A systematic scoping review of approaches to teaching and assessing empathy in medicine

Yi Zhou ,Jin Wei Kwek,Matthew Song Peng Ng,Chester Guan Hao Tan,Kia Hui Lim,Shien Ru Tan,Crystal Lim,Eng Koon Ong,Min Chiam,Anupama Roy Chowdhury,Lorraine Hui En Tan,Warren Fong,Yun Ting Ong,Stephen Mason,Nagavalli Somasundaram,Elisha Wan Ying Chia,Limin Wijaya,Annelissa Chin ,Clarissa Wei Shuen Cheong,Lalit Kumar Radha Krishna

doi:10.1186/s12909-021-02697-6

Abstract

BackgroundEmpathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed.MethodsThis systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data.ResultsIn total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum.ConclusionsNurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one’s professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.

Highlights

Empathy is pivotal to effective clinical care
To enhance understanding of how empathy may best nurtured and to address prevailing knowledge gaps, we propose a review of prevailing efforts to nurture and assess empathy amongst physicians and medical students
As the final five themes/categories identified through the Split Approach, Jigsaw Perspective and Funnelling Process were determined to be parallel in nature, they will be discussed in tandem for ease of understanding

Summary

Introduction

Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. A physician’s ability to demonstrate empathy strengthens doctor-patient relationships [1, 2], boosts patient outcomes [3, 4], patient satisfaction [2, 5], increases professional satisfaction [6, 7], improves clinical competence [8, 9] and reduces potential burnout [10, 11] Despite these benefits and evidence of diminishing empathy midway through medical school [12, 13], empathy remains poorly nurtured in medical school and postgraduation [9, 14,15,16,17,18,19]. Inconsistencies in the structuring of programs aimed at nurturing empathy and the lack of effective assessment methods further exacerbate the issue [14, 18].

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Results

Discussion

Conclusion