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Kalistratova VS, Nisanova A, Shi LZ. Student-run free clinics may enhance medical students' self-confidence in their clinical skills and preparedness for clerkships. MEDICAL EDUCATION ONLINE 2024; 29:2348276. [PMID: 38696139 PMCID: PMC11067551 DOI: 10.1080/10872981.2024.2348276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/23/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Student-run free clinics (SRFCs) offer medical students a unique opportunity to develop their clinical, diagnostic, and social skills while providing care to medically underserved communities. This study aims to evaluate the value of SRFC involvement on students' self-reported confidence in various clinical domains and satisfaction with their medical education. METHODS We conducted a single-center retrospective pre-post assessment at an urban academic institution among second- to fourth-year medical students. We administered a 25-item questionnaire capturing the scope of clinic involvement and assessing self-reported confidence in multiple clinical domains following a one-year-long participation in student-run free clinics. RESULTS Fifty-six students completed the survey. Participation in SRFCs significantly increased self-reported confidence in patient history-taking (p < 0.001), performing oral presentations (p < 0.001) and physical exams (p < 0.001). Students also reported significantly greater confidence in working with translators (p < 0.001) or as part of an interprofessional team (p < 0.001) and understanding the needs of the population served (p < 0.001). Students also found SRCs to significantly improve their confidence in preparedness for clerkships (p < 0.001). SRFC involvement can improve medical students' confidence in their clinical and interpersonal skills and enhance preparedness for clerkships and working with diverse patient groups. CONCLUSION SRFCs are a useful tool in the medical school curriculum that help bridge the gap between classroom learning and clinic and may encourage practice in medically underserved communities. SRFCs also integrate classroom material and clinical practice, although standardized evaluation metrics need to be developed. SRFCs should be incorporated as a learning experience by medical schools nationwide.
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Affiliation(s)
| | - Arina Nisanova
- School of Medicine, University of California Davis, Davis, CA, USA
| | - Lucy Z. Shi
- Department of Internal Medicine, University of California Davis, Davis, CA, USA
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Ahmadipour H, Soltanzadeh N. Cognitive empathy variations during internship: a study from Iran. BMC MEDICAL EDUCATION 2024; 24:813. [PMID: 39075399 PMCID: PMC11285376 DOI: 10.1186/s12909-024-05813-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Despite the critical role of empathy in medical students, various studies have provided conflicting evidence regarding changes in empathy during medical study. The present study was designed to investigate changes in cognitive empathy during the internship. METHOD A study was conducted at the Afzalipour School of Medicine, Kerman University of Medical Sciences. All medical students at the beginning of their internship were entered the study as a cohort and asked to complete a two-part questionnaire including demographic characteristics and the Persian version of the Jefferson Scale of Empathy-Student Version (JSE-S). The questionnaire was completed again at the end of the internship. Data were analyzed using SPSS software using paired t- test and one-way repeated measures. RESULTS A total of 108 interns participated with a mean age of 23.85 ± 1.47 years, and a female majority (61.1%). The mean score of standing in the patient's shoe increased significantly (P < 0.001) during the internship, whereas the mean score of compassionate care decreased (P < 0.001). The overall score of empathy decreased during the internship, but the difference was not statistically significant. (P = 0.105). No statistically significant difference was found in the mean score of empathy and its subscales based on demographic characteristics in the two phases of the study. CONCLUSION our results revealed that the level of cognitive empathy in the current study was higher than that in previous studies. The changes were consistent with some studies and contradictory to others. Considering that similar changes were observed in the subgroup analysis, it is necessary to focus more on the factors that cause this feeling to fade during the internship through appropriate assessment and timely intervention.
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Affiliation(s)
- Habibeh Ahmadipour
- Community Medicine Department, School of Medicine, Medical Education Leadership and Management Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Niloofar Soltanzadeh
- Community Medicine Department, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Howick J, Slavin D, Carr S, Miall F, Ohri C, Ennion S, Gay S. Towards an empathic hidden curriculum in medical school: A roadmap. J Eval Clin Pract 2024; 30:525-532. [PMID: 38332641 DOI: 10.1111/jep.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
The "hidden curriculum" in medical school includes a stressful work environment, un-empathic role models, and prioritisation of biomedical knowledge. It can provoke anxiety and cause medical students to adapt by becoming cynical, distanced and less empathic. Lower empathy, in turn, has been shown to harm patients as well as practitioners. Fortunately, evidence-based interventions can counteract the empathy dampening effects of the hidden curriculum. These include early exposure to real patients, providing students with real-world experiences, training role models, assessing empathy training, increasing the focus on the biopsychosocial model of disease, and enhanced wellbeing education. Here, we provide an overview of these interventions. Taken together, they can bring about an "empathic hidden curriculum" which can reverse the decline in medical student empathy.
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Affiliation(s)
- Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Daniel Slavin
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Sue Carr
- Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fiona Miall
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Chandra Ohri
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Steve Ennion
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Simon Gay
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
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Khatskevich K, Patel J, Klein S, Shiver L, Mason A, Gulick D. How Student and Faculty Perceptions Differ on the Stressors that Medical Students Face. South Med J 2024; 117:336-341. [PMID: 38830588 DOI: 10.14423/smj.0000000000001697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Medical education is notorious for the stress that students face as they strive to succeed both academically and clinically. This stress has been linked to declining academic performance and worsening mental health. To combat these negative outcomes, it is essential for medical school faculty and administration to address common stressors among medical students. No studies have addressed whether medical school faculty and students perceive stressors similarly, however. METHODS In this two-part study, data collected from medical students in 2021 to 2022 to identify their most significant sources of stress were used to create a survey that queries the frequency and intensity of these stressors. This survey was distributed to medical students and faculty at the same institution. The responses between students and faculty were compared and student data also were analyzed by academic year to observe changes in perception that accompany progression through the medical curriculum. RESULTS The results showed that faculty overestimated the impact of certain stressors on medical students (eg, in-house examinations, US Medical Licensing Examination Steps 1 and 2 examinations, and patient interactions). In addition, preclinical students were more concerned with finding extracurricular activities, missing opportunities, and performing research compared with clinical students. CONCLUSIONS This study demonstrated that although faculty anticipated most medical student stressors, there are significant gaps that still need to be addressed to better reduce and respond to the stress experienced by medical students.
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Affiliation(s)
- Katsiaryna Khatskevich
- From the Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston
| | - Jiten Patel
- University of South Florida (USF) Morsani College of Medicine, Tampa
| | - Sierra Klein
- University of South Florida (USF) Morsani College of Medicine, Tampa
| | - Lachlan Shiver
- University of South Florida (USF) Morsani College of Medicine, Tampa
| | - Ashley Mason
- University of South Florida (USF) Morsani College of Medicine, Tampa
| | - Danielle Gulick
- Department of Molecular Medicine, University of South Florida, Morsani College of Medicine, Tampa
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Slavin D, Winter R, Ward A, Howick J. On the need for empathy in the acute hospital setting. Br J Hosp Med (Lond) 2023; 84:1-3. [PMID: 37906071 DOI: 10.12968/hmed.2023.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
This article reviews the need for empathy, and what happens in its absence in an acute hospital setting, using the example of a homeless man in an emergency department. Three simple but meaningful changes that all healthcare practitioners can make are recommended to promote empathy.
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Affiliation(s)
- Daniel Slavin
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
| | - Rachel Winter
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
| | - Andy Ward
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
| | - Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
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Howick J, Dudko M, Feng SN, Ahmed AA, Alluri N, Nockels K, Winter R, Holland R. Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies. BMC MEDICAL EDUCATION 2023; 23:270. [PMID: 37088814 PMCID: PMC10124056 DOI: 10.1186/s12909-023-04165-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/16/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Several studies suggest that medical student empathy declines throughout medical school. However, no studies have synthesised the evidence regarding why empathy declines. OBJECTIVE To conduct a systematic review and thematic synthesis of qualitative studies investigating why student empathy may change throughout medical school. METHODS We included any qualitative study that investigated why empathy might change during medical school. We searched the Medline, Scopus, CINAHL, ERIC, and APA PsycInfo databases for relevant studies. All databases were searched from their inception to 18 July 2022. We also searched the reference lists of the included studies and contacted experts to identify additional studies. We used the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. Overall confidence in our results was assessed using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. We used thematic methods to synthesise our findings. RESULTS Our searches yielded 2523 records, and 16 studies involving a total of 771 students were eligible for analysis. Most studies (n = 11) were from Europe or North America. The descriptive themes and sub-themes were identified for each study. Increased complexity in patients and their diseases, together with the 'hidden curriculum' (including a stressful workload, prioritisation of biomedical knowledge, and (sometimes) poor role models), led to student adaptations, such as cynicism and desensitisation. Students' prior lives and professional experiences appeared to exacerbate the decline in empathy. However, there were bias concerns for most of the included studies. DISCUSSION Many of the included studies included were small, and some did not include demographic participant data. Given the likely benefits of providing empathic care for patients and practitioners, medical education interventions should focus on developing an 'empathic hidden curriculum' that mitigates the decline in medical student empathy. TRIAL REGISTRATION A protocol for this systematic review was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on 28 July 2022 (registration number CRD42022347856).
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Affiliation(s)
- Jeremy Howick
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, LE1 7HA, UK.
| | - Maya Dudko
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, LE1 7HA, UK
| | - Shi Nan Feng
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ahmed Abdirashid Ahmed
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, LE1 7HA, UK
| | | | - Keith Nockels
- University Library, University of Leicester, Leicester, LE1 7HA, UK
| | - Rachel Winter
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, LE1 7HA, UK
| | - Richard Holland
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, LE1 7HA, UK
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Howick J, Palipana D, Dambha-Miller H, Khunti K. Turning diversity from a barrier to a facilitator of empathy in health care. Br J Gen Pract 2023; 73:24-25. [PMID: 36543548 PMCID: PMC9799349 DOI: 10.3399/bjgp23x731613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jeremy Howick
- Jeremy is the Director of the Stoneygate Centre for Excellence in Empathic Healthcare at the University of Leicester and author of a bestselling book: Doctor You: Revealing the Science of Self-healing @jeremyhowick
| | - Dinesh Palipana
- Dinesh Palipana is an emergency doctor, a lawyer, and was Australia's Person of the Year in 2021
| | - Hajira Dambha-Miller
- Hajira Dambha-Miller is an NIHR Clinical Lecturer at the University of Southampton and a GP. @HDambhaMiller
| | - Kamlesh Khunti
- Kamlesh Khunti, CBE, is Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester. @kamleshkhunti
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Jobling K, Alberti H. Exploring student perceptions of empathy development during medical school - A phenomenological study. PATIENT EDUCATION AND COUNSELING 2022; 105:3515-3520. [PMID: 36064517 DOI: 10.1016/j.pec.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/09/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Empathy is an essential attribute of a good doctor. There are multiple dimensions to empathy, yet many curricula are limited to empathy display. This study's aim was to understand the relationship between teaching, learning and development of empathy from the perspective of medical students. METHODS A qualitative approach was used with interpretivist methodology. Ten final year medical students from a single UK University were interviewed. Findings came from inductive thematic analysis. RESULTS Five major themes were identified: 'The Empathic Process'; 'Self'; 'Patient'; 'Teacher/Clinician'; 'Environment'. Sub-themes included personal qualities, patient factors, role-models and assessment. Students value authentic patient encounters, focused feedback and opportunities for debriefing. Barriers include cognitive load, time-pressures and being observed. Students can maintain empathy through self-checking and addressing biases. CONCLUSIONS Students are aware of their motivations and barriers towards empathy development and can describe meaningful experiences relating to this during medical school. Students acknowledge controversy surrounding assessment of empathy, but clearly value authentic patient experiences and an environment which is free from scrutiny and distractions. PRACTICE IMPLICATIONS In addition to teaching communication skills, undergraduate programmes should focus on students' inner growth. This may be achieved by guiding students through meaningful reflection and open dialogue with supportive mentors.
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Affiliation(s)
- Kerry Jobling
- Dermatology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
| | - Hugh Alberti
- Institute of Medical Education, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
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Trott E, Watson A. The Importance of Language in Clinical Communication and Potential Impact on Empathy. MEDICAL SCIENCE EDUCATOR 2022; 32:1567-1568. [PMID: 36532390 PMCID: PMC9755372 DOI: 10.1007/s40670-022-01664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Emma Trott
- School of English, University of Leeds, Leeds, UK
| | - Alastair Watson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- University of Birmingham Medical School, Birmingham, UK
- University of Cambridge, Cambridge, UK
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