Physician Empathy Research Articles

A Survey of Patient Utilization and Trust of Emergency Medical Services

Little is known about patients’ decisions to come to the Emergency Department (ED) via emergency medical services (EMS) versus privately owned vehicle (POV); this is problematic as trust in EMS systems impacts patient care decisions. Furthermore, no studies exist that evaluate patients’ trust of the EMS system as it relates to a patient’s race. Patients completed a multi-method survey during their ED stay. Quantitative data included: patient demographics (age, gender, race) income, insurance status, previous medical training, highest level of education, self-reported medical and social history, number of ED visits in the past three months, and two scales assessing trust and empathy: the Group-Based Medical Mistrust Scale and the Jefferson Scale. Characteristics of patients who came to the ED via EMS versus POV were shown. A Wilcoxon signed rank test described differences in EMS trust scales by race. Logistic regression showed which factors contribute to the decision of EMS or POV. Qualitative comments described patients’ rationale for EMS versus POV. 23/72 (31.94%) patients utilized EMS transport and 49/72 (68.06%) utilized POV. 59.09% of patients self-identified as Black and 40.91% self-identified as White. The Group-Based Medical Mistrust Scale found Black patients had less trust in the EMS system (p=0.0001), while the Jefferson Scale of Patient Perception of Physician Empathy showed no significant difference in patient perceptions of EMS provider empathy (p=0.608). Logistic regression indicated that age predicted the use of EMS over POV (p<0.001). Lack of access to POV, physical limitations, cost, speed, perception of emergency, and fear were identified as reasons that supportg patients’ decision to use EMS or POV. Many factors can influence patients’ transportation decisions and this study highlights trust, age, and other social and economic factors. These findings could inform policy decisions and ensure emergency care systems that are accessible for all patients.

Communication and empathy within the patient-physician relationship among patients with and without chronic pain.

Chronic pain may affect the relationship between patients and their treating physicians. This study was designed to compare four aspects of physician communication and physician empathy reported by patients with chronic pain and in chronic pain-free controls. A cross-sectional study was conducted within a national pain research registry from July 2020 through January 2024. Patients with chronic low back pain of greater than 3months duration were matched to chronic pain-free controls utilizing propensity scores derived froma logistic regression model based on 11 variables thatincluded sociodemographic characteristics, cigarette smoking status, history of comorbid medical conditions, and duration of the current patient-physician relationship. Patients reported on the primary outcomes of physician communication utilizing the Communication Behavior Questionnaire (CBQ) and physician empathy utilizing the Consultation and Relational Empathy (CARE) measure. Group means were compared for each aspect of physician communication (patient participation and patient orientation, effective and open communication, emotionally supportive communication, and communication about personal circumstances) and physician empathy, and Cohen's d statistic was utilized to assess the clinical relevance of between-group differences. Secondary exploratory analyses were also performed to compare patients treated by osteopathic physicians vs. allopathic physicians and to determine whether study group X physician type interaction effects were present. The 387 patients in each study group were matched within a caliper width of 0.001 on the propensity score. Overall, patients ranged from 21 to 79 years of age (mean, 50.7 years; standard deviation [SD], 15.1 years), and 617 (79.7 %) of them were female. Patients in the chronic pain group reported poorer scores for all aspects of physician communication and physician empathy than the chronic pain-free controls. All between-group differences were clinically relevant. There were no differences in physician communication or physician empathy according to physician type in the exploratory analyses, and study group X physician type interaction effects were not observed. In this cross-sectional study, patients with chronic pain reported having physicians with poorer communication and less empathy than chronic pain-free controls. Longitudinal research is needed to more clearly determine the temporal relationship between patients' chronic pain and physician communication and physician empathy during medical encounters.

Comprehensive Analysis of Empathy by Using Jefferson Scale of Empathy – Student Version Among Undergraduate Medical and Dental Students

Empathy is essential in medicine, but many healthcare professionals struggle to integrate empathetic communication in practice. This study aims to assess empathy levels among medical and dental students and their association with age. Objectives: To evaluate empathy levels among medical and dental students using the Jefferson Scale of Physician Empathy-Student Version and examine the correlation with age. Methods: Conducted at a private medical college in Lahore, this study involved 324 medical and dental students. Empathy levels were measured using the Jefferson Scale of Physician Empathy and the data were analyzed with SPSS version 24.0. Non-parametric tests were employed to assess differences in the Jefferson Scale of Physician Empathy and subscale scores among participants, with statistical significance set at p<0.05. Results: The average Jefferson Scale of Physician Empathy score was 66.67 ± 9.5. Among the subscales, "standing in the patient's shoes" had the lowest average score. Bachelor of Dental Surgery students scored slightly higher in perspective-taking and compassionate care, while MBBS students scored higher in standing in the patient's shoes. An inverse relationship between age and empathy scores was observed, with older students exhibiting lower empathy levels. Conclusions: It was concluded that Empathy levels among medical students in Pakistan were lower compared to international studies. Emphasizing empathy in medical education should be a priority to enhance compassionate care and professional development among future healthcare professionals.

Assessing the impact of the human resources department's nurturing connect program on compassion and empathy in physicians and surgeons and its influence on patient advocacy

Background: Empathy and compassion, key to medical practice, enhance patient adherence to treatments. These traits can be developed, not just inherent. This study implemented the "human resources nurturing connect (HRNC)" program to boost empathy and compassion in healthcare providers, evaluating its impact on patient advocacy over time. Methods: This study was a two-arm, prospective, randomized, single-center conducted from March 2023 to June 2024 at Bhaktivedanta hospital and research institute, Thane, India. Thirty doctors (age 25 to 60) were randomly assigned to intervention and control groups (15 each). The intervention group underwent the HRNC Program to enhance empathy and compassion, measured by the Bhaktivedanta’s index of compassion and empathy in physicians and surgeons (BICEPS) scale, and its effect on patient advocacy assessed by the PAS scale, conducted at baseline, 3, 6, 9, and 12 months. Results: Both BICEPS and PAS scores increased more significantly in the intervention group compared to the control group (p<0.0001). The intervention group’s BICEPS scores rose from 65.47±4.99 at baseline to 83.79±7.19 at 12 months, while the control group showed minimal changes, with scores increasing from 65.48±4.41 to 67.69±5.26. The PAS score in the intervention group also increased significantly (p=0.001) from mean score of 64.48±7.39 to 90.12±10.13, with a percentage change from 21.39% to 39.76%. In contrast, the control group showed a slight increase from 63.53±3.26 to 65.89±3.34, with a percentage change from 0.87% to 3.72%. Conclusions: Study evidenced effectiveness of targeted developmental interventions in fostering empathy and compassion among healthcare providers resulting in better patient outcomes, overall healthcare quality which also translate in patient advocacy.

Impact of simulated patient-based communication training vs. real patient-based communication training on empathetic behaviour in undergraduate students – a prospective evaluation study

BackgroundEmpathy is a key competency and is essential for doctor-patient relationships. Studies have proven a continuous reduction of empathy in medical students during their study period. The use of SPs is positively evaluated for competency acquisition and real patient communication training has positive effects on empathy empowerment. Therefore, the present study focusses on the impact of simulated patient (SP) vs real patient (RP) communication training on empathetic behaviour in undergraduate medical students.MethodsThe prospective evaluation took place during a 210-minute skills lab unit on medical communication for 3rd year medical students. Study participants were allocated in advance to one of three groups: one group trained with an SP (SP-group) and was informed about the fact that it was an SP; another group trained with an SP but assumed to encounter an RP (incognito patient group (IP-group)); the last group trained with an RP and was correctly informed about it (real patient group (RP-group). Self-assessed empathy was measured by using Jefferson Scale of Physician Empathy (JSPE) and Interpersonal Reactivity Index (IRI), as these are the most commonly used instruments for assessing empathy. Study participants were evaluated on empathetic behaviour by their group-associated patient using the Consultation and Relational Empathy (CARE) scale.Results146 students participated. There was no significant difference in self-assessed empathy between groups for JSPE and IRI. External assessment via CARE showed a statistically significant difference between SP-group and IP-group , as well as between SP-group and RP-group. There was no significant difference between IP-group and RP-group. This means that students training with real patients (or who believed them to be real) did receive significantly lower performance ratings on their empathy.ConclusionThe results demonstrate a significant lower external empathy rating for students who had trained with a real patient or if they were in the belief of having encountered a real patient; this may be due to inhibitions and a lack of routine. Therefore, we recommend implementing SPs in the early study period with the gradual integration of RPs in the student’s further course of study.

Women's Relationships With Healthcare and Providers: The Role of Weight Stigma in Healthcare and Weight Bias Internalization.

Weight stigma (devaluation due to body weight) in healthcare is common and influences one's engagement in healthcare, health behaviors, and relationship with providers. Positive patient-provider relationships (PPR) are important for one's healthcare engagement and long-term health. To date, no research has yet investigated whether weight bias internalization (self-stigma due to weight; WBI) moderates the effect of weight stigma on the PPR. We predict that weight stigma in healthcare is negatively associated with (i) trust in physicians, (ii) physician empathy, (iii) autonomy and competence when interacting with physicians, and (iv) perceived physician expertise. We also predict that those with high levels of WBI would have the strongest relationship between experiences of weight stigma and PPR outcomes. We recruited women (N = 1,114) to complete a survey about weight stigma in healthcare, WBI and the previously cited PPR outcomes. Weight stigma in healthcare and WBI were associated with each of the PPR outcomes when controlling for age, BMI, education, income, race, and ethnicity. The only exception was that WBI was not associated with trust in physicians. The hypothesis that WBI would moderate the effect of weight stigma in healthcare on PPR outcomes was generally not supported. Overall, this research highlights how weight stigma in healthcare as well as one's own internalization negatively impact PPRs, especially how autonomous and competent one feels with their provider which are essential for one to take an active role in their health and healthcare.

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.

How the CAHPS Clinician and Group Patient Experience Survey Data Have Been Used in Research: A Systematic Review.

Patient experience is a key aspect of care quality. The Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS®) survey measures experiences with ambulatory care providers to inform public reporting, pay-for-performance initiatives, interventions, patient choice of physicians/practices, and quality improvement. Since the survey's 2007 release, no systematic review of its use in research has been published. We reviewed English-language, peer-reviewed articles published since 2008 using CG-CAHPS survey data in the U.S. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used the Checklist for Analytical Cross-Sectional Studies. We examined 126 articles and included 52. Twenty-seven articles focused on general primary care, and the others focused on ambulatory specialty care. Of the 52 studies, 37 were cross-sectional, and the majority conducted patient-level regression analysis, controlling for patient characteristics. The most-used CAHPS measures were overall provider rating and the provider communication composite. CG-CAHPS data were primarily utilized to evaluate interventions (24 studies) and examine cross-sectional associations (21 studies) of site-level (eg, organizational climate), provider-level (physician empathy), and patient-level (medication adherence) factors with patient experience. Four studies reported disparities in patient experience. The widespread use of CG-CAHPS data implies the survey's value in measuring and improving care quality. Unlike facility or plan surveys, the CG-CAHPS survey was designed to allow attribution to medical groups and clinicians, which, as evidence shows, is its main strength. Policymakers, researchers, clinicians, and health care leaders can leverage CG-CAHPS data in quality improvement efforts and interventions supporting patient-centered care.

Physician Empathy and Its Relation to Age, Gender, and Years of Experience

Abstract Background: Empathy is a necessary clinical skill; it is a key element of physician–patient relations which have a significant role in the effectiveness of health care, the physician must have the competence to understand the patient’s situation, perspective, and feelings, and to act on that understanding in a helpful therapeutic way. A highly empathetic doctor is the dream of every patient. Objective: The objective of the study was to determine the level of empathy among physicians at Al-Yarmouk Teaching Hospital and to assess its relation to age, gender, and years of experience. Subjects and Methods: A cross-sectional study was conducted among 300 physicians working at Al-Yarmouk Teaching Hospital in Baghdad, Iraq; the data collection was from April 14 to August 14, 2023. The data were collected by a self-administered questionnaire which consists of sociodemographic variables and questions of the Jefferson Scale of Empathy health professional version. Data analysis was done using SPSS version 24. Results: Three hundred physicians participated in the study. The mean age was 31.66 ± 5.288 years, 46% males and 54% females. The mean years of experience were 6.89 ± 5.551 years, 62.7% people-oriented physicians and 37.3% were technology oriented the majority of the people oriented were females and the majority of technology oriented were males. The median score was 102.00 with an interquartile range of 20.75, no significant association was found with gender or medical discipline. The median empathy score of physicians who had <10 years’ experience appeared to be significantly higher in comparison to other groups; (P < 0.001), and also in juniors and the age group of 25–35 years. Conclusions: Empathy scores of younger physicians with <10 years of experience were significantly higher than other physicians, indicating that there is empathy decline as the years of experience increase that could be attributed to numerous factors that need to be further evaluated.

The humanization of medical education: publications review

The humanization of medical education is targeted at integration of humanitarian values and approaches into system of education of medical personnel to improve their professional and personal training. This process includes education in medical ethics, development of communication skills, stress management and implementation of humanitarian disciplines into the curriculum. The humanization contributes into formation of empathy, responsibility and professionalism in future physicians that helps to better understand and consider psychological, social and emotional needs of patients. The problems of including humanitarian sciences into medical education are associated with lack of systematic approach, adequate curricula and qualified lecturers. To optimize process, it is necessary to focus on education of ideals and beliefs, development of integrated curricula and enhancement of humanitarian component of education.

What do physicians think about the white coat, about patients' view of the white coat, and how empathetic are physicians toward patients in hospital gowns? An enclothed cognition view.

The receipt of the white coat by medical students is a significant milestone. Extensive research has focused on the white coat, its purity, representation of authority and professionalism, its role in consolidating a medical hierarchy, and the professional status attributed to physicians wearing it. Studies suggest that the white coat is a symbol of medical competence, and patients expect physicians to wear it. Research, however, has paid little attention to what physicians think about their white coat, how they perceive the patient's view of the white coat and the hospital gown, within the patient-physician power asymmetry, which is the focus of the current study. In total, 85 physicians from three Israeli medical centers completed a questionnaire (62% Muslims, 33% Jewish, and 5% Christians; 68% men, ages ranging from 21 to 73 years). Employing the enclothed cognition theory and adopting a within-person approach, we found that the more physicians perceived the white coat as important, the more they attributed a positive view of the white coat to patients and the more they perceived the patient's view of the hospital gown as positive. In addition, the higher the perceived importance of the white coat, the higher the reported empathy of physicians toward inpatients, which is consistent with the hospital's values of care. Interestingly, although medicine is a symbol of protection and care for others, the symbolic meaning of the white coat was potent enough to elicit empathy only when physicians perceived it as important. This study extends the theoretical knowledge on the theory of enclothed cognition in healthcare regarding self-perceptions and professional conduct.

Evaluating empathy level amongst the dental students using jefferson scale of physician empathy- health professional students

BackgroundEmpathy is described as one’s ability to perceive and apprehend another person’s feelings, situation, emotions, and problems as their own. Empathetic behavior increases patients’ satisfaction, reduces discomfort, and helps with patient’s satisfaction.ObjectiveTo evaluate the psychometric properties of the Jefferson Empathy Scale and compare the measure of invariance within genders and amongst the public and private sector dental students.MethodThis cross-sectional study utilized JSE-HPS version for research purpose. An exploratory factor analysis was performed to detect underlying factors. Reliability of the study tool was evaluated using Cronbach alpha test. Mann Whitney U test was used to compare the differences in scores between genders and among public and private university students while Student’s t analysis compared the scores according to different domains. The level of significance was ≤ 0.05.ResultsFemales demonstrated higher empathy levels (88.52 ± 14.19) along with private institute students (88.46 ± 13.98). Perspective taking and compassionate care domain was also scored highest by the females (31.73 ± 6.49 & 29.31 ± 6.22) and among second year students (33.30 ± 7.11 & 30.50 ± 7.16). PCA analysis extracted 4 factors namely (i) Health-care-provider’s sense of humor contributed to improved outcome (ii) Health-care provider’s understanding of patients’ feelings and of their families influences treatment outcomes (iii) Understanding body language is as important as verbal communication and (iv) Patients feel better when their feelings are understood, which accounted for the 59.51% of the total variance.ConclusionThe findings revealed that students from private institute and females demonstrated higher empathy score. Moreover, the Jefferson Scale of Empathy (JSE) was found to be a reliable and validated tool for assessment of empathy in our sample population.

The Impact of a Computer-Based Interactive Informed Consent for Surgery on Decision Conflict

Informed consent for surgery can address the legal aspects of care while also being simple, informative, and empathic. We developed interactive informed consents and compared them with standard printed informed consents asking: (1) are there any factors associated with lower decision conflict or greater patient-rated clinician empathy including consent format? (2) Are there any factors associated with rating the consent process as informative, comfortable, and satisfying including consent format? Ninety-four adult patients accepted an offer of surgery from one of three hand surgeons to address one of six common hand surgery diagnoses: carpal tunnel release, cubital tunnel release, trigger finger release, plate and screw fixation of a distal radius fracture, removal of a benign mass, including a ganglion cyst, and Dupuytren contracture release. Fifty-three patients were randomized to complete an interactive consent, and 41, a standard written consent. Symptoms of anxiety, depression, and unhelpful thoughts were measured. Patients completed the Decision Conflict Scale and the Jefferson Scale of Patient's Perceptions of Physician Empathy and rated the consent as informative, comfortable, and satisfactory on a scale of 0-10. Greater decisional conflict was slightly associated with greater patient unhelpful thoughts about symptoms and was not associated with consent format. A higher rating of comfort with the consent process was slightly associated with patient choice to proceed with surgical treatment, but not with consent format. Accounting for potential confounding in multivariable analysis, a higher rating of the consent process as informative was slightly associated with patient preference for surgical over nonsurgical treatment, CONCLUSIONS: The observation that an interactive consent form was not related to decision conflict or other aspects of patient experience suggests that such tools may not have much weight relative to the interaction between patient and clinician. Efforts to improve informed consent may need to focus on the dialog between patient and surgeon rather than how information is presented.

Exploring Association of Level of Empathy with Demographic Factors among Medical and Dental Students, A Comparative Cross-Sectional Study

Being an effective physician, one must possess both clinical expertise and a specific range of emotional competencies, including empathy. Objective: To determine the empathy scores among medical and dental students and to correlate them with demographic factors like age, gender and academic year. Methods: A cross-sectional survey was conducted involving 324 students from medical and dental programs at a private medical and dental college in Lahore. Empathy levels were measured using Jefferson Scale of Physician Empathy- student version (JSPE-S). Data analysis was done using SPSS 24.0. Non-parametric tests were applied to find the significant difference between average scores of JSPE-S and all sub-scales across gender, age, academic year and medical program. Results: The mean empathy score on JSPE-S was 66.7. Difference of JSPE-S overall empathy score between age-groups was statistically significant (p-value 0.02). Among the medical and dental students significant difference was found between average scores of perceptive taking and compassionate care. No correlation was found between empathy scores and gender. However, empathy scores were low during initial years of medical school, being the highest in fourth year and then declining again. Conclusions: It was concluded that empathy is associated with demographical factors. Among the medical and dental students’ significant difference was found between average scores of perceptive taking and compassionate care. Although no difference in empathy scores was found between the two genders however, it declined as students gained more exposure to patients in their senior years

Physician Empathy and Chronic Pain Outcomes

Empathy is an aspect of the patient-physician relationship that may be particularly important in patients with chronic pain. To measure the association of physician empathy with pain, function, and health-related quality of life (HRQOL) among patients with chronic low back pain. This cohort study included adult enrollees from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation national pain research registry. Study dates were from April 1, 2016, to July 25, 2023, with up to 12 months of follow-up. Physician empathy was assessed with the Consultation and Relational Empathy measure and dichotomized to yield very empathic physician and slightly empathic physician groups. Main outcomes were patient-reported pain, function, and HRQOL measured with a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related disability, and the Patient-Reported Outcomes Measurement Information System for HRQOL deficits pertaining to anxiety, depression, fatigue, sleep disturbance, and pain interference. Data were collected at 5 quarterly encounters from registry enrollment through 12 months and analyzed with generalized estimating equations, including multivariable models to measure temporal trends and to adjust for baseline and longitudinal covariates. Among the 1470 patients, the mean (SD) age was 53.1 (13.2) years, and 1093 (74.4%) were female. Patients completed 5943 encounters in which multivariable analyses demonstrated that greater physician empathy was inversely associated with pain intensity (β = -0.014; 95% CI, -0.022 to -0.006; P < .001), back-related disability (β = -0.062; 95% CI, -0.085 to -0.040; P < .001), and HRQOL deficits on each measure (eg, pain interference: β = -0.080; 95% CI, -0.111 to -0.049; P < .001). Correspondingly, compared with the slightly empathic physician group, the very empathic physician group reported lower mean pain intensity (6.3; 95% CI, 6.1-6.5 vs 6.7; 95% CI, 6.5-6.9; P < .001), less mean back-related disability (14.9; 95% CI, 14.2-15.6 vs 16.8; 95% CI, 16.0-17.6; P < .001), and fewer HRQOL deficits on each measure (eg, fatigue: 57.3; 95% CI, 56.1-58.5 vs 60.4; 95% CI, 59.0-61.7; P < .001). All physician empathy group differences were clinically relevant, with Cohen d statistics ranging from 0.21 for pain intensity to 0.30 for back-related disability, fatigue, and pain interference. Physician empathy was associated with more favorable outcomes than non-pharmacological treatments, opioid therapy, and lumbar spine surgery. In this cohort study of adult patients with chronic pain, physician empathy was associated with better outcomes over 12 months. Greater efforts to cultivate and improve physician empathy appear warranted.

Cultivating physician empathy: a person-centered study based in self-determination theory

ABSTRACT While physician empathy is a vital ingredient in both physician wellness and quality of patient care, consensus on its origins, and how to cultivate it, is still lacking. The present study examines this issue in a new and innovative way, through the lens of self-determination theory. Using survey methodology, we collected data from N = 177 (44%) students at a Canadian medical school. We then used a person-centered approach (cluster analysis) to identify medical student profiles of self-determination (based on trait autonomy and perceived competence in learning) and how the learning environment impacted empathy for those in each profile. When the learning environment was more autonomy-supportive, students experienced higher satisfaction and lower frustration of their basic psychological needs in medical school, as well as greater empathy towards patients. The translation into increased empathy, however, was only evident among the students with higher self-determination at baseline. Results from this study suggest that autonomy-supportive learning environments will generally support medical students’ psychological needs for optimal motivation and well-being, but whether or not they lead to empathy towards patients will depend on individual differences in self-determination. Findings and their implications are discussed in terms of developing theory-driven approaches to cultivating empathy in medical education.

Mediating role of physician's empathy between physician's communication and patient's satisfaction.

Physician communication is vital for an effective physician-patient relationship. Physician empathy is crucial to patient communication. The relationship between physician empathy, physician communication, and patient satisfaction is not very clear. This study aims to study the mediating role of physician's empathy between physician's communication, physician's empathy, and patient's satisfaction. A cross-sectional study was conducted at the National Institute of Psychology, Quaid-i-Azam University, during the time period of December 2018 to February 2019. Employing the technique of purposive convenience sampling, data were collected (N = 238) from psychiatric, cardiology, and dermatology wards of public and private sector hospitals of Islamabad and Rawalpindi. The Communication Assessment Tool, specifically the Patient's Perception of Physician's Empathy and Patient Satisfaction Scale, was used to assess study variables. The measures used in the research assess the patient's perception of the physician's communication, empathy, and patient's satisfaction. Formal permission for the research was taken from the hospital administration with approval from the institutional review boards. Participants were briefed about the purpose of the research. Both verbal and written informed consent was taken from them. The result shows that a physician's empathy plays a mediating role between the physician's communication skills and patient satisfaction. Moreover, Pearson product-moment correlation indicated a significant positive relationship between doctors' communication skills, doctors' empathy, and patients' satisfaction. Building a positive doctor-patient relationship would not only lead to improved patient satisfaction but also reduce the likelihood of medical malpractice. Therefore, steps should be taken to enforce trust, interaction, and empathy in doctor-patient relationships, with patient-centered services. Physician's empathy plays a mediating role between physician's communication skills and patient's satisfaction.

IJCM_32A: Attitude of Medical Students Regarding Empathy towards Patients in a Medical College in Mangalore

Background: The incorporation of medical humanities, an interdisciplinary field of medicine, in medical education may offer significant benefits to the medical community. This study was done to assess the attitude of medical students regarding empathy towards patients and to find out the perception of students about the inclusion of humanity studies to their undergraduate medical curriculum. Methodology: It was a Cross-sectional study done among Final Year MBBS Part One and Part Two, Post Graduate Students of Clinical Specialities and Interns of Kasturba Medical College, Mangalore and its associated teaching hospitals. Data was collected using semi-structured questionnaire which consisted of three sections including Participant information, Jefferson Scale of Physician Empathy – Student’s Version (JSPE-S) which will be used to measure empathy towards patients among medical students and questions on assessing the perception of students regarding the introduction of humanity studies in the medical curriculum. The collected data were entered and analyzed using SPSS version 11.5. Likert scale was analysed using median (±2SD). For qualitative data statistical test Chi-square was used Results: The mean age of the 410 students who were surveyed was 22.11 with a standard deviation of ± 2.136. 41% of the respondents were male and 59% were female. The Jefferson Scale of Physician Empathy is measured on a scale of 20-140. Among the participants, 167 (40.7%) students scored between 46-90, categorized according to the Jefferson Scale as moderately empathetic. 243 students scored between 91-140 - categorized as high empathetic. None of the students scored between 20-45 (least empathetic category) Conclusion: Our study found that all the respondents were either moderately or highly empathetic according to the Jefferson Scale of Physician Empathy. A majority of respondents felt that it is important to understand the feelings and body language of the patient and that the emotions of the patient and family are important in the physician-patient relationship.

Simulating empathy: A qualitative experiential study of embedded resident learners in an empathy curriculum.

Physician empathy and communication skills are crucial parts of a successful emergency department (ED) interaction. This study aimed to evaluate whether these skills can be improved through a novel curriculum where interns act as patients for their senior residents during simulated ED cases. Twenty-five residents participated in the curriculum. Prior to the cases, participants filled out the Toronto Empathy Questionnaire (TEQ). They then completed three simulated cases, with the 11 interns portraying the patients and the 14 seniors (postgraduate year [PGY]-2 and PGY-3 residents) in the physician role. Following the cases, the residents participated in a recorded, structured focus group. At the conclusion of the session participants again filled out the TEQ and answered a Likert questionnaire on their thoughts about the curriculum. Qualitative analysis was used to determine themes from the debriefs. Twenty-two residents completed all components of the study. The mean (±SD) TEQ scores pre- and postcurriculum for all residents were 46.2 (±4.64) pre and 47.9 (±6.03) post (ns). On qualitative analysis, we derived four major themes: empathy, communication, feedback, and physician experience. The most common subthemes discussed were empathy for the patient situation and the importance of communicating visit expectations. On a 5-point Likert survey related to the simulated cases, respondents rated comfort providing feedback to their peers (mean ± SD 4.41 ± 0.95) and gaining insight into the patient experience (mean ± SD 4.27 ± 0.83). The embedded intern exercise was rated well by resident participants, with no observed change in empathy scores. Qualitative analysis identified empathy and communication as major themes. Residents enjoyed this style of simulation and found it realistic.

Shared Medical Appointment: A Novel Model for Incorporating Group Visits Into Residency Training for Substance Use Disorders.

Shared medical appointments (SMAs) are a novel modality for treating patients with similar conditions, together, by a team of interdisciplinary providers. SMAs benefit patients with substance use disorder (SUD), but no research has focused on the feasibility of implementation of SMAs in a teaching clinic. Primary care residents rotated in a half-day ambulatory addiction clinic for 4 weeks where a third-year resident co-facilitated 4 SMAs. Confidence, knowledge, and attitudes about SUD care were assessed using web-based surveys at weeks 0, 4, and 8. Pre- and post-intervention scores were compared using a t test for paired samples. Ten residents were included in the analyses. Using a 10-point Likert scale, confidence in SUD knowledge (7.0-8.3, P = .003), confidence in counseling patients with SUD (7.1-8.2, P = .023), and confidence in facilitating an SMA (5.7-8.3, P = .007) showed statistically significant increases from baseline following exposure to the SMAs. Confidence that counseling and other treatments will make a difference for patients with illicit drug use increased (7.1-8.0, P = .142), but did not differ statistically. Furthermore, on a 4-point Likert scale, understanding of behavioral therapies for treating and preventing the relapse of SUD (2.9-3.2, P = .180) showed a similar increase. Attitudes toward patients with SUD (42.4-42.1, P = .303) and physician empathy (119.3-119.2, P = .963) did not change from pre- to post-intervention. SMAs are a feasible training tool in the education of primary care residents on an addiction medicine rotation. Residents develop confidence co-facilitating SMAs after 4 weeks. Overall, exposure to SMAs during residency can provide an opportunity to increase confidence in treating patients with SUD, as well as provide a training modality that may shift the way residents interact with patients receiving SUD treatment.