Medical Empathy Research Articles

Individual Psychology During Times of the Coronavirus

Individual Psychology During Times of the Coronavirus Jon Sperry and Len Sperry This issue highlights research and clinical applications of Individual Psychology in six articles. These editors’ notes were written in the United States in April 2020, as COVID-19 cases were spiking around the country. During such unprecedented times, the principles and practices covered in this issue are more relevant than ever. The socially embedded element of Individual Psychology is ever present during this pandemic. Social distancing recommendations around the globe created significant obstacles for individuals to connect to others and community. The World Health Organization (WHO) even recommended using the term physical distancing in mid-March 2020 to suggest that social support is essential during a pandemic but must be done thorough physically distanced means such as telephone, texting, and video calls. Individuals and groups that follow and practice Adlerian theory sought ways to demonstrate social interest during the coronavirus pandemic. As editors, we believe that physical distancing is an example of social interest because it helps reduce the spread of coronavirus simply by staying home and preventing infection, particularly for at-risk populations. Additional examples of these efforts include the North American Society of Adlerian Psychology (NASAP) and the International Adlerian Summer Schools and Institutes (ICASSI), which have made efforts to gather participants for social gatherings on Zoom and to assemble a fully online conference under the direction of NASAP’s president Dr. Susan Belangee. In line with managing major or minor challenges in life, the first article by Paul Rasmussen and Erin Schuyler, “Life Tasks and Psychological Muscle,” discusses how to navigate life challenges through Adlerian principles. The authors discuss the three tasks of life relative to the personal qualities necessary for successful satisfaction of each task. They also highlight how psychological muscle is an amalgamation of responsibility, cooperation, and respect. [End Page 305] The second article, by Evan Ripley-McNeil and Kenneth Cramer, makes an empirical link between social interest and perceived well-being. Their article, titled “Can Group Membership and Volunteering Predict Well-Being in the World Values Survey: Correlates, Sex Differences, and Age Moderation,” examined Wave 6 of the World Values Survey (2010–2014), which included 89,564 respondents from 60 nations. They explored social interest and well-being as measured by perceived group membership and volunteering and found a positive correlation to perceived well-being (as measured by both perceived happiness and perceived health). The next article, by Rebecca Dickinson and Ellen Daly, titled “Using Personality Priorities in Adlerian Play Therapy Parent Consultation,” examines the use of personality priorities of children and of parents and caregivers as part of parent consultation in Adlerian play therapy. The article provides theoretical insight and clinical procedures to guide the use of personality priorities with families and children. The authors also provide a case vignette to demonstrate the use of the “top card” activity by Nelsen and Lott in a family Adlerian play therapy session followed by a parent consultation. Courtney Evans’s article, titled “A Fear Come True: An Autobiographical Narrative Inquiry of Birth Trauma Through an Adlerian Lens,” examines the impact of traumatic birth on mother’s and child’s well-being. The use of autobiographical narrative inquiry is used to examine the themes related to the labor and delivery of twins through an unplanned cesarean section. The themes included helplessness or lack of control; guilt; anxiety, fear, or terror; lack of memory or dissociation; lack of medical support or empathy; and inability to be present focused. The article articulates clinical and theoretical implications when considering factors like control, support, and lifestyle convictions when applied to traumatic birth experiences. Ashley Koerick Sauer and Carman Gill offer an exciting integration of equine therapy and Adlerian therapy in their article “Treating Disruptive Mood Dysregulation Disorder: An Integrated Adlerian and Equine Therapy Approach.” The authors describe the integration of equine therapy assessment, skills, and intervention into the Adlerian psychotherapy framework. The authors provide a compelling case example illustrating how equine therapy from an Adlerian theoretical orientation can assist in treatment of a teenager with the diagnosis of disruptive mood dysregulation disorder. The final piece in the issue is the second of a two-part article discussing Adler...

EMPATHY IN NURSING STUDENTS FROM THE METROPOLITANA UNIVERSITY OF BARRANQUILLA (COLOMBIA)

ABSTRACT Objective: to evaluate the Empathic Orientation in Nursing students of the Universidad Metropolitana of Barranquilla (Colombia). Method: a descriptive, exploratory and transversal study in which the Jefferson Medical Empathy Scale in an anonymous and confidential manner was applied to 489 students from the first to fourth undergraduate year of the Nursing Program of the Universidad Metropolitana (Barranquilla, Colombia); the corresponding ethical and methodological rigor was kept. Results: the ANOVA results were not significant in the Academic Year factor and in the interaction (p=0.261), but significant by Gender. It was observed that behavior was different in both genders. The masculine gender tends to descend between the first and third undergraduate year and female gender also descends between first and second undergraduate year to later reach the average levels of empathy of the male gender. Conclusion: the results obtained show that the means of the variable studied do not show a great difference between the different undergraduate courses, nevertheless, a slight increase in the fourth undergraduate year is observed. There were significant differences between genders, the scores observed in men students were higher than those obtained from women students.

NARRATIVES ENHANCING TRAINEES’ ATTITUDES TOWARD AGING

We analyzed narratives from graduate students trained in aging themes who then interviewed older hospitalized adults about their life experiences. Three Discovery Fellows given a 90-minute training on open-ended interviewing, the medical care system, empathy, and aging themes derived from the Reframing Aging Program performed semi-structured interviews of 30-90 minutes. Subjects were hospitalized older veterans receiving care by an interdisciplinary geriatric rehabilitation team. Narratives were composed following the interviews and electronically uploaded to a secure site. Qualitative analysis was performed with each statement treated as a separate quote using a hierarchical coding system. A total of 774 codes were used to describe the themes present in 582 quotes. A conceptual framework from the narrative themes emerged with 5 groupings: 1) personal experience, 2) people important in life, 3) self-reflection, 4) medical condition, and 5) health maintenance. Concepts displayed included openness, compassion, and morality, as components of wisdom.

The Positive Association Between Empathy and Self-Esteem in Chinese Medical Students: A Multi-Institutional Study.

BackgroundEmpathy is an important element of the physician-patient relationship and is a critical personality trait for medical students. However, research has shown that it declines during undergraduate medical education. It is still unclear how empathy interrelates with the psychological elements of medical students, in particular, self-esteem. This study examined the relationship between empathy and self-esteem to explore other possible methods to improve medical students’ empathy.MethodsA stratified sampling strategy was used to select 1690 medical students from 3 medical institutions in Shanghai as study participants. The questionnaires used to collect data included the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), the Rosenberg Self-esteem Scale (RSES), and a self-made inventory on personal information. Descriptive analysis, independent t-test, One-Way ANOVA, and linear regression were used to analyze the data.ResultsThe mean empathy score among medical students was 102.73 with SD = 12.64. Multiple regression analysis revealed that, “age,” “perception of the importance of empathy,” “academic pressure,” “desire to be a doctor after graduation,” and “self-esteem” were significant predictors of empathy (P < 0.05) and the adjusted R2 was 0.462. The correlation matrix between empathy and self-esteem was significant (r = 0.510, P < 0.01). Self-esteem explained 15.5% of the variation of empathy in the final regression model.ConclusionThere was a positive association between self-esteem and empathy. Self-esteem is one of many factors which contribute to medical students’ empathy. Age, academic pressure, attitude toward empathy and future career also play a critical role in medical student empathy. Enhancing medical students’ self-esteem may be an efficacious way to improve medical students’ empathy.

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 Development of Cognitive and Affective Skills Through a Sexual and Reproductive Health Medical Education Unit.

IntroductionAlthough better medical training on sexual and reproductive health (SRH) is an unquestionable global need, and recent research has emphasized the importance of SRH education, few studies have presented alternative teaching models to conventional approaches.AimTo examine the structure and evaluation of a curricular unit that uses an active teaching and learning strategy, and to evaluate both the cognitive and affective student learning outcomes.MethodsThis study used retrospective and cross-sectional analyses of a curricular unit with 8 weekly lessons structured into individual activities before the class, group activities monitored in class, feedback, and the development of medical empathy.Main Outcome MeasureStudent performance was evaluated through summative and formative activities. The process was evaluated quantitatively by a questionnaire containing Likert-type and open-ended questions with speech analysis and with categorical evaluation.ResultsThe final average of the analyzed group was 7.95 ± 0.5 on a scale of 10. Likert-type assessment (Cronbach's α = 0.86) revealed strong student adherence and, through responses to open-ended questions, positive evaluations of the proposed SRH teaching model. The Jefferson Scale of Physician Empathy showed a high index of self-reported general empathy (117.3 ± 11), with a significantly higher index for female students (P = .019) than male students; however, this gender difference disappeared after the intervention (P = .086).ConclusionsThe curriculum model was developed and continuously adjusted based on grounded theory for teaching SRH and included both cognitive and affective stimuli; the results showed favorable student evaluation of the unit, and it proved feasible to implement in the time available.de Oliveira R, Montagna E, Zaia V, et al. The Development of Cognitive and Affective Skills Through a Sexual and Reproductive Health Medical Education Unit. Sex Med 2019;7:326–336.

Utilización de la Escala de Empatía Médica de Jefferson en Residentes que realizan su especialización en un hospital peruano.

La empatía es definida como la capacidad de comprender los sentimientos y emociones de los demás, basada en el reconocimiento del otro como persona similar o semejante. Aplicada a la relación médico-paciente, puede mejorar los resultados clínicos, por lo que es considerada una habilidad esencial en la capacitación de todo profesional médico. Objetivo: Identificar el nivel de empatía y factores relacionados en médicos residentes de áreas médicas y quirúrgicas realizando entrenamiento especializado en un hospital de Lima, Perú. Material y métodos: Se obtuvieron esenciales datos sociodemográficos y profesionales y se aplicó la Escala de Empatía Médica de Jefferson, conformada por 20 preguntas, con puntuación Likert de 1 a 7, puntaje mínimo de 20 y máximo de 140, y nivel de empatía directamente proporcional al puntaje obtenido. Resultados: Cien médicos residentes, 52% de sexo femenino constituyeron la muestra. La media del puntaje obtenido fue 112,88, con DE 14.51, mediana de 115 y coeficiente alfa de Cronbach de 0,82. Los valores de los cuartiles fueron de 102, 115 y 124. Veintiséis por ciento de los médicos residentes de medicina, 19,2% de cirugía, 10% de Gineco-obstetricia y 35% de pediatría alcanzaron puntajes del cuartil superior. No se hallaron diferencias estadísticamente significativas al comparar el puntaje de los encuestados con cada una de las variables estudiadas. Conclusiones: Los médicos residentes de la especialidad de Pediatría presentaron puntajes más altos que el resto de especialidades, pero no se encontraron variables específicas significativas para explicar las diferencias detectadas en niveles de empatía.

King George’s Medical University: Inculcating a Service Mindset

The case narrates the dilemma faced by Dr Ravi Kant, the Vice Chancellor (VC) of King George’s Medical University, and the steps he took to resolve the same. The widely reputed public hospital had, under the leadership of Dr Ravi Kant, successfully introduced a series of communication interventions in the hospital in 2015. The aim of these interventions was to sensitize the doctors on the importance of empathy, patient-centred care, and its outcomes in line with the recent directives of the Medical Council of India. However, no tangible benefits of these interventions were visible, just yet. Doctor–patient clashes were far more frequent. Many times, the university almost came to a standstill because of flash strikes by the junior doctors and even doctors in residence. The VC was often confronted with disgruntled patients, irritated patient attendants, an angry media and missives from the state government. The key issues highlighted in this case are: How to make the doctors more responsive to the needs of the patient? What additional measures should be initiated to inculcate values of medical ethics and empathy within the doctors? What more could be added to the medical curriculum to bring about a greater change in perspective? Finally, how to develop a service mindset?

Understanding medical students' empathy based on Enneagram personality types.

PurposeHigh self-awareness can promote communication and empathy. The Enneagram is a well-known personality tool to enhance self-awareness. We evaluated differences in empathy among medical students using the Enneagram typology.MethodsThis cross-sectional study included first and second grade students at the Inje University College of Medicine. The Jefferson Scale of Empathy was used to measure empathy and the Korean Enneagram Personality Type Indicator was used for examining personality characteristics. Empathy scores were analyzed according to the Triads, Hornevian group, Harmonic group, and each Enneagram type.ResultsThe Instinctive triad, the Withdrawns, and the Positive outlook group were the most common, and the Feeling triad, the Assertives, and the Emotional realness group were the least common. Students in the Feeling triad and the Dutifuls had higher compassionate care (CC) scores as compared to their counterparts. Type 2 and 6 students showed the two highest empathy and CC scores. The empathy score of type 3 students was the lowest. Type 7 had the lowest CC score but the highest perspective taking score.ConclusionThese differences in empathy according to Enneagram personality types can be applied to medical education to maintain and improve medical students’ empathy.

Empathy levels among medical students in a military medical university and the influencing factors

Objective To investigate the empathy levels of medical students in a military medical university and explore the influencing factors. Methods Self-developed demographic information questionnaire, Jefferson Scale of Empathy (JSPE-S), Interpersonal Reactivity Index (IRI), and Chinese Perceived Stress Scale (CPSS) were used to collect data from June to October 2016. Medical undergraduate students were conveniently enrolled in the survey. SPSS 17.0 software was used for statistical analysis. T test, ANOVA, and chi-square test or Fisher exact test were used to compare the data of different categories of students. Results A total of 683 questionnaires were distributed and 594 valid questionnaires were returned, with a valid response rate of 86.97%. Students had an above-average level of medical empathy with JSPE-S score as (104.11±19.66), and IRI score was (51.63±10.08). There was a statically difference on level of medical empathy between groups of students with different genders, specialties, professional satisfaction, future career desire, and relative courses learning experience (P<0.05 for all). Medical empathy was significantly negatively correlated with perceived stress (r=-0.392, P=0.000) and significantly positively correlated with perceived stress (r=0.298, P=0.000). Conclusion Targeted strategies should be conducted to improve the empathy levels of students in the military medical university. Key words: Military university; Medical students; Medical empathy; General empathy; Perceived stress

Did medical curiosity kill the cat?

This article was migrated. The article was marked as recommended. Curiosity is the urge to explore, understand, and discover anything new. Curious doctors act as 'frontier workers' between the humanities and natural sciences. In their efforts towards trying to "understand" both their patients and their complaints, they function as detectives searching for every seemingly unimportant detail in their constant endeavor of solving the mysterious medical puzzle of illness and providing their ailed patients with adequate help. The curiosity to discover my patients' character, to learn their hopes and desires, to explore their past and current social environment is a crucial part of the manifold studied foundation of what is termed medical empathy. Therefore, nurturing curiosity during the course of medical training should be highly desirable. That said, it seems all the more regrettable that medical education often suppresses the development of curiosity rather than nurtures it, often overemphasizing verifiable facts rather than stimulating more complex thought and reflection processes. The importance of medical curiosity, previously neglected as a potent effect and success factor in the medical-therapeutic setting, should no longer be misunderstood or denied its role. We, as physicians and lecturers, have the power to ignite our students' medical curiosity, if we manage to transmit the "spark". This Personal View by a German MD is intended as a passionate plea for more curiosity in medical education.

Influence of oncology nurses' empathy on lung cancer patients' cellular immunity.

BackgroundMedical staff’s empathy is closely related to patients’ outcome. This research aimed to verify the influence of Chinese oncology nurses’ empathy on the cellular immunity of lung cancer patients.Materials and methodsThe study included 365 lung cancer patients, who were attended by 30 oncology nurses between October 2016 and May 2017. At the time of admission and discharge, flow cytometric analysis was used to measure the cellular immunity of patients, including T-cell subsets and natural killer (NK)-cell activity. The level of empathy of the oncology nurses was measured by the Jefferson Scale of Empathy (JSE, Chinese version). The nurses were divided into high, moderate, and low empathy groups based on JSE scores. Associations between the empathy shown by nurses and the cellular immunity of patients were examined.ResultsOn admission, there was no statistical difference in the cellular immunity of the patients taken care of by the three groups of nurses (P>0.05). At discharge, patients whose nurses were in the high empathy group reported significantly higher B-cell and NK-cell percentages than those whose nurses were in the low empathy group (P<0.001). There was a positive correlation between nurse empathy and percentage of B cells (P=0.003) and NK cells (P<0.001), but no correlation was found between empathy and percentage of CD3+, CD4+, and CD8+ cells. Multiple linear regression analyses indicated that nurse empathy significantly contributed to patient percentage of B cells and NK cells after controlling for patient demographics, disease conditions, and lifestyle.ConclusionThe effect of oncology nurses’ empathy on cellular immunity was confirmed in lung cancer patients, suggesting empathy education, such as narrative medicine education, should be strengthened to improve patient outcome.

The announcement of the diagnosis of trisomy21

The announcement of trisomy21 in a child, either in the prenatal or postnatal period, is a difficult moment for the parents as well as for the caregivers. The latter must be skilled in the general principles of communication and be able to adapt to each specific situation while providing the necessary medical care, support and empathy.

Insights on the Nationwide Project in Osteopathic Medical Education and Empathy (POMEE).

Initial data from the first phase of a nationwide study of cognitive empathy, the Project in Osteopathic Medical Education and Empathy (POMEE), have been gathered. At the beginning of their first year of medical school, more than 6000 osteopathic medical students filled out the Jefferson Scale of Empathy. The POMEE principal investigator and co-investigators-Mohammadreza Hojat, PhD; Leonard H. Calabrese, DO; and Stephen C. Shannon, DO-responded to a series of questions posed by the author pertaining to the importance of POMEE and the impact the findings will have on educating osteopathic medical students. Continued success of this large-scale study will depend on the deans of the 41 participating osteopathic medical schools to continue to encourage student involvement in the study as they progress through their 4 years of undergraduate medical education. Study results will be disseminated via national and international meetings and professional journals.

Empathy in the Curriculum for Patient Care

INTRODUCTION: Empathy on nursing education is an important element in therapeutic communication and in the type of humanized care provided, due the strengthening of the nurse-patient relationship depends on this.OBJECTIVE: To evaluate the levels of empathy on nursing students of a Higher Education Institution. Cartagena de Indias/Colombia.MATERIAL &amp; METHODS: Cross-sectional exploratory study. A sample of 320 nursing students from first to fourth year of training, to whom the Jefferson Medical Empathy Scale (JMES) was applied in the Spanish version.RESULTS: Levels of empathy are reflected more in women than in men in general. However, some values vary with respect to the average at 3.14 levels in relation to the first year of schooling.CONCLUSION: The need for a curricular redesign and favoring empathic actions by professors worthy of being imitated by students as a way of encouraging empathy when caring for patients.

Does medical students' empathy change during their 5-year MBBS degree?

Research evidence over the past 20 years has established that doctors' ability to empathize with their patients is a crucial component of effective health care. Consequently, teaching and reinforcing empathy has entered undergraduate medical education curricula; however, there have been mixed results in terms of its effectiveness. While there is evidence that empathy fluctuates during undergraduate medical training, there has been very little longitudinal research looking at medical students' empathy levels over their full course of study. The aim of the current study was to investigate whether medical students' empathy changed during their 5-year MBBS degree. Students completed the medical student version of the Jefferson Scale of Physician Empathy (JSPE) at the start of Year 1 and then near the end of Years 2, 3, 4, and 5 during 2009-2015. Total empathy score for students who had completed the JSPE in all 5 years of medical training was compared over time using nonparametrical statistical analysis. Results indicated that medical students' empathy varies with empathy being highest at the start of the medical course in Year 1, declining to a low in Year 3 and then rising again in Years 4 and 5. There was a tendency for female students to have higher empathy scores compared to male students in each of the 5 years, with scores significantly different in Years 2, 3, and 4. However, there were no differences in empathy scores according to the students' age. The decline in empathy in the early years of undergraduate medical training is a concern. Medical educators should teach and reinforce empathy during early years of undergraduate medical training in a sustainable way to guard against declining empathy levels. Specific interventions targeted at increasing empathy in male students might be warranted in the future.

Correlates of Empathy Level in Incoming Medical Residents in a Large Peruvian Hospital

Background: Empathy is an important ability for interpersonal relationships, of special interest in the relationship between physician and patient. However, despite its importance, there has been very little work done on the study and evaluation of medical empathy in Peru. Objectives: The study was aimed at evaluating level of empathy in medical residents entering Hospital Nacional Guillermo Almenara Irigoyen (HNGAI), a large hospital in Lima, Peru and at evaluating its correlation with some important contextual and developmental variables. Material and Methods: This was an observational cross-sectional study conducted on 107 incoming medical residents from a total of 142. The Jefferson Scale of Physician Empathy (JSPE) was used and sociodemographic, professional and academic variables were collected. An exploratory data analysis was performed with SPSS 20. Results: The mean score of empathy level was 116.07. Although interesting rends were noted, no significant differences were found between level of empathy and specialty choice (“People-oriented”: 116.28 versus “technology-oriented”: 115.65; p = 0.837); gender (men: 114.74 versus women: 117.43; p = 0.341); and desire to study the selected specialty (desire: 116.37 versus no desire: 111.17; p = 0.333). Significant correlations were found between empathy level and “having a professional mentor for treating patients” (p = 0.024) and “affiliation to a religion”(p = 0.025). There was no significant correlation between level of empathy and age of the resident (r = 0.089; p = 0.373). Conclusions: Residents who identified themselves as affiliated to a religion as well as those who had a professional mentor for treating patients obtained higher scores of empathy level. While the study reflected positively on the establishment of a research program on empathy, further studies, including longitudinal ones are warranted.

Changes in Empathy Levels on Dentistry’s Students of Public University in Cartagena City, Colombia

Objective: To compare levels of empathy in dentistry students in the cohorts of 2013 and 2016 years, in a public university in Cartagena, Colombia. Material and Methods: The sample consists of 332 students from first to fifth year. The instrument used was the Jefferson Medical Empathy Scale (EEMJ), Spanish version for medical students (version S), validated in Mexico and Chile and adapted for students of dentistry in Colombia. Implementation was anonymous and confidential and informed consent was used. The scale was judged by judges in order to verify cultural validity and students' understanding of the scale was evaluated. The means and standard deviation were estimated. A bifactorial variance analysis, model III was applied to find differences of means between years, the genders and in the interaction of these factors. The comparison between empathic cohort data 2013 and 2016 was performed using the Wilks Lambda Statistician and the M Box test. The level of significance used was α≤0.05 and β<0.20. Results: The results were significant for the academic years factor (p = 0.027), gender (p = 0.782) and interaction (p = 0.364) were not significant. The size of the effect of the statistical differences found is not high. The value of R2 corrected shows that the factors studied explain only 2.9% of all the variation of empathy. Conclusion: The empathy in the study subjects presents some fluctuations; however there are no statistically significant differences for the factors of interest among the cohorts evaluated.

The Structural Relationship between Trust, Customer Satisfaction, and Loyalty of the Medical Service Quality and Empathy Ability

[연구목적] 본 연구는 의료서비스품질(물리적 환경 품질, 결과 품질, 상호작용 품질)과 서비스제공자 공감능력(인지적 공감, 감정적 공감)이 신뢰, 고객만족, 충성도에 미치는 영향관계를 확인하고 이를 통해 병원경영에 의미 있는 시사점을 제공하고자 한다. [연구방법] 연구대상은 종합병원이나 대학병원 이용경험이 있는 대상자를 편의 표본 추출하여 설문조사를 실시하였다. 최종 분석에 249부가 사용되었다. SPSS 20.0을 이용하여 기술적 분석, 신뢰성분석 등을 실시하였고, AMOS 21.0을 이용하여 확인적 요인분석과 경로분석을 실시하였다. [연구결과] 본 연구결과를 요약하면 다음과 같다. 첫째, 상호작용 품질과 인지적 공감능력은 고객만족에 정(＋)의 영향이 있음을 확인하였다. 둘째, 결과 품질, 상호작용 품질, 인지적 공감능력, 감정적 공감능력은 신뢰에 정(＋)의 영향이 있음을 확인하였다. 셋째, 신뢰는 고객만족에 정(＋)의 영향이 있으며 고객만족과 신뢰는 충성도에 정(＋)의 영향이 있음을 확인하였다. [연구의 시사점] 본 연구는 선행연구를 토대로 의료서비스에서 의료서비스품질 뿐 만 아니라 서비스제공자의 공감능력을 가지고 신뢰, 고객만족, 충성도의 관계를 실증적으로 분석하였다는데 의의가 있다.

Role of a Semiotics-Based Curriculum in Empathy Enhancement: A Longitudinal Study in Three Dominican Medical Schools.

Background: Empathy in the context of patient care is defined as a predominantly cognitive attribute that involves an understanding of the patient’s experiences, concerns, and perspectives, combined with a capacity to communicate this understanding and an intention to help. In medical education, it is recognized that empathy can be improved by interventional approaches. In this sense, a semiotic-based curriculum could be an important didactic tool for improving medical empathy. The main purpose of this study was to determine if in medical schools where a semiotic-based curriculum is offered, the empathetic orientation of medical students improves as a consequence of the acquisition and development of students’ communication skills that are required in clinician–patient encounters.Design: This quasi-experimental study was conducted in three medical schools of the Dominican Republic that offer three different medical curricula: (i) a theoretical and practical semiotic-based curriculum; (ii) a theoretical semiotic-based curriculum; and (iii) a curriculum without semiotic courses. The Jefferson scale of empathy was administered in two different moments to students enrolled in pre-clinical cycles of those institutions. Data was subjected to comparative statistical analysis and logistic regression analysis.Results: The study included 165 students (55 male and 110 female). Comparison analysis showed statistically significant differences in the development of empathy among groups (p < 0.001). Logistic regression confirmed that gender, age, and a semiotic-based curriculum contributed toward the enhancement of empathy.Conclusion: These findings demonstrate the importance of medical semiotics as a didactic teaching method for improving beginners’ empathetic orientation in patients’ care.