Empathy In Medical Students Research Articles

Can communication skills training improve empathy? A six-year longitudinal study of medical students in Japan

Background: Empathy is an important component of overall clinical competence; thus, enhancing empathy in medical education is essential for quality patient care.Aim: This longitudinal study was designed to address the following questions: 1. Can a targeted educational program in communication skills training enhance empathy in medical students? and 2. Can such a program have a sustained effect?Methods: Study participants included 116 students who entered Okayama University Medical School in 2011. Students participated in a communication skills training program aimed to enhance their empathy, and completed the Jefferson Scale of Empathy (JSE) five times: at the beginning of medical school, prior to participation in the program, immediately after the program, and in last years of medical school. A total of 69 students, representing 59% of the cohort, completed the JSE in all five test administrations.Results: Students’ total scores on the JSE and its two factors (Perspective Taking and Compassionate Care) increased significantly (p < 0.001) after participation in the communication skills training program. However, the program did not have a sustained effect.Conclusions: Targeted educational programs to enhance empathy in medical students can have a significant effect; however, additional reinforcements may be needed for a sustained effect.

Associations between emotional intelligence, empathy and personality in Japanese medical students

BackgroundIt is known that empathic communication is important for physicians to achieve higher patient satisfaction and health outcomes. Emotional intelligence (EI), empathy and personality in medical students predict students’ individual disposition and their emotional and empathic perceptions. This study aimed to investigate: 1) The association between empathy, EI and personality, and 2) Gender differences in the association between empathy, EI and personality.MethodParticipants were 357 1st year medical students from 2008 to 2011 at one medical school in Japan. Students completed self-report questionnaires comprising three validated instruments measuring EI: Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), empathy: Jefferson Scale of Physician Empathy- student version (JSPE) and personality: NEO-Five-Factor Inventory (NEO-FFI), which explores 5 dimensions of personality Neuroticism (N), Extraversion (E), Openness to experience (O), Agreeableness (A), and Conscientiousness (C).ResultsPearson Correlations showed weak association between TEIQue-SF and JSPE. TEIQue-SF and NEO-FFI showed positive correlation for E and C, and strong negative correlation for N and weak positive correlation for A and O. Weak positive correlation between JSPE and the NEO-FFI were observed for E and A. Although effect sizes were small, N, A and empathy were significantly higher in females (unpaired t-test). However, hierarchical multiple-regression analysis when controlling for gender and personality showed no association between EI, empathy and gender. A, TEIQue-SF and N were found to make small contributions in respect of predictions for JSPE. Personality contributed significantly to the prediction of TEIQue-SF. N had the largest independent negative contribution (β = − 0,38).ConclusionIn our study population of 1st year medical students, females had significantly higher N, A and empathy scores than males. Medical students’ N score was strongly negatively associated with EI. Empathy was weakly associated with EI and A. However, when controlling gender and personality in regression analysis, gender did not affect EI and empathy, rather personality is the most important factor. Our findings indicate that N is a major factor that negatively affects EI. It is important to mitigate N using thoughtful training, taking into account students’ personalities, to reduce N. In future studies, we will assess how communication trainings for students might enhance EI.

Evidence-based poetry: using poetic representation of phenomenological research to create an educational tool for enhancing empathy in medical trainees in the management of depression

ABSTRACTCurrent medical education provides insufficient training in clinical empathy, which is important when caring for mentally ill patients Reading and discussing poetry are promising methods for developing clinical empathy. This qualitative study aims to improve empathy in medical students and practitioners towards patients with depression, by creating poetry as a medical education intervention. Five patients with depression shared their lived experience of depression in focus groups. For each of the nine major symptoms of depression, three types of poems were created: found poems using poetic condensation of phenomenological data, thematic poems based on thematic analysis, and freestyle poems. Participants with depression evaluated the poems. 26 out of 30 poems were felt to capture the lived experience of depression, and all three types of poetry were effective. Incidentally, themes of stigmatization and lack of empathy also emerged. Further directions include publishing and studying whether these poems improve empathy in medical trainees.

The IMPACT Q framework: teaching medical students how to gather a psychosocial history.

Many patient visits in primary care are driven by psychosocial concerns1 and medical illness is invariably linked to these. Yet when we teach undergraduate medical students to explore such psychosocial issues in the standard social history, in practice this often comprises a limited number of questions relating to smoking, alcohol, and occupation. Junior doctors, trainees, and students infrequently ask about the impact of an illness or problem on issues such as the patient’s ability to provide for themselves or on the psychological impact. These questions are more meaningful to patients than being asked about their use of recreational drugs or cigarettes in the traditional social history, where such psychosocial issues are often explored and contained near the end of a patient’s history. Failing to ask these important questions relating to impact of a problem on a patient’s life, in a natural and fluid way throughout the history, can lead to a disconnect between the clinician and patient agenda. Furthermore, this disconnect can make it difficult to move towards approaches such as shared decision making, management plans, and self-care, which are all essential outcomes in the current NHS. It is hoped that, by encouraging a more natural and reflexive questioning style to emotive psychosocial issues, students will be able to really listen, understand, and react to these feelings in an appropriate way in real time. The current history-gathering template is therefore at risk of contributing to the so-called ‘empathy erosion’ where there is a decrease in compassion and empathy in clinical medical students, as they start viewing patients as cases needing to be medically managed, with psychosocial issues often shackled to the social history tagged on to the end of the encounter. This article aims to address the imbalance of biomedical versus psychosocial enquiry in current clinical history …

Clinical empathy in medical students in India measured using the Jefferson Scale of Empathy-Student Version.

PurposeThe purpose of this study was to assess the clinical empathy of a cohort of medical students spanning 4 years of undergraduate study and to identify factors associated with empathy.MethodsA cross-sectional study to assess the empathy of undergraduate medical students at the University College of Medical Sciences and GTB Hospital in Delhi, India, was conducted using the Jefferson Scale of Empathy–Student Version. Demographic data were obtained using a pre-tested, semi-open-ended questionnaire.ResultsOf the 600 students, 418 participated in the survey (69.7%). The mean empathy score was 96.01 (of a maximum of 140), with a standard deviation of 14.56. The empathy scores decreased from the first to the third semester, plateaued at the fifth semester, and rose again in the seventh semester. Empathy was found to be significantly associated with the gender of the participant, with females having higher scores (P<0.001). The age of the participant, place of residence, whose decision it was for the student to enroll in an MBBS (bachelor of medicine and bachelor of surgery) program, and the choice of future specialty were not significantly associated with students’ empathy scores.ConclusionThe study found significant gender differences in empathy among the participants. The empathy scores tended to decline initially and then rebound over time. The mean empathy levels found in this study are lower than those reported in most similar studies around the world; therefore, further studies are needed to analyze and address the underlying factors associated with this discrepancy.

Empathy and specialty preference in medical students. Follow-up study and feedback

Abstract Introduction The evolution of empathy among medical students according to gender and specialty preference is explored using several validated scales. The value of our feedback to the medical students at the end of the study is also assessed. Materials and methods A total of 151 students completed the initial questionnaire, including the following scales: Jefferson Scale of Physician Empathy (JSPE), Interpersonal Reactivity Index (IRI), and Empathy Quotient (EQ). The final questionnaire was completed by 99 of them. Results According to the EQ classification, it was found that 7.3% of students had low empathy, 49.7% average, 36.4% above average, and 6.6% very high. Empathy was higher among women in IRI-FS, IRI-EC, and EQ. Students who preferred people-oriented specialties score higher in JSPE and EQ. The IRI-Fantasy Scale was the only scale that shows increased scores on follow-up and in students with preference for people-oriented specialties. Discussion This study shows that most of the medical students in our sample had a good level of empathy. Empathy was unchanged throughout the follow-up. Medical students had different profiles of empathy. In extreme profiles, feedback could offer advice in the process of choosing a specialty to best suit their empathic skills.

The impact of empathy on burnout in medical students: new findings

Introduction: Research on medical students has shown they are at a higher risk for burnout and that this burnout may become more prevalent as they advance in medical school. The literature, thus far, has not explored the construct of ,emotional empathy and whether this can impact burnout in medical students. Objective: To understand the relationship between empathy (Empathic Concern [EC] and Personal Distress [PD]) and burnout in medical students. Method: Five successive classes of medical students enrolled at a new medical school were given the Maslach Burnout Inventory and Davis’ Interpersonal Reactivity Index over the course of three successive years (n = 353). Two dimensions of empathy were evaluated to determine if they have an impact on three dimensions of burnout (Emotional Exhaustion/EE, Depersonalization/DP, Personal Accomplishment/PA). Results: data was analyzed using a linear mixed model for each of the three components of burnout based on gender, age, year in medical school, and two types of empathy: EC, and PD. Conclusion: It was discovered that students with high levels of EC had statistically lower scores of burnout over time while students with high levels of PD empathy showed statistically higher scores of burnout over three years. Implications for these findings are discussed.

Effect of Educational Intervention on Empowering the Sense of Empathy in Medical Students: Application of Health Belief Model

Background and Objectives Empathy is one of the main skills in establishing a relationship between physicians and patients, and in order to increase this sense in students, it is necessary to introduce systematic and active programs into medical education. The aim of this study is to determine the effect of an educational intervention based on a health belief model on empowering the sense of empathy in medical students. Methods This was a quasi-experimental intervention conducted on two groups of 80 medical students involved in the internship program from Tehran University of Medical Sciences in 2015. Sampling was done randomly, and the subjects were randomly assigned to two groups, experimental and control. In the pre-test phase, all students completed a three-dimensional questionnaire including demographic data; a valid, reliable, and standardized Jefferson empathy questionnaire; and a section comprising questions designed by the researcher based on the constructs of the health belief model. Educational intervention was conducted only for the experimental group. To measure the results of educational intervention, the standardized patient questionnaires and the questionnaires completed by the students were used. Data were analyzed by means of frequency, percentage, mean and standard deviation, ANOVA, and independent t-tests. Results Before the intervention, the two groups were similar and comparable in terms of demographic variables. After the intervention, there was a significant difference in the mean scores of perceived susceptibility (P < 0.001) and perceived severity (P = 0.002) between the two groups. The mean scores of perceived barriers and perceived benefits were significant among the two groups (P < 0.001). In addition, there were significant differences in the constructs of self-efficacy and cues to action three months after intervention (P < 0.001). Conclusions Training based on the health belief model was effective in empowering the sense of empathy among medical students. Training on empathy skills is recommended in order to increase patient satisfaction, promote health outcomes, and increase job satisfaction among physicians.

Cross-cultural Differences in Mental Health, Quality of Life, Empathy, and Burnout between US and Brazilian Medical Students.

This study aimed to compare mental health, quality of life, empathy, and burnout in medical students from a medical institution in the USA and another one in Brazil. This cross-cultural study included students enrolled in the first and second years of their undergraduate medical training. We evaluated depression, anxiety, and stress (DASS 21), empathy, openness to spirituality, and wellness (ESWIM), burnout (Oldenburg), and quality of life (WHOQOL-Bref) and compared them between schools. A total of 138 Brazilian and 73 US medical students were included. The comparison between all US medical students and all Brazilian medical students revealed that Brazilians reported more depression and stress and US students reported greater wellness, less exhaustion, and greater environmental quality of life. In order to address a possible response bias favoring respondents with better mental health, we also compared all US medical students with the 50% of Brazilian medical students who reported better mental health. In this comparison, we found Brazilian medical students had higher physical quality of life and US students again reported greater environmental quality of life. Cultural, social, infrastructural, and curricular differences were compared between institutions. Some noted differences were that students at the US institution were older and were exposed to smaller class sizes, earlier patient encounters, problem-based learning, and psychological support. We found important differences between Brazilian and US medical students, particularly in mental health and wellness. These findings could be explained by a complex interaction between several factors, highlighting the importance of considering cultural and school-level influences on well-being.

The Impact of a Required Longitudinal Stress Management and Resilience Training Course for First-Year Medical Students.

Although psychological distress is common among medical students, little remains known about effective interventions. One promising individual-focused approach is mindfulness-based stress management interventions; however, studies to date have relied on volunteers. To determine whether a required longitudinal stress management and resilience course improves well-being among first-year medical students. A quasi-experimental study. Two cohorts of medical students who participated in a required stress management and resilience course and completed pre and post questionnaires. Validated instruments were used to examine the effects on burnout, quality of life (QOL), stress, resilience, happiness, and empathy. Paired analysis was conducted to explore changes from baseline. On paired analysis of individual students, mean mental QOL and happiness declined (mental QOL: -5.63 [P<0.001] and -5.15 [P=0.015] and happiness: -0.31 [P=0.02] and -0.4 [P=0.01], cohorts 1 and 2, respectively) over the course of the year. Similarly, stress scores increased by 4.22 (P<0.0001) and 3.62 (P=0.03) in cohorts 1 and 2, respectively. Cognitive and emotive empathy declined in both cohorts but was only statistically significant for cohort 1 (-1.64 and -2.07, P<0.01). No statistically significant differences in burnout or resilience were seen. The required longitudinal mindfulness-based stress management course tested in first-year medical students did not lead to measurable improvements in medical student well-being or empathy. These findings contrast with those of studies using volunteer medical students or physicians, which suggested a reduction in burnout and stress using a similar curriculum. Medical schools should consider offering a variety of effective options so that students can select activities they want to engage in.

Promoting empathy using video-based teaching.

Empathy is fundamental to patient-centred care. It has been shown to improve patient satisfaction and therapeutic outcomes. The success of educational interventions in enhancing students' empathy has been mixed, however, and a consensus on the most effective approach is lacking. Patients were videoed discussing their hospital experiences and interactions with clinicians. These videos were shown to groups of medical students, who then took part in a facilitated discussion around themes of health care communication and patient experience. The session was delivered to 48 students over seven sessions and evaluated by way of serial attitude questionnaires (the Patient-Practitioner Orientation Scale, PPOS) and written feedback. There was an improvement in PPOS scores amongst participants, with pre- and post-intervention means of 78.8 and 82.0, respectively, indicating an improvement in patient-centred attitudes. Written feedback highlighted the emotional impact of hearing patients' stories, and that the discussion explored issues not covered in previous teaching. Students reported changes in their approach to patients, including introducing themselves more often, and taking measures to make patients feel more at ease on ward rounds. Empathy is fundamentalto patient-centred care DISCUSSION: This study describes the use of patient video interviews to promote empathy in medical students, by stimulating reflective discussion on themes of health care communication and patient experience. Future use of these methods are recommended, although further research would benefit from larger student numbers and the use of objective clinical examination scores to assess behaviour change.

Empathy training in medical students – a randomized controlled trial

Aim: Empathy is a core element in the doctor–patient relationship. This study examined whether empathy in medical students can be improved by specific training.Methods: 158 medical students were randomized into two groups. The intervention group participated in an empathy skills training with simulated patients (SPs). The control group participated in a history course. After the intervention, empathy was assessed by blinded SPs and experts in an Objective Structured Clinical Examination (OSCE). Students also filled out a self-assessment concerning their attitude on empathy (Jefferson Scale of Physician Empathy Student Version, JSPE-S-S).Results and Conclusions: Participants of the intervention group showed significantly higher levels of empathy when rated by SPs and experts than the control group. In contrast to that, no significant group differences were observed in self-rated empathy. The results underpin the value of empathy skills trainings in medical school study programs.

Tomorrow’s doctors and dentists in Malaysia: empathic or indifferent?

Objectives: This study compared the empathic behaviour of first year to final year dental and medical students in Malaysia and explored whether academic training of dental and medical students increases their subjective empathic tendencies. Methods: This cross-sectional study was carried out among 1020 first year to final year (fifth-year) undergraduate medical and dental students using a validated, self-administered Jefferson Scale of Empathy-Health Care Provider Student Version (JSE-HPS) questionnaire. The data were collected from first year to final year (fifth-year) students enrolled in Bachelor of Medicine/Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS) degree programs at 2 government-funded universities and one private university. Results: Dental students had a significantly higher total mean empathy score than medical students (84.11 versus 81.96, p &lt; 0.05). However, medical students had a narrow actual score range (59.35 - 133.35) than dental (22.05 - 133.35) students. Males (Medical: 82.57, Dental: 84.97) and students of Malay origin (Medical: 82.52, Dental: 85.11) were more empathic than females and students of other ethnic origins. The results also indicate that third-year medical students (mean: 82.95) and fourth-year dental students (mean: 86.36) were more empathic than students in other professional years.Conclusions: We recommend the use of some form of active training and assessment to assist in the development of empathy in medical and dental students. Medical and dental schools should place more emphasis on teaching empathic communication.

Medical school selection criteria as predictors of medical student empathy: a cross-sectional study of medical students, Ireland

ObjectivesTo determine whether performance in any of the Health Professions Admissions Test (HPAT) sections, most specifically the interpersonal understanding section, correlates with self-reported empathy levels in medical students.SettingThe study was...

(Almost) forgetting to care: an unanticipated source of empathy loss in clerkship.

The erosion of empathy in medical students is well documented. Both the hidden curriculum associated with poor role modelling and a sense of burnout have been proposed as key factors, but the precise mechanisms by which this loss of empathy occurs have not been elaborated. In the context of a course designed to help students manage the hidden curriculum, we collected data that raised questions about current conceptualisations of the aspects of medical training that lead to loss of empathy. We held nine sessions in the first year of clinical clerkship, in which we asked students to bring to the group their experiences of the hidden curriculum for reflection. Course sessions were recorded, transcribed and qualitatively analysed, and themes were generated for further exploration. We identified an identity developmental trajectory in early clerkship in which students started with feelings of excitement, transitioned quickly to 'shock andawe', progressed into 'survival mode' and then passed into a stage of 'recovery'. Interestingly, in the early stages, students' sense of empathic virtuosity was reinforced. It was not until later, when students were more comfortable in their clinical role, that theyreported their tendency to connect with the patient only as an afterthought to the encounter, or not at all, and needed to remind themselves to care. We offer new data for consideration with regard to medical students'loss of empathy during early clinical training that suggest it is the process of making patient care routine that shifts the patient from the status of an individual with suffering to theobject of the work of being a physician.

What Matters More About the Interpersonal Reactivity Index and the Jefferson Scale of Empathy? Their Underlying Constructs or Their Relationships With Pertinent Measures of Clinical Competence and Patient Outcomes?

In their study published in this issue of Academic Medicine, Costa and colleagues confirmed the underlying constructs of the Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy (JSE) in medical students. The authors of this Commentary propose that in comparing two instruments that both purport to measure empathy, researchers or test users must pay close attention to the target populations, the conceptualizations of empathy, and the validity evidence in relation to pertinent criterion measures. The Commentary's authors draw attention to the fact that the IRI was developed for administration to the general population, whereas the JSE was developed specifically for administration to students and practitioners of health professions. Also, the author of the IRI conceptualized empathy as a combination of cognitive and emotional attributes, whereas the authors of the JSE defined empathy as a predominantly cognitive attribute. These differences are reflected in the content of the items, which determines the underlying constructs of the two instruments. The Commentary authors suggest that any empathy-measuring instrument in the context of health professions education and patient care requires the crucial evidence of significant relationships with indicators of clinical competence and positive patient outcomes. Such validity evidence is readily available for the JSE, and the Commentary authors recommend that researchers make efforts to provide pertinent validity support for any other instrument measuring empathy in health professionals-in-training and in-practice.

Improving medical student empathy: Initial findings on the use of a book club and an old age simulation suit

IntroductionEmpathy is critical to the development of professionalism in medical students, but evidence suggests that empathy actually declines over the course of undergraduate medical education.ObjectivesImproving medical student empathy by encouraging students to think about the person behind the illness.MethodsTwo interventions were studied. From December 2015 until November 2016, a fourth year psychiatry medical student book club was conducted. Students were asked to read an autobiography of a lived experience of psychosis. The old age simulation suit aims to simulate the sensory and physical impairments faced by older adults with age related illnesses. A training session provided a transient experience of old age for the students.ResultsForty-four students completed the feedback on the book club. Twenty-eight (64%) stated that they strongly agreed with the statement ‘the book club encouraged me to consider the person behind the illness’. Thirty-nine (89%) stated that after attending the book club their empathy towards people with mental health problems had increased. Eleven students completed full feedback following the old age simulation session. Empathy statements relating to living in an ageing body improved from the pre-test median score of 4 (range 1–7) to a median score of 6 (range 2–8) post-teaching session. Empathy statements focusing on sensory and physical impairments had pre-test score median of 3 (range 1–7) and post-test median 8 (range 3–9).ConclusionsFeedback from these sessions has demonstrated that with a little creativity, empathy training can be delivered to medical students with a positive impact.Disclosure of interestThe authors have not supplied their declaration of competing interest.

통증사진에 대한 반복적 통증평가가 의대생의 인지적 공감과 정서적 공감에 미치는 영향

통증사진에 대한 반복적 통증평가가 의대생의 인지적 공감과 정서적 공감에 미치는 영향

Ageing simulation for promoting empathy in medical students.

Elderly patients have complex health needs and are vulnerable to inadequate or undignified treatment.1 Fostering professional and altruistic attitudes in medical education is necessary in order to prepare medical students for care of older patients.2 This paper describes a low-fidelity simulation session designed to increase empathy towards elderly patients among University of Edinburgh medical students. The session aims to enhance understanding of effects of age-related physical impairments on activities of daily living; how these impairments may challenge good clinical care and stimulate discussion about how these challenges may be mitigated. The session has been integrated into the Medicine of the Elderly teaching programme and here we describe it as delivered in NHS Fife, where the session has expanded to include a commercial age simulation suit3 to further enhance the learning experience. The 90 min session accommodates six medical students and is facilitated by two tutors in the Education Centre, Victoria Hospital, Kirkcaldy. Initially, the students are introduced to the aims during a 10 min briefing, and safety aspects are discussed. The students are divided into groups: the first focus on mobility; the second on special senses, before switching over after 30 min. Finally, there is a 20 min debrief. The students are supervised at all times. ### Mobility Each student has the opportunity to wear the simulation suit, consisting of a weighted vest, soft collar, straps and overshoes (see figure 1). The student is dressed in the components over her/his own attire by the other group members before carrying out tasks around the education centre: getting from seated to standing position; …

Narrative Medicine: An unexplored perspective in the medical curriculum to enhance patient-centredness and empathy in medical students

Narrative Medicine: An unexplored perspective in the medical curriculum to enhance patient-centredness and empathy in medical students