatre you’re being asked to exercise getting into someone else’s psychology,” says Feldman. “There is something about writing other characters that is a fundamental act of empathy and emotional, psychological imagination.” Feldman emphasizes that it is less important to teach her students every single thing she knows about playwriting than to give them the tools to express themselves differently. For Mangione, the core issue is to revisit what it means to be a physician. Rather than the contemporary model of physicians as highly specialized technicians, he wants to return to the concept of physicians as humanists.
Mangione is quick to remind us that the Greeks invented medicine based on the assumption that in order to achieve wisdom you need to live a long life. Since living a long life is no guarantee for achieving wisdom, the Greeks invented theatre. Getting adds, “The communal nature of theatre has the power to better connect us with our neighborhoods, as well as with our neighbors who need help and who we seek help from.”
“I think it’s easy for what we do as theatre people to become insular or really niche, sometimes disconnected from the larger world,” Feldman admits. “I reach people’s souls with my plays, but usually nobody’s going to die [without them].” By moving theatre practice into the realm of medicine, the Empathy Project demonstrates just how vital the art form can be, so much so that by shaping tomorrow’s doctors, theatre might even assist them in saving patients’ lives.