“Remember, a horse doesn’t 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 respond similarly to a quiet, focused, peaceful approach.

Studying how a horse responds to the manner, tone, touch, and eye contact of a human helps 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 Bedside

The course connecting the medical student to the horse for non-verbal skills was originally called “From Barnyard to Bedside Manner,” and began with Allan Hamilton, M.D., at the University of Arizona in 2000.

The inspiration struck during a medical round. Hamilton, a horse trainer, neurosurgeon, and professor at the University of Arizona had medical residents following him at the hospital when they rushed into a patient’s room following a series of stressful emergency conditions that 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 this training have also been used at Stanford University and other healthcare colleges in the United States.

Hamilton considered what a horse needs when you’re approaching him to gain confidence and reduce fear; this is similar to what the patient needs. A human may be polite, but a horse will show you exactly how you affect his environmental sphere.

Beverley 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 student’s 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 and distractions before approaching the patient, the same state of mind needed to work with a horse.

Hands-On Horses

Maria Katsamanis, Psy.D., is a horse trainer, psychologist, scientist, and Clinical Assistant Professor of Psychiatry at RWJMS. She suggested a program similar to Hamilton’s to the department.

Rutgers formed a credit elective version of the Barnyard course in 2011, called “Horses for Healers: Improving Bedside Manners.” A new dimension was added, integrating psychiatry so medical students could hone their non-verbal skills, including gestures, touch, empathy, tone, attitude, and eye contact.

The 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 the two-week course and more in-person equine education was added, a change based on student course evaluations requesting more hands-on time 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, she says, “Without it, understanding is like an iceberg floating on water. You only see the surface of it; you are only getting 10 percent of the information.”

Taking a Pause

A course exercise called “Meet Your Patient” is based on meeting your patient where they are.

At a session, a third-year medical 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 clinical experience, went up to the horse, and the horse started following him. The third-year student observed others having success.

He asked the psychiatry student, “How did you do that?” He learned that he should try it a different way. Horses sense pressure and give feedback, and they can pull back 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.

Part of the method is learning to “take a pause,” a concept Hamilton promoted as a horse trainer. The third-year student mentioned above took two or three minutes with the horse, in a softer approach, explaining to him, “Here’s what we’ll do. I’m going to be with you.” The method was the opposite of “We need to get here and do this.”

Not An Intellectual Exercise

The state of mind for gaining trust in the course applies to horse training as well. There is discussion about not approaching the horse—the patient—as an intellectual exercise.

Katsamanis explains that doctors are taught a mindset of “I am supposed to know everything.” Psychological self-disclosure is encouraged in the way doctors are trained.

Witnessing students’ successful solutions to working with horses and asking fellow students, “How did that work?” if they don’t know, is an important teaching tool in both the barnyard and the hospital environment.

Trustworthy Communication

The stress isn’t 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 is a very important non-verbal biomarker because it’s the one that animals recognize,” says Katsamanis. “The breath, like heart rate (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.

Then he or she guides the horse towards the “pocket,” set up 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 hospital setting. For example, if the receptionist, a nurse, or part of medical staff isn’t helpful, the patient experience and satisfaction with their doctor is further affected.

The exercise is analogous to contending with hospital-patient challenges. If something doesn’t work with a horse (patient) or a horse is nervous, the doctor can try different or less pressuring methods next time.

The Horses

The horses used for the medical program include a Lipizzan, 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 therapy work, not riding.

Insights into personal relationships are drawn; 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 Response

In order to set 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 and not filtering through a polite manner. Since medical students practice with patients who are actors, they may not get to realize the breadth of necessary non-verbal skills. 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 Illustrated magazine. Click here to subscribe!

The post Horses Helping in the Training of Medical Students appeared first on Horse Illustrated Magazine.

From the TRF website:

The Second Chances Program is a unique and pioneering program where inmates build life skills while participating in a vocational training program as they provide supervised care to our retired racehorses. Located at correctional facilities in eight states, inmates from every imaginable background take part in a rigorous training program where they learn horse anatomy, how to care for injuries, equine nutrition and other aspects of horse care. Graduates of the program receive a certification based on the level of expertise they have mastered. After their release from prison, graduates of the TRF Second Chances Program have gone on to careers as farriers, vet assistants, and caretakers.

What Makes the Second Chances Program Different

The inmates must learn about protecting a sentient creature; they have to think about a living thing other than themselves. The Second Chances Program is distinctive among vocational prison education because it is based on the horse, a being requiring complex care and training.

But vocational education doesn’t just help the inmates. The TRF program rehabs ex-racehorses, a concept known as “aftercare.”

Horses go to TRF with various needs due to age, injury or circumstance. Aftercare helps keep them from possible abuse and neglect. If they can’t be retrained as riding horses, or are not suitable for a particular program, they will go to a sanctuary farm managed by TRF staff who aren’t in the corrections system.

The Program’s Impact

In prison management, the focus is about keeping the population quieter, increasing positive communication, and tempering behavior, says TRF Director of Major Gifts and Planned Giving, Kim Weir. The inmates see improved self-esteem and gain a greater sense of purpose.

A warden at the flagship men’s program at the Walkill, N.Y., facility comments that the Second Chances Program constructively impacts all the people who work in the prison, including the women’s staff. Corrections news can be “dark” much of the time, but the equine education helps provide a positive environment, and the staff is part of a project having a favorable outcome.

Participants in the program, many of whom don’t have experience with horses, are each responsible for the care of four horses, including their feeding, stall cleaning and general health. They work an eight-hour day, and the hands-on education is supplemented with a course in Equine Science Management from the College of Central Florida.

Helping Incarcerated Women

The Second Chances Program at Lowell Correctional Institute in Ocala, Fla., specializes in incarcerated women. Most are convicted of drug offenses; violent offenders aren’t allowed in the program.

Chelsea O’Reilly, program manager, says the Second Chances training gives inmates “a different kind of teacher.” They learn how to diagnose a creature “who can’t tell what’s wrong with words.”    

O’Reilly comments that “the women are more open about their emotions than the men; they are forthcoming.”

The Department of Corrections (DOC) supported the idea of the women’s program; historically, women have not had as much opportunity for vocational rehabilitation in prison as men. Many are mothers, so they are eager to earn the credit of completing the program and get out to see their kids.

“I don’t have to worry about them running away,” says John Evans, former program director, of the women who qualify for the program. “The women are a lot less angry when they bond with a horse.”

To qualify for the program, the women must be within a few years of being released from the facility. After graduation, they get referred to work primarily at horse facilities or a non-equine job where the focus and communication tools they learned can be applied.

Lauren Vanucci, a former hunter/jumper rider, served a sentence for DWI manslaughter, wherein the victim was paralyzed. After graduation from the program, she was hired in a client relations position by Niall Brennan, a leading racehorse trainer in Ocala, Fla.

Vanucci says that the skills she learned from Second Chances, such as how to be a team player and how to be a leader for yourself, apply to any kind of work.                       

Lowering Recidivism

The DOC cites an average 20 percent recidivism rate (a measure of the tendency of convicted individuals to reoffend). Studies have shown a reduction in recidivism rates at facilities that host the Second Chances Program.

According to Weir, their behavior prior to release improves, providing more reason for the parole board to end their sentence, and helping prevent them from going back to prison after release.

Evans also maintains a broad spectrum of contacts in the horse industry that help newly released participants with finding jobs.

Funding and Donations for Second Chances

The funding supporting the horses initially came from the Florida Thoroughbred Breeders and Owners Association. Currently, TRF is supported by private donations.

Donors are prompted in part, says Weir, by the belief that humans brought racehorses into the world for entertainment, so the horses deserve to have a healthy, happy life. The second reason is that the Second Chance Program is profoundly changing the lives of inmates.

The racing industry also contributes to Second Chances through promotion in broadcasting and media; Gulfstream Park and Santa Anita Park had a race named in honor of the program on the same day.

“They are teaching generations about equine aftercare,” says Weir.

There are some famed former racehorses in the Second Chances herd, including Shake You Down, who earned more than $1.4 million on the track. He recently passed away at the age of 23, but had been retired to the TRF’s Second Chances Farm at the Lowell Correctional Institution for Women in Ocala, Fla., for 15 years.

Hemingway’s Key, who placed third in the 2006 Preakness Stakes, was another favorite at Lowell who relocated to an adjacent farm in 2021 to become a part of the TRF’s Second Chances Juvenile Program. There, he helps give at-risk youth (young men ages 12-18) a chance to learn hands-on training in animal skills and life skills that they can use once released.

Skills Learned

Even the veterinarian visits spark thinking skills, as the vet asks inmates gathered there: “What would you look for? Why did this (condition) happen? How would you prevent this from happening? How do you treat it?”

O’Reilly notes the interdependence of the horse-human bond. The horse needs the inmate to care for its health, and the inmate needs the horse to learn about the benefit of bonding in nature to diffuse the effect of the tiled, cement-covered and loud environment they live in. The connection provides purpose with support and structure.

Confidence may be hard-won for those who end up in prison, but it can result from learning how to be sensitive to a horse while handling and training such a large animal and keeping it healthy.

More on the Second Chances Program

To learn more about TRF’s Second Chances Program, visit their website here. If you have felt moved by learning how much these horses and inmates impact each other’s lives for the better, consider donating. The program relies on donations, rather than government grants, to continue.

This article about the Second Chances Program appeared in the October 2023 issue of Horse Illustrated magazine. Click here to subscribe!

The post Second Chances: Inmates and Thoroughbreds Helping Each Other appeared first on Horse Illustrated Magazine.