Self-perceived Empathy Research Articles

Use of the arts in pharmacy education to develop self-perceived empathy

Background: Demonstrating empathy is a key competency expected of pharmacy undergraduate students. Various art media have been shown to help develop empathy in students. A new optional module designed to incorporate a range of art forms to support empathy development has been delivered and evaluated in a UK School of Pharmacy. The aim of this paper is to present this module and its evaluation. Methods: A standard teaching evaluation was emailed to students at the end of the module, and reflective work submitted as part of the assessment was thematically analysed in this mixed methods study. Ethics approval was obtained from Keele University to undertake the study. Results: Eleven students were assigned to the module. The teaching evaluation was completed by ten students and was rated favourably in every respect. This positive viewpoint was supported by analysis of eleven reflective pieces. Four key themes emerged from the data, namely, i) the learning experience; ii) the perception of illness; iii) seeing the patient as an individual; and iv) perceived empathy development. Conclusion: This study describes a range of artistic activities that can increase perceived empathy levels and be enjoyed by students. Further research is necessary to ascertain if this self-perceived empathy results in increased levels in practice.

Changes in the empathy levels of a group of undergraduate medical students: A longitudinal study

Background. The concept of empathy in students has gained significant attention in medical education. Whether implementing formal educational interventions to promote long-term and effective empathy levels leads to sustained increased empathy levels in students, is however less clear. Objectives. The study aimed to evaluate the trajectory of medical students’ self-perceived empathy levels during their 6-year MB ChB degree. Methods. A longitudinal, prospective study was conducted over 4 years. A cohort of 292 medical students was invited to participate. Participants completed the Jefferson Scale of Empathy for Students (JSE-S) at three intervals during their studies. The students attended two workshops related to empathic patient interactions during this time. The JSE-S mean score by age and gender was compared, making use of a linear regression model. Results. A total of 119 students completed the study. Students’ total empathy levels were similar during the first and the last measuring point (110), but there was a significant rise in the intermediate measuring point (113.3). When the male and female cohorts’ scores were interpreted separately, both genders demonstrated a similar pattern to the total score, although females’ JSE-S scores were higher than the males. Conclusion. The results of the study confirm that educational interventions can increase students’ self-perceived empathy levels; however, we suggest that students require reinforcement and multiple opportunities to practise and observe empathic communication with patients to sustain high levels of empathy. Follow-up sessions to specifically target the promotion of empathy should be implemented; otherwise the long-term effect of educational interventions might be limited.

Effect of Storytelling and Empathy Training to Support Affective Learning in Undergraduate Nursing Students.

Empathy is a desired characteristic in nurses, but its development is often overlooked in nursing simulation. This study evaluated the effect of a storytelling and empathy training intervention to enhance empathy development in simulation-based learning. A quasi-experimental control group design was used to evaluate differences in self-perceived and observed empathy in undergraduate nursing students (N = 71). Relationships between self-perceived and observed empathy were also assessed. Repeated-measures analysis of variance revealed a statistically significant increase in self-perceived empathy, and higher, but nonstatistically significant differences in observed empathy for subjects in the treatment condition. No relationship between self-perceived and observed empathy was observed. Storytelling and empathy training may augment simulation-based learning experiences to promote empathy development in undergraduate nursing students.

The Effects of an Empathic Communication Workshop on Internal Medicine Residents' Self-Perceived Empathy and Their Patients' Perception of Physician's Empathy: A Single-Group Experimental Study.

Background: Empathetic communication improves the physician-patient relationship and enhances patient and physician satisfaction. This study aims to evaluate the impact of empathic communication skills training on physicians' self-perceived performance and patient satisfaction regarding the empathetic quality of their relationship with their physicians. Methods: In this single-group before-after experimental study, we recruited 50 internal medicine residents at a large teaching hospital. We assessed the residents' empathy using the Jefferson Scale of Empathy before and 3 weeks after an 8-hour workshop on empathic communication skills. We also recruited 50 of their patients before and another 50 patients 3 weeks after the training to assess the patient's perceptions of their physician's empathy using the Consultation and Relational Empathy scale. Physicians' and patients' mean scores on empathetic care at the beginning of the study were then compared using paired t-tests with their scores after the workshop. Results: The residents' mean score on Jefferson Empathy Scale increased from 81.1(95%CI:78.8-83.3) at baseline to 96.8(95%CI:93.6-100) following the workshop (p < 0.001). Before the empathetic communication skills training, patients assessed their doctors' empathy at 68.3(95%CI:63.5-73.2). After the intervention, this improved to 84.9(95%CI:82.2-87.5) (p < 0.001). Conclusion: In this study, both the residents and their patients stated that the residents' empathy skills had significantly improved after an empathetic communication workshop for internal medicine residents.

Remember as we empathize. Do brain mechanisms engaged in autobiographical memory retrieval causally affect empathy awareness? A combined TMS and EEG registered report

Social interactions are partly driven by our ability to empathize-the capacity to share and understand others' inner states. While a growing body of evidence suggests a link between past experiences and empathy, to what degree empathy is dependent on our own previous experiences (autobiographical memories, AMs) is still unclear. Whereas neuroimaging studies have shown wide overlapping brain networks underpinning AM and empathic processes, studies on clinical populations with memory loss have not always shown empathy is impaired. The current transcranial magnetic stimulation (TMS) and electroencephalography study will seek to shed light on this neuropsychological puzzle by testing whether self-perceived empathy is causally linked to AM retrieval. Cortical activity, together with self-rating of empathy, will be recorded for scenarios that echo personal experiences while a brain region critical for AM retrieval will be transiently inhibited using TMS before task performance.

Comparison of the Effectiveness of an Abbreviated Program versus a Standard Program in Mindfulness, Self-Compassion and Self-Perceived Empathy in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain.

Health professionals are among the most vulnerable to work stress and emotional exhaustion problems. These health professionals include tutors and resident intern specialists, due to the growing demand for the former and the high work overload of the latter. Mindfulness training programs can support these professionals during times of crisis, such as the current global pandemic caused by the coronavirus-19 disease. The objective of this study was to compare the effectiveness of an abbreviated Mindfulness-Based Stress Reduction (MBSR) and Mindful Self-Compassion (MSC) training program in relation to a standard training program on the levels of mindfulness, self-compassion, and self-perceived empathy in tutors and resident intern specialists of Family and Community Medicine and Nursing. A total of 112 professionals attached to six Spanish National Health System teaching units (TUs) participated in this randomized and controlled clinical trial. Experimental Group (GE) participants were included in the standard or abbreviated MBSR programs. The Five Facet Mindfulness Questionnaire (FFMQ), the Self-Compassion Scale short form (SCS-SF), and the Jefferson Scale of Physician Empathy (JSPE) were administered three times during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant increase in mindfulness (F(2,91) = 3.271; p = 0.042; η2 = 0.067) and self-compassion (F(2,91) = 6.046; p = 0.003; η2 = 0.117) in the post-test visit, and in self-compassion (F(2,79) = 3.880; p = 0.025; η2 = 0.089) in the follow-up visit, attributable to the implementation of the standard training program. The standard MBSR and MSC training program improves levels of mindfulness and self-compassion, and promotes long-lasting effects in tutors and resident intern specialists. New studies are needed to demonstrate the effectiveness of abbreviated training programs.

Are women the more empathetic gender? The effects of gender role expectations

The present research aimed to extend the state of knowledge regarding the relationship between self-perceived empathy and traditional gender roles and placed particular focus on the contextual conditions under which gender differences in empathy are present, can be created, or eliminated. Across two studies, women rated themselves higher in empathy than men in all experimental conditions, whereas an objective female superiority in emotion recognition was only evident in one condition. In Study 1 (n = 736), using the term ‘social-analytic capacity’ instead of ‘empathic capacity’ increased gender differences in self-reported empathy and resulted in women performing better in the Eyes-test than men. In a neutral task (verbal intelligence), gender differences (in this case, a male superiority), were only found when participants believed that this task had an association with empathy. In Study 2 (n = 701), gender differences in self-reported empathic capacity, but not in performance in emotion recognition, increased when motivation for empathy was raised. Further, gender-role orientation mediated the association between gender and self-reported empathic capacity, whereas it did not account for the association between gender and emotion recognition. Overall, the present studies provide strong support for the idea that empathy is influenced by contextual factors and can be systematically biased by gender roles and stereotypical beliefs.

A simulated patient experience to improve pharmacy student empathy for patients on hemodialysis

IntroductionThe aim of this study was to increase student empathy towards hemodialysis patients through an educational intervention that simulates a hemodialysis patient experience. MethodsSecond-year pharmacy students (n = 83) in a required therapeutic module were asked to follow key lifestyle modifications of a hemodialysis patient for two weeks. Students' self-perceived empathy level was assessed using the Kiersma-Chen Empathy Scale (KCES) pre- and post-intervention and post-reflection questions captured students' perceptions of the experience. Data were analyzed using frequencies and Wilcoxon signed ranks tests to assess pre-post changes. Reflection questions were assessed using a grounded analysis to identify themes. ResultsSignificant differences were found on 13 of 15 KCES items and KCES composite scores. Of the 13 significant KCES items, nine were related to the cognitive domain and four were related to the affective domain. When asked how the experience impacted the student personally, 38 responded that it provided them with a better understanding of the challenges associated with managing hemodialysis treatments. In response to how this experience would change their professional interactions with a hemodialysis patient, students explained that they felt more equipped to empathize with patients (n = 22). ConclusionsThis intervention improved students' cognitive and affective empathy towards hemodialysis patients, which may prepare them to be more compassionate healthcare professionals. Experiencing first-hand some of the quality-of-life challenges hemodialysis patients face significantly influenced student empathy levels towards this population.

Video-based feedback using real consultations for a formative assessment in communication skills

BackgroundPre-recorded videotapes have become the standard approach when teaching clinical communication skills (CCS). Furthermore, video-based feedback (VF) has proven to be beneficial in formative assessments. However, VF in CCS with the use of pre-recorded videos from real-life settings is less commonly studied than the use of simulated patients.To explore: 1) perceptions about the potential benefits and challenges in this kind of VF; 2) differences in the CCC scores in first-year medical residents in primary care, before and after a communication program using VF in a curricular formative assessment.MethodWe conducted a pre/post study with a control group. The intervention consisted of VF sessions regarding CCS, performed in a small group with peers and a facilitator. They reviewed clinical consultations pre-recorded in a primary care setting with real patients. Before and after the intervention, 54 medical residents performed two clinical examinations with simulated patients (SP), answered quantitative scales (Perception of Patient-Centeredness and Jefferson Empathy Scale), and semi-structured qualitative questionnaires. The performances were scored by SP (Perception of Patient-Centeredness and CARE scale) and by two blind raters (SPIKES protocol-based and CCOG-based scale). The quantitative data analysis employed repeated-measures ANOVA. The qualitative analysis used the Braun and Clarke framework for thematic analysis.ResultsThe quantitative analyses did not reveal any significant differences in the sum scores of the questionnaires, except for the Jefferson Empathy Scale. In the qualitative questionnaires, the main potential benefits that emerged from the thematic analysis of the VF method were self-perception, peer-feedback, patient-centered approach, and incorporation of reflective practices. A challenging aspect that emerged from facilitators was the struggle to relate the VF with theoretical references and the resident’s initial stress to record and watch oneself on video.ConclusionVF taken from real-life settings seems to be associated with a significant increase in self-perceived empathy. The study of other quantitative outcomes related to this VF intervention needs larger sample sizes. VF with clinical patients from real healthcare settings appears to be an opportunity for a deeper level of self-assessment, peer-feedback, and reflective practices.

Using resting-state DMN effective connectivity to characterize the neurofunctional architecture of empathy

Neuroimaging studies in social neuroscience have largely relied on functional connectivity (FC) methods to characterize the functional integration between different brain regions. However, these methods have limited utility in social-cognitive studies that aim to understand the directed information flow among brain areas that underlies complex psychological processes. In this study we combined functional and effective connectivity approaches to characterize the functional integration within the Default Mode Network (DMN) and its role in self-perceived empathy. Forty-two participants underwent a resting state fMRI scan and completed a questionnaire of dyadic empathy. Independent Component Analysis (ICA) showed that higher empathy scores were associated with an increased contribution of the medial prefrontal cortex (mPFC) to the DMN spatial mode. Dynamic causal modelling (DCM) combined with Canonical Variance Analysis (CVA) revealed that this association was mediated indirectly by the posterior cingulate cortex (PCC) via the right inferior parietal lobule (IPL). More specifically, in participants with higher scores in empathy, the PCC had a greater effect on bilateral IPL and the right IPL had a greater influence on mPFC. These results highlight the importance of using analytic approaches that address directed and hierarchical connectivity within networks, when studying complex psychological phenomena, such as empathy.

Empatía médica en residentes y tutores de medicina familiar y comunitaria. La visión del profesional y del paciente

AimTo determine the degree of clinical empathy among family medicine residents and tutors. To gauge whether there is a relationship between physicians’ self-perceived empathy levels and their patients’ assessments. Study designObservational, cross-sectional survey. LocationPrimary Care Teaching Unit. Madrid. ParticipantsA survey was sent by email to all the Teaching Unit's family medicine tutors and residents. Responses were received from 50 residents (39.4%) and 41 tutors (45%). In addition, 428 patients were opportunistically recruited at a healthcare centre and their doctors were also interviewed. Primary measurement instrumentsEmpathy was measured using the Jefferson Scale of Empathy and the Jefferson Scale of Patient Perceptions of Physician Empathy. ResultsThe tutors scored 2.53 points higher for cognitive empathy than the residents (P=.04). Emotional empathy scores declined among older tutors (r= −0.32; P=.05). The Spanish students (82% of the total) without previous work experience scored higher for overall empathy (P=.02). Final-year residents recorded significantly worse empathy assessments than the other residents. A positive correlation (r=0.72; P=.01) was observed between physicians’ self-perceived empathy and their patients’ perceptions. ConclusionsResidents with previous work experience, final-year residents and those of Latin American origin score lower for empathy. There is a strong relationship between physicians’ self-perceived empathy and their patients’ views of their empathy levels.

Reflective Writing for Medical Students on the Surgical Clerkship: Oxymoron or Antidote?

Reflective writing has emerged as a solution to declining empathy during clinical training. However, the role for reflective writing has not been studied in a surgical setting. The aim of this proof-of-concept study was to assess receptivity to a reflective-writing intervention among third-year medical students on their surgical clerkship. The reflective-writing intervention was a 1-hour, peer-facilitated writing workshop. This study employed a pre-post-intervention design. Subjects were surveyed on their experience 4 weeks before participation in the intervention and immediately afterwards. Surveys assessed student receptivity to reflective writing as well as self-perceived empathy, writing habits, and communication behaviors using a Likert-response scale. Quantitative responses were analyzed using paired t tests and linear regression. Qualitative responses were analyzed using an iterative consensus model. Yale-New Haven hospital, a tertiary care academic center. All medical students of Yale School of Medicine, rotating on their surgical clerkship during a 9-month period (74 in total) were eligible. In all, 25 students completed this study. The proportion of students desiring more opportunities for reflective writing increased from 32%-64%. The proportion of students receptive to a mandatory writing workshop increased from 16%-40%. These differences were both significant (p = 0.003 and p = 0.001). In all, 88% of students also reported new insight as a result of the workshop. In total, 39% of students reported a more positive impression of the surgical profession after participation. Overall, the workshop was well-received by students and improved student attitudes toward reflective writing and the surgical profession. Larger studies are required to validate the effect of this workshop on objective empathy measures. This study demonstrates how reflective writing can be incorporated into a presurgical curriculum.

Enhancing empathy in healthcare: mixed-method evaluation of a pilot project implementing the CARE Approach in primary and community care settings in Scotland

The importance of empathic, person-centred care that is responsive to the individual patients’ needs is increasingly visible in national and international healthcare policies but there is a need for practical tools to help healthcare practitioners. The CARE Approach is a new ‘generic’ learning tool that aims to foster the achievement of empathic, person-centred communication in healthcare encounters. This study aimed to evaluate a pilot project which used the CARE Approach in peer facilitated groups in primary and community healthcare settings in Scotland. The CARE Approach was piloted in 5 sites (4 general practice and 1 community rehabilitation team) serving different areas and populations. Evaluation employed a mixed-methods approach, with questionnaires and semi-structured interviews with a purposive sample of participating facilitators and healthcare practitioners. 131 practitioners took part in the CARE Approach pilot across the five sites. 84 participants (64.1%) completed a baseline questionnaire and 51 (38.9%) a post-pilot questionnaire. Semi-structured interviews were conducted with all facilitators and with a purposive sample of 23 participants from the sites. Overall the results indicate that the CARE Approach was perceived as useful and relevant to practice across different disciplines and settings. The flexibility of the CARE Approach materials facilitated its delivery and implementation across the sites. Healthcare professionals’ self-perceived empathy at baseline and follow-up suggested a possible impact on daily practice. The CARE Approach appears to be useful to practitioners in primary and community care and can feasibly be delivered in peer facilitated learning groups. Further work is required to determine the utility of the approach when used in other ways and in other settings and to ascertain the effectiveness of the approach in the longer-term.

P.2.d.044 Functional remediation in bipolar disorder: results of the one-year follow-up

Although social cognitive impairments are key determinants of functional outcome in schizophrenia their neural bases are poorly understood. This study investigated neural activity during imitation and observation of finger movements and facial expressions in schizophrenia, and their correlates with self-reported empathy.23 schizophrenia outpatients and 23 healthy controls were studied with functional magnetic resonance imaging (fMRI) while they imitated, executed, or simply observed finger movements and facial emotional expressions. Between-group activation differences, as well as relationships between activation and self-reported empathy, were evaluated.Both patients and controls similarly activated neural systems previously associated with these tasks. We found no significant between-group differences in task-related activations. There were, however, between-group differences in the correlation between self-reported empathy and right inferior frontal (pars opercularis) activity during observation of facial emotional expressions. As in previous studies, controls demonstrated a positive association between brain activity and empathy scores. In contrast, the pattern in the patient group reflected a negative association between brain activity and empathy.Although patients with schizophrenia demonstrated largely normal patterns of neural activation across the finger movement and facial expression tasks, they reported decreased self perceived empathy and failed to show the typical relationship between neural activity and self-reported empathy seen in controls. These findings suggest that patients show a disjunction between automatic neural responses to low level social cues and higher level, integrative social cognitive processes involved in self-perceived empathy.

Self-reported empathy and neural activity during action imitation and observation in schizophrenia.

IntroductionAlthough social cognitive impairments are key determinants of functional outcome in schizophrenia their neural bases are poorly understood. This study investigated neural activity during imitation and observation of finger movements and facial expressions in schizophrenia, and their correlates with self-reported empathy.Methods23 schizophrenia outpatients and 23 healthy controls were studied with functional magnetic resonance imaging (fMRI) while they imitated, executed, or simply observed finger movements and facial emotional expressions. Between-group activation differences, as well as relationships between activation and self-reported empathy, were evaluated.ResultsBoth patients and controls similarly activated neural systems previously associated with these tasks. We found no significant between-group differences in task-related activations. There were, however, between-group differences in the correlation between self-reported empathy and right inferior frontal (pars opercularis) activity during observation of facial emotional expressions. As in previous studies, controls demonstrated a positive association between brain activity and empathy scores. In contrast, the pattern in the patient group reflected a negative association between brain activity and empathy.ConclusionsAlthough patients with schizophrenia demonstrated largely normal patterns of neural activation across the finger movement and facial expression tasks, they reported decreased self perceived empathy and failed to show the typical relationship between neural activity and self-reported empathy seen in controls. These findings suggest that patients show a disjunction between automatic neural responses to low level social cues and higher level, integrative social cognitive processes involved in self-perceived empathy.

Detection of the facial expression of emotion and self-report measures in empathic situations are influenced by sensorimotor circuit inhibition by low-frequency rTMS

Empathic responses to facial cues are a main social competency. Both appraisal processes (facial emotion detection) and self-perceived empathy (empathic responsiveness) in response to emotional faces are thought to be related to empathic behavior, although no systematic analysis has been performed to assess their relationship. The current research explored the contribution of the frontal sensorimotor system to facial detection and self-reported empathic measures by using repetitive transcranial magnetic stimulation (rTMS) to produce a temporary disruption of this specific cortical site. Eighteen subjects were asked to detect facial expression of emotions (anger, fear, happiness, and neutrality) and to evaluate their empathic responsiveness to these facial cues. A 5-second rTMS (1 Hz, inhibition paradigm) pulse was delivered before the stimulus onset. Error rates and response times (RTs) increased when brain activity was disrupted, specifically in response to anger and fear. Self-reported measures showed a concomitant decreased empathic response when the frontal sensorimotor system was deactivated. The ability to monitor emotional cues and the behavioral empathic responsiveness to emotional situations was shown to be partially compromised in the case of frontal activity disruption, highlighting the main role of the sensorimotor system for empathic social skills.

Conflict and emotional exhaustion in obstetrician-gynaecologists: a national survey

ContextConflicts over treatment decisions have been linked to physicians' emotional states.ObjectiveTo measure the prevalence of emotional exhaustion and conflicts over treatment decisions among US obstetrician/gynaecologists (ob/gyns), and to examine the...

An Analogue Study of Therapist Empathic Process: Working With Difference.

Most theories of psychotherapy advocate therapist empathy, although little is known about the process. A study, using analogue clinical scenarios, suggests psychotherapists can bridge perceived differences between their clients’ life experiences and their own. Ninetythree therapists viewed 5 videotaped vignettes based on actual cases. Each completed a demographic questionnaire, Interpersonal Reactivity Index (M. H. Davis, 1980), vignette response empathy scale, difference measure, reference point questionnaire, and selfperceived empathy measure. Findings show therapists perceived scenarios as different from their lives and that they were generally empathic across client vignettes. Gender differences emerged on measures of empathy. The research suggests therapists’ ability to use reference points from their own experience may help facilitate empathy when responding to client life stories of difference.