Empathy In Medical Students Research Articles

Relationship between emotional exhaustion and empathy in medical students from monteria - colombia

IntroductionEmpathy is considered one of the most relevant characteristics in the interaction between the doctor and the patient, highlighting the need to enhance it from the professional training stage. However, some studies have established that high levels of empathy could generate emotional exhaustion (Boujut, Sultan, Woemer & Zenasni, 2012). However, if a certain type of empathy can lead to burnout, it must also be considered that an optimal empathic posture can, on the contrary, relieve stress and exhaustion.ObjectivesEstablish the relationship between the level of emotional exhaustion and empathy in medical students.MethodsA cross-sectional study of correlational scope was conducted in 182 (n = 90) medical students. The cognitive and affective empathy test (López, et al., 2008) and the adaptation of the MBI instrument for the Colombian population (Barbato, Córdoba, González, Martínez & Tamayo, 2011) were used to assess emotional exhaustionResultsStatistically significant correlations of positive magnitude were evidenced between the variables emotional exhaustion and cognitive empathy (Table 1)ConclusionsIt was possible to conclude that the higher levels of cognitive empathy (adoption of perspective) in medical students, also resulted in greater emotional exhaustion, revealing an inappropriate consequence of empathy, where professionals can excessively adopt the patient’s feelings, generating wear. It is essential to promote optimal levels of empathy, which are beneficial for both the patient and the doctor.

Guilt and Burnout in Medical Students

Theory Burnout is prevalent among medical students and is correlated with negative feelings, behaviors, and outcomes. Empathy is a desired trait for medical students that has been correlated with reduced burnout. The concept of guilt is closely related to concern about the well-being of others; therefore, feelings of guilt may be associated with empathy. Excessive guilt poses an increased risk for internalized distress, symptoms such as anhedonia, and may be related to burnout. The relationship between pathogenic guilt and burnout in medical students is unknown. Hypothesis We hypothesize that pathogenic guilt is present and related to both burnout and empathy in medical students. Methods We conducted a cross-sectional survey study of all students in one medical school. Data were collected in February 2020. The Oldenburg Burnout Inventory (OBLI), Toronto Empathy Questionnaire (TEQ), and Interpersonal Guilt Questionaire-67 (IGQ-67) were used. A modified version of IGQ-67 was used to measure four subscales of pathogenic guilt: survival guilt, separation guilt, omnipotence guilt, and self-hate guilt. Data analyses for this study including screening, evaluation of assumptions, descriptive statistics, reliabilities, one-way ANOVA, and correlation coefficients, were conducted using SPSS version 26. Results Of 300, 168 (56.0%) students participated in the study. Survival, omnipotence, and self-hate classes of pathogenic guilt were positively correlated with burnout. Empathy was correlated with two classes of pathogenic guilt: survival and omnipotence. Empathy was inversely related to burnout (disengagement). Conclusions Pathogenic guilt may be a contributor to burnout in medical students. Guilt should be a target of prevention and treatment in burnout in medical students. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1891544.

Personality traits are associated with cognitive empathy in medical students but not with its evolution and interventions to improve it

ObjectiveCognitive empathy might decrease during medical school. Factors associated with its evolution remain poorly understood, as well as whether such factors could moderate the effect of an intervention to preserve cognitive empathy. The aim was to explore the associations between personality traits and both cognitive empathy at baseline and its changes at follow-up. The possible effect of an intervention depended upon personality traits was also examined. MethodsThe cohort consisted of fourth year medical students and the associations between personality traits, using the Short Big Five Inventory, and cognitive empathy changes at 3-month, using the Jefferson Scale of Empathy-Student version (JSE-S), were examined. A randomization in two groups (Balint groups versus no intervention) allowed examining whether the effect of the intervention depended upon personality traits. Linear regressions were adjusted for gender, anticipated specialty choice, parental education, living status, financial insecurity, randomization group and baseline JSE-S. ResultsThe cohort included 311 participants from October 2015 to December 2016 at Paris Diderot and Paris Descartes University. At follow-up, there was a JSE-S total score increase of 1.22(SD:9.10) in the intervention group, compared to a decrease of 1.64(SD:10.74) in the other group. Baseline JSE-S was positively associated with Extraversion and Conscientiousness and negatively with Neuroticism. In contrast, we found no associations between baseline personality traits and JSE-S change. There were no interactions between personality traits and randomization group. ConclusionAlthough personality might be linked with cognitive empathy, medical students may benefit from strategies designed for improving cognitive empathy regardless of their personality.

Attitudes toward patient-centeredness, personality and empathy of Chinese medical students

Previous studies of medical students showed correlations between empathy and personality traits. No study examined the relationship among attitudes toward patient-centeredness, empathy and personality of Chinese medical students yet. The current cross-sectional research used Patient-Practitioner Orientation Scale, Jefferson Scale of Physician Empathy and NEO Five-Factor Inventory to investigate the relationship of these factors among 686 medical students in Beijing, China. The results proved the correlations among specific personality traits, attitudes toward patient-centeredness and empathy. Agreeableness, Openness to experience and patient centered attitudes were significant predictors of empathy. Grade can moderate the relation between PPOS and empathy. Gender and grade differences were discussed. Cultural implications were also illustrated.

In Reply to Schattner and to Ozair et al.

Thanks to the authors of both letters for their comments and their kind words about our study. Schattner suggests it would be important to shift the emphasis from empathy research to indicators of burnout (e.g., emotional exhaustion, depersonalization) because of high rates of burnout in physicians-in-training and in practice, as well as wider implications. We believe that empirical research on burnout in medical students is as important as empathy research because they both have implications for medical education and patient care. In addition, in our previous research with MD-degree medical students,1 we found a significant inverse association between scores of the Jefferson Scale of Empathy (JSE) and those of the Maslach Burnout Inventory, suggesting that higher empathic orientation in medical students predicts lower burnout. Thus, because of the significant relationship between empathy and burnout, it would be more desirable to study both topics together. Ozair and colleagues correctly suggest that rigorous longitudinal, multi-institutional, and international research is required to address the issue of erosion of empathy in medical students. We agree that longitudinal study is more desirable than cross sectional to examine changes over time.2 The first longitudinal study of decline in empathy in medical students from matriculation to graduation2 was undertaken by our team. Currently, we are involved in a 5-year nationwide longitudinal study of DO-degree medical students that should provide the most definitive answers to the questions of changes in empathy and burnout and explore reasons for such changes, as reported by students’ own experiences/observations in each year of medical school. Preliminary data collected in the first year of this large-scale project (unpublished) show a significantly negative correlation between JSE scores and a measure of burnout, but significantly positive correlations between JSE scores and validated measures of orientation toward interprofessional collaboration and lifelong learning. Interestingly, a recent longitudinal study of U.S. MD-degree medical students3 reports a decline in empathy scores when the JSE was used, but an increase in empathy scores in the same sample when the Questionnaire of Cognitive and Affective Empathy was used. The controversial findings were attributed to the sensitivity and specificity of the JSE in measuring changes in empathy in medical students.4

A Longitudinal Measure of Medical Student Empathy at a Regional Campus

Introduction Empathy is an important characteristic of the ideal physician. Various quantitative measures of empathy have shown a steep decline during the third year of medical school. Methods We had 4 classes of medical students at our regional rural campus complete the Jefferson Scale of Empathy after each of the first 3 years. We report longitudinal results of 30 students, individually matched, including an analysis by gender. Separately, we report the cross-sectional results for 39 of our students as they began medical school. We compare our student scores to other allopathic and osteopathic student scores from large urban campuses. The Baptist Health Madisonville IRB approved the protocol as exempt. Results As they begin medical school, our students have similar scores to those at large urban campuses (difference of 1.1 points, p=.421). After the M-2 year, our students had significantly higher scores than those at urban campuses (5.7 points, p=.002) and after the M-3 year, they show an even larger positive difference (9.0 points, p<.001). As in previous publications, females had higher overall mean scores at each measure, but with our students this was only significant in post-M-2 measures (8.9 points, p=.01). Discussion We conclude that something about our students’ experience during their M-3 year is associated with a smaller decline in empathy measures than reported previously. We propose that some of this difference could be due to a formal professional identity curriculum we implemented recently during the M-3 year. However, without a concurrent or historical control group, we cannot be certain. We offer the concept of measuring empathy before and after curricular change as another useful evaluation tool for medical educators.

Letter to the Editor in Response to "The Impact of Meeting Patients with Neurological Disorders on Medical Student Empathy".

Letter to the Editor in Response to "The Impact of Meeting Patients with Neurological Disorders on Medical Student Empathy".

Impact of Reflection on Empathy and Emotional Intelligence in Third-Year Medical Students.

This study analyzed the impact that structured Reflection Rounds had on self-reported empathy and emotional intelligence scores for third-year medical students. Third-year students at the Renaissance School of Medicine at Stony Brook University (RSOM) were required to participate in Reflection Rounds during their core clinical clerkships. Over the study period, 285 students participated. Reflection Rounds are facilitated, small-group meetings, where students reflect upon their thoughts, feelings, and emotions about clinical experiences and receive feedback from peers and a trained facilitator. Empathy and emotional intelligence (EI) scores were measured pre- and post-intervention utilizing the Jefferson scale of empathy (JSE) student version and Wong law emotional intelligence scale (WLEIS) (Hojat 2016; Wong and Law Leadersh Q. 13:243-74, 2004). Participation in the study was voluntary. Pre-intervention surveys were collected from 185 students for the JSE and 173 students for the WLEIS. Post survey responses were collected from 120 students for both scales. Empathy scores increased from 80.4 to 82.6 (p = 0.02) post-intervention. No significant difference in EI scores was demonstrated post-intervention, 5.4 to 5.5 (p = 0.55) CONCLUSION: Students who participated in Reflection Rounds did not demonstrate the erosion of empathy that has been previously documented following the completion of the clerkship year. Improvements in empathy scores were demonstrated. No change in EI was observed post-intervention. It is possible that an intervention such as Reflection Rounds may represent a way of preventing the empathy decline that can be seen in medical students as they progress through their training.

Assessing empathy in final-year medical students using the Persian version of the Jefferson Scale of Physician Empathy.

BACKGROUND:A doctor–patient relationship built on the concept of empathy is so essential to attain the best clinical outcomes in medicine. Since empathy has a positive role in interpersonal relationships and medical outcomes, its assessment is highly crucial. The aim of this study was to assess the empathy in last-year medical students using the Persian version of the Jefferson Scale of Physician Empathy (JSPE) and correlate empathy scores with demographic features.MATERIALS AND METHODS:In this cross-sectional study, last-year medical students at Shiraz Medical School, Shiraz, Iran, were recruited for this study. In this research, we used the Persian version of JSPE. The validity and reliability of the Persian version of this tool were confirmed in the previous research. For the analysis of data, we employed descriptive statistics and the independent sample t-test.RESULTS:One hundred and eighty-five final-year medical students were included in this study. The maximum score of the questionnaire was 140, and the total mean score of empathy was 98.15 ± 13.29. The females' total mean score (102.05 ± 11.89) was higher than the males' score (93.57 ± 13.46). The difference between the mean score of gender and empathy was significant (P value <.001), but there was no significant difference between empathy and the two other demographic factors (P > 0.05).CONCLUSIONS:Although physicians would gain the essential characteristics of empathy during their career, attending professors and other responsible policymakers in medical education should focus more on the factors related to physicians' empathy to train better and more professional physicians.

Correlation between Stress and Empathy in Medical Students As Compared To General Population

Background: Medical students are exposed to numerous internal and external pressures exerted by the environment which may affect their empathy towards patients. This study was conducted to find association between perceived stress and empathy.&#x0D; Methodology: The study was conducted in Surat, Gujarat, India from August 15 2021 to September 15 2021 among 225 participants using perceived stress score and using the Toronto Empathy Questionnaire. Two groups -Undergraduate medical students and general population were compared.&#x0D; Results: Out of 160 medical undergraduates and 65 people from general population below average empathy was noted in total 51.1%. High empathic attitude was noted in general population in comparison to other medical undergraduates. 24.4% reported low stress, 64% moderate stress and 11.6% high stress and we can appreciate that low stress scores were calculated in general population in comparison to medical undergraduate students. A weak negative correlation between empathy and perceived stress was calculated in medical students whereas strong positive correlation between empathy and perceived stress was calculated in general population.&#x0D; Conclusion: A significant proportion of medical students had a comparatively higher stress scores and decreased empathy hence their stress is considered distress whereas general population’s high stress scores were corelating to high empathic attitude, therefore their stress can be considered eustress.

Mental health in medical students during COVID-19 quarantine: a comprehensive analysis across year-classes

OBJECTIVES:The COVID-19 pandemic brought abrupt changes when quarantine measures were implemented. Most medical students had distance learning as their main content delivery mode, but in clerkship (fifth and sixth years), in-person activities were maintained under new protocols. These different modes may have affected student mental health. This study examines mental burden and empathy in medical students during the beginning of the COVID-19 pandemic according to the year of attendance.METHODS:All students attending first to the sixth year in the same medical school were invited to participate. The Hospital Anxiety and Depression Scale (HADS), the Self-Reporting Questionnaire (SRQ-20), the Interpersonal Reactivity Index (IRI), and the Mindful Attention Awareness Scale (MAAS) were provided.RESULTS:HADS scores for Anxiety and Depression (n=347) were 9.8±4.3 and 7.1±3.6, respectively; the SRQ-20 (n=373) score was 8.1±4.5; all scores were negatively correlated with the year of attendance. IRI (n=373) scores were: 2.6±0.5 (Empathic Concern), 2.7±0.7 (Perspective Taking), 2.5±0.9 (Fantasy), and 1.7±0.7 (Personal Distress). Fantasy was negatively correlated with the year of attendance. MAAS scores were positively correlated with the year of attendance. Worse mental health scores were found for first-year students across all scales.CONCLUSIONS:We found high levels of mental burden in medical students in the early period of the COVID-19 pandemic, especially in first-year students, who may have fewer resources to deal with stress. Moreover, as they entered college a short time before the pandemic, they were unable to experience academic life fully or create important new social support networks to deal with adversities.

Multiple cross-sectional assessments of empathy in medical undergraduate students.

Introduction:Empathy a cognitive phenomenon, with affective and behavioral components; helps improve clinical competence. It varies depending on physicians' gender and specialty. While some western studies reported significant fall in empathy levels when they progressed from non-clinical to clinical training years, Asian studies including Indian had varied results. We hypothesize that empathy will decrease among medical undergraduates over four years while they progress from non- clinical to clinical rotations and that female medical students and those opting for clinical specialties will have higher empathy than male medical students and those opting for non clinical specialty.Methodology:This study was carried out in a medical college from the year 2012 to 2015. Each year at the beginning of academic session all students were asked to complete Jefferson's -Scale for Physician's Empathy (JSPE student) student version. Over next three years similar assessments were repeated for all batches. The results were tabulated and analyzed using EpiInfo7 software.Results:Over four years 481, 416, 412 and 354 medical students in 1st, 2nd, 3rd and 4th year respectively from seven different batches were evaluated. Choice of specialty differed significantly in each year different batches. The empathy score had no relation to gender or choice of specialty. Empathy declines from first year onwards till third year but is not statistically significant.Conclusion:In this large multiple sample cross sectional study, it is evident empathy drops from 1st to 3rd year therefore there is an urgent need to evaluate why empathy falls.

Association of Medical Student Characteristics and Empathy After a Communication Workshop.

Medical education values patient-centered communication skills of responding to patient's emotions, however, guidance is limited on how to provide a well-rounded curriculum. This study examines the effect of a 90-minute communication workshop on the level of empathy of the 116 medical students who participated in the workshop. We used three psychometric categories from the Jefferson Scale of Empathy (JSE) as dependent variables. We conducted mixed analysis of variance (ANOVA) analyses to determine the change in empathy scores after the workshop, the main effects for gender and medical specialty, and their interaction with time. We found an increase in perspective taking and compassionate care scales, although no changes on walking in patients’ shoes scale. Female and people-oriented specialty students scored higher on all scales. Some gender-specialty groups showed an empathy decrease: people-oriented specialty females on compassionate care scale and people-oriented and other specialty males on walking in patients’ shoes scale. We concluded that communication training requires a multidimensional approach to target various areas of building empathy. Standardization of training should be embedded with empathy development within medical education curriculum.

The Effect of Reflection Rounds on Medical Students’ Empathy

Background: Students’ decline in empathy during medical school raises concerns. Empathic physician-patient interactions positively impact health outcomes and patient satisfaction, while improving job satisfaction and reducing physician burnout. Reflection rounds may be suitable for maintaining student empathy during training. Hypothesis: Our hypothesis was Reflection Rounds would increase empathy scores of MS3s and results would vary by gender. Methods: MS3s completed the Jefferson Scale of Empathy upon starting and finishing their clerkship. Students in the experimental group attended four 1-hour sessions, led by a clinician and pastoral team member. The control group did not attend sessions. Results: No significant difference in baseline empathy scores was found between the two groups. There was a significant increase in student empathy scores among the experimental group, improving mean score from 114.1 to 116.5, p-value of 0.04. There were no significant changes among the students who did not participate in Reflection Rounds. Differences were found according to gender, with women scoring higher overall than men at baseline and increasing after sessions. Conclusion: These results indicate that Reflection Rounds can improve the empathy of medical students, and warrant further investigation into their effects and utility within medical education.

Searching for the erosion of empathy in medical undergraduate students: a longitudinal study

ObjectiveTo analyse the trajectory of empathy throughout the degree programme of medicine in a Spanish school of medicine.DesignLongitudinal, prospective 5-year study, between October 2014 and June 2019.SettingStudents from a Spanish...

What is the Level of Empathy in Medical Students of University of Ghana Medical School in Accra Ghana?

Empathy has been described as a multi-dimensional construct with cognitive and emotional components, both of which are concerned about responsivity to others. It has been touted as a skill essential for medical practice and thus useful to all healthcare professionals. It has been assessed in several countries and among several healthcare cadres however, there is a yawning gap in Ghana about its level in medical students. This study utilised a cross-sectional design to assess empathy using the Multi-Dimensional Emotional Empathy Scale in medical students of the University in Ghana. The scale has an alpha reliability of 0.88. One hundred and eleven students, aged 24 years ±1.5 years completed the study. Overall, there were more males than females. The mean empathy score for the cohort was 101SD 13 and this was adjudged to be low. There was no statistical difference between age, gender and clinical year and empathy in this cohort. The authors recommend that empathy, especially its cognitive aspects, should be taught in medical school curriculum of the University of Ghana Medical School, Accra.

Reflective Writing on the Cadaveric Dissection Experience: An Effective Tool to Assess the Impact of Dissection on Learning of Anatomy, Humanism, Empathy, Well-Being, and Professional Identity Formation in Medical Students.

Growing evidence supports the use of reflective writing activities centered around the human cadaveric dissection experience to support and assess elements of medical student wellness. Dissection may promote personal and professional development, increase resilience, and foster a sense of connection and community. This study employed a qualitative analysis of a reflective writing exercise to explore the question: "What is the impact of the cadaveric dissection anatomy experience on the personal and professional development of medical students?" This cross-sectional study was conducted at the conclusion of the first-year anatomy module. A total of 117 United States allopathic medical students were given a questionnaire designed to elicit the students' experiences and introspection. The exercise included four reflective questions that were provided to 20 groups of six students. Grounded theory analysis was used to explore themes that arose in students' responses. Participants exhibited several common reactions to cadaveric dissection. After analyzing all responses, 266 unique open codes were identified for all four questions. These open codes were sorted into ten distinct axial codes, which are broader categorical themes of open codes. The aims of our study were to identify themes that emerged as students reflected on the impact of their dissection experience using reflective writing as a tool to capture these themes and to gather information to inform pedagogical methodologies. The researchers observed that the educational effects of dissection captured in the reflective writing resembled those found in other areas of medical education that emphasize professional identity formation and important humanistic qualities.

Empathy for patient care in medical students: new evidence on the importance of self-transcendence

ABSTRACT Empathy is essential in clinical care to achieve patient satisfaction, treatment adherence and health outcomes. Understanding how personality traits might influence the development of medical students’ empathy for patient care is important in medical education. Previous studies have shown associations between medical students’ personality and empathy. This study aims to explore the associations between temperament and character and empathy for patient care in a sample of young medical students. Participants were 299 second-year Italian medical students. They completed the Italian versions of the Jefferson Scale of Empathy for medical students (JSE-S) and the Temperament and Character Inventory (TCI-140). Correlation and regression analyses were performed. Significant positive low correlations were found between empathy and Reward Dependence, Cooperativeness and Self-transcendence. The regression model of the sex and personality dimensions explained 14% of the variance in empathy with two significant predictors: sex (B = 4.034) and Self-transcendence (B = 0.361). This study confirms that female medical students are more empathetic than males. It also suggests that the greater students’ Self-transcendence is, the more empathetic towards patient care they are. Attention to medical students’ personality should be present within medical curricula, as it may help to generate methods of enhancing and sustaining the empathy of students.

Empathy Enhancement Based on a Semiotics Training Program: A Longitudinal Study in Peruvian Medical Students.

BackgroundEmpathy, as a core element of medical professionalism, is part of leadership in medicine. This attribute, predominantly cognitive, involves understanding and communication capacity. Empathy can be enhanced with courses on medical semiotics. It appears adequate to apply this enhancement in the early stages of professional training. Based on this, this study was performed with the purpose of demonstrating the positive effect that an academic course on medical semiotics has on the development of empathy in medical students.MethodsA quasi-experimental study was conducted in one School of Medicine in Peru, where medical students had to attend a 17-week course on medical semiotics as part of their regular training. The sample, composed by 269 students, included two cohorts of third-year medical students. As main measures, the Jefferson Scales of Empathy (JSE), inter-professional collaboration (JSAPNC), and lifelong learning (JeffSPLL), were used. In addition, students’ scores evaluating theoretical and practical aspects of the course were collected once the course was finished. Pre- and post-tests were administered in week 1 and in week 17. Analyses compared measures in both moments and in time. Inter-professional collaboration and lifelong learning scores and empathy scores were used as discriminant and convergent validity measures of students’ course scores, respectively.ResultsGender differences on empathy appeared, but only at the beginning. In the entire sample, empathy enhancement was confirmed in time (p < 0.001), with a large effect size (r = 0.45). This effect was also observed in both gender groups, separately. On the contrary, no changes appeared in inter-professional collaboration and in lifelong learning abilities in time. In addition, a positive correlation was observed among empathy, inter-professional collaboration and lifelong learning abilities at the beginning and at the end, confirming that the improvement observed was specific for empathy and explained by the educational intervention assessed.ConclusionThese findings bring empiric evidence supporting the positive effect that training in medical semiotics has on empathy. In addition, these findings highlight some gender differences in the development of empathy in medical students.

Developing Emotional Intelligence Through a Longitudinal Leadership Curriculum in UME: Combating the Decline in Medical Student Empathy.

We report on a novel curriculum (Scholarly Excellence, Leadership Experiences, Collaborative Training [SELECT]) in an allopathic medical school designed to prepare students to be physician leaders while remaining empathetic by combating burnout. SELECT students were surveyed annually. The survey contained the Jefferson Scale of Empathy (JSE) and Maslach Burnout Inventory (MBI). In this cohort, empathy did not decrease, as measured by the JSE, and SELECT students' MBI Depersonalization burnout scores decreased after year 3. In summary, in this allopathic US medical school utilizing a novel curriculum, there was no significant decline in empathy after the third year of medical school. The SELECT program appears to mitigate the decline in empathy and increased Depersonalization burnout levels often seen at the end of the third year of medical school.