Cover Story - October 14, 2009

Horse sense

At Webb Ranch, horses teach Stanford medical students how to better relate to their human patients

by Maggie Mah Johnson

Dr. Beverley Kane is a physician with an impressive resume. She teaches second- and third-year medical students how to be better doctors. She uses horses to do it. WHOA! What's up with that?

Since 2005, Dr. Kane has been the program director for "Medicine & Horsemanship" at the Stanford School of Medicine. The course is designed to help doctors develop the interpersonal skills necessary for good communication with patients and other doctors, a key issue in health care.

Studies by the American Medical Association and others show poor communication to be a common cause of medical errors. It is often a factor in malpractice suits and patient dissatisfaction, and has a lot to do with whether a patient follows through with treatment.

According to the AMA, the ability to empathize decreases as medical students deal with increasing time constraints and the strain of treating people in highly emotional situations.

"Many health-care professionals have not developed the emotional intelligence and perception required for clinical excellence," Dr. Kane says.

On top of that, patients don't always say what's really going on. It's left up to the doctor to figure things out.

"We've all been socialized into hiding our feelings and reactions, especially from somebody in a white coat," says Dr. Kane. "Horses will tell you in no uncertain terms how you're affecting them."

How horses help

Many experts agree that much and maybe most of human communication is non-verbal. But in medicine, as elsewhere, the focus is on spoken and written words.

Tuning into non-verbal communication could make an enormous difference, maybe even between life and death.

Unlike most humans, horses are experts at non-verbal communication. Evolving as prey animals, their survival has depended on being extremely sensitive to minute gestures, eye movement and emotional energy. The way horses respond to body language makes them uniquely suited to teach humans that actions can speak louder than words.

The idea of using horses to teach humans, "equine facilitated learning," was conceived by Dr. Allan Hamilton, chief neurosurgeon and chairman of the department of surgery at the University of Arizona Health Sciences Center. As a physician and lifelong horseman, he knew the importance of relating fully to his patients and recognized that calming a horse had the potential to open the doors to more sympathetic human responses.

Since their inception in 2001, equine facilitated learning programs have been adopted by a number of medical schools across the country, including Stanford. Similar programs help cancer patients and their families cope with the disease, and help those with a range of learning disabilities.

At Webb Ranch

Dr. Kane's classroom is a large corral at Webb Ranch. During a six-week course, medical students work with their 1,200-pound "patients" in a series of exercises designed around health-care situations.

The motivation for taking the Webb Ranch course varies from student to student. Two second-year students, Diana Wertz and Katalin Szabo, had both gotten feedback about their communications skills from another class, where actors portray patients.

"One 'patient' said I made him nervous with my lack of confidence," says Ms.Wertz.

Ms. Szabo was told she focused too much on the checklist of medical tasks and hadn't paid enough attention to the patient.

At Webb Ranch, class begins with medical students watching a large group of horses coming into a corral. The students are asked to observe the horses' body language and interactions within the group.

"Pay close attention to their ears," says Dr. Kane, placing a hand on either side of her head to demonstrate the range of subtle movements.

The animals move about freely, some finding a comfortable spot right away while others continue to mill about. Meanwhile, several horses with ears pinned back stir up plenty of dust.

The students, most of whom have never been around horses, report their observations.

Dr. Kane listens carefully to the first comment and then asks, "Is that an observation or an interpretation?" Since the latter comes from a person's own feelings and self-image projected onto another, understanding the difference is a first step toward improved communication skills.

Listening to horses

Another aspect of Medicine & Horsemanship helps doctors deal with their own internal stress, and the impact it can have on their ability to provide care.

Dr. Kane gathers the class in a circle and asks them to address the chatter going on in their minds. "In horsemanship there is a concept called 'Leaving it at the Gate.'"

Drawing on another horse-world analogy, Dr. Kane illustrates the importance of setting aside day-to-day worries. "A dressage rider has five minutes to impress the judge," she says. "To do that, you must be totally present and focused on your horse."

Later on, students learn another important lesson about equine body language. "Horses respond to pressure," Dr. Kane notes. "They move each other around by putting pressure on one another." Making the connection to medicine, Dr. Kane points out: "In a professional situation, your patient will feel pressure from you."

As the course progresses, the students work with the horses individually and in groups through a series of increasingly complex exercises.

In learning how to recognize and deal effectively with a dominant horse, for example, the students learn the importance of setting boundaries, and setting the stage for dealing with a difficult situation, such as saying "no" to patients accustomed to getting their own way.

Working in teams, students come to understand how a hospital patient can be unnerved when suddenly surrounded by a group of doctors in white coats. A horse confronted with a similar situation runs away. Team members learn to tune in to each other and make adjustments.

One exercise simulates the challenges faced by surgical teams. Four students work together as one body. One acts as the right half of the brain, another as the left. The others are the left and right arms. Together, they must halter and saddle a horse. As if that weren't enough of a challenge, they must rotate positions every three minutes.

To the casual observer, it might look like horsing around, but for the med students in Dr. Kane's class, it is serious training for their future in the medical profession.

"I became a lot more conscious of how I behaved in certain situations and what my body language would be telling a patient," says fifth-year medical student Tracy Dooley.

One student summed it up: "Effective communication is at the heart of the best care possible."

To learn more about Dr. Kane, go to


Hoof Beat is a new feature in The Almanac, written by Maggie Mah Johnson, who lives and rides horses in Woodside. She is writing this as a member of WHOA! (Woodside Horse Owners Association), whose mission is to promote and preserve the equestrian lifestyle of Woodside and the surrounding areas. For more information on WHOA! go to or call 380-6408.


Posted by Nan Meek, a resident of another community
on Oct 14, 2009 at 9:23 am

Great article, great program. Kudos to Stanford and Dr. Kane for recognizing the lessons that horses can teach to open-minded humans. As our medical system faces increasing challenges, anything that helps doctors and other health workers communicate better and provide better care is valuable. Thanks to Maggie and The Almanac for spreading the word about this program.

Posted by Julie Suhr, a resident of another community
on Oct 14, 2009 at 8:50 pm

Having been closely associated with many horses for many years, I know I have not begun to teach them as much as they have taught me. I am a better person for it. I have learned to watch keenly subtle movements on the part of the horse that give me an insight into a particular individual's personality. This is a valuable course Dr. Kane is teaching as what you learn from animal/human exchange can guide you in human/human relationships.

Posted by Stefanie Mazer, a resident of another community
on Oct 25, 2009 at 9:55 pm

This is a fantastic program! I wish we could find ways to offer this type of training to students and professionals in many more human service fields. What a fun and humbleing way to learn about another's worldview!

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