Differences in medical students' empathy

Psychometric properties of the Greek version of the Jefferson Scale of Empathy and empathy levels in Greek dental postgraduate students

PURPOSE

The aims of this study were to: (1) examine the psychometric properties of the Greek version of JSE-HP and (2) explore empathy among Greek dental postgraduate students.

METHODS

The JSE-HP scale was translated into Greek using the back translation method. The questionnaire was given to 111 dental postgraduate students between November 2017 and February 2018. A random sample of 25% was retested to assess test-retest reliability. The reliability of the Greek version of JSE-HP was measured with Cronbach's alpha (α) and Discrimination Indices (DIs). Exploratory Factor Analysis, with varimax rotation of the factorial axes, was used to examine the dimensionality and the factorial validity of the Greek version of the JSE-HP. Comparisons between groups of postgraduate students were performed as appropriate with the Kruskal-Wallis or the Mann-Whitney U test.

RESULTS

The response rate was 100%. The mean age was 28.9 years. The reliability, in the sense of internal consistency of the questionnaire was considered satisfactory (Cronbach's alpha: 0.76, average DI: 0.33.) The test-retest reliability was satisfactory (Pearson's r = 0.77, p < 0.001). Factor Analysis revealed 7 significant factors. No statistically significant differences in empathy scores were found among groups of postgraduate students.

CONCLUSIONS

The Greek version of the JSE-HP shows good psychometric properties. Empathy scores do not differ among Greek dental postgraduate students.

Perceived team roles of medical students: a five year cross-sectional study

INTRODUCTION

Despite the increasing importance of teamwork in healthcare, medical education still puts great emphasis on individual achievements. The purpose of this study is to examine medical students' team role preferences, including the association with gender and specialty; and to provide implications for policy makers and medical educators.

METHODS

We used an exploratory methodology, following a cross-sectional design. Data was collected from first year master students in medicine (n = 2293) during five consecutive years (2016-2020). The Belbin Team Role Self Perception Inventory (BTRSPI) was used to measure medical students' self-perceptions of their team role.

RESULTS

The Team Worker was the most preferred team role among medical students (35.8%), regardless of gender or specialty. Female and male students had similar team role patterns, although female students scored higher on Team Worker (40.4% vs. 29.1%, P < .001) and Completer-Finisher (14.0% vs. 8.0%, P < .001). With regard to specialties, the Team Worker role was more often chosen by general practitioners than by person-centered and technique-oriented specialties (47.1% vs. 41.8% vs. 29.1%, P < .001).

CONCLUSIONS

Our findings contribute to an increased scientific understanding of how medical students perceive their own team role, and how this is related to gender and specialty. This is valuable due to the increased importance of interdisciplinary teamwork in healthcare. Medical schools should prioritize stimulating teamwork skills through the implementation of different interventions at all stages (i.e. from the admission process to curricula to residency) and all levels (i.e. explicit and implicit curricula).

A cross sectional study: The association between sleeping quality and stress among second and third medical students at the University of Jordan

OBJECTIVE

Medicine is considered one if not the most stressful educational field. Thus, the aim of this study is to investigate the prevalence of stress and poor sleeping quality among medical students and the association between them.

METHOD

This cross-sectional study was conducted at the University of Jordan on second- and third-year medical students. The questionnaire consisted of: 1) Demographics; 2) The assessment tools which were Pittsburgh Quality of Sleep Index (PSQI) and Kessler Psychological Distress Status (K10). Binary logistic regression, chi-square and linear regression were used to investigate the association between PSQI, K10, and their determinants.

RESULTS

The mean for PSQI score was 6.76 ± 3.32. PSQI scores interpretation revealed that 61.7% of the 282 participants of this study were poor sleepers. Logistic regression results showed that only the category of not napping at all from the napping hours variable was significantly associated with sleeping quality. Furthermore, the mean of K10 scores was 24.5 ± 8.5. K10 scores revealed that 66.3% of the participants were stressed. Logistic regression results showed that gender and regular exercise were significantly associated with psychological distress. Additionally, chi-square test, logistic regression and linear regression showed that PSQI was significantly associated with K10 (P <0.01).

CONCLUSIONS

Stress and poor sleeping quality in medical students at the University of Jordan were highly prevalent and strongly associated. What determined PSQI was daytime napping, and for K10 were regular exercise and gender. Further investigations into stress and sleep quality in the Arabian region are needed.

Does the hospitalization immersion experience improve medical students' understanding of patients' perspectives? A qualitative study

PURPOSE

Although many studies have assessed the impact of interventions to increase medical students' empathy by improving their understanding of patients' perspectives and feelings, the impact of hospitalization experiences remains unclear.

METHODS

Fifth-year medical students at Kyushu University from 2009-2013 participated in a 2-day/1-night course to provide a hospitalization experience. After the course, participants answered an online, anonymous, open-ended questionnaire created by the authors.

RESULTS

Of 488 participants, 462 provided responses (95% response rate), which were evaluated by thematic analysis. Students understood inpatients not only through their own hospitalization experience, but also through observations of and conversations with the inpatients they encountered, from a shared perspective of both. Students experienced the realities of hospital life, stress and psychological states of being an inpatient, and psychological pressure from physicians. In addition, students observed the distress of other inpatients and dedication of medical staff. Furthermore, through communication with these inpatients, students understood other inpatients' anxiety about illness and empathy as one of the requirements of health care providers from the patients' perspective.

CONCLUSION

This qualitative study investigated the effectiveness of a course on the hospitalization experience. Results showed that medical students understood the perspectives, distress, and anxiety of being an inpatient, not only from their own experiences but also from observation and communication with other inpatients they encountered during their hospitalization. This experience appeared to be an effective teaching strategy for enhancing medical students' empathy by improving their understanding of patients' perspectives and feelings.

Medical Students' Perspectives on Empathy: A Systematic Review and Metasynthesis

PURPOSE

Some evidence indicates that physician empathy declines during medical training, which has made it the subject of much research. Qualitative studies are relevant in this context, focusing as they do on how students themselves conceive and understand empathy during medical school. The aim of this study was to explore medical students' perspectives on empathy by conducting a metasynthesis, including a systematic review of the literature and analysis of included studies.

METHOD

The authors systematically searched 4 databases through June 17, 2019, for qualitative studies reporting medical students' perspectives on empathy in medical school. They assessed article quality using the Critical Appraisal Skills Program, and they applied thematic analysis to identify key themes and synthesize them.

RESULTS

The authors included 35 articles from 18 countries in their analysis. Four main themes emerged: (1) Defining empathy, with a lack of understanding of the concept; (2) Teaching empathy, with a focus on the hidden curriculum and clinical supervisors; (3) Willingness to be an empathetic doctor, with ambivalence expressed by some study participants; and (4) Evolution of empathy during medical school, specifically its decline.

CONCLUSIONS

Medical students are beset by theoretical confusion regarding the concept of empathy, and they express doubts about its utility and relevance. Instruction should focus on simpler concepts such as listening, and schools should leverage clinical supervisors' strong influence on students' empathy. Prioritizing certain types of knowledge (clinical facts) during medical education has a globally negative effect on medical students' empathy.

Attitudes of Anatomy Students toward Commemorations for Body Donors: A Multicultural Perspective

Many medical schools practice commemorative ceremonies to honor body donors. Attitudes of medical education stakeholders toward these ceremonies have not yet been fully investigated. The aim of this study was to explore anatomy students' attitudes toward commemorations at a multicultural institution which has not introduced these ceremonies yet. A survey was carried out on different groups of anatomy students that were exposed and not yet exposed to human remains. The survey was used to record basic demographic data from the respondents, ask if they would support the establishment of an anatomy commemoration and in which format. A total of 756 anatomy students participated in the survey (response rate 69.8%). The majority (76.3%) were in favor of introducing a commemoration for donors. The associations of students' gender, attitude toward body donation, and level of exposure to human remains with attitudes toward commemoration for donors were identified (P < 0.05), whereas ethnicity and religion seemed to have no influence on attitudes (P > 0.05). Most students believed that anatomy staff and students should organize the commemoration. There was a preference for the commemoration to be secular with revealed identities of donors, and not recorded for social media. The support for the establishment of commemorations transcended cultural and religious differences and confirmed students' respectful attitude toward donors. Anatomy commemorations seem to have potential not only to engage students with one another, and donor families, but also to pave the way for students to become life-long ethical and empathetic learners and practitioners.

Gender differences in the effect of medical humanities program on medical students' empathy: a prospective longitudinal study

BACKGROUND

Previous studies have suggested that Medical students' empathy declines during medical school, especially during the clinical studies. The aim of this study was to examine. Changes in medical students' empathy during their first clinical experience, and to determine the impact of gender and humanities curriculum on empathy changes.

METHODS

In this prospective longitudinal study, 262 4th year students from three consecutive classes were assessed. Empathy was assessed before and at 4th-year-end, using the Jefferson Scale of Physician Empathy-Student Version (JSPE-S). The three classes differed in humanities curriculum [limited Medical Humanities (MH_(lim)) vs. extended Medical Humanities (MH_(ext))], and in admission system [Personal Interview (PI) vs. multiple mini interviews (MMI)].

RESULTS

Overall, there was a small but significant decrease in JSPE-S during the fourth year (114.40 ± 11.32 vs. 112.75 ± 14.19, p = 0.034). Among men there was a statistically significant decline in JSPE-S during the fourth year, and the MH_(ext) (but not the MH_(lim)) was associated with the decline (t₍₃₅₎ = 2.38, p = 0.023). Women students showed no decline in empathy during the fourth-year of studies, regardless of type of humanities program. In addition, women who participated in MH_(ext) had a higher JSPE-S scores during the 4th -year as compared to women who participated in MH_(lim).

CONCLUSION

Pre-clinical humanities program was associated with a decline in empathy among men medical students during the fourth-year of medical studies. Gender differences in response to medical humanities programs require further study.

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.

Empathy in Podiatric Medical Education: Challenges and Opportunities for Comprehensive Care

BACKGROUND

Many regard empathy as a critical component of comprehensive health care. Much interest has been generated in the field of medical empathy, in particular as it relates to education. Many desirable outcomes correlate with perceived empathy during the patient encounter, but paradoxically, empathy levels have been reported to decline during the years of medical education. Several new approaches have been described in the literature that intend to teach or develop empathy skills in health-care students.

METHODS

PubMed, PsycINFO, and Google Scholar databases were searched for the terms empathy education, medical education, medical student, podiatric medical education, medical empathy, compassion, emotional intelligence, biopsychosocial model, and bedside manner. After implementing inclusion and exclusion criteria, articles were selected for preparation of a literature review. Analysis of the podiatric medical education on empathy was conducted by reviewing descriptions of all courses listed on each of the nine US podiatric medical schools' Web sites. The 2018 Curricular Guide for Podiatric Medical Education was analyzed.

RESULTS

In this review, we examine the current state of empathy from a context of medical education in general, followed by a specific analysis in podiatric medicine. We define key terms, describe the measuring of empathy in medicine, explore outcomes of empathy in the health-care setting, review the reports of a decline in medical education, and highlight some of the current efforts to develop the skill in education. An overview of empathy in the podiatric medical curriculum is presented.

CONCLUSIONS

To improve the quality of care that physicians provide, a transformation in podiatric medical education is necessary. A variety of tools are available for education reform with the target of developing empathy skills in podiatric medical students.

Is empathy change in medical school geo-socioculturally influenced?

CONTEXT

There is convincing evidence that physician empathy leads to better patient care. As a result, there has been considerable research interest in investigating how empathy changes during undergraduate medical studies. Early (generally North American) studies raised concerns that medical training causes a decline in empathy. More recent studies (conducted around the world) have begun to suggest that either a slight increase or decrease in empathy occurs during undergraduate medical training, which has led some to argue that empathy changes indiscriminately (with no discernible pattern). This paper explores whether there is evidence to suggest that empathy changes indiscriminately or with a discernible geo-sociocultural pattern during undergraduate medical training.

METHODS

Literature that investigated change in empathy during undergraduate medical training was reviewed. Cross-sectional and longitudinal studies were tabulated separately according to their respective geographical locations. The tabulated results were analysed to investigate whether empathy changed similarly or differently within different geographical locations.

RESULTS

The studies reviewed indicate similar patterns of empathy change within approximate geo-sociocultural clusters. Whereas US studies predominantly show small but significant decreases in empathy, Far Eastern studies mostly show small but significant increases in empathy as undergraduates progress through the medical course.

CONCLUSIONS

These results suggest that change in empathy during undergraduate medical education is not as indiscriminate (patternless) as once thought. Additionally, these results support the notion that empathy is a locally construed global construct.

Is empathy an important attribute of midwives and other health professionals?: A review

INTRODUCTION

This paper is a report of a systematic review to identify and analyze studies of the measurement of empathy in midwives and other health professionals. Empathy has been recognized as an important factor in patient care, with positive outcomes for both patients and health professionals. There is a debate on the definition of empathy, on its measurement and on the possibility of improvement.

METHODS

Searches were made of the CINAHL, SCOPUS, PubMed and PsychINFO databases using the terms empathy, clinical, midwifery, nursing, medical students, measurement, and health professionals, singly or in combination, to identify literature published in English between 2002-2015. The included papers were critically reviewed and a narrative synthesis was conducted.

RESULTS

In all, 22 papers met the inclusion criteria by studies that were conducted to measure the levels of empathy in a variety of health professionals and students. Their scores were analyzed in correlation with their sociodemographic factors.

CONCLUSIONS

Despite numerous studies, many correlations but also differences exist, indicating the complexity of empathy and the need to further study it.

How to clarify the aims of empathy in medicine

This paper argues that enthusiasm for empathy has grown to the point at which empathy has taken on the status of an "ideal" in modern medicine. We need to pause and scrutinize this ideal before moving forward with empathy training programs for medical students. Taking empathy as an ideal obscures the distinction between the multiple aims that calls for empathy seek to achieve. While these aims may work together, they also come apart and yield different recommendations about the sort of behavior physicians should cultivate in a given situation. I begin by demonstrating how enthusiasm for empathy has increased dramatically. I then specify precisely what I mean in calling empathy an "ideal." I then describe some dangers associated with taking empathy to be an ideal unreflectively. I discuss the merits of works that provide conceptualizations of empathy that are specifically tailored for the medical domain and conclude that although these works move discussions about empathy in medical care forward, they could do more to foreground the goals and aims underlying calls for increased empathy. I provide specific suggestions as to how exactly we might foreground these goals and aims to further avoid conceptual confusion about empathy in medical education.

Palliative care and the arts: vehicles to introduce medical students to patient-centred decision-making and the art of caring

BACKGROUND

Medical Schools are challenged to improve palliative care education and to find ways to introduce and nurture attitudes and behaviours such as empathy, patient-centred care and wholistic care. This paper describes the curriculum and evaluation results of a unique course centred on palliative care decision-making but aimed at introducing these other important competencies as well.

METHODS

The 20 h-long optional course, presented in an art museum, combined different learning methods, including reflections on art, case studies, didactic sessions, personal experiences of faculty, reflective trigger videos and group discussions. A mixed methods approach was used to evaluate the course, including a) a post-course reflective exercise; b) a standardized evaluation form used by the University for all courses; and c) a focus group.

RESULTS

Twenty students (2nd to 6th years) participated. The course was rated highly by the students. Their understanding of palliative care changed and misconceptions were dispelled. They came to appreciate the multifaceted nature of decision-making in the palliative care setting and the need to individualize care plans. Moreover, the course resulted in a re-conceptualization of relationships with patients and families, as well as their role as future physicians.

CONCLUSIONS

Palliative care decision-making therefore, augmented by the visual arts, can serve as a vehicle to address several competencies, including the introduction of competencies related to being patient-centred and empathic.

Changes in Empathy during Medical Education: An Example from Turkey

Objective:

Empathy is a key element of patient– physician communication; it is relevant to and positively influences patients’ health. In this study we aimed to present the Turkey example for the empathy change during the medical faculty training.

Methods:

This cross-sectional study was carried out at Ondokuz Mayis University, Faculty of Medicine, Department of Family Medicine, Samsun, Turkey. in first three years students of medicine during September 2014 to June 2015. Turkish adapted form of the student version of Jefferson empathy scale and sociodemographic questionnaire was used and data was assessed with the SPSS program.

Results:

Total 511 students (52.5% female, 47.5% male), from first three years of medical faculty participated in the study. Two hundred thirty three (44.5%) students were from the First Year class, while 130 (27.1%) and 148 (28.4%) of them were from Second and Third Year respectively. The mean age was 20.63±2.73 years. Significant differences in the empathy scores were observed among first three years in medical school as like as between gender.

Conclusion:

Although medical schools tend to raise students with higher empathy levels, medical education itself is more scientific based than humanistic approach, and makes medical students more tough and insensitive to the problems of patients. Patient-centered approach and empathy training should be implemented in the curriculum during whole medical education.

A new admission method may select applicants with a distinct personality profile

BACKGROUND

There is little data to suggest that a specific admission method can select students with a distinct personality profile. We have recently introduced a new admission process that combines a computerized personality test, with a single interview. The purpose of the current study was to find whether the new method selects applicants with a different personality profile and attitudes compared with the previous method.

METHOD

Using a validated personality questionnaire (HEXACO) and attitudes questionnair, that were filled anonymously between November 2014 and May 2015, the authors compared two groups of students: group A comprising students accepted with the new method (first and second year) with group B comprising students accepted with the previous method (third to sixth year).

RESULTS

In group A, 157 responded out of 250 (63%), while in group B 194 out of 352 (55%). Group A students ranked significantly higher in honesty-humility, extraversion, agreeableness and openness to experience, and lower in emotionality. Physicians' role in society was perceived to be more meaningful among Group A students (M = 4.19, SD = 0.50, N = 152) compared to Group B students (M = 3.86, SD = 0.57, N = 184).

CONCLUSIONS

The new method may select applicants with a distinct personality profile and different attitudes toward the physicians' role in the society.

International study of medical school learning environments and their relationship with student well-being and empathy

OBJECTIVE

To assess whether favourable perceptions of the learning environment (LE) were associated with better quality of life, less burnout and more empathy across three undergraduate medical education programmes in Israel, Malaysia and China.

METHODS

Cross-sectional surveys were administered at the end of the 2013-2014 academic year at three medical schools: Technion American Medical Students Program (TAMS) in Israel, Perdana University-Royal College of Surgeons in Ireland School of Medicine (PURCSI) in Malaysia and Peking Union Medical College (PUMC) in China. LE perceptions were assessed using the Johns Hopkins Learning Environment Scale (JHLES). Well-being was assessed using validated items for quality of life and the depersonalisation and emotional exhaustion domains of burnout. The 20-item Jefferson Empathy Scale assessed empathy. Statistical analyses included bivariate regressions and multivariate regressions that adjusted for gender, school, class year and perceived academic rank.

RESULTS

Overall, 400/622 (64.3%) students responded, with the following rates by site: TAMS 92/121 (76.0%), PURCSI 160/198 (80.1%) and PUMC 148/303 (48.8%). In multivariate models, favourable overall LE perceptions were associated with higher odds of good quality of life (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.8-5.8; p < 0.001) and lower odds of emotional exhaustion (OR, 0.34; 95% CI, 0.24-0.50; p < 0.001) and depersonaliation (OR, 0.30; 95% CI, 0.24-0.37; p = 0.001). 'Community of Peers', one of seven factors in the JHLES, was the only one to be independently associated with better quality of life and less emotional exhaustion and depersonalisation. After adjusting for covariates, there was not a statistically significant association between overall LE and empathy (OR, 1.4; 95% CI, 0.91-2.2; p = 0.12).

CONCLUSIONS

Students' LE perceptions are closely associated with their well-being, and fostering peer community may hold promise for enhancing quality of life and protecting against burnout. Across these three settings, LE and empathy were not closely related, suggesting that any influence of learning environment on empathy would be modest.

If You Could Read My Mind: The Role of Healthcare Providers' Empathic and Communicative Competencies in Clients' Satisfaction with Consultations

This article investigates the relationship between healthcare providers' empathic and communicative competencies and clients' overall satisfaction with consultations. Two aspects of empathy were included: empathic attitude (sensitivity to the clients' perspective) and empathic skills (ability to estimate clients' evaluations). Communicative competencies were narrowed down to the clarity of the information provided. In the context of work disability examinations, 90 healthcare providers (44% physicians, 56% vocational experts) participated. For each provider, up to 20 dyads with clients were investigated. Within every dyad, clients rated their experiences and healthcare providers estimated clients' scores. The results show that both aspects of empathy and clarity of information significantly contribute to clients' overall satisfaction and as such confirm the importance of empathy and communication in medical consultations. Specifically, healthcare providers' empathic dispositions, in addition to their overt communicative behavior, appear to contribute to clients' overall satisfaction. Of the two aspects of empathy, only empathic attitude is significantly related to the clarity of information.

Measuring Empathy Levels among Kurdish Medical Students in Erbil City, Iraq: Cross-sectional study

OBJECTIVES

Empathy is a crucial attribute within the physician-patient relationship. This study aimed to evaluate the empathy levels of students in the College of Medicine at Hawler Medical University (HMU) in Erbil city, Iraq.

METHODS

This cross-sectional study took place between January and May 2015 and included all medical undergraduates enrolled at HMU (n = 989). The validated self-administered English language version of the Jefferson Scale of Physician Empathy-Student Version (JSPE-SV) was used to measure empathy levels. Students reported their conformity to each statement of the 20-item questionnaire on a 7-point Likert scale. Levels of empathy were considered directly relative to their final score.

RESULTS

A total of 927 students completed the questionnaire (response rate: 93.7%). The male-to-female ratio was 0.72:1 and the mean age was 21.3 ± 1.4 years. The mean empathy score was 101.9 ± 19.2. Female students had significantly higher empathy (P = 0.023) and more frequently chose people-oriented specialties (P = 0.001) than males. First-year students reported the highest mean score (112.9 ± 20.1) while fourth-year students had the lowest (92.7 ± 16.0). There was a significant decline in mean scores between first- and second-year male students (P = 0.020) and first- and fourth-year male students (P = 0.050). Students who chose people-oriented specialties had significantly higher scores than those who chose technology-oriented specialties (P = 0.002).

CONCLUSION

The studied cohort of HMU students demonstrated low empathy levels. As such, the inclusion of empathy instruction in medical school curricula is recommended to promote professionalism and patient welfare.

A Methodological Review of the Assessment of Humanism in Medical Students

BACKGROUND

Humanism is a complex construct that defies simplistic measurement. How educators measure humanism shapes understanding and implications for learners. This systematic review sought to address the following questions: How do medical educators assess humanism in medical students, and how does the measurement impact the understanding of humanism in undergraduate medical education (UME)?

METHOD

Using the IECARES (integrity, excellence, compassion, altruism, respect, empathy, and service) Gold Foundation framework, a search of English literature databases from 2000 to 2013 on assessment of humanism in medical students revealed more than 900 articles, of which 155 met criteria for analysis. Using descriptive statistics, articles and assessments were analyzed for construct measured, study design, assessment method, instrument type, perspective/source of assessment, student level, validity evidence, and national context.

RESULTS

Of 202 assessments reported in 155 articles, 162 (80%) used surveys; 164 (81%) used student self-reports. One hundred nine articles (70%) included only one humanism construct. Empathy was the most prevalent construct present in 96 (62%); 49 (51%) of those used a single instrument. One hundred fifteen (74%) used exclusively quantitative data; only 48 (31%) used a longitudinal design. Construct underrepresentation was identified as a threat to validity in half of the assessments. Articles included 34 countries; 87 (56%) were from North America.

CONCLUSIONS

Assessment of humanism in UME incorporates a limited scope of a complex construct, often relying on single quantitative measures from self-reported survey instruments. This highlights the need for multiple methods, perspectives, and longitudinal designs to strengthen the validity of humanism assessments.

Educational Research Report: Changes in Students' Levels of Empathy during the Didactic Portion of a Veterinary Program

Empathy can be defined as the ability to understand and connect with the emotional state and frame of mind of another. Establishing connections with others is a crucial skill for veterinarians who must earn the trust and compliance of their clients to provide quality care for their patients. This is a longitudinal study using the Davis Interpersonal Reactivity Index (IRI) to assess changes in veterinary students' self-reported empathy as they progressed through the didactic portion of the DVM program at Colorado State University. The IRI consists of four subscales that measure cognitive and affective components of empathy: Perspective Taking, Fantasy, Emphatic Concern, and Personal Distress. Data were collected at three time points, corresponding to the start of the first year, the fourth semester (second year), and the fifth semester (third year). Results showed an overall decline in Perspective Taking scores, with a significant decrease between first and second year. There was an overall increase in students' levels of Personal Distress as they progressed through the program. The significant difference was found between years 1 and 3. This is especially concerning because the enhanced unease in interpersonal interactions coincides with students entering clinical rotations in the third year-the very time when these traits are necessary for quality client and patient care. Veterinary educators are urged to use this information as a basis for investigating novel curricular and programmatic interventions to counteract these changes in student empathy.

Changes in wellbeing and professional values among medical undergraduate students: a narrative review of the literature

BACKGROUND

Educators are concerned by the high prevalence of emotional distress among medical students, and by the alleged decline in their humanitarian values.

OBJECTIVE

To re-examine these concerns by reviewing studies of medical students' wellbeing and development.

METHOD

Narrative review of the literature.

MAIN FINDINGS

(a) Medical students' emotional distress increases during their undergraduate training. However, although higher than in the general population, the prevalence of distress among medical students is similar to that among other university students. (b) Medical students' distress is independently related to endogenous factors (personality traits and life events) and to their perception of the medical learning environment. (c) Medical students do not display a measurable increase in moral reasoning, empathy and tolerance of uncertainty. (d) Students' wellbeing, moral development, reflectivity and tolerance of uncertainty have been shown to be interrelated, and associated with clinical performance.

CONCLUSIONS

The findings of this review endorse the concerns about the wellbeing and development of undergraduate medical students. The design of the reviewed studies does not permit inferences about causality. Yet, these findings are consistent with the hypothesis that medical training causes emotional distress that delays students' development and affects their clinical performance.

Test anxiety and academic performance in chiropractic students

Objective : We assessed the level of students' test anxiety, and the relationship between test anxiety and academic performance. Methods : We recruited 166 third-quarter students. The Test Anxiety Inventory (TAI) was administered to all participants. Total scores from written examinations and objective structured clinical examinations (OSCEs) were used as response variables. Results : Multiple regression analysis shows that there was a modest, but statistically significant negative correlation between TAI scores and written exam scores, but not OSCE scores. Worry and emotionality were the best predictive models for written exam scores. Mean total anxiety and emotionality scores for females were significantly higher than those for males, but not worry scores. Conclusion : Moderate-to-high test anxiety was observed in 85% of the chiropractic students examined. However, total test anxiety, as measured by the TAI score, was a very weak predictive model for written exam performance. Multiple regression analysis demonstrated that replacing total anxiety (TAI) with worry and emotionality (TAI subscales) produces a much more effective predictive model of written exam performance. Sex, age, highest current academic degree, and ethnicity contributed little additional predictive power in either regression model. Moreover, TAI scores were not found to be statistically significant predictors of physical exam skill performance, as measured by OSCEs.

Teaching empathy to medical students: an updated, systematic review

PURPOSE

Some research shows that empathy declines during medical school. The authors conducted an updated, systematic review of the literature on empathy-enhancing educational interventions in undergraduate medical education.

METHOD

The authors searched PubMed, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science (January 1, 2004 through March 19, 2012) using key words related to undergraduate medical education and empathy. They independently selected and reviewed all English-language articles that described an educational intervention designed to promote empathy in medical students, assessing the quality of the quantitative studies using the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

The authors identified and reviewed the full texts of 18 articles (15 quantitative and 3 qualitative studies). Included interventions used one or more of the following-patient narrative and creative arts (n=7), writing (n=3), drama (n=1), communication skills training (n=4), problem-based learning (n=1), interprofessional skills training (n=1), patient interviews (n=4), experiential learning (n=2), and empathy-focused training (n=1). Fifteen articles reported significant increases in empathy. Mean effect size was 0.23. Mean MERSQI score was 10.13 (range 6.5-14).

CONCLUSIONS

These findings suggest that educational interventions can be effective in maintaining and enhancing empathy in undergraduate medical students. In addition, they highlight the need for multicenter, randomized controlled trials, reporting long-term data to evaluate the longevity of intervention effects. Defining empathy remains problematic, and the authors call for conceptual clarity to aid future research.

Walking a fine line: is it possible to remain an empathic physician and have a hardened heart?

Establishing an empathic physician-patient relationship is an essential physician skill. This chapter discusses the sexually dimorphic aspects of the neural components involved in affective and cognitive empathy, and examines why men and women medical students or physicians express different levels of empathy. Studies reveal levels of medical student affective or cognitive empathy can help reveal which medical specialty a student will enter. The data show students or physicians with higher empathy enter into specialties characterized by large amounts of patient contact and continuity of care; and individuals with lower levels of empathy desire specialties having little or no patient contact and little to no continuity of care. Burnout and stress can decrease the empathy physicians had when they first entered medical school to unacceptable levels. Conversely, having a too empathetic physician can let patient conditions and reactions interfere with the ability to provide effective care. By learning to blunt affective empathic responses, physicians establish a certain degree of empathic detachment with the patient in order to provide objective care. However, a physician must not become so detached and hardened that their conduct appears callous, because it is still important for physicians, especially those in specialties with a large amount of patient contact, to use empathic communication skills.

Measurement of empathy levels in undergraduate paramedic students

INTRODUCTION

Paramedics rely on establishing a health provider-patient relationship with patients that promotes two-way communication, patient satisfaction, and facilitates appropriate patient assessment and treatment. Paramedics also must have an ability to empathize with patients and their family members in order to develop a successful health provider-patient relationship. The objective of this study was to assess paramedics' empathy and attitudes toward patients with specific conditions.

METHODS

This was a cross-sectional study using a convenience sample of first-, second-, and third-year, Australian undergraduate paramedic students. Student empathy levels were assessed using two standardized self-reporting instruments: the Jefferson Scale of Physician Empathy (JSPE) Health Professional (HP) version and the Medical Condition Regard Scale (MCRS).

RESULTS

A total of 94 paramedic students participated in the study. The JSPE demonstrated that male paramedic students had higher mean empathy scores than did female paramedic students (113.25 and 107.5, respectively; P = .042). The JSPE empathy level scores were lowest among first-year paramedic students (mean = 107.53); age was not found to be a significant variable on empathy scores. The Medical Condition Regard Scale revealed lowest scores in compassion towards substance abuse (mean = 46.42).

CONCLUSIONS

The results of this study provide the discipline of paramedic health care with useful data, and provide students, academics, and other educators with important information regarding the improvement of the health provider-patient relationship and paramedic education curriculum development.

Personality types and specialist choices in medical students

BACKGROUND

Research on the correlation between personality and students' specialty choice is helpful in their career counselling process and in predicting the future distribution of the specialties in a country.

AIMS

This study is the first of its kind in the Arab world. The research questions were: (1) What is the influence of gender on the personality profiles of medical students? (2) What are the personality profiles of students categorized according to their preferred specialist choices? (3) What are the preferred career choices of students categorized according to the stage of their medical education?

METHOD

A cross-sectional study was performed at King Khalid University Medical School including 590 students during the academic year 2010-2011. A long version of the Zuckerman-Kuhlman personality questionnaire measuring five personality factors was used. Students were also asked for their specialty interests. Students were asked by means of a written questionnaire.

RESULTS

Study response was 92.5%. Surgery was the single most popular specialty amongst both male and female students. Males had significantly higher scores on the 'impulsive sensation seeking' scale and students preferring a surgery specialty had the highest score on the 'impulsive sensation seeking', 'neuroticism-anxiety', 'aggression-hostility' and 'sociability' scales. Hospital-based, surgical and primary care specialties became more popular as students progressed through their undergraduate years.

CONCLUSIONS

Different personality types have distinct preferences in medical students' choice of careers. Personality and specialty choice research can enhance career counselling of medical students and fresh graduates. This also has implications for predicting the specialty distribution of the future health careers.

Measurement and correlates of empathy among female Japanese physicians

BACKGROUND

The measurement of empathy is important in the assessment of physician competence and patient outcomes. The prevailing view is that female physicians have higher empathy scores compared with male physicians. In Japan, the number of female physicians has increased rapidly in the past ten years. In this study, we focused on female Japanese physicians and addressed factors that were associated with their empathic engagement in patient care.

METHODS

The Jefferson Scale of Empathy (JSE) was translated into Japanese by using the back-translation procedure, and was administered to 285 female Japanese physicians. We designed this study to examine the psychometrics of the JSE and group differences among female Japanese physicians.

RESULTS

The item-total score correlations of the JSE were all positive and statistically significant, ranging from .20 to .54, with a median of .41. The Cronbach's coefficient alpha was .81. Female physicians who were practicing in "people-oriented" specialties obtained a significantly higher mean empathy score than their counterparts in "procedure-" or "technology-oriented" specialties. In addition, physicians who reported living with their parents in an extended family or living close to their parents, scored higher on the JSE than those who were living alone or in a nuclear family.

CONCLUSIONS

Our results provide support for the measurement property and reliability of the JSE in a sample of female Japanese physicians. The observed group differences associated with specialties and living arrangement may have implications for sustaining empathy. In addition, recognizing these factors that reinforce physicians' empathy may help physicians to avoid career burnout.

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.

Expected benefits of streamlining undergraduate medical education by early commitment to specific medical specialties

Undergraduate medical education is too long; it does not meet the needs for physicians' workforce; and its content is inconsistent with the job characteristics of some of its graduates. In this paper we attempt to respond to these problems by streamlining medical education along the following three reforms. First, high school graduates would be eligible for undergraduate medical education programs of 4 years duration. Second, medical school applicants would be required to commit themselves to a medical specialty and choose one of four undergraduate paths: (1) "Interventions/consultations" path that would prepare its graduates for residencies in secondary and tertiary specialties, such as cardiology and surgery, (2) "continuous patient care" path for primary care specialties, such as family medicine and psychiatry, (3) "diagnostic laboratory medicine and biomedical research" path that would prepare for either laboratory-based careers, such as pathology, biochemistry and bacteriology, or research in e.g., immunology and molecular genetics, and (4) "epidemiology and public health" path that would include population-based research, preventive medicine and health care administration. Third, the content of each of these paths would focus on relevant learning outcomes, and medical school graduates would be eligible for residency training only in specialties included in their path. Hopefully, an early commitment to a medical specialty will reduce the duration of medical education, improve the regulation of physicians' workforce and adapt the curricular content to the future job requirements from medical school graduates.

Distress and empathy do not drive changes in specialty preference among US medical students

BACKGROUND

Although medical student specialty choices shape the future of the healthcare workforce, factors influencing changes in specialty preference during training remain poorly understood.

AIM

To explore if medical student distress and empathy predicts changes in students' specialty preference.

METHODS

A total of 858/1321 medical students attending five medical schools responded to surveys in 2006 and 2007. The survey included questions about specialty choice, burnout, depression, quality of life, and empathy.

RESULTS

A total of 26% (205/799) changed their specialty preference over 1 year. Depersonalization--an aspect of burnout--was the only distress variable associated with change in specialty preference (OR, odds ratio 0.962 for each 1-point increase in score, p = 0.03). Empathy at baseline and changes in empathy over the course of 1 year did not predict change in specialty preference (all p > 0.05). On multi-variable analysis, being a third year (OR 1.92), being male (OR 1.48), and depersonalization score (OR 0.962 for each point increase) independently predicted a change in specialty preference. Distress and empathy did not independently predict students' losing interest in primary care whereas being a fourth-year student (OR 1.83) and being female (OR 1.83) did.

CONCLUSION

Among those who did have a major change in their specialty preference, distress and empathy did not play a major role.

Reports of the decline of empathy during medical education are greatly exaggerated: a reexamination of the research

PURPOSE

Research is said to show that empathy declines during medical school and residency training. These studies and their results were examined to determine the extent of the decline and the plausibility of any alternative explanations.

METHOD

Eleven studies published from 2000 to 2008 which reported empathy at various stages of physician training were reexamined. Their results were transformed back to the original units of the rating scales to make results more interpretable by reporting them in the metric of the original anchors. Next, the relationship between empathy ratings and response rates were examined to see whether response bias was a plausible threat to the validity of the empathy decline conclusion.

RESULTS

The changes in mean empathy ranged across the 11 studies from a 0.1-point increase in empathy to a 0.5-point decrease, with an average of a 0.2-point decline for the 11 studies (ratings were on 5-point, 7-point, and 9-point scales). Mean ratings were similar in medical school and residency. Response rates were low and-where reported-declined on average about 26 percentage points.

CONCLUSIONS

Reexamination revealed that the evidence does not warrant the strong, disturbing conclusion that empathy declines during medical education. Results show a very weak decline in mean ratings, and even the weak decline is questionable because of the low and varying response rates. Moreover, the empathy instruments are self-reports, and it isn't clear what they measure-or whether what they measure is indicative of patients' perceptions and the effectiveness of patient care.

The prevalence, causes, and consequences of experiencing a life crisis during medical school

BACKGROUND

Little is known about the prevalence, causes, and consequences of experiencing a major life crisis during medical school.

PURPOSE

The objective is to describe the prevalence, causes, and consequences through internship of experiencing a major life crisis while enrolled as a medical student at Uniformed Services University (USU).

METHOD

USU graduates from 1980 to 1999 were surveyed regarding their experiences at USU and career milestones. Predictor markers were obtained from the USU Admissions, Promotions, and Registrar's office. Outcome data were derived from a survey of intern program directors from the years 1993 to 1999.

RESULTS

There were 1,807 (67%) of USU graduates who responded to our survey. There were 394 (22%) who reported experiencing a major life crisis during medical school. Graduates reporting a major life crisis performed slightly poorer in terms of basic science GPAs (2.95 vs. 2.85, p <.001), USMLE exam scores, and performance ratings by their program directors than did graduates who did not experience a crisis.

CONCLUSIONS

A large fraction of medical students experience major life crises. The effects of these crises may persist throughout internship.

Empathy and its correlates in Iranian physicians: A preliminary psychometric study of the Jefferson Scale of Physician Empathy

BACKGROUND

Empathy is one of the fundamental factors in patient care that is beneficial to both patient and physician.

AIMS

To assess the psychometric properties of the Persian version of the Jefferson Scale of Physician Empathy (JSPE) in a sample of Iranian physicians and examine its correlates.

METHOD

Two hundred and seven general physicians completed the JSPE. The associations of empathy scores with demographic characteristics and practice-related variables were examined.

RESULTS

The scale showed an acceptable internal consistency (α = 0.78). Three of six extracted factors were considered as prominent based on the scree test, which were similar to those obtained in the US samples. Women scored higher than men. Empathy improved with increasing practice experiences. Other practice-related variables did not show a significant association with empathy.

CONCLUSIONS

Results support the construct and criterion-related validities and reliability of the Persian version of the JSPE. Score difference between Iranian and American samples may not reflect a genuine difference in empathy trait and can be explained by cultural factors.

Empathy in Iranian medical students: A preliminary psychometric analysis and differences by gender and year of medical school

BACKGROUND

It has been well documented that effective empathic communication in the context of patient care is associated with improved health care outcomes. However, the emphasis given to empathy in medical education in Iran is limited, and the state of such teaching is unknown in many countries.

AIMS

To determine the psychometric properties of an Iranian translation of the Jefferson Scale of Physician Empathy (JSPE) among medical students, and to examine the differences on mean empathy scores by gender and the different years of medical school.

METHOD

A cross-sectional study was conducted among medical students. Data analysis was based on 181 questionnaires. Principal component analysis (PCA) with Varimax rotation was used to identify the number and composition of components constituting the developed constructs.

RESULTS

The PCA yielded three factors: Compassionate care, perspective-taking, and the ability to walk in the patient's shoes. No statistically significant differences in the empathy means scores were found by gender and the different years of medical school.

CONCLUSIONS

The Persian version of JSPE is a psychometrically sound instrument to measure empathy. Cultural backgrounds and pedagogical practice may influence medical students' attitudes towards empathy. Some recommendations are made, and the study limitations are discussed.

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.

Values parents apply to decision-making regarding delivery room resuscitation for high-risk newborns

OBJECTIVE

The aim of this study was to characterize parental decision-making regarding delivery room resuscitation for infants born extremely prematurely or with potentially lethal congenital anomalies.

METHODS

This was a qualitative multicenter study. We identified English-speaking parents at 3 hospitals whose infants had died as a result of extreme prematurity or lethal congenital anomalies in 1999-2005. Parents were interviewed about their prenatal decision-making. Maternal medical charts were reviewed for documented discussions regarding delivery room resuscitation. Subject enrollment was stopped when saturation of themes was achieved.

RESULTS

Twenty-six mothers of infants were interviewed. All parents wanted to participate to some degree in decisions regarding delivery room resuscitation. Few parents recalled discussing options for delivery room resuscitation with physicians, and even fewer recalled being offered the option of comfort care, even when these discussions were documented in the medical chart. Parents did not report physicians' predictions of morbidity and death to be central to their decision-making. Religion, spirituality, and hope guided decision-making for most parents. Some parents felt that they had not made any decisions regarding resuscitation and instead "left things in God's hands." These parents typically were documented by staff members to "want everything done."

CONCLUSIONS

The values that parents find most important during decision-making regarding delivery room resuscitation may not be addressed routinely in prenatal counseling. Parents and physicians may have different interpretations of what is discussed and what decisions are made. Future work should investigate whether physicians can be trained to address effectively parents' values during the decision-making process and whether addressing these values may improve physician-parent communication and lead to better postdecision outcomes for parents.

Is there hardening of the heart during medical school?

PURPOSE

To determine whether vicarious empathy (i.e., to have a visceral empathic response, versus role-playing empathy) decreases, and whether students choosing specialties with greater patient contact maintain vicarious empathy better than do students choosing specialties with less patient contact.

METHOD

The Balanced Emotional Empathy Scale was administered at the beginning of each academic year at the University of Arkansas for Medical Sciences for four classes, 2001-2004. Students also reported their gender and specialty choice. Specialty choice was classified as core (internal medicine, family medicine, obstetrics-gynecology, pediatrics, and psychiatry) or noncore (all other specialties).

RESULTS

Vicarious empathy significantly decreased during medical education (P < .001), especially after the first and third years. Students choosing core careers had higher empathy than did those choosing noncore careers. Men choosing core careers initially had empathy exceeding population norms, but their empathy fell to be comparable with that of norms by the end of their third year. The empathy of men choosing noncore careers was comparable with that of norms. Women choosing core careers had empathy scores comparable with those of norms, but the scores of women choosing noncore careers fell below those of the norms by their second year.

CONCLUSIONS

The findings suggest that undergraduate medical education may be a major determinant differentially affecting the vicarious empathy of students on the basis of gender and/or specialty choice. The greatest impact occurred in men who chose noncore specialties. The significant decrease in vicarious empathy is of concern, because empathy is crucial for a successful physician-patient relationship.

Personality and specialty interest in medical students

BACKGROUND

Research on the relationship between personality and specialty interest is important because of its implications in student career counseling and in forecasting future specialty distribution.

AIM

This study was designed to test the following hypotheses: 1. Students interested in 'surgical' specialties would obtain higher scores on a measure of 'impulsive sensation seeking' and lower scores on a measure of 'neuroticism-anxiety'. 2. Students interested in 'hospital-based' specialties would score lower on a measure of 'sociability' whereas those interested in 'primary care' would score higher on this measure. In addition to these two hypotheses, gender differences on personality were also examined.

METHOD

Study participants were 1,076 students who matriculated at Jefferson Medical College between 2002 to 2006. A short version of the Zuckerman-Kuhlman personality questionnaire (ZKPQ) measuring five personality factors of 'impulsive sensation Seeking', 'neuroticism-anxiety', 'aggression-hostility', 'sociability', and 'activity' was completed by research participants at the beginning of medical school. Students were also asked to note their specialty interests.

RESULTS

Multivariate statistical analyses confirmed the first and partially confirmed the second research hypotheses. Results also showed that men scored higher on 'impulsive sensation seeking,' and women outscored men in the 'neuroticism-Anxiety' and 'activity' scales.

CONCLUSIONS

Findings suggest that information about the personalities of medical students can help to predict their career interests. Implications for career counseling are discussed.