Abstract
BackgroundEmpathy and compassion are vital components of health care quality; however, physicians frequently miss opportunities for empathy and compassion in patient care. Despite evidence that empathy and compassion training can be effective, the specific behaviors that should be taught remain unclear. We synthesized the biomedical literature on empathy and compassion training in medical education to find the specific curricula components (skills and behaviors) demonstrated to be effective.MethodsWe searched CENTRAL, MEDLINE, EMBASE, and CINAHL using a previously published comprehensive search strategy. We screened reference lists of the articles meeting inclusion criteria to identify additional studies for potential inclusion. Study inclusion criteria were: (1) intervention arm in which subjects underwent an educational curriculum aimed at enhancing empathy and/or compassion; (2) clearly defined control arm in which subjects did not receive the curriculum; (3) curriculum was tested on physicians (or physicians-in-training); and (4) outcome measure assessing the effect of the curriculum on physician empathy and/or compassion. We performed a qualitative analysis to collate and tabulate effects of tested curricula according to recommended methodology from the Cochrane Handbook. We used the Cochrane Collaboration’s tool for assessing risk of bias.ResultsFifty-two studies (total n = 5,316) met inclusion criteria. Most (75%) studies found that the tested curricula improved physician empathy and/or compassion on at least one outcome measure. We identified the following key behaviors to be effective: (1) sitting (versus standing) during the interview; (2) detecting patients’ non-verbal cues of emotion; (3) recognizing and responding to opportunities for compassion; (4) non-verbal communication of caring (e.g. eye contact); and (5) verbal statements of acknowledgement, validation, and support. These behaviors were found to improve patient perception of physician empathy and/or compassion.ConclusionEvidence suggests that training can enhance physician empathy and compassion. Training curricula should incorporate the specific behaviors identified in this report.
Highlights
Empathy and compassion are foundational elements of the practice of medicine and vital cornerstones of high quality health care.[1, 2] They are closely related terms, with empathy defined as the ability to sense, feel, and understand another’s emotions, and compassion defined as an emotional response to another’s pain or suffering involving an authentic desire to help.[3, 4] Both are essential in the care of patients, in that empathy is required to spur compassion.[5]
Most (75%) studies found that the tested curricula improved physician empathy and/or compassion on at least one outcome measure
Training curricula should incorporate the specific behaviors identified in this report
Summary
Empathy and compassion are foundational elements of the practice of medicine and vital cornerstones of high quality health care.[1, 2] They are closely related terms, with empathy defined as the ability to sense, feel, and understand another’s emotions, and compassion defined as an emotional response to another’s pain or suffering involving an authentic desire to help.[3, 4] Both are essential in the care of patients, in that empathy (i.e. understanding of patient suffering) is required to spur compassion (i.e. the emotional response involving action aimed at alleviating patient suffering).[5]. Within health care systems compassionate care is associated with lower health care costs (e.g. better patient communication resulting in lower spending on unnecessary diagnostic tests and referrals).[21] Despite abundant evidence supporting the importance of compassionate patient care, there is currently evidence to suggest that health care is experiencing a compassion crisis (i.e. an absence of–or inconsistency in–compassionate patient care),[6] in which physicians miss the majority of opportunities to show compassion,[22] instead focusing on narrow biomedical inquiry and explanations.[23]. Despite evidence that empathy and compassion training can be effective, the specific behaviors that should be taught remain unclear. We synthesized the biomedical literature on empathy and compassion training in medical education to find the specific curricula components (skills and behaviors) demonstrated to be effective
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