Empathy In Medicine Research Articles

Applying narrative medicine to prepare empathetic healthcare providers in undergraduate pharmacy education in Singapore: a mixed methods study

BackgroundNarrative medicine demonstrated positive impact on empathy in medicine and nursing students. However, this pedagogical approach had not been evaluated in pharmacy education. This study sought to apply and evaluate the narrative medicine approach in extending empathy in Asian undergraduate pharmacy students.MethodsNarrative medicine was applied through workshops which used narratives of people with different experiences and perspectives. First-year undergraduate pharmacy students who volunteered and attended these workshops formed the intervention group (N = 31) and the remaining first-year cohort formed the control group (N = 112). A sequential explanatory mixed methods approach was adopted in which quantitative methods were first used to measure impact on pharmacy students’ empathy using the Jefferson Scale of Empathy– Health Professions Student (JSE-HPS), and qualitative methods (i.e. group interviews) were then used to assess pharmacy students’ emotional responses to narratives, and the perspectives of pharmacy students and faculty of this pedagogical approach.ResultsThere was no difference in JSE-HPS scores between intervention and control groups across baseline (i.e. upon matriculation), pre-intervention, and post-intervention timepoints. Pharmacy students in the intervention group had lower scores in Factor 3 (“Standing in People’s Shoes”) following the intervention. Five themes, guided by internal and external factors in cognition, emerged from the Group Interviews: (1) incongruence between students’ motivation and faculty’s perception, (2) learning context, (3) academic context, (4) cognitive system, and (5) affective system. Themes 1, 4 and 5 referred to internal factors such as students’ motivation, perceived learnings, and feelings. Themes 2 and 3 referred to external factors including workshop materials, activities, content, and facilitation.ConclusionThis study is the first to demonstrate that pharmacy students engaged with the narrative medicine approach as narratives elicited emotional responses, exposed them to diverse perspectives, and deepened their appreciation of the importance of empathy and complexities of understanding patients’ perspectives. Scaffolded educational interventions using narratives and real-life patient encounters, alongside longitudinal measurements of empathy, are necessary to bring about meaningful and sustained improvements in empathy.

Machines and empathy in medicine

Machines and empathy in medicine

Empathy in medicine: A ritualistic healing function?

Marcel Réja (1873–1957) French alienist evokes in his book « Au pays des miracles » this innumerable people of healers, mystics, empirics, magnetizers, mediums and fantasists. All operating “cures more wonderful than each other”. This book questions in a very relevant way the role of the power of the spirit, of healing by the spirit and therefore of suggestion. This “art” of healers includes an affective and emotional coefficient which constitutes its essential spring. There is a mysterious force between the sick and the physician that goes “soul to soul”. Current medicine is still very much borrowed from its past with a remnant of “magical” thought. Also, the empathetic dimension of the care relationship remains one of the most necessary dimensions for the exercise of the medical profession.

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

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

The Experience of Empathy in Medicine

The Experience of Empathy in Medicine

Components of Successful Spiritual Care.

The quantifiable health benefits of spiritual practice and religious community have inspired a movement toward addressing religion within health care and medical education, yet biomedical professionals still often avoid this topic (Giordano and Engebretson in Explore 2(3):216--225, 2006; Post et al. in Ann Intern Med 132(7):578, 2000). This is largely due to a lack of clarity on how to ethically engage with diverse spiritual practices and maintain professional boundaries regarding spiritual care. However, a majority of patients desire increased incorporation of spirituality in medical discussions, indicating a deficit in care that must be addressed (Best et al. in Patient Educ Couns 98(11):1320-1328, 2015; Zaidi in AMA J Ethics 20(7), 2018). In this article, I clarify what constitutes successful spiritual care by identifying its key components and major challenges. I then make recommendations for ethically mindful, comprehensive spiritual care and consider potential next steps including structural changes that prioritize compassion and empathy in medicine.

Empathy in Podiatric Medical Education: Challenges and Opportunities for Comprehensive Care.

Many regard empathy as a critical component of comprehensive health care. Much interest has been generated in the field of medical empathy, in particular as it relates to education. Many desirable outcomes correlate with perceived empathy during the patient encounter, but paradoxically, empathy levels have been reported to decline during the years of medical education. Several new approaches have been described in the literature that intend to teach or develop empathy skills in health-care students. PubMed, PsycINFO, and Google Scholar databases were searched for the terms empathy education, medical education, medical student, podiatric medical education, medical empathy, compassion, emotional intelligence, biopsychosocial model, and bedside manner. After implementing inclusion and exclusion criteria, articles were selected for preparation of a literature review. Analysis of the podiatric medical education on empathy was conducted by reviewing descriptions of all courses listed on each of the nine US podiatric medical schools' Web sites. The 2018 Curricular Guide for Podiatric Medical Education was analyzed. In this review, we examine the current state of empathy from a context of medical education in general, followed by a specific analysis in podiatric medicine. We define key terms, describe the measuring of empathy in medicine, explore outcomes of empathy in the health-care setting, review the reports of a decline in medical education, and highlight some of the current efforts to develop the skill in education. An overview of empathy in the podiatric medical curriculum is presented. To improve the quality of care that physicians provide, a transformation in podiatric medical education is necessary. A variety of tools are available for education reform with the target of developing empathy skills in podiatric medical students.

Developing reflective skills among first year MBBS students

Introduction: Transitional period of students towards becoming professional should be aimed for making self-motivated learners by medical education. It is known that reflective writing expands the affective domain of persons and promotes mind mapping which are integral parts of good professional. The present study aimed to develop reflective writing skills of the medical students and to increase awareness about reflective writing skills. Method: Prospective analytical study. Students were educated with a reflective writing skill workshop and requested to write four reflections after a specific interval with guidance. Reflections of students were analyzed for levels by the modified REFLECT Rubric method. Students were given individual feedback and /or by focus group discussion in between successive reflections. Feedback of whole process was taken from students. Results: At the end of first reflection, 65% students had a clear concept of reflection whereas at the end of the fourth reflection, all students had a clear concept with achievement of a higher level of reflection; 33% students were transferred to the level of introspection; 11% students were found in reflection. However no student reached to the level of critical reflection. Conclusion: Formal training and guiding for writing reflections over a period of time helped medical students to get sensitized and develop reflective writing skills. They had perception of enhanced skills of effective communication, ethical issues in medicine, empathy in medicine and patient’s need. For holistic growth of students, teaching reflective writing skills to students should be incorporated.

L’empathie en médecine

ObjectivesEmpathy is everywhere. It has become a major topic of interest in many disciplines and professions. Cultivating empathy has been prescribed as a solution to numerous social ailments and political problems. One reason for such a proliferation of attention is the lack of a clear conceptual taxonomy and the use of empathy as an umbrella under which definitions vary enormously. It is widely acknowledged that empathy plays a critical role in the physician-patient relationship and has a positive impact in clinical practice. However, the medical profession is struggling to achieve an appropriate balance between clinical distance and empathy. Too much sensitivity to negative affect expressed by patients, without proper emotion regulation, may lead to anxiety and personal distress, which is detrimental to efficient cognitive functioning and can take a toll on the well-being of physicians. Too little empathy may lead to an underestimation of the pain of others and poor rapport with patients. As the field of empathy expands, the lack of conceptual coherence challenges advances in medicine. Moreover, in some cases there is little added theoretical or clinical value in applying the broad/all-encompassing term of empathy, which is by nature multidimensional and interpersonal. MethodsThe number of competing conceptualizations of empathy circulating the literature has created a serious problem by making it difficult to keep track of which process or mental state this neologism refers to in any given discussion. Multiple definitions limit progress in the role of empathy in medicine, and which instruments are appropriate to assess its function and utility. Keeping track is important because the different conceptualizations refer to distinct psychological processes that vary, sometimes widely, in their function, phenomenology, biological mechanisms, and effects on interpersonal relationships. In this article, after considering the polysemic nature of empathy, I briefly review the functions attributed to empathy in medicine. Then I explain how theoretical clarity may be improved by examining knowledge from empirical investigations in psychology and social neuroscience which has led to better define the different components of empathy as well as their neurological mechanisms. One section critically reviews the functional neuroimaging studies that have been specifically designed to examine patterns of brain response in physicians and health professionals. A separate section addresses how social and relational factors, particularly group membership, may impact the expression and effect of empathy in medical care. This new perspective, based on advances in scientific psychology and social neuroscience, has the potential to reduce confusion and ambiguity. This critical and informed analysis of empirical studies in functional neuroimaging with health professionals calls for a nuanced assessment of empathy's functions, that are not necessarily a panacea as some seem to think. ConclusionA provocative and more sober view on the value and the very interest in the notion of empathy in medicine is proposed. Ultimately, cultivating empathic concern (sympathy or compassion in today's medicine) seems more important than other aspects, particularly affect sharing or putting oneself in the patient's shoes.

A Cultural Shift Away from Cognitive-behavioral Empathy.

Empathy in medicine is often neglected due to various constraints imposed on the physician. Despite empathy being proven as beneficial to the patient health and outcomes, patients remain unsatisfied with the healthcare system and usually, in turn, their physicians. To instill empathetic patient-physician relationships, medical training has for some time focused on cognitive-behavioral empathy. This is taught through cognitive and behavioral skills, with expressions such as “I understand how you feel”. Naturally, these skills are often forced and feel disingenuous. Hence, a cultural shift in medicine is required to effectively communicate the importance of empathy: a shift that cultivates altruistic properties most healthcare professionals bring to medicine in the first place.

Empathy in Medicine National Norms for the Jefferson Scale of Empathy: A Nationwide Project in Osteopathic Medical Education and Empathy (POMEE).

National norms are necessary to assess individual scores from validated instruments. Before undertaking this study, no national norms were available on empathy scores. The Project in Osteopathic Medical Education and Empathy (POMEE) provided a unique opportunity to develop the first national norms for medical students. To develop national norms for the assessments of osteopathic medical students' empathy scores on the broadly used and well-validated Jefferson Scale of Empathy (JSE) at all levels of osteopathic medical school education. Participants were students from 41 of 48 participating campuses of osteopathic medical schools. Students were invited to complete a web-based survey, which included the JSE, in the 2017-2018 academic year. A total of 16,149 completed surveys were used to create national norm tables. Three national norm tables were developed for first-year matriculants and for students in preclinical (years 1 and 2) and clinical (years 3 and 4) phases of medical school. The norm tables allow any raw score on the JSE for male and female osteopathic medical students from matriculation to graduation to be converted to a percentile rank to assess an individual's score against national data. National norms developed in this project, for men and women and at different levels of medical school education, can not only be used for the assessment of student's individual scores on the JSE, but can also serve as a supplementary measure for admissions to medical school and postgraduate medical education programs.

The human kindness curriculum: An innovative preclinical initiative to highlight kindness and empathy in medicine.

Prior studies have shown a marked drop in empathy among students during their third (clinical) year of medical school. Curricula developed to address this problem have varied greatly in content and have not always been subjected to validated measures of impact. In 2015, we initiated a Human Kindness (HK) curriculum for the initial 2 years of medical school. This mandatory 12-h curriculum (6 h/year) included an innovative series of lectures and patient interactions with regard to compassion and empathy in the clinical setting. Both quantitative (Jefferson Scale of Empathy [JSE]) and qualitative data were collected prospectively to evaluate the impact of the HK curriculum. In the initial Pilot Year, neither 1st (Group 1) nor 2nd (Group 2) year medical students showed pre-post changes in JSE scores. Substantial changes were made to the curriculum based on faculty and student evaluations. In the following Implementation Year, both the new 1st (Group 3) and the now 2nd year (Group 4) students, who previously experienced the Pilot Year, showed significant improvements in post-course JSE scores; this improvement remained valid across subanalyses of gender, age, and student career focus (e.g., internal medicine, surgery, etc.). Despite the disappointingly flat initial Pilot Year JSE scores, the 3rd year students (Group 2) who experienced only the Pilot Year of the curriculum (i.e., 2nd year students at the time of the Pilot Year) had subsequent JSE scores that did not show the typical decline associated with the clinical years. Students generally evaluated the HK curriculum positively and rated it as being important to their medical education and development as a physician. A required preclinical curriculum focused on HK resulted in significant improvements in medical student empathy; this improvement was maintained during the 1st clinical year of training.

Should physicians be empathetic? Rethinking clinical empathy.

The role and importance of empathy in clinical practice has been widely discussed. This paper focuses on the ideal of clinical empathy, as involving both cognitive understanding and affective resonance. I argue that this account is subject to a number of objections. Affective resonance may serve more as a liability than asa benefit in clinical settings, and utilizing this capacity is not clearly supported by the relevant empirical literature. Instead, I argue that the ideal account of empathy in medicine remains cognitive, though there is a central role for expressing empathic concern toward patients.

How to clarify the aims of empathy in medicine.

This paper argues that enthusiasm for empathy has grown to the point at which empathy has taken on the status of an "ideal" in modern medicine. We need to pause and scrutinize this ideal before moving forward with empathy training programs for medical students. Taking empathy as an ideal obscures the distinction between the multiple aims that calls for empathy seek to achieve. While these aims may work together, they also come apart and yield different recommendations about the sort of behavior physicians should cultivate in a given situation. I begin by demonstrating how enthusiasm for empathy has increased dramatically. I then specify precisely what I mean in calling empathy an "ideal." I then describe some dangers associated with taking empathy to be an ideal unreflectively. I discuss the merits of works that provide conceptualizations of empathy that are specifically tailored for the medical domain and conclude that although these works move discussions about empathy in medical care forward, they could do more to foreground the goals and aims underlying calls for increased empathy. I provide specific suggestions as to how exactly we might foreground these goals and aims to further avoid conceptual confusion about empathy in medical education.

Empathy in medicine: Neuroscience, education and challenges

Empathy is a multifaceted skill and asset for health care providers. This paper uses current neuroscience literature of empathy to generate nuanced theory of how empathy can be blocked by personal stress and aversion among health care professionals. Current training approaches for educating sustainable empathy are reviewed in depth. The final part of the paper provides suggestions on how to spread empathy education farther and wider across medical education.

Simulating Care and Empathy in Medicine – Can We Trust Artificial Agents

The utilization of artificial agents in medicine becomes a foremost topic in research of recent medical advances. Moreover, to possibility to simulate adequate care and create the sense of empathy towards the patients, becomes a major question for research that would rather fall in the area of philosophy of medicine than in any other discipline as the very notion of empathy is a complex topic that is difficult to define in its natural concept boundaries, and furthermore in proposing the notion of artificial care and empathy. The question of whether we can define and simulate those would also help us answer a larger problem – can we trust artificial agents as aids or replacements of humans in the medical environment and healthcare in general.

The physician's role and empathy - a qualitative study of third year medical students.

BackgroundEmpathy is important in ensuring the quality of the patient-physician relationship. Several studies have concluded that empathy declines during medical training, especially during the third year. However, there is little empirical research on what may influence a medical student’s empathy. In addition, studies of empathy in medicine have generally been dominated by quantitative approaches, primarily self-assessment questionnaires. This is a paradox given the complexity and importance of empathy. In this paper we explore medical students’ opinions of what may foster or inhibit empathy during medical school, with a particular emphasis on how empathy is influenced by the initiation into the physician’s role.MethodsWe performed semi-structured qualitative interviews with 11 third year medical students. Content analysis was used to analyse the transcribed interviews.ResultsFive aspects of the the physician’s role and the students’ role acquisition emerged when the students were asked to describe what may influence their empathy: 1) Becoming and being a professional, 2) Rules concerning emotions and care, 3) Emotional control, 4) The primary importance of biomedical knowledge, and 5) Cynicism as a coping strategy.ConclusionThis study suggest that the described inhibitors of empathy may originate in the hidden curriculum and reinforce each other, creating a greater distance between the physician and the patient, and possibly resulting in decreased empathy. Mastering biomedical knowledge is an important part of the students’ ideals of the physician’s role, and sometimes objective and distanced ideals may suppress empathy and the students’ own emotions.

The phenomenology of empathy in medicine: an introduction

This article is an introduction to a thematic section on the phenomenology of empathy in medicine, attempting to provide an expose of the field. It also provides introductions to the individual articles of the thematic section.

Empathy as a necessary condition of phronesis: a line of thought for medical ethics

Empathy is a thing constantly asked for and stressed as a central skill and character trait of the good physician and nurse. To be a good doctor or a good nurse one needs to be empathic-one needs to be able to feel and understand the needs and wishes of patients in order to help them in the best possible way, in a medical, as well as in an ethical sense. The problem with most studies of empathy in medicine is that empathy is poorly defined and tends to overlap with other related things, such as emotional contagion, sympathy, or a caring personality in general. It is far from clear how empathy fits into the general picture of medical ethics and the framework of norms that are most often stressed there, such as respect for autonomy and beneficience. How are we to look upon the role and importance of empathy in medical ethics? Is empathy an affective and/or cognitive phenomenon only, or does it carry moral significance in itself as a skill and/or virtue? How does empathy attain moral importance for medicine? In this paper I will attempt to show that a comparison with the Aristotelian concept of phronesis makes it easier to see what empathy is and how it fits into the general picture of medical ethics. I will argue that empathy is a basic condition and source of moral knowledge by being the feeling component of phronesis, and, by the same power, it is also a motivation for acting in a good way.

Medical students′ and residents′ conceptual structure of empathy: A qualitative study

Empathy is a crucial component of medicine. However, many studies that have used quantitative methods have revealed decline of learners' empathy during undergraduate and postgraduate medical education. We identified medical students' and residents' conceptual structures of empathy in medicine to examine possible differences between the groups in how they conceive empathy. We conducted a qualitative study with two focus group discussions in which six medical students and seven residents participated separately. The transcripts of the focus group discussions were analysed combining qualitative data analysis and theoretical coding. Medical students and residents had different conceptual structures of empathy. While medical students thought that sharing emotions with patients was essential to showing empathy, residents expressed empathy according to their evaluation of patients' physical and mental health status. If the residents thought that showing empathy was necessary for the care of patients, they could show it, regardless of whether they shared the patients' emotions or not. The comparison of medical students' and residents' conceptual structures of empathy reveals a qualitative difference. Residents show more empathy to their patients by a cognitive decision as clinicians than medical students do. Communication skills training should consider the qualitative change of students' and residents' empathy with clinical experience. We should consider the change when we evaluate learners' empathy and introduce methods that cover the qualitative range of empathy.