Compassionate Physician Research Articles

The Physician King Buddhadasa: A Mine of Virtues, as the Sea is of Jewels.

King Buddhadasa was a monarch of the Kingdom of Anuradhapura, Sri Lanka, in the 4th century A.D. He was a unique king with sound knowledge and skill in medicine according to the traditional medical system. The primary source of Sri Lankan history describes him as "a mine of virtues, as the sea is of jewels." This is due to his virtue of being a righteous king and a compassionate physician, whose healing extended to both humans and animals. His contributions went beyond curative medicine to include preventative care, medical administration, and scholarly work such as the Sarartha Sangrahaya. Similar to Charaka and Sushruta in the South Asian region, his life and work are exemplary and inspirational to modern-day physicians. This review provides an account of the life of King Buddhadasa as recorded in the primary chronicle of Sri Lankan history. Some of his healing accounts may seem mystical to the reader. The article also endeavours to find plausible explanations for those occurrences based on allopathy and science. These records serve as important lessons for modern-day physicians, encouraging the inculcation of good conscience and morality in medical practice.

Empathy Unmasked: Patient Perception of Physician Empathy in an Oncologic Emergency Setting. A Randomized Controlled Trial Comparing Personal Protective Equipment Wear versus Unmasked Video Communication

BackgroundAmidst the COVID-19 pandemic, telemedicine emerged as an important option that supports and facilitates clinical practice, however, its usefulness in emergency settings that treat patients with cancer is unclear. ObjectiveTo evaluate patient perception of physician empathy in an emergency oncology setting, comparing video interaction to an in-person with personal protective equipment (PPE) approach. MethodsIn this single-center, prospective, cross-sectional, survey-based randomized controlled trial, patients were randomized 1:1 for the concluding conversation done in-person which included either interacting with physicians wearing PPE or video interaction with physicians without PPE (virtual). Patients’ perceptions of the physicians’ relational empathy were assessed and compared for each group by using the Consultation and Relational Empathy (CARE) Measure and the Perception of Physician Compassion measure. ResultsPatients (n=106) in both the PPE and virtual arms provided favorable responses to all questions. The mean overall CARE scores for the PPE and virtual arms were 45.02 and 44.43, respectively (difference, 0.58 [95% CI: -2.10, 3.30]). Regarding the linear physician compassion scores, patients in the virtual arm appeared to consider physicians to be warmer (difference, -0.42 [95% CI: -0.87, 0.04]) but less pleasant (difference, 0.33 [95% CI: -0.40, 1.10]) than did patients in the PPE arm. ConclusionsCancer patients presenting to the emergency department perceive empathy and compassion equally when approached by physicians virtually without PPE or in person while wearing PPE. Virtual services for specific aspects of clinical practice during emergency department visits in an oncology setting can be implemented to ensure safer interactions between patients and physicians without compromising the physician-patient relationship.

Is the Compassion of Anesthesiologists Associated With Postoperative Pain and Patient Experience? A Prospective Cohort Study.

Patient perception of physician compassion may be associated with improved health outcomes, yet it is unclear whether it is associated with postoperative pain reduction or improved patient experience metrics in same-day surgery patients. We hypothesized that higher anesthesiologist compassion during the preanesthesia interview, rated by patients, is associated with lower postoperative pain via the anxiety pathway in same-day surgery patients. We also performed exploratory correlation analysis to assess whether compassion was associated with less opioid consumption and improved patient experience in same-day surgery patients. We conducted a single-center, prospective, observational cohort study in American Society of Anesthesiologists (ASA) physical status I to III patients scheduled to undergo same-day surgery with anesthesia. Compassion was scored using a validated 5-item tool. State anxiety (SA) and trait anxiety (TA) were measured using the State-Trait Anxiety Inventory. Pain scores were obtained using a 0 to 10 Likert scale. Daily opioid use was recorded. Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) and the Surgical Care CAHPS. Mediation analysis was used to assess the association between compassion and pain scores via the anxiety pathway. Spearman correlation was performed to test for association between the compassion score and the secondary outcomes. A total of 147 subjects completed the study with a median age of 50 years and 81% female. Fifty percent underwent breast surgery, 35% abdominal surgery, and the rest underwent gynecological and urological surgeries. The median (Q1-Q3) postoperative pain scores on postoperative days 0 and 3 days later were 4 (1.5-6) and 3 (1-5), respectively.Mediation analysis results showed a same-day anxiety-mediated effect (95% confidence interval [CI]) of compassion on pain of -0.08 (-0.13 to -0.02), attributing to 9% of the total effect. On postoperative day 0, an increase in compassion was associated with a significant average drop in pain of between 0.02 and 0.13. In addition, higher compassion was correlated with better patient experience metrics (ρ= -0.53 [95% CI, -0.64 to -0.39]). The study results suggest that an anxiety-mediated pathway exists through which compassionate care may help improve the patient's perception of postoperative pain on the day of surgery (before discharge from the hospital). Higher compassion was also associated with better patient experience metrics.

Competence or Experience

Competence or Experience

Validity and reliability of the Japanese version of the Patient Satisfaction Questionnaire (PSQ-J) for evaluating oncologist consultations

To develop the Japanese version of the Patient Satisfaction Questionnaire (PSQ-J) and examine its validity and reliability. A cross-sectional, web-based survey was conducted among cancer patients in Japan. The PSQ-J was developed following the forward-backward translation method, using a numerical rating scale. Data on patient characteristics and psychometric scales, like the PSQ-J, willingness to recommend an oncologist to others, trust in the healthcare system, uncertainty, and the Physician Compassion Questionnaire were collected. Validity was examined using exploratory and confirmatory factor analyses and by calculating the correlations between the total PSQ-J score and the criterion variables. Reliability was confirmed by Cronbach's alpha and test-retest score correlations at a two-week interval. The first and second surveys were conducted on 309 and 107 patients, respectively. One-dimensionality and model fit were verified using factor analyses. The PSQ-J was significantly associated with other comparable scales. Cronbach's alpha was 0.962; the correlation between the PSQ-J test-retest scores was 0.835 (p < .001). The current study indicates that the PSQ-J can be valid and reliable for assessing satisfaction with oncologist consultation. The PSQ-J enables the effective assessment of patient satisfaction with oncologist consultations, leading to better practice reflecting the patient's viewpoint.

Assessing Levels of Empathy among Undergraduate Medical Students: Results of a Cross-Sectional Study Conducted in a Medical College in Sohar, Oman

OBJECTIVE: Empathy is an essential aspect of communication skills for physicians, especially primary care physicians. The study aims to explore the empathy scores among medical students at different stages of medical training and to analyze the effect of gender and career choice on the empathy scores of medical students. METHODOLOGY: A cross-sectional study was conducted from October 2021 to January 2022 in a medical college in Sohar, Oman. All the students were eligible to participate in this study. Simple random sampling was employed, and participants were administered a 20-item Jefferson Scale of Empathy-Student (JSE-S) Version. Data were analyzed using SPSS version 22. Mean and standard deviation were reported for continuous variables. Subgroup comparisons were conducted using t-test and ANOVA. RESULTS: Out of 424 participants, the majority were female (n=390,92%), and over half of the students (56%) were less than 22 years of age. The mean empathy score of students on the JSE-S scale was 104.6 ± 17.43 (range: 37-140). Subgroup analysis revealed that males had a slightly high score on JSE-S (male: 105.7+14.56, female: 104.5+17.6, p-0.23). Empathy scores showed an increasing trend as the student progressed through medical school (6th year: 106.2+16.16). Empathy scores were almost similar for students who had preferred people or procedure-oriented fields as their career pathway (p-0.59). CONCLUSION: The study reflects the need to include empathy in teaching communication skills to medical students as an integral part of the medical school curriculum, which could assist them in becoming compassionate physicians and increasing patient satisfaction. KEYWORDS: Empathy, empathy scores, JSPE, Medical Students, Physicians, Undergraduate Medical Students.

Factors influencing patient experience during incision and drainage procedures in hidradenitis suppurativa: an analysis of patient-reported outcomes.

Patients with hidradenitis suppurativa who undergo incision and drainage experience higher levels of dread and lower levels of benefit due to poor anaesthesia and wound packing practices, and lower levels of provider compassion. Higher levels of dread were associated with increased pain during incision (coefficient 0.3, 95% CI 0.19–0.42) and wound packing or drain vs. simple bandaging (coefficient 2.25, 95% CI 0.61–3.90). Higher perceived benefits over drawbacks were associated with higher physician compassion (coefficient 0.21, 95% CI 0.06–0.36) and decreased pain during incision (coefficient 0.14, 95% CI 0.03–0.27).

And Finally: Matters of Life and Death

And Finally: Matters of Life and Death

Rosa Maria Rodrigues Pereira (1958-2022).

Her interest in bone metabolism started during her internship in rheumatology; she was particularly intrigued by osteoporosis and the negative effects of corticosteroids on the bone. In the 1990s, she began interacting with the endocrinology service led by Professor Aurelio Borelli, probably the only place in São Paulo University that subscribed to the main journals focused on bone research. Despite her limited experience in a basic research laboratory, she decided to face the challenges of a bench research-based postdoctoral fellowship and joined the laboratory of Professor Ernesto Canalis at Saint Francis Hospital, Hartford, CT, USA. She learned bone cell biology and became proficient with the bench research techniques that she established in her lab in São Paulo after her return to Brazil. She created and directed the Laboratory of Bone Metabolism, which became a center of excellence for training students and young physicians from different specialties. She was able to secure financing to acquire one of the few high-resolution peripheral quantitative computed tomography machines available in Brazil. She became a go-to specialist in rare and challenging bone diseases, many of which made their way into high-impact publications. Prof Pereira developed original research directions and extensively published. Her research focused on bone and mineral disorders related to rheumatic diseases, including pediatric rheumatology and inflammatory vascular diseases. During her career, she published 391 original articles, 85 book chapters, and 8 books. She made major contributions to the use of vitamin D, including a randomized clinical trial, whose results were published in JAMA in 2021, demonstrating that among hospitalized patients with COVID-19, a single high dose of vitamin D3 did not impact the length of hospital stay. Prof Pereira contributed to the development of the Brazilian National Guidelines for Prevention and Treatment of Osteoporosis and was the coordinator of the São Paulo Ageing and Health Study, a population-based prospective cohort study in Brazil, which resulted in more than 17 publications focusing on bone microarchitecture and fragility fractures. The outstanding quality of her work has been recognized by more than 80 national and international awards. She held leadership roles with high-profile journals, including the International Advisory Board of The Lancet Rheumatology, and served as the Regional Editor of Journal of Bone and Mineral Research. Prof Pereira was instrumental in the creation of the Brazilian Association of Bone Assessment and Osteometabolism (ABRASSO) in 2007, contributing to the organization of the scientific program at their conferences, where she proudly showcased the results of her research. Despite her many professional commitments, Prof Pereira was a compassionate physician who was fully dedicated to patients with rheumatologic diseases during her 40-year career. She led weekly rheumatology rounds and inspired many students and residents who had the fortune of coming under her wings during her 4-decade-long career. Prof Pereira mentored 7 postdoctoral students, 33 doctoral students, 5 master's degree students, and 22 undergraduate students. They will certainly continue to have the legacy of patient care and academic excellence. Prof Pereira was tireless and determined. Her work schedule included weekdays and weekends; she continued her hectic schedule until just a few weeks before she was overcome by illness. Prof Pereira exemplifies how effective leadership can have long-lasting positive effects on others and on our field at large. Her work and legacy will remain a source of inspiration for new generations of clinicians and researchers who will continue to advance our knowledge of rheumatology and metabolic bone diseases. Prof Pereira will be missed by her family, many lifelong colleagues, friends, and patients. She is survived by her husband, Ricardo, a great motivator and supporter of her academic career. We are now committed to turning sadness into a strength and celebrating Prof Pereira's personal and scientific legacy. The peer review history for this article is available at https://publons.com/publon/10.1002/jbmr.4767. The peer review history for this article is available at https://publons.com/publon/10.1002/jbmr.4767.

Hunter H McGuire– Ignominious Legacy of a Confederate Surgeon

Objectives National protests in the wake of the murder of George Floyddemanded that Confederate statues be removed from public view as symbols of slavery and racism. A statue still stands in Richmond, Virginia, dedicated to a Confederate surgeon, Hunter Holmes McGuire (1835-1900). The Richmond, Virginia Veterans Administration (VA) Hospital bears his name. Dr. McGuire became a contemproary influential figure in American medicine, and served as the President of the American Medical Association; he was also a racist. A biogaphy of McGuire is hereby compiled to better understand his rise to prominence in the Confederate South. Methods Medical articles, commentaries and speeches authored by Dr. McGuire, bibliographies and contemporary newspaper columns. Results Dr. McGuire served as a surgeon in the Confederacy from 1861-1865 and in that rolewas credited for saving many lives. After the war, he became nationally and internationally known as a compassionate physician, gifted surgeon, teacher and educator. A third of his medical publications were devoted to advancing urologic care. He founded Richmond’sUniversity College of Medicine (which merged with the Medical College of Virginia in 1913) and later became president of the American Medical Association. Dr. McGuire was also a pro-slavery advocate his entire life, was a white supremacist, whose statue still sits behind the Virginia state capital building. Conclusions HunterMcGuire made significant contributions to American medicine, but his unrepentent racism and pro-slavery views and actions have tarnished his legacy.

Poor Online Patient Ratings of Otolaryngologists in the United States: What are Patients Saying?

Online patient forums have become a platform for patient education and advocacy in many areas of medicine. The anonymity provided by such forums may encourage honest, candid responses. Using patient online reviews, this study sought to explore themes that arose from negatively perceived care interactions with American otolaryngologists using the Accreditation Council for Graduate Medical Education (ACGME) competency framework. Qualitative thematic analysis. Through an iterative multistep process, a qualitative thematic analysis was conducted on negative reviews (defined as ratings of two or less out of five) of all American otolaryngologists found on a popular online physician-rating website (RateMDs.com). A systematic search through the RateMDs website revealed 2950 separate comments of negative reviews. Of these negative reviews, 350 were randomly selected for thematic analysis. The predominant themes that emerged aligned closely with the Accreditation Council for Graduate Medical Education (ACGME) competencies, in particularly with professionalism and interprofessional skills and communication. The negative reviews of American otolaryngologists revealed a number of areas where improvements could be made to quality of care. Patients value evidence-based medicine delivered by compassionate and respectful physicians. Isolating and aligning predominant themes within the ACGME framework proved a productive method to collect and organize pertinent patient feedback and integrate teaching into the post-graduate training and continuing professional development in order to avoid such negatively perceived interactions in the future.

Student Leadership Development Initiative for Medical Students: Lessons Learned From Transitioning to Virtual Modalities.

Leadership training is a necessary component of undergraduate medical education. Our group successfully implemented a student-led organization starting from 2016 (Student Leadership Development Initiative; SLDI) that aimed to provide medical students with exposure to physician-leader career paths in an informal, organic, interactive setting. The COVID-19 pandemic necessitated a shift to online programming, and given the high prevalence of ZOOMTM fatigue, we incorporated monthly, freely available, self-directed modules as an additional leadership training opportunity. The goals of this study are to assess the (1) feasibility of and participation in a virtual student organization focused on leadership training, (2) whether students' perceptions of the importance of leadership were associated with participation in SLDI, and (3) lessons learned from transitioning to virtual modalities. An anonymous, retrospective cross-sectional survey with 13-items was distributed through an email listserv and a 6-question survey was sent to attendees following each virtual group-discussion. A Fisher's exact test was conducted to assess whether the number of modules completed was associated with students' perception of leadership importance. Survey results showed that 85% strongly agreed or agreed that SLDI helped them develop professional goals and career paths, and 74% reported benefits in becoming more compassionate physician leaders and valuing wellness. All respondents completed ≥1 self-directed module, and the students' perception of leadership importance did not influence the number of self-directed modules completed (p > .05). Most participants (63%) attended ≥67% of virtual events, and postevent feedback was positive; however, only 46% of respondents reported meeting someone new at events and 32% reported that they intended on connecting with new contacts. Our results suggest that virtual leadership student-organization, involving small-group discussions and self-directed modules, is feasible and beneficial for medical students. However, the inability to promote meaningful networking opportunities is a major limitation of a virtual training model.

Surgeon compassion may mitigate quality of life disparities associated with health literacy

ObjectivesPatients with health literacy (HL) disparities are less likely to comprehend hospital discharge instructions and less satisfied with physician communication. In this prospective cohort study, we sought to examine the...

“See One, Do One, Perceive One”: Analyzing the Role of the Third-Year Surgery Clerkship on Students’ Perceptions of Surgeons and Their Lifestyles Amidst the COVID-19 Pandemic

INTRODUCTION: Long hours, poor work-life balance, pessimism, and cynicism are the notorious perceptions of surgeons thought to be held by medical students. The impact that the third-year surgery clerkship has on these perceptions has been discussed, but it’s unclear whether changes to the clinical environments due to COVID-19 hamper such impacts. We sought to provide updated analysis on this common question. METHODS: Identical survey questions were given to third-year medical students before and after their surgery clerkship. Students were asked whether they strongly agreed, agreed, neither agreed nor disagreed, disagreed, or strongly disagreed with multiple statements about surgeons. A p-value <0.05 was considered statistically significant. RESULTS: 91 students responded to the pre-clerkship survey (82.7% response rate) and 34 students to the post-clerkship survey (38.6% response rate). Compared to pre-clerkship responses, post-clerkship responses demonstrated a significant increase in the percentage of students who believe that surgeons are good teachers (p = 0.00092), respect medical students (p=0.00326) encourage students to pursue surgery (p = 0.0114) and are compassionate physicians (p = 0.00429), and a significant decrease in the percentage of students who believe that surgeons are mean (p = 0.0394) or pessimistic (p = 0.0161). There was no change seen with respect to students’ perceptions of surgeons’ workload (p = 0.304)/lifestyle (p = 0.0796), reputation (p = 0.0873)/respect received (p = 0.750), contentment with career choice (p = 0.268) or respect for other physicians (p = 0.151). CONCLUSION: The third-year surgery clerkship appeared to have improved students’ perception of surgeons’ personality traits and role as educators but did not appear to affect students’ perceptions of surgeons’ lifestyle, inter-personal traits, or reputation.

The impact of mindfulness practice on physician burnout: A scoping review.

BackgroundPhysician burnout is a growing phenomenon in current health systems worldwide. With the emergence of COVID-19, burnout in healthcare is progressively becoming a serious concern. Increasing emotional exhaustion, depersonalization, and reduced personal accomplishment threaten the effective delivery of healthcare. Compassion fatigue and moral injury are a considerable risk to the doctor-patient relationship. These issues can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in physicians.MethodologyA scoping review was conducted to investigate the effects of mindfulness practice on physician burnout. High-ranking journals were targeted to analyze high-quality studies and synthesize common themes in the literature. Studies conducted on current practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Gray literature and studies conducted only on allied health personnel were excluded from this review.Results31 studies were included in this scoping review. Mindfulness practice decreased emotional exhaustion and depersonalization while improving mood, responses to stress, and vigor. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to physician mindfulness practice.ConclusionMindfulness was widely reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate physician leader will play a crucial role in addressing current practice gaps, prioritizing staff mental health, and providing a supportive platform for innovation.

Self-compassion and barriers to self-compassion in physicians at a NCI-designated comprehensive cancer center (396)

<b>Objectives:</b> Physician compassion is associated with improved patient outcomes, including patient satisfaction and compliance. Compassion for oneself has been shown to ameliorate burnout and anxiety in physicians. Self-compassion is an adaptive coping mechanism to respond to uncertainty and challenges. Self-compassion encompasses three components: self-kindness versus self-judgment, a sense of common humanity versus isolation, and mindfulness versus over-identification with painful thoughts and emotions. Our objective was to evaluate self-compassion across physicians at a comprehensive cancer center and identify differences in self-compassion according to workplace factors and demographic variables. <b>Methods:</b> A cross-sectional study of physicians employed at an NCI- designated Comprehensive Cancer Center in December 2019 using a 115-question instrument that included multiple validated measures of wellbeing, including the Neff's Self-Compassion Scale short form (SCS-SF). SCS-SF is a 12-item scale scored on a 5-point Likert scale. Professional Fulfilment Index (PFI), a 16-item measure, evaluating burnout and fulfillment, was included. Data were analyzed using independent t-tests, ANOVAs, and Pearson's correlations. <b>Results:</b> One hundred and seventy-three surveys were collected with a response rate of 46.6%. Respondents were 63% male and 36% female. The majority of participants were aged 30-49 years, and subspecialty was evenly distributed. There were differences in selfcompassion scores across self-reported gender in the subscales of over-identification, common humanity, and mindfulness (Table 1). Increasing age and years of clinical experience were associated with better scores on the overidentified sub-scales (p=0.009, p=0.005). Self-compassion was not statistically associated with a subspecialty, hours worked, or percentage of clinical time. Respondents with children at home had greater scores in the common humanity subscale (p=0.039). Self-compassion composite mean and subscales scores (except over-identification) were positively correlated with all categories of physician support. Performance on all PFI subscales correlated with self-compassion. Participants that met the criteria for burnout had lower scores on all the SCS subscales. <b>Conclusions:</b> Physicians with higher self-compassion experience better professional well-being, more work engagement, and less work exhaustion. In this study of physicians at a large NCC, we identified several groups with lower self-compassion scores, including females, those with burnout, and those with lower job satisfaction. Additionally, increasing age and clinical experience were positively correlated with higher self-compassion, as were nearly all types of reported support. As self-compassion is a learned skill that can be fostered, these findings suggest that there are multiple cohorts of physicians that may benefit from additional institutional-sponsored interventions and enhanced support.

Predictors of Medical Students’ Compassion and Related Constructs: A Systematic Review

Phenomenon: Compassion, and related constructs such as empathy, are core values in healthcare, with known benefits for both patients and staff. Yet research on the factors that affect compassion and compassion-related constructs remains scattered. This review systematizes and synthesizes studies investigating the predictors of compassion and related constructs among medical students, allowing for a better understanding of the factors that both positively and negatively contribute to the development of compassionate future physicians. Approach: A systematic review of 12 databases for studies from database inception up until April 2020 was conducted. Non–peer-reviewed literature and studies in which >50% of the sample were non-medical students were excluded. Intervention studies were also out of the scope of this review. We assessed risk of bias and confidence in the findings using standardized tools. Data were categorized within the Transactional Model of Physician Compassion, a framework in which compassion is influenced by personal (student), environmental, patient/family, and clinical factors. Findings: Of 14,060 retrieved articles, 222 studies were included. Of these, 95% studied student factors, but only 25% studied environmental, 9% studied patient, and 6% studied clinical factors. Predictors of greater compassion included maturity; work and life experiences; personality traits of openness to experience and agreeableness; skills such as perspective taking, reflection, and mindfulness; and positive role modeling. Conversely, negative attitudes/emotions, burnout, stress, detachment, operating in cultures prioritizing knowledge and efficiency over humanistic care, negative role models, time constraints, and heavy workloads predicted lower compassion. Patient-related factors included “difficult” and “noncompliant” patients or those perceived as responsible for their illness. Overall, 60% of studies had a serious risk of bias, particularly confounding and participant selection biases. Insights: Medical student compassion is predicted by a wide range of factors relating to the student, their training environment, their patients, and the clinical situation. However, existing research has largely focused on student factors (e.g., sociodemographic and dispositional traits), many of which are not amenable to intervention. Skills such as perspective taking, reflection, and mindfulness are associated with higher compassion and may present opportunities for intervention. There is also strong evidence that environmental factors shape students’ compassion. Researchers and educators should continue to explore the impact of patient and clinical factors on students’ compassion. Studies remain at high risk of bias.

Editor's Spotlight/Take 5: Discussing Two Systematic Reviews With Opposing Conclusions on Shoulder Pain After Vaccine Administration.

Editor's Spotlight/Take 5: Discussing Two Systematic Reviews With Opposing Conclusions on Shoulder Pain After Vaccine Administration.

Donald P. Pinkel: In Memoriam (1926–2022)

Donald P. Pinkel: In Memoriam (1926–2022)

Beyond empathy decline: Do the barriers to compassion change across medical training?

Background: Despite being a mandated, foundational value in healthcare, research on compassion remains limited. Studying the individual, patient, clinical, and contextual factors that interfere with compassion—the “barriers”—may clarify our understanding of the origins of compassion and identify potential targets for improving patient-centred care. Studies of the related construct of empathy have suggested that medical students report declines with increasing clinical experience. In contrast, when comparing physicians with medical students, increased clinical experience predicts lower barriers to compassion. Whether—and how—a similar experience-related decline in the factors that interfere with compassion occurs across medical training remains unknown.Aims: To describe how the barriers to compassion vary across clinical training in medical students.Method: New Zealand medical students (N = 351) in their clinical years (Years 4–6) completed measures of the Barriers to Physician Compassion (BPCQ) and potential covariates such as demographics, work burden factors, and dispositional factors. The BPCQ indexes the extent to which barriers in four domains (individual, patient, clinical, and contextual) interfere with a physician/student’s compassion towards patients. Analyses of variance and regression analyses were used to explore the effect of year level on the four types of barriers.Results: Year 4 students reported slightly lower student-related, environmental and patient/family-related (but not clinical) barriers than Year 6 students (effect size: ɷ2 < 0.05); all barriers increased comparably across training. Controlling for relevant confounds, regression analyses confirmed that lower year level predicted lower barriers to compassion. Higher self-compassion, but not gender, predicted lower barriers.Conclusions: In extending studies of empathy decline, this report suggests that students experience higher barriers to compassion as clinical training progresses. This is in contrast to existing studies contrasting physicians with medical students, where greater experience was associated with lower perceived barriers to compassion. Self-compassion may offset increases in barriers to care.