Compassionate-empathic physicians: personality traits and social-organizational factors that enhance or inhibit this behavior pattern

Compassionate Behavior of Clinical Faculty: Associations with Role Modelling and Gender Specific Differences

Introduction

For future doctors, learning compassion skills is heavily dependent on female and male faculty's role modelling in practice. As such, more insight into the relationships between faculty's compassionate behavior, faculty gender and role modelling is needed.

Methods

In this cross-sectional survey, we analyzed 12416 resident evaluations of 2399 faculty members across 22 Dutch hospitals. The predictor variables were: observed compassionate behavior, faculty gender (reference category: female), and an interaction term between those two. Our outcome variables were: person, teacher and physician role model. All variables, except for faculty gender, were scored on a 7-point Likert scale ranging from 1 "totally disagree" to 7 "totally agree".

Results

Female faculty scored slightly but significantly higher (M = 6.2, SD = 0.7) than male faculty (M = 5.9, SD = 0.6) on observed compassionate behavior. Observed compassionate behavior was significantly positively associated with being seen as a role model teacher (b = 0.695; 95% CI = 0.623 - 0.767), physician (b = 0.657; 95% CI = 0.598 - 0.716) and person (b = 0.714; 95% CI = 0.653 - 0.775). Male gender showed significant negative associations with role model teacher (b = -0.847; 95% CI = -1.431 - -0.262), physician (b = -0.630, 95% CI = -1.111 - -0.149) and person (b = -0.601, 95% CI = -1.099 - -0.103). The interaction term showed positive significant associations with role model teacher (b = 0.157, 95% CI = 0.061 - 0.767), physician (b = 0.116, 95% CI = 0.037 - 0.194) and person (b = 0.102, 95% CI = 0.021 - 0.183).

Discussion

Dutch residents, in general, observed their faculty to be compassionate towards patients and families and faculty's observed compassionate behavior is related to being seen as a role model. However, male faculty benefit more from demonstrating compassion, as it has a greater positive influence on their perceived role model status compared to female faculty.

A thematic content analysis of the structure and effects of good doctor abilities in China

BACKGROUND

The efforts to explore and build the structure of good doctor abilities are important because they help improve the quality of education for medical students and better standardize the working performance of doctors. However, at present, no worldwide standards for such a structure have been established. In this study, we endeavoured to map the structure of good doctor abilities and identify their effects.

METHODS

With a focus on China, a thematic content analysis was adopted in this study to analyse the personal profiles of 50 widely recognized good doctors. NVivo11 software was used.

RESULTS

The Structure and Effects of Good Doctor Abilities in China model was proposed, and interpretations were made based on AMO theory. Good doctor abilities fall within six categories: rigorous clinical thinking, skilled in diagnosis and therapy, clinical empathy, continuous learning and innovation, enhancing and sharing experiences, and communication and coordination. These abilities have positive impacts on doctors' work performances and social benefits by encouraging good behaviours, ultimately promoting the sustainable development of the hospitals where they serve.

CONCLUSIONS

In this study, we established a model of the structure and effects of good-doctor abilities in China and interpreted its mechanism, innovation and theory diversification in "good-doctor" research. Moreover, this study has practical significance because it provides systematic and well-targeted criteria for improving the professionalism of doctors, promoting more good doctor behaviours, providing guidance for regulating doctors' conduct and providing a reference for medical education and working performance reviews worldwide.

Compassion and Self-Compassion: Counterfactors of Burnout in Medical Students and Physicians

OBJECTIVE

To examine the relationship between self-compassion, compassion for others and Burnout in medical students and physicians.

METHODS

A cross-sectional study was conducted. Medicine students and general physicians from two Colombian cities participated (n = 359). The Compassion Scales and the Maslach Inventory were administered. An Exploratory Structural Equation approach was used for validating new measures and testing for relationships between latent variables.

RESULTS

Most participants were students (85.9%), mean age was 22 years (SD = 7), 55.2% were female, 62,6% dedicated more than 48 weekly hours to study or practice, while physicians had worked a mean of 10.34 years (SD = 8.67). Self-compassion and Compassion for others action subscales were validated, but engagement subscales of were not. Participant´s compassion actions for others and self-compassion actions are negatively related to depersonalization and emotional exhaustion, respectively. Additionally, compassion dimensions were positively associated with professional accomplishment.

CONCLUSION

Our findings indicate that compassion and self-compassion actions inversely relate to different components of Burnout and could constitute protective factors against the stress of healthcare. Compassion and self-compassion training programs for medical students and physicians might be an alternative to avoid Burnout, diminishing physicians' depersonalization and emotional exhaustion while enhancing their professional accomplishment.

Empathy Among Medical Students: An Exploratory Cross-Sectional Survey

Context In the context of healthcare, effective communication and empathy are fundamental skills for physicians, as empathy correlates positively with patient satisfaction, compliance, treatment adherence, and lower rates of physician burnout, depression and anxiety. This study aimed to assess empathy levels and related factors among undergraduate medical students. Methods A cross-sectional study in a Central Indian medical institute examined empathy levels and factors associated with it among medical students, utilizing various scales and statistical analyses. Results This study found that while empathy levels were relatively high among undergraduate students, there was a decline as they progressed through medical education, particularly after the first year of clinical exposure. The study identified several factors associated with empathy levels, including perceived stress, emotional separation, and social support. Notably, individuals experiencing higher levels of stress and emotional separation tended to have higher empathy levels. Conclusions The study's findings suggest that medical education should incorporate interventions to enhance empathy, including addressing stress, providing social support, and exposing students to the emotional aspects of patient care.

Rekindling Joy in Medicine Through Thoughtful Communication: A Practical Guide

Joy in medicine, or the loss of it, is a popular topic of conversation, even more so since the pandemic. Burnout in oncology is common and diminishes the satisfaction of practicing medicine. One of the challenges clinicians face is the way in which modern clinical practice takes us away from what we find most meaningful in our work: time with patients. Strategies like being kind, expressing gratitude, and using effective communication skills can establish more connection with our colleagues and our patients, and, in turn, result in a more joyful work environment. Creating space for more moments of feeling deep interconnectedness with patients and colleagues can rekindle feelings of joy in oncology practice. This article reviews the concepts of joy in medicine, the term sacred moments, and outlines practical strategies and communication skills that are effective in enhancing the patient-provider relationship.

What is the Link Between Different Components of Empathy and Burnout in Healthcare Professionals? A Systematic Review and Meta-Analysis

Research on healthcare shows that the relationship between empathy and burnout is complex. The aim of this systematic review and meta-analysis is to clarify the link between different empathic components and burnout components in healthcare professionals. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. The search strategy was applied in PubMed, PsycINFO, CINAHL, Scopus, and Medline, from January 1990 to January 2021. Population included nurses and doctors. Key inclusion criteria were articles addressing the relationship between different components of empathy and professional performance and wellbeing or burn out, or studies using burnout and empathy measures with validity support from commonly accepted sources of evidence. Risk of bias was assessed using the Mixed Methods Appraisal Tool. From 1159 references identified, 22 studies were included in the systematic review, and 5 studies in the meta-analysis. Empathic Concern was significantly correlated with Depersonalization and Personal Accomplishment. Moreover, the links between Perspective Taking, Depersonalization and Personal Accomplishment were statistically significant. In conclusion, exploring and understanding the complex links between empathy and burnout could help healthcare professionals as well as institutions to reduce the risk of suffering burnout.

Communicating With Breast Imaging Patients During the COVID-19 Pandemic: Impact on Patient Care and Physician Wellness

OBJECTIVE

Assess the impact of COVID-19 on patient-breast radiologist interactions and evaluate the relationship between safety measure-constrained communication and physician wellbeing.

METHODS

A 41-question survey on the perceived effect of COVID-19 on patient care was distributed from June 2020 to September 2020 to members of the Society of Breast Imaging and the National Consortium of Breast Centers. Non-radiologists and international members were excluded. Anxiety and psychological distress scores were calculated. A multivariable logistic model was used to identify demographic and mental health factors associated with responses.

RESULTS

Five hundred twenty-five surveys met inclusion criteria (23% response rate). Diminished ability to fulfill patients' emotional needs was reported by 46% (221/479), a response associated with younger age (OR, 0.8 per decade; P < 0.01), higher anxiety (OR, 2.3; P < 0.01), and higher psychological distress (OR, 2.2; P = 0.04). Personal protective equipment made patient communication more difficult for 88% (422/478), a response associated with younger age (OR, 0.8 per decade; P = 0.008), female gender (OR, 1.9; P < 0.01), and greater anxiety (OR, 2.6; P = 0.001). The inability to provide the same level of care as prior to COVID-19 was reported by 37% (177/481) and was associated with greater anxiety (OR, 3.4; P < 0.001) and psychological distress (OR, 1.7; P = 0.03).

CONCLUSION

The majority of breast radiologists reported that COVID-19 has had a negative impact on patient care. This perception was more likely among younger radiologists and those with higher levels of anxiety and psychological distress.

Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review

BACKGROUND

Compassion in healthcare provides measurable benefits to patients, physicians, and healthcare systems. However, data regarding the factors that predict care (and a lack of care) are scattered. This study systematically reviews biomedical literature within the Transactional Model of Physician Compassion and synthesizes evidence regarding the predictors of physician empathy, compassion, and related constructs (ECRC).

METHODS

A systematic literature search was conducted in CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, OvidJournals, ProQuest, Web of Science, and Scopus using search terms relating to ECRC and its predictors. Eligible studies included physicians as participants. Methodological quality was assessed based on the Cochrane Handbook, using ROBINS-I risk of bias tool for quantitative and CASP for qualitative studies. Confidence in findings was evaluated according to GRADE-CERQual approach.

RESULTS

One hundred fifty-two included studies (74,866 physicians) highlighted the diversity of influences on compassion in healthcare (54 unique predictors). Physician-related predictors (88%) were gender, experience, values, emotions and coping strategies, quality of life, and burnout. Environmental predictors (38%) were organizational structure, resources, culture, and clinical environment and processes. Patient-related predictors (24%) were communication ease, and physicians' perceptions of patients' motives; compassion was also less forthcoming with lower SES and minority patients. Evidence related to clinical predictors (15%) was scarce; high acuity presentations predicted greater ECRC.

DISCUSSION

The growth of evidence in the recent years reflects ECRC's ongoing importance. However, evidence remains scattered, concentrates on physicians' factors that may not be amenable to interventions, lacks designs permitting causal commentary, and is limited by self-reported outcomes. Inconsistent findings in the direction of the predictors' effects indicate the need to study the relationships among predictors to better understand the mechanisms of ECRCs. The current review can guide future research and interventions.

Perceptions of Practicing Physicians and Members of the Public on the Attributes of a "Good Doctor"

Since physician–patient relationships are a central part of the medical practice, it is essential to understand whether physicians and the general public share the same perspective on traits defining a “good doctor”. Our study compared the perceptions of physicians and members of the public on the essential traits of a “good doctor.” We conducted parallel surveys of 1000 practicing specialist-physicians, and 500 members of the public in Israel. Respondents were asked about the two most important attributes of a “good doctor” and whether they thought the physicians’ role was to reduce health disparities. Many physicians (56%) and members of the public (48%) reported that the role of physicians includes helping to reduce health disparities. Physicians emphasized the importance of non-technical skills such as humaneness and concern for patients as important traits of a “good doctor,” while the public emphasized professional and technical skills. Internal medicine physicians were more likely than surgeons to emphasize humaneness, empathy, and professionalism. Future research should focus on actionable approaches to bridge the gap in the perceptions between the groups, and that may support the formation of caring physicians embedded in a complex array of relationships within clinical and community contexts.

How does narrative medicine impact medical trainees' learning of professionalism? A qualitative study

BACKGROUND

Narrative medicine (NM) is an approach involving narrative skills and is regarded as a model for medical humanism and effective medical practice. This study aims to explore how NM impacts medical trainees' learning of professionalism during a clerkship in a Taiwanese clinical setting.

METHODS

A qualitative interview study adopting a purposive sampling method was undertaken. Thirty medical trainees participated in this study, including five fifth-year medical students (MSs), ten sixth-year MSs, nine seventh-year MSs, and six postgraduate year (PGY) trainees. Thematic framework analysis was applied, and a modified realist evaluation approach was further used to analyse the interview data.

RESULTS

We identified self-exploration, reflection, and awareness of professional identity as mechanisms explaining how NM impacted professionalism learning in our participants. Furthermore, empathy, communication, doctor-patient relationship and understanding patients were identified as the outcomes of the NM intervention for trainees' learning of professionalism.

CONCLUSIONS

NM facilitates medical trainees' self-exploration, reflection, and awareness of professional identity, thereby affecting their learning of professionalism in clinical settings. Adopting NM as an educational intervention in undergraduate medical education could play an important role in professionalism learning, as trainees can thereby be supported to gradually develop self-exploration and reflection capabilities and heightened awareness of professional identity reflectively through a narrative process.

The effect of Humanitude care methodology on improving empathy: a six-year longitudinal study of medical students in Japan

BACKGROUND

Empathy, which involves understanding another person's experiences and concerns, is an important component for developing physicians' overall competence. This longitudinal study was designed to test the hypothesis that medical students' empathy can be enhanced and sustained by Humanitude Care Methodology, which focuses on perception, emotion and speech.

METHODS

This six-year longitudinal observational study examined 115 students who entered Okayama University Medical School in 2013. The study participants were exposed to two empathy-enhancing programs: (1) a communication skills training program (involving medical interviews) and (2) a Humanitude training program aimed at enhancing their empathy. They completed the Jefferson Scale of Empathy (JSE) seven times: when they entered medical school, before participation in the first program (medical interview), immediately after the first program, before the second program (Humanitude exercise), immediately after the second program, and in the 5th and 6th year (last year) of medical school. A total of 79 students (69% of the cohort) completed all seven test administrations of the JSE.

RESULTS

The mean JSE scores improved significantly after participation in the medical interview program (p < 0.01) and the Humanitude training program (p = 0.001). However, neither program showed a sustained effect.

CONCLUSIONS

The Humanitude training program as well as medical interview training program, had significant short-term positive effects for improving empathy among medical students. Additional reinforcements may be necessary for a long-term sustained effect.

Sustainable Engaged Accountable Learners

The development of lifelong learners is among the most challenging goals for medical educators. The authors identify two important scholarly works that profoundly altered their understanding and approach to lifelong learning and curriculum design: L. Dee Fink's Taxonomy of Significant Learning and Cutrer et al.'s Master Adaptive Learner model. By applying these guides to their teaching and related research, three important characteristics of lifelong learning became evident: sustainability, engagement, and accountability. These are abbreviated "SEALs," for sustainable engaged accountable learners. This paper defines these qualities as they relate to emergency medicine training, significant learning, and the development of adaptive expertise. Connections to Fink's and Cutrer's works are offered for each learner characteristic. Educational and psychological theories that support the SEALs model are paired with practical suggestions for educators to promote these desired qualities in their trainees. Relevant features of adult learning are highlighted, including self-regulation, motivation, agency, and autonomy.

Disciplining empathy: Differences in empathy with U.S. medical students by college major

Citing their students' low levels of empathy, medical educators have scrambled to implement curricula with the hopes of buffering against the corrosive effects of biomedical and clinical experiences in medical school. The assumption undergirding these studies by social scientists and medical educators alike is that immersion in biomedical education and clinical experience erodes students' empathic capacities, and that exposure to humanities and social sciences content will amend these losses. But we do not know if this assumption is correct. In this project, we empirically assess this assumption by utilizing a unique data set constructed from student applicant and survey data from the American Medical College Application Service (AMCAS) and the Association of American Medical Colleges (AAMC). We test whether medical school students (N = 8255) from the United States (U.S.) with different academic backgrounds represented by their college major have different levels of empathy, net of demographic control variables. We report two findings. First, we find that students who majored in humanities or interpretive social sciences disciplines have higher empathy scores than their peers who majored in the positivistic social sciences and STEM (science, technology, engineering, and mathematics) disciplines. Second, we find that the relationship between empathy and time in medical school is more nuanced than we would expect from the existing literature.

Obesity bias among preclinical and clinical chiropractic students and faculty at an integrative health care institution: A cross-sectional study

OBJECTIVE:

The purpose of this study was to assess the prevalence of obesity bias among preclinical and clinical chiropractic students and faculty at an integrative health care academic institution.

METHODS:

This was a cross-sectional quantitative, single-method survey with group comparison using the Beliefs About Obese Persons scale (BAOP) and the Attitudes Toward Obese Persons scale. Both instruments were administered as a single 28 question survey via email to 450 students and 46 faculty members in a doctor of chiropractic (DC) program. Differences were determined by 2 tailed t tests.

RESULTS:

The response rate for faculty and students was 31% and 65%, respectively. One hundred forty-three DC students, preclinical ( n = 65) and clinical ( n = 78), and 30 DC faculty, preclinical ( n = 15) and clinical ( n = 15) completed the survey. Both students and faculty harbored antiobesity attitudes and moderate antiobesity beliefs. Students demonstrated slightly more positive attitudes toward obese persons than did preclinical faculty. Although preclinical faculty did not demonstrate more biased attitudes than did preclinical students ( p = .057), they were more biased than clinical students ( p = .26). On the BAOP, preclinical faculty scored significantly lower than both preclinical students and clinical students ( p = .013 and .017, respectively).

CONCLUSION:

Obesity bias was common among clinical and preclinical chiropractic students and faculty at our institution. A cultural shift that reduces bias may require changes in both the curriculum and cocurriculum.

Intervention for Physician Burnout: A Systematic Review

Burnout is an important problem for physicians, with a strong impact on their quality of life and a corresponding decrease in the quality of care with an evident economical burden for the healthcare system. However, the range of interventions used to decrease this problem could be very fragmented and with the aim to shed some light on this issue, this study reviews and summarizes the currently available studies. We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify studies about intervention on physician burnout. Two authors independently searched into scientific databases to analyze and review the full papers that met the inclusion criteria. As a result, from an initial search of 11029 articles, 13 studies met full criteria and were included in this review. Of the 13 studies presented, only 4 utilized randomized controlled trials, therefore the results should be interpreted with caution. Future interventions should focus on a more holistic approach using a wider range of techniques. According to the studies selected in this review, it appears that a successful intervention for burnout should take into account the broad range of causes incorporating a variety of therapeutic tools.

Emotional intelligence among medical students: a mixed methods study from Chennai, India

BACKGROUND

Emotional Intelligence is the ability of a person to understand and respond to one's own and others' emotions and use this understanding to guide one's thoughts and actions. To assess the level of emotional intelligence of medical students in a medical college in Chennai and to explore their understanding of the role of emotions in medical practice.

METHODS

A quantitative, cross sectional, questionnaire based, survey was conducted among 207 medical students in a college in Chennai, India using the Quick Emotional Intelligence Self Assessment Test and some hypothetical emotional clinical vignettes. This was followed by a qualitative moderated fish-bowl discussion to elicit the opinion of medical students on role of emotions in the practice of medicine.

RESULTS

The mean score of Emotional Intelligence was 107.58 (SD 16.44) out of a maximum possible score of 160. Students who went to government schools for high school education had greater emotional intelligence than students from private schools (p = 0.044) and women were more emotionally intelligent in their response to emotional vignettes than men (p = 0.056). The fish bowl discussion highlighted several positive and negative impacts of emotions in clinical care. The students concluded at the end of the discussion that emotions are inevitable in the practice of medicine and a good physician should know how to handle them.

CONCLUSIONS

Medical students, both men and women, had good level of emotional intelligence in the college that was studied. Students from collectivist social settings like government high schools have better emotional intelligence, which may indicate that a collectivist, community oriented medical education can serve the same purpose. Though students have diverse opinions on the role of emotions in clinical care, cognitive reflection exercises can help them understand its importance.

When authenticity matters most: Physicians' regulation of emotional display and patient satisfaction

OBJECTIVE

The emotions expressed by physicians in medical encounters have significant impact on health outcomes and patient satisfaction. This study explored how physicians' regulation of displayed emotions affects patients' satisfaction, under low and high levels of patient distress and length of physician-patient acquaintance.

METHODS

Questionnaires were administered to 46 physicians and 230 of their patients (before and after the medical encounter) in outpatient clinics of two hospitals.

RESULTS

Data were analyzed with hierarchical linear modeling which takes the nested data structure into account. We found a significant interaction effect of physician regulation of displayed emotions and patient distress on satisfaction: When distress was high, physician regulation of emotions was negatively related to patient satisfaction. The results also show a significant interaction effect of physician regulation of displayed emotions and length of physician-patient acquaintance: With a longer acquaintance, physician regulation of emotions was negatively related to patient satisfaction.

CONCLUSION

The effect of the physicians' emotional display on patient satisfaction depends on contextual factors, such as patient distress and length of physician-patient acquaintance, which affect patients' emotional needs and expectations.

PRACTICAL IMPLICATIONS

When patients have high emotional involvement in the encounter it is suggested that physicians consider presenting genuine emotions to patients.

Who serves the underserved? Predictors of physician care to medically indigent patients

Using a national sample of 466 doctors, this work is the first to determine how sociodemographic characteristics, family lives, educational experiences and work environments combine over the life course to shape physician attitudes and behaviors toward serving the medically indigent. Survey data reveal that most physicians have positive experiences with indigent patients, and feel responsible for providing care for the needy. On average, one-quarter of doctors’ patients are medically indigent, and physicians provide six hours of charity care per week.

Multivariate regression and path analyses indicate that disparate social forces predict humanitarian attitudes and behaviors of physicians. Physician attitudes toward the indigent are shaped largely by socializing forces, including medical education and relationships with mentors. In contrast, care of indigent patients is driven by physician attitudes and by characteristics of medical practice such as specialty and practice setting. Implications for scholarship and for medical education, practice and health policy are discussed.

Assessing empathy development in medical education: a systematic review

CONTEXT

Empathy in doctor-patient relationships is a familiar topic for medical scholars and a crucial goal for medical educators. Nonetheless, there are persistent disagreements in the research literature concerning how best to evaluate empathy among physicians, and whether empathy declines or increases across medical education. Some researchers have argued that the instruments used to study 'empathy' may not measure anything meaningful to clinical practice or patient satisfaction.

METHODS

We performed a systematic review to learn how empathy is conceptualised in medical education research. We examined how researchers define the central construct of empathy and what they choose to measure, and investigated how well definitions and operationalisations match.

RESULTS

Among the 109 studies that met our search criteria, 20% failed to define the central construct of empathy at all and only 13% used an operationalisation that was well matched to the definition provided. The majority of studies were characterised by internal inconsistencies and vagueness in both the conceptualisation and operationalisation of empathy, constraining the validity and usefulness of the research. The methods most commonly used to measure empathy relied heavily on self-report and cognition divorced from action, and may therefore have limited power to predict the presence or absence of empathy in clinical settings. Finally, the large majority of studies treated empathy itself as a 'black box', using global construct measurements that are unable to shed light on the underlying processes that produce an empathic response.

CONCLUSIONS

We suggest that future research should follow the lead of basic scientific research that conceptualises empathy as relational - an engagement between a subject and an object - rather than as a personal quality that may be modified wholesale through appropriate training.

'The first pulse you take is your own' - but don't forget your colleagues'. Emotion teamwork in pre-hospital emergency medical services

This article examines the way that intense emotions, both positive and negative, are collectively regulated at work by pre-hospital emergency teams. We analyse the collective strategies and solutions that are developed in daily medical work by teams and individuals with a view to furthering the action. After a review of the literature on emotion work in work collectives, we discuss the nature of pre-hospital emergency work and the role of emotions in this work. We then examine the collective management of both disruptive and desired emotions by teams during interventions. The last section reflects on the long-term management of emotions at work using Randall Collins' concepts of interaction ritual and emotional energy. This study relies on fieldwork performed in emergency medical services in New York and Paris.

Association between Sick Leave Prescribing Practices and Physician Burnout and Empathy

OBJECTIVES

To investigate the association between sick leave prescription and physician burnout and empathy in a primary care health district in Lleida, Spain.

METHODS

This descriptive study included 108 primary care doctors from 22 primary care centers in Lleida in 2014 (183,600 patients). Burnout was measured with the Maslach Burnout Inventory and empathy with the Jefferson Scale of Physician Empathy. The reliability of the instruments was measured by calculating Cronbach's alpha and normal distribution was analyzed using the Kolmogorov-Smirnov-Lilliefors and χ2 tests. Burnout and empathy scores were analyzed by age, sex, and place of work (urban vs rural). Sick leave data were obtained from the Catalan Health Institute.

RESULTS

High empathy was significantly associated with low burnout. Neither empathy nor burnout were significantly associated with sick leave prescription.

CONCLUSION

Sick leave prescription by physicians is not associated with physicians' empathy or burnout and may mostly depend on prescribing guidelines.

Empathy problematic in psychological aspects of professional medical care (review)

The article covers summary report of the main aspects of empathy research in medical care. Data of an empathy level diagnostics depending on social aspects is pre¬sented, as well as an issue of empathy consideration as a stable personal characteristic, its dependency on experience and doctor's specialization, context of medical activity (necessary pain infliction, emergency aid assistance) is discussed. Aspects of empathic communication for medical workers of various specialties, inter alia psychiatrists and oncologists, as well as communication strategies, developed for coping with cocurrent negative emotions are analyzed. An example of a medical interview facilitating the quality of interpersonal relationship in the pair patient-doctor alliance" is given. In conclusion there are presented actual scientific contra¬dictions and set the possible main lines of future researches.

Empathy as a "risky strength": a multilevel examination of empathy and risk for internalizing disorders

Learning to respond to others' distress with well-regulated empathy is an important developmental task linked to positive health outcomes and moral achievements. However, this important interpersonal skill set may also confer risk for depression and anxiety when present at extreme levels and in combination with certain individual characteristics or within particular contexts. The purpose of this review is to describe an empirically grounded theoretical rationale for the hypothesis that empathic tendencies can be "risky strengths." We propose a model in which typical development of affective and cognitive empathy can be influenced by complex interplay among intraindividual and interindividual moderators that increase risk for empathic personal distress and excessive interpersonal guilt. These intermediate states in turn precipitate internalizing problems that map onto empirically derived fear/arousal and anhedonia/misery subfactors of internalizing disorders. The intraindividual moderators include a genetically influenced propensity toward physiological hyperarousal, which is proposed to interact with genetic propensity to empathic sensitivity to contribute to neurobiological processes that underlie personal distress responses to others' pain or unhappiness. This empathic personal distress then increases risk for internalizing problems, particularly fear/arousal symptoms. In a similar fashion, interactions between genetic propensities toward negative thinking processes and empathic sensitivity are hypothesized to contribute to excess interpersonal guilt in response to others' distress. This interpersonal guilt then increases the risk for internalizing problems, especially anhedonia/misery symptoms. Interindividual moderators, such as maladaptive parenting or chronic exposure to parents' negative affect, further interact with these genetic liabilities to amplify risk for personal distress and interpersonal guilt as well as for consequent internalizing problems. Age-related increases in the heritability of depression, anxiety, and empathy-related constructs are consistent with developmental shifts toward greater influence of intraindividual moderators throughout childhood and adolescence, with interindividual moderators exerting their greatest influence during early childhood. Efforts to modulate neurobiological and behavioral expressions of genetic dysregulation liabilities and to promote adaptive empathic skills must thus begin early in development.

Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: a report from the CHANGES study

OBJECTIVE

Medical school curricula intended to promote empathy varies widely. Even the most effective curricula leave a significant group of students untouched. Pre-existing student factors influence their response to learning experiences. We examined the individual predictors of first semester medical students' attitudes toward the value of physician empathy in clinical encounters.

METHODS

First year students (n=4732) attending a stratified random sample of 49 US medical schools completed an online questionnaire that included measures of dispositional characteristics, attitudes and beliefs, self-concept and well-being.

RESULTS

Discomfort with uncertainty, close-mindedness, dispositional empathy, elitism, medical authoritarianism, egalitarianism, self-concept and well-being all independently predicted first year medical students' attitudes toward the benefit of physician empathy in clinical encounters.

CONCLUSION

Students vary on their attitude toward the value of physician empathy when they start medical school. The individual factors that predict their attitudes toward empathy may also influence their response to curricula promoting empathic care.

PRACTICE IMPLICATIONS

Curricula in medical school promoting empathic care may be more universally effective if students' preexisting attitudes are taken into account. Messages about the importance of physician empathy may need to be framed in ways that are consistent with the beliefs and prior world-views of medical students.

Surgical inpatient satisfaction: what are the real drivers?

BACKGROUND

Inpatient satisfaction is a key element of hospital pay-for-performance programs. Communication and pain management are known to influence results, but additional factors may affect satisfaction scores. We tested the hypothesis that patient factors and outcome parameters not considered previously are clinically important drivers of inpatient satisfaction.

METHODS

Medical records were reviewed for 1,340 surgical patients who returned nationally standardized inpatient satisfaction questionnaires. These patients were managed by 41 surgeons in seven specialties at two academic medical centers. Thirty-two parameters based on the patient, surgeon, outcomes, and survey were measured. Univariate and multivariable analyses were performed.

RESULTS

Inpatients rated their overall experience favorably 75.7% of the time. Less-satisfied patients were more likely to be female, younger, less ill, taking outpatient narcotics, and admitted via the emergency department (all P < .02). Less-satisfied patients also were more likely to have unresected cancer (P < .001) or a postoperative complication (P < .001). The most relevant independent predictors of dissatisfaction in multivariable analyses were younger age, admission via the emergency department, preoperative narcotic use, lesser severity of illness, unresected cancer, and postoperative morbidity (all P < .01).

CONCLUSION

Several patient factors, expectations of patients with cancer, and postoperative complications are important and clinically relevant drivers of surgical inpatient satisfaction. Programs to manage expectations of cancer patient expectations and decrease postoperative morbidity should improve surgical inpatient satisfaction. Further efforts to risk-adjust patient satisfaction scores should be undertaken.

The design of compassionate care

AIMS AND OBJECTIVES

To investigate the tension between individual and organisational responses to contemporary demands for compassionate interactions in health care.

BACKGROUND

Health care is often said to need more compassion among its practitioners. However, this represents a rather simplistic view of the issue, situating the problem with individual practitioners rather than focusing on the overall design of care and healthcare organisations, which have often adopted a production-line approach.

DESIGN

This is a position paper informed by a narrative literature review.

METHODS

A search of the PubMed, Science Direct and CINAHL databases for the terms compassion, care and design was conducted in the research literature published from 2000 through to mid-2013.

RESULTS

There is a relatively large literature on compassion in health care, where authors discuss the value of imbuing a variety of aspects of health services with compassion including nurses, other practitioners and, ultimately, among patients. This contrasts with the rather limited attention that compassionate practice has received in healthcare curricula and the lack of attention to how compassion is informed by organisational structures and processes. We discuss how making the clinic more welcoming for patients and promoting bidirectional compassion and compassion formation in nursing education can be part of an overall approach to the design of compassionate care.

CONCLUSIONS

We discuss a number of ways in which compassion can be enhanced through training, educational and organisational design, through exploiting the potential of brief opportunities for communication and through initiatives involving patients and service users, as well as practitioners and service leaders.

RELEVANCE TO CLINICAL PRACTICE

The development of contemporary healthcare systems could usefully address the overall design of compassionate care rather than blame individual practitioners for a lack of compassion.

Associations between medical student empathy and personality: a multi-institutional study

BACKGROUND

More empathetic physicians are more likely to achieve higher patient satisfaction, adherence to treatments, and health outcomes. In the context of medical education, it is thus important to understand how personality might condition the empathetic development of medical students. Single institutional evidence shows associations between students' personality and empathy. This multi-institutional study aimed to assess such associations across institutions, looking for personality differences between students with high empathy and low empathy levels.

METHODS

Participants were 472 students from three medical schools in Portugal. They completed validated adaptations to Portuguese of self-report measures of the NEO-Five Factor Inventory(NEO-FFI) and the Jefferson Scale of Physician Empathy(JSPE-spv). Students were categorized into two groups: "Bottom" (low empathy, N = 165) and "Top" (high empathy, N = 169) according to their empathy JSPE-spv total score terciles. Correlation analysis, binary logistic regression analysis and ROC curve analysis were conducted.

RESULTS

A regression model with gender, age and university had a predictive power (pseudo R2) for belonging to the top or bottom group of 6.4%. The addition of personality dimensions improved the predictive power to 16.8%. Openness to experience and Agreeableness were important to predict top or bottom empathy scores when gender, age and university were considered." Based on the considered predictors the model correctly classified 69.3% of all students.

CONCLUSIONS

The present multi-institutional cross-sectional study in Portugal revealed across-school associations between the Big5 dimensions Agreeableness and Openness to experience and the empathy of medical students and that personality made a significant contribution to identify the more empathic students. Therefore, medical schools may need to pay attention to the personality of medical students to understand how to enhance the empathy of medical students.

Enhancing and sustaining empathy in medical students

BACKGROUND

Empathy is an important component of physician competence that needs to be enhanced.

AIM

To test the hypotheses that medical students' empathy can be enhanced and sustained by targeted activities.

METHODS

This was a two-phase study in which 248 medical students participated. In Phase 1, students in the experimental group watched and discussed video clips of patient encounters meant to enhance empathic understanding; those in the control group watched a documentary film. Ten weeks later in Phase 2 of the study, students who were in the experimental group were divided into two groups. One group attended a lecture on empathy in patient care, and the other plus the control group watched a movie about racism. The Jefferson Scale of Empathy (JSE) was administered pre-post in Phase 1 and posttest in Phase 2.

RESULTS

In Phase 1, the JSE mean score for the experimental group improved significantly (p < 0.01); no change in the JSE scores was observed in the control group. In Phase 2, the JSE mean score improvement was sustained in the group that attended the lecture, but not in the other group. No change in empathy was noticed in the control group.

CONCLUSION

Research hypotheses were confirmed.

Characteristics associated with empathic behavior in Japanese oncologists

OBJECTIVE

Oncologists must have empathy when breaking bad news to patients who have incurable advanced cancer, and the level of empathy often depends on various individual characteristics. This study aimed to clarify the relationship between these characteristics and empathic behavior in Japanese oncologists.

METHODS

We videotaped consultations in which oncologists conveyed news of incurable advanced cancer to simulated patients. Oncologists' empathetic behaviors were coded, and regression analysis was performed to determine the existence of any relationships with factors such as age, sex, and specialism.

RESULTS

Sixty oncologists participated. In a multivariate model, only age was related to the empathy score (r=0.406, p=0.033); younger oncologists scored higher than did older oncologists.

CONCLUSIONS

We found that empathic behaviors were more frequent in younger oncologists.

PRACTICE IMPLICATIONS

This information could be useful in determining the best approach for implementing future empathy and communication training programs for experienced oncologists in Japanese medical institutions.

Empathy in adults with clinical or subclinical depressive symptoms

BACKGROUND

Depression is associated with problems in social functioning. Impaired empathic abilities might underlie this association. Empathy is a multidimensional construct and involves both affective and cognitive processes. We reviewed the literature to find out to what extent depression may be associated with abnormal levels of affective and cognitive empathy. We also explored potential gender differences in these associations.

METHODS

We used PsycInfo and Medline to conduct a systematic review of all studies on empathy and depression conducted in individuals with a primary diagnosis of major depressive disorder (MDD; patient samples) or in individuals with primarily subclinical depressive symptoms (analog samples).

RESULTS

Thirty-seven studies met the inclusion criteria. The results indicated that depression was related to one type of affective empathy. Specifically, depression was related to high levels of empathic stress but not to abnormal empathic concern. Further, depression was related to limited cognitive empathy, as indicated by poor perspective taking, theory of mind, and empathic accuracy.

LIMITATIONS

Few studies have considered the variable gender in their design and analyses. Between and within study variation in demographic and clinical variables limits the interpretation of results. Self-report measures of empathy are subjective and vulnerable to bias. Poor performance on the more objective laboratory tasks might partially be explained by the broader cognitive deficits commonly observed in depression. Lastly, because all studies used a cross-sectional design, causality is difficult to establish.

CONCLUSIONS

Empathic abilities may be impaired in depression. The relation between empathy, depression, and gender is unclear. Future studies could use implicit and more ecologically valid measures of empathy. Insight into impaired empathy in depression may not only help explain poor social functioning in MDD but also benefit clinician-patient interactions.

Doctors' emotion regulation and patient satisfaction: a social-functional perspective

Emotion regulation has been identified as an important component of medical consultation but there is limited research on the topic. Two studies tested expected relationships between doctors' emotion regulation (ER) skills and patient satisfaction and quality of doctor-patient interaction, focusing in particular on the role patient perceptions' of doctors' emotion regulation skills play in these associations. Study 1 comprised 100 patients reporting on their perceptions of doctors' overall emotion regulation skills, communication quality and nonverbal immediacy, and their satisfaction with the care provided. Patients' perceptions of doctors' emotion regulation skills were associated with patient satisfaction and communication quality; patient perceptions of doctors' nonverbal immediacy partially mediated these relationships. Study 2 collected data from 30 doctors who reported on their typical emotion regulation strategies of reappraisal and suppression and 139 of their patients who reported on satisfaction with the medical treatment and positive affect. As expected, doctors' self-reported reappraisal was positively associated with their patients' satisfaction and positive affect. Doctors' suppression was also positively associated with patient satisfaction, while patients' gender moderated these effects. The two studies empirically document proposed links between doctors' emotion regulation and patient satisfaction. Notably, the results underline the role of patients' perceptions of doctors' emotion regulation skills and emotion expressions for patient outcomes and are in line with functional models of emotion in social interaction.

Active student participation may enhance patient centeredness: patients' assessments of the clinical education ward for integrative medicine

Objectives. To examine the impact of active student participation on quality of care in an integrative inpatient setting. Methods. Over a two-year period, we surveyed all patients treated on the Clinical Education Ward for Integrative Medicine (CEWIM), where final-year medical students are integrated into an internal medicine ward complementing conventional medicine with anthroposophic medicine. Patients treated on the regular wards of the same internal medicine department served as the control group (CG). General quality of care was studied with the Picker Inpatient Questionnaire, physician empathy with the Consultation and Relational Empathy measure, and patient enablement with the Patient Enablement Index. ANCOVA was used to control for covariates while examining significant differences between both patient groups. Results. Comparison of the CG wards and the CEWIM revealed no significant differences in medical treatment success. The CEWIM, however, achieved better results for physician-patient interaction, physician empathy, and patient enablement. Eighty Percent of the CEWIM patients rated student participation as positively impacting quality of care. Conclusion. Our results indicate that incorporating students in an integrative healthcare setting may result in greater patient centeredness. Further studies are needed to determine whether this is due to organizational advantages, students' empathic activity, the impact of teaching, or learner-teacher interaction.

The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy

PURPOSE

To test the hypothesis that scores of a validated measure of physician empathy are associated with clinical outcomes for patients with diabetes mellitus.

METHOD

This retrospective correlational study included 20,961 patients with type 1 or type 2 diabetes mellitus from a population of 284,298 adult patients in the Local Health Authority, Parma, Italy, enrolled with one of 242 primary care physicians for the entire year of 2009. Participating physicians' Jefferson Scale of Empathy scores were compared with occurrence of acute metabolic complications (hyperosmolar state, diabetic ketoacidosis, coma) in diabetes patients hospitalized in 2009.

RESULTS

Patients of physicians with high empathy scores, compared with patients of physicians with moderate and low empathy scores, had a significantly lower rate of acute metabolic complications (4.0, 7.1, and 6.5 per 1,000 patients, respectively, P < .05). Logistic regression analysis showed physicians' empathy scores were associated with acute metabolic complications: odds ratio (OR) = 0.59 (95% confidence interval [CI], 0.37-0.95, contrasting physicians with high and low empathy scores). Patients' age (≥69 years) also contributed to the prediction of acute metabolic complications: OR = 1.7 (95% CI, 1.2-1.4). Physicians' gender and age, patients' gender, type of practice (solo, association), geographical location of practice (mountain, hills, plain), and length of time the patient had been enrolled with the physician were not associated with acute metabolic complications.

CONCLUSIONS

These results suggest that physician empathy is significantly associated with clinical outcome for patients with diabetes mellitus and should be considered an important component of clinical competence.

Medical students' understanding of empathy: a phenomenological study

CONTEXT

Empathy towards patients is associated with improved health outcomes. However, quantitative studies using self-reported data have not provided an in-depth opportunity to explore the lived experiences of medical students concerning empathy.

OBJECTIVES

This study was designed to investigate undergraduate medical students' experiences of the phenomenon of empathy during the course of their medical education and to explore the essence of their empathy.

METHODS

This was a descriptive, phenomenological study of medical student interviews conducted using the method of Colaizzi and Giorgi. The sample (n = 10) was drawn from medical students in Years 4 and 5. In-depth interviews were used to obtain a clear understanding of their experiences of empathy in the context of patient care. Interviews continued until no new information could be identified from transcripts.

RESULTS

Five themes were identified from analysis: the meaning of empathy; willingness to empathise; innate empathic ability; empathy decline or enhancement, and empathy education. Empathic ability was manifested through two factors: innate capacity for empathy, and barriers to displaying empathy. Different experiences and explanations concerning the decline or enhancement of empathy during medical education were explored.

CONCLUSIONS

Empathic ability was identified as an important innate attribute which nevertheless can be enhanced by educational interventions. Barriers to the expression of empathy with patients were identified. Role-modelling by clinical teachers was seen as the most important influence on empathy education for students engaged in experiential learning.

Empathy of medical students and personality: evidence from the Five-Factor Model

The main aim of this study was to test hypothetical associations between personality dimensions and empathy scores in medical students. The Portuguese version of NEO-FFI was administered in order to characterize participants in terms of five personality traits: Neuroticism, Extraversion, Agreeableness, Openness to Experience, and Conscientiousness. Self-reported empathy measures were obtained with the Portuguese version of the Jefferson Scale of Physician Empathy (JSPE-spv), a Likert-type questionnaire specifically developed for administration in health sciences settings that measures domains, such as compassionate care and perspective taking. Correlation analysis, multivariate analysis of covariance, and logistic regression analysis were conducted. The results confirmed positive associations between agreeableness, openness to experience and empathy, and did not support our hypothesis of negative associations between neuroticism and empathy. It is suggested that that the personality of students should be taken into account in programs to enhance empathy in undergraduate medical education.

The effect of surgeon empathy and emotional intelligence on patient satisfaction

We investigated the associations of surgeons' emotional intelligence and surgeons' empathy with patient-surgeon relationships, patient perceptions of their health, and patient satisfaction before and after surgical procedures. We used multi-source approaches to survey 50 surgeons and their 549 outpatients during initial and follow-up visits. Surgeons' emotional intelligence had a positive effect (r = .45; p < .001) on patient-rated patient-surgeon relationships. Patient-surgeon relationships had a positive impact on patient satisfaction before surgery (r = .95; p < .001). Surgeon empathy did not have an effect on patient-surgeon relationships or patient satisfaction prior to surgery. But after surgery, surgeon empathy appeared to have a significantly positive and indirect effect on patient satisfaction through the mediating effect of patients' self-reported health status (r = .21; p < .001). Our study showed that long-term patient satisfaction with their surgeons is affected less by emotional intelligence than by empathy. Furthermore, empathy indirectly affects patient satisfaction through its positive effect on health outcomes, which have a direct effect on patients' satisfaction with their surgeons.

Physicians' empathy and clinical outcomes for diabetic patients

PURPOSE

To test the hypothesis that physicians' empathy is associated with positive clinical outcomes for diabetic patients.

METHOD

A correlational study design was used in a university-affiliated outpatient setting. Participants were 891 diabetic patients, treated between July 2006 and June 2009, by 29 family physicians. Results of the most recent hemoglobin A1c and LDL-C tests were extracted from the patients' electronic records. The results of hemoglobin A1c tests were categorized into good control (<7.0%) and poor control (>9.0%). Similarly, the results of the LDL-C tests were grouped into good control (<100) and poor control (>130). The physicians, who completed the Jefferson Scale of Empathy in 2009, were grouped into high, moderate, and low empathy scorers. Associations between physicians' level of empathy scores and patient outcomes were examined.

RESULTS

Patients of physicians with high empathy scores were significantly more likely to have good control of hemoglobin A1c (56%) than were patients of physicians with low empathy scores (40%, P < .001). Similarly, the proportion of patients with good LDL-C control was significantly higher for physicians with high empathy scores (59%) than physicians with low scores (44%, P < .001). Logistic regression analyses indicated that physicians' empathy had a unique contribution to the prediction of optimal clinical outcomes after controlling for physicians' and patients' gender and age, and patients' health insurance.

CONCLUSIONS

The hypothesis of a positive relationship between physicians' empathy and patients' clinical outcomes was confirmed, suggesting that physicians' empathy is an important factor associated with clinical competence and patient outcomes.

Empirical research on empathy in medicine-A critical review

OBJECTIVE

There is a growing amount of empirical research on empathy in medicine. This critical review assesses methodological limitations in this body of research that have not received adequate attention.

METHODS

Scientific publications presenting empirical research on medical students' or physicians' empathy were systematically searched for.

RESULTS

206 publications were identified and critically reviewed. Multiple empirical approaches have been used. However, there are some remarkable tendencies given the complexity of the study object: empathy is often not defined. Qualitative approaches are rarely used and the predominant quantitative instruments have a relatively narrow or peripheral scope. For example, the concrete experiences, feelings, and interpretations of the physician and the patient, and empathy in clinical practice, are often neglected. Furthermore, possible influences of medical training and working conditions on empathy have not been adequately explored.

CONCLUSION

The empirical studies of empathy in medicine tend to separate empathy from main parts of clinical perception, judgment, and communication. Thus, important aspects and influences of empathy have been relatively neglected.

PRACTICE IMPLICATIONS

Future studies should include transparent concepts, more than one method and perspective, qualitative approaches, the physician's and the patient's concrete experiences and interpretations, and the context in which empathy is developed and practiced.

Empathy: necessary for effective pain management?

Empathy is a provider attribute that has been a topic of increased clinical interest, particularly as it relates to pain. This article examines various dimensions of the pain and empathy literature: definitions of empathy, research regarding the psychophysiology of empathy for pain, and research related to empathy in psychological and medical care. Research regarding topics broadly related to empathy is also reviewed, including communication skills and patient-centered care. Although this literature supports the clinical value of provider empathy and/or behaviors likely to reflect empathy, little research has explicitly examined empathy in the treatment of pain. Nonetheless, when considered in the broader context, the evidence is sufficient to draw some conclusions regarding approaches to pain care that are likely to reflect and/or elicit provider empathy and are central to effective pain management.

Communicating with children and families: from everyday interactions to skill in conveying distressing information

Health care communication is a skill that is critical to safe and effective medical practice; it can and must be taught. Communication skill influences patient disclosure, treatment adherence and outcome, adaptation to illness, and bereavement. This article provides a review of the evidence regarding clinical communication in the pediatric setting, covering the spectrum from outpatient primary care consultation to death notification, and provides practical suggestions to improve communication with patients and families, enabling more effective, efficient, and empathic pediatric health care.

Reducing racial bias among health care providers: lessons from social-cognitive psychology

The paper sets forth a set of evidence-based recommendations for interventions to combat unintentional bias among health care providers, drawing upon theory and research in social cognitive psychology. Our primary aim is to provide a framework that outlines strategies and skills, which can be taught to medical trainees and practicing physicians, to prevent unconscious racial attitudes and stereotypes from negatively influencing the course and outcomes of clinical encounters. These strategies and skills are designed to: 1) enhance internal motivation to reduce bias, while avoiding external pressure; 2) increase understanding about the psychological basis of bias; 3) enhance providers' confidence in their ability to successfully interact with socially dissimilar patients; 4) enhance emotional regulation skills; and 5) improve the ability to build partnerships with patients. We emphasize the need for programs to provide a nonthreatening environment in which to practice new skills and the need to avoid making providers ashamed of having racial, ethnic, or cultural stereotypes. These recommendations are also intended to provide a springboard for research on interventions to reduce unintentional racial bias in health care.

How do distress and well-being relate to medical student empathy? A multicenter study

OBJECTIVE

To determine whether lower levels of empathy among a sample of medical students in the United States are associated with personal and professional distress and to explore whether a high degree of personal well-being is associated with higher levels of empathy.

DESIGN

Multi-institutional, cross-sectional survey.

SETTING

All medical schools in Minnesota (a private medical school, a traditional public university, and a public university with a focus in primary care).

PARTICIPANTS

A total of 1,098 medical students.

MEASUREMENTS

Validated instruments were used to measure empathy, distress (i.e., burnout and symptoms of depression), and well-being (high quality of life).

RESULTS

Medical student empathy scores were higher than normative samples of similarly aged individuals and were similar to other medical student samples. Domains of burnout inversely correlated with empathy (depersonalization with empathy independent of gender, all P < .02, and emotional exhaustion with emotive empathy for men, P = .009). Symptoms of depression inversely correlated with empathy for women (all P < or = .01). In contrast, students' sense of personal accomplishment demonstrated a positive correlation with empathy independent of gender (all P < .001). Similarly, achieving a high quality of life in specific domains correlated with higher empathy scores (P < .05). On multivariate analysis evaluating measures of distress and well-being simultaneously, both burnout (negative correlation) and well-being (positive correlation) independently correlated with student empathy scores.

CONCLUSIONS

Both distress and well-being are related to medical student empathy. Efforts to reduce student distress should be part of broader efforts to promote student well-being, which may enhance aspects of professionalism. Additional studies of student well-being and its potential influence on professionalism are needed.