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Ghorbani B, Jackson AC, Dehghan-Nayeri N, Bahramnezhad F. Standardized patients' experience of participating in medical students' education: a qualitative content analysis. BMC MEDICAL EDUCATION 2024; 24:586. [PMID: 38807118 PMCID: PMC11134940 DOI: 10.1186/s12909-024-05531-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 05/07/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Standardized patients are considered a significant educational method in medical sciences and have been successfully employed for many years. This study was conducted with the aim of explaining the experience of standardized patients participating in the education of medical student. METHOD A qualitative content analysis approach was used. This study was conducted at Standardized Patient Center, Tehran University of Medical Sciences, Tehran, Iran, May to February 2022. Fifteen standard patients were selected through purposive sampling with maximum variation. Semi-structured, in-depth, face-to-face interviews were conducted with standard patients. The average duration of the interviews was 60 to 90 min. Data were transcribed and analyzed using the Graneheim and Lundman approach. RESULTS A passport for the future and duality of feelings were the two main themes identified in this study with six subthemes. One of the main themes was passport for the future with subthemes creative, participation in educating future generation, reflection and another theme was duality of feeling with subthemes feeling of value, guilty conscience, and fear of judgment by others. CONCLUSION The participants expressed having mixed feelings about their role as standard patients. They felt conflicted because they were compensated for their participation, which made them worry about being judged by others and feel guilty about taking the fee. Therefore, it is recommended to conduct further studies in this area.
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Affiliation(s)
- Banafsheh Ghorbani
- Nursing department, Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Alun C Jackson
- Australian Centre for Heart Health, Melbourne, Australia
- Faculty of Health, Deakin University, Geelong, Australia
- Centre on Behavioural Health, Hong Kong University, Sandy Bay, Hong Kong, China
| | - Nahid Dehghan-Nayeri
- Department of Nursing Management, Nursing and Midwifery Care Research Center,School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Bahramnezhad
- Department of Critical Care Nursing, Nursing and Midwifery Care Research Center, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat st, Tohid sq, Tehran, I.IRAN141973317, Iran.
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Hamilton A. Artificial Intelligence and Healthcare Simulation: The Shifting Landscape of Medical Education. Cureus 2024; 16:e59747. [PMID: 38840993 PMCID: PMC11152357 DOI: 10.7759/cureus.59747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 06/07/2024] Open
Abstract
The impact of artificial intelligence (AI) will be felt not only in the arena of patient care and deliverable therapies but will also be uniquely disruptive in medical education and healthcare simulation (HCS), in particular. As HCS is intertwined with computer technology, it offers opportunities for rapid scalability with AI and, therefore, will be the most practical place to test new AI applications. This will ensure the acquisition of AI literacy for graduates from the country's various healthcare professional schools. Artificial intelligence has proven to be a useful adjunct in developing interprofessional education and team and leadership skills assessments. Outcome-driven medical simulation has been extensively used to train students in image-centric disciplines such as radiology, ultrasound, echocardiography, and pathology. Allowing students and trainees in healthcare to first apply diagnostic decision support systems (DDSS) under simulated conditions leads to improved diagnostic accuracy, enhanced communication with patients, safer triage decisions, and improved outcomes from rapid response teams. However, the issue of bias, hallucinations, and the uncertainty of emergent properties may undermine the faith of healthcare professionals as they see AI systems deployed in the clinical setting and participating in diagnostic judgments. Also, the demands of ensuring AI literacy in our healthcare professional curricula will place burdens on simulation assets and faculty to adapt to a rapidly changing technological landscape. Nevertheless, the introduction of AI will place increased emphasis on virtual reality platforms, thereby improving the availability of self-directed learning and making it available 24/7, along with uniquely personalized evaluations and customized coaching. Yet, caution must be exercised concerning AI, especially as society's earlier, delayed, and muted responses to the inherent dangers of social media raise serious questions about whether the American government and its citizenry can anticipate the security and privacy guardrails that need to be in place to protect our healthcare practitioners, medical students, and patients.
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Affiliation(s)
- Allan Hamilton
- Artificial Intelligence Division, Arizona Simulation Technology and Education Center (ASTEC) University of Arizona, Tucson, USA
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3
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Benmaarmar S, Bourkhime H, El Harch I, El Rhazi K. The level and determinants of empathy among medical students from Arabic speaking countries: A systematic review. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc15. [PMID: 38779697 PMCID: PMC11106575 DOI: 10.3205/zma001670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/13/2023] [Accepted: 02/09/2024] [Indexed: 05/25/2024]
Abstract
Aim This systematic review aims to investigate the level of empathy among medical students in Arabic speaking countries and analyze its determinants. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2022 (PRISMA), the authors conducted a systematic research of studies investigating the level and determinants of empathy among medical students in Arabic speaking countries. The databases PubMed, Scopus, web of science and google scholar were searched. Results Ten studies from six countries were included. Nine of which had a cross-sectional study design. Level of empathy was assessed using the Jefferson scale in seven studies and using the Interpersonal Reactivity Index in two studies. The mean of empathy scale ranges between 97.65±14.10 to 106.55±19.16 in studies used the Jefferson scale of empathy. The associated factors with empathy were gender; high levels of empathy were reported in female students. Other factors are explored in relation with empathy such as specialty preference (surgery or medicine, "people-orientated" specialties or ''technology-oriented specialties''), family factors (marital status of parents, satisfactory relationship with parents, parents level of education and household income) and factors related to medical education (academic performance, year of study and type of curriculum) but the results are heterogeneous. Conclusion This is the first systematic review, which illustrated the determinants of empathy in Arabic medical students. Our results revealed varied results on empathy determinants. Further studies may guarantee a full exploration of this ability in order to improve the doctor-patient relationship and patient management in the Arab world.
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Affiliation(s)
- Soumaya Benmaarmar
- Sidi Mohamed Ben Abdellah University, Faculty of Medicine and Pharmacy of Fez, Department of Epidemiology, Clinical Research and Community Health, Fez, Morocco
| | - Hind Bourkhime
- Sidi Mohamed Ben Abdellah University, Faculty of Medicine and Pharmacy of Fez, Biostatistics and Informatics Unit, Department of Epidemiology, Clinical Research and Community Health, Fez, Morocco
| | - Ibtissam El Harch
- Sidi Mohamed Ben Abdellah University, Faculty of Medicine and Pharmacy of Fez, Department of Epidemiology, Clinical Research and Community Health, Fez, Morocco
| | - Karima El Rhazi
- Sidi Mohamed Ben Abdellah University, Faculty of Medicine and Pharmacy of Fez, Department of Epidemiology, Clinical Research and Community Health, Fez, Morocco
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Haruta J, Nakajima R, Monkawa T. Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey. BMC MEDICAL EDUCATION 2024; 24:399. [PMID: 38600531 PMCID: PMC11007881 DOI: 10.1186/s12909-024-05386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The use of simulated patients (SPs) to assess medical students' clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students' medical interview. METHODS This longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment's internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT's 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach's alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson's correlation coefficient. RESULTS Of the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach's alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity. CONCLUSIONS Evidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.
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Affiliation(s)
- Junji Haruta
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan.
| | - Rika Nakajima
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Toshiaki Monkawa
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
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Wang CXY, Pavlova A, Boggiss AL, O'Callaghan A, Consedine NS. Predictors of Medical Students' Compassion and Related Constructs: A Systematic Review. TEACHING AND LEARNING IN MEDICINE 2023; 35:502-513. [PMID: 35930256 DOI: 10.1080/10401334.2022.2103816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Phenomenon: Compassion, and related constructs such as empathy, are core values in healthcare, with known benefits for both patients and staff. Yet research on the factors that affect compassion and compassion-related constructs remains scattered. This review systematizes and synthesizes studies investigating the predictors of compassion and related constructs among medical students, allowing for a better understanding of the factors that both positively and negatively contribute to the development of compassionate future physicians. Approach: A systematic review of 12 databases for studies from database inception up until April 2020 was conducted. Non-peer-reviewed literature and studies in which >50% of the sample were non-medical students were excluded. Intervention studies were also out of the scope of this review. We assessed risk of bias and confidence in the findings using standardized tools. Data were categorized within the Transactional Model of Physician Compassion, a framework in which compassion is influenced by personal (student), environmental, patient/family, and clinical factors. Findings: Of 14,060 retrieved articles, 222 studies were included. Of these, 95% studied student factors, but only 25% studied environmental, 9% studied patient, and 6% studied clinical factors. Predictors of greater compassion included maturity; work and life experiences; personality traits of openness to experience and agreeableness; skills such as perspective taking, reflection, and mindfulness; and positive role modeling. Conversely, negative attitudes/emotions, burnout, stress, detachment, operating in cultures prioritizing knowledge and efficiency over humanistic care, negative role models, time constraints, and heavy workloads predicted lower compassion. Patient-related factors included "difficult" and "noncompliant" patients or those perceived as responsible for their illness. Overall, 60% of studies had a serious risk of bias, particularly confounding and participant selection biases. Insights: Medical student compassion is predicted by a wide range of factors relating to the student, their training environment, their patients, and the clinical situation. However, existing research has largely focused on student factors (e.g., sociodemographic and dispositional traits), many of which are not amenable to intervention. Skills such as perspective taking, reflection, and mindfulness are associated with higher compassion and may present opportunities for intervention. There is also strong evidence that environmental factors shape students' compassion. Researchers and educators should continue to explore the impact of patient and clinical factors on students' compassion. Studies remain at high risk of bias.
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Affiliation(s)
- Clair X Y Wang
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Alina Pavlova
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Anna L Boggiss
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Anne O'Callaghan
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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van Dijke J, van Nistelrooij I, Bos P, Duyndam J. Engaging otherness: care ethics radical perspectives on empathy. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:385-399. [PMID: 37171745 PMCID: PMC10425473 DOI: 10.1007/s11019-023-10152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023]
Abstract
Throughout the years, care ethicists have raised concerns that prevalent definitions of empathy fail to adequately address the problem of otherness. They have proposed alternative conceptualizations of empathy that aim to acknowledge individual differences, help to extend care beyond one's inner circle, and develop a critical awareness of biases and prejudices. We explore three such alternatives: Noddings' concept of engrossment, Meyers' account of broad empathy, and Baart's concept of perspective-shifting. Based on these accounts, we explain that care ethics promotes a conceptualization of empathy that is radical in its commitment to engage otherness and that is characterized by being: (1) receptive and open, (2) broad and deep in scope, (3) relational and interactive, (4) mature and multifaceted, (5) critical and reflective, (6) disruptive and transformative. This type of empathy is both demanding and rewarding, as it may inspire health professionals to rethink empathy, its challenges, and its contribution to good care and as it may enrich empathy education and professional empathy practices in health care.
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Affiliation(s)
- Jolanda van Dijke
- University of Humanistic Studies, Kromme Nieuwegracht 29, Utrecht, 3512 HD The Netherlands
| | | | - Pien Bos
- Research Methodology, University of Humanistic Studies, Utrecht, The Netherlands
| | - Joachim Duyndam
- Philosophy, University of Humanistic Studies, Utrecht, The Netherlands
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Al-Hashimi K, Said UN, Khan TN. Formative Objective Structured Clinical Examinations (OSCEs) as an Assessment Tool in UK Undergraduate Medical Education: A Review of Its Utility. Cureus 2023; 15:e38519. [PMID: 37288230 PMCID: PMC10241740 DOI: 10.7759/cureus.38519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
The Objective Structured Clinical Examination (OSCE) is a globally established clinical examination; it is often considered the gold standard in evaluating clinical competence within medicine and other healthcare professionals' educations alike. The OSCE consists of a circuit of multiple stations testing a multitude of clinical competencies expected of undergraduate students at certain levels throughout training. Despite its widespread use, the evidence regarding formative renditions of the examination in medical training is highly variable; thus, its suitability as an assessment has been challenged for various reasons. Classically, Van Der Vleuten's formula of utility has been adopted in the appraisal of assessment methods as means of testing, including the OSCE. This review aims to provide a comprehensive overview of the literature surrounding the formative use of OSCEs in undergraduate medical training, whilst specifically focusing on the constituents of the equation and means of mitigating factors that compromise its objectivity.
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Affiliation(s)
| | - Umar N Said
- Trauma and Orthopaedics, Huddersfield Royal Infirmary, Huddersfield, GBR
| | - Taherah N Khan
- General Medicine, Worcestershire Acute Hospital NHS Trust, Worcestershire, GBR
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8
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John JT, Gowda D, Schlair S, Hojsak J, Milan F, Auerbach L. After the Discontinuation of Step 2 CS: A Collaborative Statement from the Directors of Clinical Skills Education (DOCS). TEACHING AND LEARNING IN MEDICINE 2023; 35:218-223. [PMID: 35287502 DOI: 10.1080/10401334.2022.2039154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Issue: The United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills Examination (Step 2 CS), the only clinical skills competency testing required for licensure in the United States, has been discontinued. Evidence: This exam, though controversial, propelled a movement emphasizing the value of clinical skills instruction and assessment in undergraduate medical education. While disappointed by the loss of this national driver that facilitated standardization of clinical skills education, the Directors of Clinical Skills Education (DOCS) see prospects for educational innovation and growth. DOCS is a national organization and inclusive community of clinical skills education leaders. This statement from DOCS regarding the discontinuation of USMLE Step 2 CS has been informed by DOCS meetings, listserv discussions, an internal survey, and a review of recent literature. Implications: Rigorous clinical skills assessment remains central to effective and patient-centered healthcare. DOCS shares specific concerns as well as potential solutions. Now free from the external pressure to prepare students for success on Step 2 CS, clinical skills educators can reprioritize content and restructure clinical skills programs to best meet the needs of learners and the ever-evolving healthcare landscape. DOCS, as an organization of clinical skills leaders, makes the following recommendations: 1) Collaboration amongst institutions must be prioritized; clinical skills assessment consortia should be expanded. 2) Governing, accrediting, and licensing organizations should leverage their influence to support and require high quality clinical skills assessments. 3) UME clinical skills leaders should develop ways to identify students who perform with exceptional, borderline, and poor clinical skills at their local institutions. 4) UME leadership should fully commit resources and curricular time to graduate students with excellent clinical skills.
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Affiliation(s)
- Janice Thomas John
- Science Education and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Deepthiman Gowda
- Medical Education and Medicine, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Sheira Schlair
- Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joanne Hojsak
- Pediatrics and Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Felise Milan
- Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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Fluet A, Essakow J, Ju M. Standardized Patients' Perspectives on Bias in Student Encounters. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S29-S34. [PMID: 35947468 DOI: 10.1097/acm.0000000000004925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Standardized patient (SP) encounters are widely used in health professional education to evaluate trainees' clinical skills. Prior literature suggests that bias can influence the evaluations of student learners in SP-student encounters. Understanding how SPs perceive bias in their work and how they view their role in mitigating or perpetuating bias in simulation is an important first step in addressing bias in the SP-student encounter. METHOD Researchers designed a qualitative interview study and conducted 16 semistructured interviews with SPs at the University of California, San Francisco Kanbar Simulation Center from July through September of 2020. Participants were selected using purposive sampling. The interviews were transcribed and analyzed by researchers using inductive thematic analysis. Researchers met iteratively to reconcile codes and identify themes. RESULTS SPs identified bias occurring in multiple directions: SP-to-student, student-to-SP, student-to-character, and SP-to-character. SPs were hesitant to label their own biases and instead used words such as "comfort" or "preference." SPs reported little bias from students, because students were being evaluated and therefore behaving carefully. Additionally, SPs perceived bias in the implementation of health care simulation, which manifests as underrepresentation of certain groups amongst actors and character descriptions. Most SPs felt that they should play a role in mitigating bias in SP-student encounters, including addressing bias that occurs, challenging stereotypes, teaching about cultural differences, and/or being conscious of bias in their assessments of learners. CONCLUSIONS In the SP-student encounter, bias can occur on many levels and between many individuals, including between the SP and the character they are portraying. Identifying the areas in which bias can exist can help simulation educators mitigate bias.
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Affiliation(s)
- Angelina Fluet
- A. Fluet is a medical student, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Jenna Essakow
- J. Essakow is a clinical fellow, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Mindy Ju
- M. Ju is assistant clinical professor, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, and associate education director, University of California, San Francisco Kanbar Center for Simulation, San Francisco, California
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10
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Kennedy AB, Riyad CNY, Ellis R, Fleming PR, Gainey M, Templeton K, Nourse A, Hardaway V, Brown A, Evans P, Natafgi N. Evaluating a Global Assessment Measure Created by Standardized Patients for the Multiple Mini Interview in Medical School Admissions: Mixed Methods Study. J Particip Med 2022; 14:e38209. [PMID: 36040776 PMCID: PMC9472042 DOI: 10.2196/38209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background Standardized patients (SPs) are essential stakeholders in the multiple mini interviews (MMIs) that are increasingly used to assess medical school applicants’ interpersonal skills. However, there is little evidence for their inclusion in the development of instruments. Objective This study aimed to describe the process and evaluate the impact of having SPs co-design and cocreate a global measurement question that assesses medical school applicants’ readiness for medical school and acceptance status. Methods This study used an exploratory, sequential, and mixed methods study design. First, we evaluated the initial MMI program and determined the next quality improvement steps. Second, we held a collaborative workshop with SPs to codevelop the assessment question and response options. Third, we evaluated the created question and the additional MMI rubric items through statistical tests based on 1084 applicants’ data from 3 cohorts of applicants starting in the 2018-2019 academic year. The internal reliability of the MMI was measured using a Cronbach α test, and its prediction of admission status was tested using a forward stepwise binary logistic regression. Results Program evaluation indicated the need for an additional quantitative question to assess applicant readiness for medical school. In total, 3 simulation specialists, 2 researchers, and 21 SPs participated in a workshop leading to a final global assessment question and responses. The Cronbach α’s were >0.8 overall and in each cohort year. The final stepwise logistic model for all cohorts combined was statistically significant (P<.001), explained 9.2% (R2) of the variance in acceptance status, and correctly classified 65.5% (637/972) of cases. The final model consisted of 3 variables: empathy, rank of readiness, and opening the encounter. Conclusions The collaborative nature of this project between stakeholders, including nonacademics and researchers, was vital for the success of this project. The SP-created question had a significant impact on the final model predicting acceptance to medical school. This finding indicates that SPs bring a critical perspective that can improve the process of evaluating medical school applicants.
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Affiliation(s)
- Ann Blair Kennedy
- Biomedical Sciences Department, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
- Family Medicine Department, Prisma Health, Greenville, SC, United States
| | - Cindy Nessim Youssef Riyad
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
- Hospital Based Accreditation, Accreditation Council of Graduate Medical Education, Chicago, IL, United States
| | - Ryan Ellis
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Perry R Fleming
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
- School of Medicine Columbia, University of South Carolina, Columbia, SC, United States
| | - Mallorie Gainey
- School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Kara Templeton
- Prisma Health-Upstate Simulation Center, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Anna Nourse
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
| | - Virginia Hardaway
- Admissions and Registration, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - April Brown
- Prisma Health-Upstate Simulation Center, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Pam Evans
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
- Prisma Health-Upstate Simulation Center, School of Medicine Greenville, University of South Carolina, Greenville, SC, United States
| | - Nabil Natafgi
- Patient Engagement Studio, University of South Carolina, Greenville, SC, United States
- Health Services, Policy, Management Department, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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11
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Ahuja TK, John JT, Olvet DM, Crilly C, Petrizzo MC, Weiner JS, Pawelczak M. Teaching Second-Year Medical Students How to Counsel Pediatric Patients with Unhealthy Body Mass Index. Child Obes 2022. [PMID: 35951010 DOI: 10.1089/chi.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Obesity affects the health and well-being of children globally. Despite recommendations to routinely screen children for obesity starting at age 6 years, physicians do not consistently address weight or provide effective weight-management counseling. We developed an interactive session for second-year medical students with foundational knowledge and practical communication skills around partnership and discussion of pediatric healthy weight management. Students were administered a pre-/post-Likert survey to self-assess knowledge, comfort, and confidence in counseling patients and caregivers about weight management. Students' related counseling skills were assessed during a standardized patient encounter of a teen with rapid weight gain. The session successfully increased students' self-assessed knowledge, comfort, and confidence, and resulted in successful application of weight management skills in a simulated patient encounter. Utilization of empathy skills requires continued coaching. We propose incorporation of similar sessions into medical school curricula to address the pediatric obesity epidemic.
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Affiliation(s)
- Taranjeet Kalra Ahuja
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Janice Thomas John
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Doreen M Olvet
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Colin Crilly
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marie Cavuoto Petrizzo
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joseph S Weiner
- Department of Psychiatry, Medicine, and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Melissa Pawelczak
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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12
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Poon SC, Nellans K, Gorroochurn P, Chahine NO. Race, But Not Gender, Is Associated With Admissions Into Orthopaedic Residency Programs. Clin Orthop Relat Res 2022; 480:1441-1449. [PMID: 33229901 PMCID: PMC9278929 DOI: 10.1097/corr.0000000000001553] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/09/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Orthopaedic surgery is one of the most competitive but least diverse surgical specialties, with ever-increasing academic achievements (such as test scores) shown by applicants. Prior research shows that white applicants had higher United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge scores as well as higher odds of Alpha Omega Alpha status compared with Black, Hispanic, and other applicant groups. Yet, it still remains unknown whether differences in application metrics by race/ethnicity sufficiently explain the underrepresentation of certain racial or ethnic minority groups in orthopaedic residency programs. QUESTIONS/PURPOSES In this study, we sought to determine (1) the relative weight of academic variables for admission into orthopaedic residency, and (2) whether race and gender are independently associated with admission into an orthopedic residency. METHODS The Electronic Residency Application System (ERAS) data from the Association of American Medical Colleges (AAMC) and the National Board of Medical Examiners (NBME) of first-time MD applicants (n = 8966) for orthopaedic surgery residency positions in the United States and of admitted orthopaedic residents (n = 6218) from 2005 to 2014 were reviewed. This dataset is the first and most comprehensive of its kind to date in orthopaedic surgery. Academic metrics, such as USMLE Step 1 and Step 2 Clinical Knowledge scores, number of publications, Alpha Omega Alpha status, volunteer experiences, work experience, as well as race and gender, were analyzed using hierarchical logistic regression models. The first model analyzed the association of academic metrics with admission into orthopaedic residency. In the second model, we added race and gender and controlled for metrics of academic performance. To determine how well the models simulated the actual admissions data, we computed the receiver operating characteristics (ROC) including the area under curve (AUC), which measures the model's ability to simulate which applicants were admitted or not admitted, with an AUC = 1.0 representing a perfect simulation. The odds ratio and confidence interval of each variable were computed. RESULTS When only academic variables were analyzed in the first model, Alpha Omega Alpha status (odds ratio 2.12 [95% CI 1.80 to 2.50]; p < 0.001), the USMLE Step 1 score (OR 1.04 [95% CI 1.03 to 1.04]; p < 0.001), the USMLE Step 2 Clinical Knowledge score (OR 1.01 [95% CI 1.01 to 1.02]; p < 0.001), publication count (OR 1.04 [95% CI 1.03 to 1.05]; p < 0.001), and volunteer experience (OR 1.03 [95% CI 1.01 to 1.04]; p < 0.001) were associated with admissions into orthopaedics while work and research experience were not. This model yielded a good prediction of the results with an AUC of 0.755. The second model, in which the variables of race and gender were added to the academic variables, also had a good prediction of the results with an AUC of 0.759. This model indicates that applicant race, but not gender, is associated with admissions into orthopaedic residency. Applicants from Asian (OR 0.78 [95% CI 0.67 to 0.92]), Black (OR 0.63 [95% CI 0.51 to 0.77], Hispanic (OR 0.48 [95% CI 0.36 to 0.65]), or other race groups (OR 0.65 [95% CI 0.55 to 0.77]) had lower odds of admission into residency compared with white applicants. CONCLUSION Minority applicants, but not women, have lower odds of admission into orthopaedic surgery residency, even when accounting for academic performance metrics. Changes in the residency selection processes are needed to eliminate the lower admission probability of qualified minority applicants in orthopaedic residency and to improve the diversity and inclusion of orthopaedic surgery. Changes including increasing the diversity of the selection committee, bias training, blinding applications before review, removal of metrics with history of racial disparities from an interviewer's candidate profile before an interview, and use of holistic application review (where an applicants' experiences, attributes, and academic metrics are all considered) can improve the diversity landscape in training. In addition, cultivating an environment of inclusion will be necessary to address these long-standing trends in orthopaedic surgery. CLINICAL RELEVANCE Race, but not gender, is associated with the odds of acceptance into orthopaedic surgery residency despite equivalent academic metrics. Changes in residency selection processes are suggested to eliminate the lower admission probability of qualified minority applicants into orthopaedic residency and to improve the diversity and inclusion of orthopaedic surgery.
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Affiliation(s)
- Selina C Poon
- Orthopaedic Surgery Department, Shriners for Children Medical Center at Pasadena, Pasadena, CA, USA
| | - Kate Nellans
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nadeen O Chahine
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, NY, USA
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Radcliff KE, Leopold SS. Editor's Spotlight/Take 5: Race, But Not Gender, Is Associated With Admissions Into Orthopaedic Residency Programs. Clin Orthop Relat Res 2022; 480:1435-1440. [PMID: 35767820 PMCID: PMC9278934 DOI: 10.1097/corr.0000000000001627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Kris E Radcliff
- Associate Editor, Clinical Orthopaedics and Related Research® , Park Ridge, IL, USA
| | - Seth S Leopold
- Editor-in-Chief, Clinical Orthopaedics and Related Research® , Park Ridge, IL, PA, USA
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Blanco Canseco JM, Blanco Alfonso A, Caballero Martínez F, Hawkins Solís MM, Fernández Agulló T, Lledó García L, López Román A, Piñas Mesa A, Vara Ameigeiras EM, Monge Martín D. Medical empathy in medical students in Madrid: A proposal for empathy level cut-off points for Spain. PLoS One 2022; 17:e0267172. [PMID: 35604951 PMCID: PMC9126362 DOI: 10.1371/journal.pone.0267172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/03/2022] [Indexed: 11/18/2022] Open
Abstract
This study evaluates the degree of empathy among medical students and its influencing factors at three critical moments of their degree studies (beginning of first year and end of third and sixth years) as well as establishes low-, medium-, and high-empathy cut-off points to obtain valid and reliable results that can be extrapolated to the general population. This cross-sectional study of the eight (public and private) medical schools in the province of Madrid, used an electronic questionnaire with the Jefferson Scale of Empathy (JSE), Medical Student Well-Being Index, and other independent characteristics as measuring instruments. Of the 2,264 student participants, 1,679 (74.0%) were women, with a 50.7% participation rate. No significant differences were found in empathy levels by academic year. Regarding range, percentile and cut-off point tables were established to identify students with high, medium, and low empathy levels. Women (p<0.001), volunteer workers (p<0.001), and those preferring general specialties (internal medicine, psychiatry, pediatrics, or family medicine) scored higher on the JSE (p<0.02). Moreover, 41.6% presented high level of psychological distress. Women reported a lower well-being level and a higher risk of psychological distress (p = 0.004). In sum, the empathy of medical students in Madrid did not differ among the three critical moments of their university studies. The established cut-off points could be taken into account when accessing the medical degree and identifying students with low levels of empathy to implement curricular interventions to rectify this perceived deficiency. There was a high percentage of medical students with high levels of psychological distress.
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Affiliation(s)
- José Manuel Blanco Canseco
- School of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
- Valle de la Oliva Healthcare Centre, Majadahonda, Madrid, Spain
| | - Augusto Blanco Alfonso
- Reina Victoria Healthcare Centre, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | - Lourdes Lledó García
- Dean Faculty of Medicine and Health Sciences, Universidad de Alcalá, Madrid, Spain
| | | | | | | | - Diana Monge Martín
- School of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
- * E-mail:
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Serrada-Tejeda S, Martínez-Piedrola RM, Huertas-Hoyas E, Máximo-Bocanegra N, Trugeda-Pedrajo N, Rodríguez-Pérez MP, Sánchez-Herrera Baeza P, Pérez-de-Heredia-Torres M. Empathy in occupational therapy students: a cross-sectional study at a Spanish university. BMJ Open 2022; 12:e058821. [PMID: 35473733 PMCID: PMC9045041 DOI: 10.1136/bmjopen-2021-058821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Empathy is an important interpersonal skill and a fundamental component in the professional-patient relationship, being the basis for implementing person-centred practice. In several studies, a decrease in empathy levels throughout training in medicine, nursing or dentistry, among others, has been shown. There are few studies on the occupational therapy branch of healthcare. The aim was to determine the degree of empathy perceived by students of occupational therapy at a Spanish university, as well as to analyse the differences between empathy levels according to the different degree courses and gender. METHODS A descriptive cross-sectional study was designed with a sample of 221 occupational therapy students from a Spanish university. The Davis Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy-Health Profession Student's Spanish version (JSPE-HPS-S) were used as outcome measures. RESULTS According to the results found, high level of empathy was found on all dimension of the IRI (69.84 (9.80)) and the JSPE-HPS-S (122 (94-140)). Although high levels of empathy among occupational therapy students are observed in all degree courses, no significant differences were found between them. Statistically significant differences and a moderate effect size (r) were found between the variables according to the gender of the participants, with females showing greater empathy in the overall scores of the IRI as well as in the JSPE-HPS-S (p=0.002, r=0.212; p=0.001, r=0.327, respectively). CONCLUSIONS Empathy is an essential competence for the development of quality occupational therapy practice. According to the results and although occupational therapy students showed high levels of empathy, it is important to pay attention to the evolution of empathy and to provide students with learning experiences that prevent its possible decline.
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Murry LT, Reist JC, Fravel MA, Knockel LE, Witry MJ. An Exploratory Mixed Methods Study of Standardized Patient Comments on Empathy and Student Communication Scores. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:ajpe8642. [PMID: 34301573 PMCID: PMC8887057 DOI: 10.5688/ajpe8642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
Objective. To quantify student pharmacists' communication ability based on scores from standardized patient (SP) communication rubrics, describe and categorize SP comments about student empathy, and test the relationship between students' communication scores and empathy.Methods. A concurrent mixed methods research design was used to assess a graded performance-based assessment (PBA) of student pharmacists that had been conducted at one college of pharmacy. The PBA rubrics (n=218) completed by SPs contained 20 assessment items and space for open-ended feedback. Scoring categories for communication assessment included: yes, inconsistent, no, and not applicable (N/A). Descriptive statistics were calculated for rubric scores. Feedback from standardized patients was analyzed and used to categorize student interactions during the encounter as reflecting high empathy, mixed empathy, or low empathy. Kruskal-Wallis ANOVA was used to test the relationship between empathy category and communication score.Results. Standardized patients had written comments on 141 of the 218 rubrics (64.7%). The mean communication score was 39.0±1.6 (range, 31-40) out of a maximum 40 points. The total scores for the low, mixed, and high empathy category transformations were 6 (4.3%), 95 (67.4%), and 40 (28.4%), respectively. The results of the Kruskal-Wallis ANOVA were significant, suggesting that communication scores were different between empathy categories.Conclusion. There was a positive association between students' scores on communication rubrics and student empathy categorization, with student pharmacists exhibiting different levels of clinical empathy. While the PBA of interest was not specifically focused on empathy, SPs frequently provided feedback about empathy to students, suggesting that showing empathy during the encounter was important.
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Affiliation(s)
- Logan T Murry
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
| | - Jeffrey C Reist
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
| | | | - Laura E Knockel
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
| | - Mathew J Witry
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
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Joseph OR, Flint SW, Raymond-Williams R, Awadzi R, Johnson J. Understanding Healthcare Students' Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312771. [PMID: 34886495 PMCID: PMC8657581 DOI: 10.3390/ijerph182312771] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022]
Abstract
Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.
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Affiliation(s)
- Olivia Rochelle Joseph
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford BD9 6RJ, UK
- Correspondence:
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Scaled Insights, Nexus, University of Leeds, Leeds LS2 3AA, UK
| | | | - Rossby Awadzi
- Postgraduate Graduate Medical Education, Northwick Park Hospital, London HA1 3UJ, UK;
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford BD9 6RJ, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia
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18
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Heath JK, Dine CJ, LaMarra D, Cardillo S. The Impact of Trainee and Standardized Patient Race and Gender on Internal Medicine Resident Communication Assessment Scores. J Grad Med Educ 2021; 13:643-649. [PMID: 34721792 PMCID: PMC8527939 DOI: 10.4300/jgme-d-21-00106.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/12/2021] [Accepted: 06/03/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Standardized patient (SP) encounters are commonly used to assess communication skills in medical training. The impact of SP and resident demographics on the standardized communication ratings in residents has not been evaluated. OBJECTIVE To examine the impact of gender and race on SP assessments of internal medicine (IM) residents' communication skills during postgraduate year (PGY) 1. METHODS We performed a retrospective cohort study of all SP assessments of IM PGY-1 residents for a standardized communication exercise from 2012 to 2018. We performed descriptive analyses of numeric communication SP ratings by gender, race, and age (for residents and SPs). A generalized estimating equation model, clustered on individual SP, was used to determine the association of gender (among SP and residents) with communication ratings. A secondary analysis was performed to determine the impact of residents and SP racial concordance in communication scores. RESULTS There were 1356 SP assessments of 379 IM residents (199 male residents [53%] and 178 female residents [47%]). There were significant differences in average numeric communication rating (mean 3.40 vs 3.34, P = .009) by gender of resident, with higher scores in female residents. There were no significant interactions between SP and resident gender across the communication domains. There were no significant interactions noted with racial concordance between interns and SPs. CONCLUSIONS Our data demonstrate an association of resident gender on ratings in standardized communication exercises, across multiple communication skills. There was not an interaction impact for gender or racial concordance between SPs and interns.
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Affiliation(s)
- Janae K. Heath
- All authors are with the Perelman School of Medicine at the University of Pennsylvania
- Janae K. Heath, MD, MS, is Assistant Professor of Medicine, Department of Medicine
| | - C. Jessica Dine
- All authors are with the Perelman School of Medicine at the University of Pennsylvania
- C. Jessica Dine, MD, MS, is Associate Professor of Medicine, Department of Medicine
| | - Denise LaMarra
- All authors are with the Perelman School of Medicine at the University of Pennsylvania
- Denise LaMarra, MS, CHSE, is Director, Standardized Patient Program
| | - Serena Cardillo
- All authors are with the Perelman School of Medicine at the University of Pennsylvania
- Serena Cardillo, MD, is Professor of Medicine, Department of Medicine
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19
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Chrisman-Khawam LM, Manzi JA. Empathy in MedicineCultivating an Empathetic Professional Identity in Osteopathic Medical Students Through Service Learning: A Qualitative Analysis of Reflective Essays. J Osteopath Med 2021; 120:263-272. [PMID: 32227151 DOI: 10.7556/jaoa.2020.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Context The role of professional identity development has been established as a significant element of the "hidden curriculum" in medical education. While most programs do not contain explicit instruction on that topic, service learning initiatives are a popular trend in medical education that offer medical students early clinical experience and an opportunity to develop professional identity. Through intentional reflective practices, service learning can also promote empathy development, a critical component missing from current models. Objective To determine the role of service learning participation on the development of empathy and professional identity among osteopathic medical students. Methods Using a grounded theory method, the authors analyzed reflective essays from students who voluntarily participated in a service learning project that provided medical care to patients who are homeless. Essays were completed within 1 week of volunteer experience. Results The authors collected and analyzed 64 reflective essays from 55 students in this study. A review of the 64 texts yielded 5 coding domains and several subdomains. The codes revealed 4 major themes: (1) incoming attitudes, (2) transformative experiences, (3) empathy development, and (4) professional identity formation. Conclusions Structured service learning experiences provide students with an opportunity to develop an empathetic professional identity in the preclinical stage of medical education. This form of volunteer service is a transformative experience that challenges students' incoming perceptions and leads to the development of both empathy and professional identity.
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20
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Bukowski H, Ahmad Kamal NF, Bennett D, Rizzo G, O'Tuathaigh C. Association between dispositional empathy and self-other distinction in Irish and Belgian medical students: a cross-sectional analysis. BMJ Open 2021; 11:e048597. [PMID: 34521665 PMCID: PMC8442071 DOI: 10.1136/bmjopen-2020-048597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Physicians' cognitive empathy is associated with improved diagnosis and better patient outcomes. The relationship between self-reported and performance-based measures of cognitive empathic processes is unclear. DESIGN Cross-sectional analysis of the association between medical students' empathy scale scores and their empathic performance in a visuospatial perspective-taking (VPT) task. PARTICIPANTS Undergraduate medical students across two European medical schools (n=194). PRIMARY AND SECONDARY OUTCOME MEASURES Two self-report empathy and one performance-based perspective-taking outcome: Jefferson Scale of Physician Empathy (JSPE); Empathy Quotient (EQ); Samson's level-1 VPT task. RESULTS Higher scores on the 'standing in patient's shoes' subscale of the JSPE were associated with a lower congruency effect (as well as lower egocentric and altercentric biases) in the VPT (B=-0.007, 95% CI=-0.013 to 0.002, p<0.05), which reflects an association with better capacity to manage conflicting self-other perspectives, also known as self-other distinction. Lower egocentric bias was also associated with higher scores on the 'social skills' EQ subscale (B=-10.17, 95% CI=-17.98 to 2.36, p<0.05). Additionally, selection of a 'technique-oriented' clinical specialty preference was associated with a higher self-perspective advantage in the VPT, reflecting greater attentional priority given to the self-perspective. CONCLUSIONS We show that self-assessment scores are associated with selected performance-based indices of perspective taking, providing a more fine-grained analysis of the cognitive domain of empathy assessed in medical student empathy scales. This analysis allows us to generate new critical hypotheses about the reasons why only certain self-report empathy measures (or their subscales) are associated with physicians' observed empathic ability.
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Affiliation(s)
- Henryk Bukowski
- Psychological Sciences Research Institute, Universite catholique de Louvain, Louvain-la-Neuve, Walloon Brabant, Belgium
| | | | - Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Gabriella Rizzo
- Department of Medicine, Cork University Hospital, Cork, Ireland
| | - Colm O'Tuathaigh
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
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21
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Doreille A, Vilaine E, Belenfant X, Tabbi W, Massy Z, Corruble E, Basse O, Luque Y, Rondeau E, Benhamou D, François H. Can empathy be taught? A cross-sectional survey assessing training to deliver the diagnosis of end stage renal disease. PLoS One 2021; 16:e0249956. [PMID: 34495963 PMCID: PMC8425537 DOI: 10.1371/journal.pone.0249956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/26/2021] [Indexed: 12/30/2022] Open
Abstract
Background Receiving the diagnosis of kidney failure has a major impact on patients. Yet, the way in which this diagnosis should be delivered is not formally taught within our medical curriculum. To fill this gap we set up a training course of kidney failure diagnosis delivery for nephrology trainees since 2016. This study assessed the effectiveness of this educational intervention. Methods The primary outcome was change in the empathy score immediately after the training session and several months afterward, based on the Jefferson Scale of Physician Empathy (JSPE). Self-reported change in clinical practice was also evaluated. As control groups, we assessed empathy levels in untrained nephrology trainees (n = 26) and senior nephrologists (n = 71). Later on (>6 months) we evaluated participants’ perception of changes in their clinical practice due to the training. Results Six training sessions permitted to train 46 trainees. Most respondents (76%) considered the training to have a durable effect on their clinical practice. Average empathy scores were not significantly different in pre-trained trainees (average JSPE: 103.7 ± 11.4), untrained trainees (102.8 ± 16.4; P = 0.81) and senior nephrologists (107.2 ± 13.6; P = 0.15). Participants’ empathy score significantly improved after the training session (112.8 ± 13.9; P = 0.003). This improvement was sustained several months afterwards (average JSPE 110.5 ± 10.8; P = 0.04). Conclusion A single 4-hour training session can have long lasting impact on empathy and clinical practice of participants. Willingness to listen, empathy and kindness are thought to be innate and instinctive skills, but they can be acquired and should be taught.
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Affiliation(s)
- Alice Doreille
- Department of Nephrology and Transplantation, Hôpital Tenon, AP-HP, Paris, France
| | - Eve Vilaine
- Department of Nephrology, CHU Ambroise Paré, AP-HP, Paris, France
| | - Xavier Belenfant
- Department of Nephrology, CHI André Grégoire, Montreuil, France
- Réseau de Néphrologie d’Ile de France (Rénif), Paris, France
| | - Wided Tabbi
- Department of Nephrology, CHI André Grégoire, Montreuil, France
| | - Ziad Massy
- Department of Nephrology, CHU Ambroise Paré, AP-HP, Paris, France
- Centre for Research in Epidemiology and Population Health (CESP), UMRS 1018, team 5, UVSQ, University Paris Saclay, Villejuif, France
| | | | - Odile Basse
- Association France Rein Ile de France, Paris, France
| | - Yosu Luque
- Department of Nephrology and Transplantation, Hôpital Tenon, AP-HP, Paris, France
- Sorbonne Université, UMR_S1155, Paris, France
| | - Eric Rondeau
- Department of Nephrology and Transplantation, Hôpital Tenon, AP-HP, Paris, France
- Sorbonne Université, UMR_S1155, Paris, France
| | - Dan Benhamou
- Department of Anesthesiology, Hôpital Bicêtre, AP-HP, Kremlin Bicêtre, France
- LabForSIMS Simulation Center, Paris Sud University, Kremlin Bicêtre, France
| | - Helene François
- Department of Nephrology and Transplantation, Hôpital Tenon, AP-HP, Paris, France
- Sorbonne Université, UMR_S1155, Paris, France
- LabForSIMS Simulation Center, Paris Sud University, Kremlin Bicêtre, France
- * E-mail:
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Onumah CM, Lai CJ, Levine D, Ismail N, Pincavage AT, Osman NY. Aiming for Equity in Clerkship Grading: Recommendations for Reducing the Effects of Structural and Individual Bias. Am J Med 2021; 134:1175-1183.e4. [PMID: 34144012 DOI: 10.1016/j.amjmed.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Chavon M Onumah
- Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Cindy J Lai
- Department of Medicine, University of California, San Francisco, School of Medicine
| | - Diane Levine
- Department of Medicine, Wayne State University School of Medicine, Detroit, Mich
| | - Nadia Ismail
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Amber T Pincavage
- Department of Medicine, University of Chicago Pritzker School of Medicine, Ill
| | - Nora Y Osman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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Kirby R, Knowles HC, Patel A, Alanis N, Rice C, d'Etienne JP, Schrader CD, Zenarosa NR, Wang H. The influence of patient perception of physician empathy on patient satisfaction among attending physicians working with residents in an emergent care setting. Health Sci Rep 2021; 4:e337. [PMID: 34430711 PMCID: PMC8369944 DOI: 10.1002/hsr2.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is unclear whether the patient's perception of attending physician empathy and the patient's satisfaction can be affected when attending physicians work alongside residents. We aim to determine the influence residents may have on (1) patient perception of attending physician empathy and (2) patient satisfaction as it relates to their respective attending physicians. METHODS This is a prospective single-center observational study. Patient perception of physician empathy was measured using Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE) in both attendings and residents in the Emergency Department. Patient satisfaction with attending physicians and residents was measured by real-time patient satisfaction survey. Multivariate logistic regressions were performed to determine the association between patient satisfaction and JSPPPE after patient demographics, attending physician different experience, and residents with different years of training were adjusted. RESULTS A total of 351 patients were enrolled. Mean JSPPPE scores were 30.1 among attending working alone, 30.1 in attending working with PGY-1 EM residents, 29.6 in attending working with PGY-2, and 27.8 in attending working with PGY-3 (p < 0.05). Strong correlation occurred between attending JSPPPE score and patient satisfaction to attending physicians (ρ > 0.5). The adjusted odds ratio was 1.32 (95% CI 1.23-1.41, p < 0.001) on attending's JSPPPE score predicting patient satisfaction to the attending physicians. However, there were no significant differences on patient satisfaction among four different groups. CONCLUSION Empathy has strong correlation with patient satisfaction. Decreased patient perception of attending physician empathy was found when working with senior residents in comparison to working alone or with junior residents.
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Affiliation(s)
- Ryan Kirby
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexasUSA
| | - Heidi C. Knowles
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexasUSA
| | - Anant Patel
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexasUSA
| | - Naomi Alanis
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexasUSA
| | - Colton Rice
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexasUSA
| | - James P. d'Etienne
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexasUSA
| | - Chet D. Schrader
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexasUSA
| | - Nestor R. Zenarosa
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexasUSA
| | - Hao Wang
- Department of Emergency MedicineJohn Peter Smith Health NetworkFort WorthTexasUSA
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Nasiri M, Amini M, Mani A, Delavari S, Kiani M, Sagheb MM, Tabari P. Assessing empathy in final-year medical students using the Persian version of the Jefferson Scale of Physician Empathy. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:310. [PMID: 34667810 PMCID: PMC8459864 DOI: 10.4103/jehp.jehp_1539_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND A doctor-patient relationship built on the concept of empathy is so essential to attain the best clinical outcomes in medicine. Since empathy has a positive role in interpersonal relationships and medical outcomes, its assessment is highly crucial. The aim of this study was to assess the empathy in last-year medical students using the Persian version of the Jefferson Scale of Physician Empathy (JSPE) and correlate empathy scores with demographic features. MATERIALS AND METHODS In this cross-sectional study, last-year medical students at Shiraz Medical School, Shiraz, Iran, were recruited for this study. In this research, we used the Persian version of JSPE. The validity and reliability of the Persian version of this tool were confirmed in the previous research. For the analysis of data, we employed descriptive statistics and the independent sample t-test. RESULTS One hundred and eighty-five final-year medical students were included in this study. The maximum score of the questionnaire was 140, and the total mean score of empathy was 98.15 ± 13.29. The females' total mean score (102.05 ± 11.89) was higher than the males' score (93.57 ± 13.46). The difference between the mean score of gender and empathy was significant (P value <.001), but there was no significant difference between empathy and the two other demographic factors (P > 0.05). CONCLUSIONS Although physicians would gain the essential characteristics of empathy during their career, attending professors and other responsible policymakers in medical education should focus more on the factors related to physicians' empathy to train better and more professional physicians.
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Affiliation(s)
- Marzieh Nasiri
- Department of Psychiatry, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Amini
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Mani
- Cognitive Neuroscience Research Center for Psychiatry and Behavioral Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somayeh Delavari
- Center for Educational Research in Medical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Kiani
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Sagheb
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parinaz Tabari
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations and Guidelines for the Use of Simulation to Address Structural Racism and Implicit Bias. Simul Healthc 2021; 16:275-284. [PMID: 34398114 DOI: 10.1097/sih.0000000000000591] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY STATEMENT Simulation-based education is a particularly germane strategy for addressing the difficult topic of racism and implicit bias due to its immersive nature and the paradigm of structured debriefing. Researchers have proposed actionable frameworks for implicit bias education, particularly outlining the need to shift from recognition to transformation, with the goal of changing discriminatory behaviors and policies. As simulation educators tasked with training health care professionals, we have an opportunity to meet this need for transformation. Simulation can shift behaviors, but missteps in design and implementation when used to address implicit bias can also lead to negative outcomes. The focus of this article is to provide recommendations to consider when designing simulation-based education to specifically address racism and implicit bias.
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Affiliation(s)
- Samreen Vora
- From the Simulation Program (S.V.), Children's Minnesota, Minneapolis, MN; Center for Professional Development and Practice (B.D.), Children's Minnesota, Minneapolis, MN; Department of Pediatrics and Medical Education (M.A.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Emergency Medicine (D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York City, NY; Department of Pediatrics (V.F.J.), University of Louisville, Louisville, KY; Division of Education and Training (S.K.), The University of Texas MD Anderson Cancer Center, Houston, TX; and Department of Pediatricsa (A.C.), University of Louisville, Norton Children's Hospital, Louisville, KY
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Smith KJ, Farland MZ, Edwards M, Buring S, Childs GS, Dunleavy K, Estrada AH, Multak N, Patton PR, Schentrup D, Blue A. Assessing professionalism in health profession degree programs: A scoping review. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:1078-1098. [PMID: 34294251 DOI: 10.1016/j.cptl.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/06/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND To identify and classify methods for assessing professionalism across health profession degree programs and identify gaps in the literature regarding types of assessments. METHODS The authors conducted a scoping review of articles published from database inception through 24 January 2020. Included articles described an assessment approach for professionalism in health profession degree programs available in full-text in the English language. Articles were classified based on profession, timing of assessment, feedback type, assessment type, professionalism dimension, and Barr's modified Kirkpatrick hierarchy. RESULTS Authors classified 277 articles meeting inclusion criteria. Most articles were from medical education (62.5%) conducted during didactic (62.1%) or experiential/clinical curriculum (49.8%). Few articles (15.5%) described longitudinal assessment. Feedback type was formative (32.2%) or summative (35%), with only 8.3% using both. Assessment types frequently reported included self-administered rating scales (30%), reflections (18.8%), observed clinical encounters (17.3%), and knowledge-based tests (13.4%). Ethical practice principles (65%) and effective interactions with patients (48.4%) were the most frequently assessed dimensions of professionalism. Authors observed balanced distribution among Barr's modified Kirkpatrick model at levels of reaction (38.3%), modification of perceptions and attitudes (33.6%), acquisition of knowledge and skills (39%), and behavioral change (36.1%). IMPLICATIONS The classification scheme identified in current literature on professionalism assessment does not align with International Ottawa Conference Working Group on the Assessment of Professionalism recommendations. Gaps identified were limited description of professionalism assessment during admissions, infrequent longitudinal assessment, limited use of methods for both formative and summative assessment, and limited reports of assessments applicable to interprofessional education settings.
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Affiliation(s)
- Kathryn J Smith
- University of Florida College of Pharmacy, P.O. Box 100486, Gainesville, FL 32610, United States.
| | - Michelle Z Farland
- University of Florida College of Pharmacy, P.O. Box 100486, Gainesville, FL 32610, United States.
| | - Mary Edwards
- University of Florida Health Science Center Library, P.O. Box 100206, Gainesville, FL 32610-0206, United States.
| | - Shauna Buring
- University of Florida College of Pharmacy, P.O. Box 100486, Gainesville, FL 32610, United States.
| | - Gail Schneider Childs
- Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, P.O. Box 1004078 PM D311, Gainesville, FL 32610-0407, United States.
| | - Kim Dunleavy
- Department of Physical Therapy, University of Florida College of Public Health and Health Professions, P.O. Box 100154, Gainesville, FL 32610-0154, United States.
| | - Amara H Estrada
- University of Florida College of Veterinary Medicine, P.O. Box 100116, Gainesville, FL 32610-0116, United States.
| | - Nina Multak
- University of Florida School of Physician Assistant Studies, P.O. Box 100176, Gainesville, Florida 32610-0176, United States.
| | - Pamela R Patton
- University of Florida School of Physician Assistant Studies, P.O. Box 100176, Gainesville, Florida 32610-0176, United States.
| | - Denise Schentrup
- University of Florida College of Nursing, P.O. Box 100187, Gainesville, FL 32610-0187, United States.
| | - Amy Blue
- Department of Environmental and Global Health, University of Florida College of Public Health and Health Professions, P.O.Box 100175, Gainesville, FL 32610-0175, United States.
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Dashash M, Boubou M. Measurement of empathy among health professionals during Syrian crisis using the Syrian empathy scale. BMC MEDICAL EDUCATION 2021; 21:409. [PMID: 34325698 PMCID: PMC8319893 DOI: 10.1186/s12909-021-02835-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/15/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND Health professionals should have certain degree of empathy to eliminate the pain and suffering of their patients. There is a need to design a scale, which can assess empathy among health professionals and is relevant to community and culture. Therefore, this study was undertaken to measure the empathy among Syrian health professionals and students of health professions using a newly designed Syrian Empathy Scale that is relevant to community during Syrian crisis. METHODS A cross-sectional observational study was undertaken. A total of 214 participants (118 males and 96 females) responded to the Syrian Empathy Scale SES from Medical (n = 62), Dental (n = 152). They were 59 undergraduates, 116 postgraduates and 39 general practitioners. The SES was designed as a tool that includes 20 items in a 7-point Likert-type scale with overall score ranges from 20 to 140. Group comparisons of the empathy scores were conducted using t-test and analysis of variance (ANOVA). A factor analysis was performed. Bartlett's test of the sphericity and the KMO measure of sampling adequacy were also determined. Cronbach's alpha was calculated. RESULTS A significant difference was found between males and females in the SES mean score. The ANOVA analysis showed that the SES empathy scores of dentists were higher than the SES empathy scores in medical doctors with no significant difference. The SES empathy score of undergraduates was significantly higher than postgraduates and practitioners. Findings of KMO indicated sampling adequacy (KMO = 0.824 > 0.7) and the value of Bartlett's test of the sphericity (1255.65, df = 190, P-value< 0.001) proved that the factor analysis is meaningful and acceptable. The results of varimax rotation proved that five main factors were retained. CONCLUSION Findings of this study support the reliability of the newly designed Syrian Empathy Scale for measuring empathy in the field of health care. The SES can be suggested for assessing empathy in different health educational programs. However, future works are still essential to support the validity of the scale as well as to ascertain the role of empathy in improving health care.
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Affiliation(s)
- Mayssoon Dashash
- Faculty of Dentistry, Damascus University, Damascus, Syria.
- Program of Medical Education, Syrian Virtual University, Damascus, Syria.
| | - Mounzer Boubou
- Program of Medical Education, Syrian Virtual University, Damascus, Syria
- Faculty of Education, Tishreen University, Latakia, Syria
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Rusling M, Masin D, Voss M, Gottumukkala P, Keenan C, Botten M, Chambers D, Parrill C, Dube J, Tucker JR. Medical student coping and performance in simulated disasters. ANXIETY STRESS AND COPING 2021; 34:766-777. [PMID: 33896294 DOI: 10.1080/10615806.2021.1916481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Coping with the stress of real and simulated disasters is thought to be integral to the performance of emergency medicine providers. Yet, little is known about which coping strategies are employed in these scenarios and whether differential use of strategies predicts actual clinical and interpersonal performance. METHODS Thirty-four medical students were evaluated by trained simulated patients and physician observers across 111 clinical encounters during a simulated disaster. Linear Mixed Effects Modelling was used to test study hypotheses while accounting for demographic variables, psychological factors, and the dependency of multiple encounters for each participant. RESULTS Results indicated that multilevel modeling was necessary. Positive thinking positively predicted observed clinical performance whereas avoidant coping was a negative predictor. Anticipatory anxiety and positive affect, but not reported coping, positively predicted student interpersonal performance. CONCLUSIONS The present study indicates that the way medical students report managing the stress of disaster scenarios has clear links to their observed clinical performance above and beyond demographic and psychological factors. It further demonstrates the feasibility of empirically identifying specific coping strategies that may be important targets for disaster response training.
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Affiliation(s)
- Matthew Rusling
- Department of Behavioral Medicine, Medical Humanities & Bioethics at Des Moines University, Des Moines, IA, USA
| | - Daniel Masin
- Department of Behavioral Medicine, Medical Humanities & Bioethics at Des Moines University, Des Moines, IA, USA
| | - Marcus Voss
- Department of Behavioral Medicine, Medical Humanities & Bioethics at Des Moines University, Des Moines, IA, USA
| | - Pooja Gottumukkala
- Department of Behavioral Medicine, Medical Humanities & Bioethics at Des Moines University, Des Moines, IA, USA
| | - Corey Keenan
- Department of Behavioral Medicine, Medical Humanities & Bioethics at Des Moines University, Des Moines, IA, USA
| | - Marijo Botten
- Department of Behavioral Medicine, Medical Humanities & Bioethics at Des Moines University, Des Moines, IA, USA
| | - Davis Chambers
- Department of Behavioral Medicine, Medical Humanities & Bioethics at Des Moines University, Des Moines, IA, USA
| | - Chris Parrill
- Department of Behavioral Medicine, Medical Humanities & Bioethics at Des Moines University, Des Moines, IA, USA
| | - John Dube
- Department of Behavioral Medicine, Medical Humanities & Bioethics at Des Moines University, Des Moines, IA, USA
| | - Jeritt R Tucker
- Department of Behavioral Medicine, Medical Humanities & Bioethics at Des Moines University, Des Moines, IA, USA
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Heath JK, Davis JE, Dine CJ, Padmore JS. Faculty Development for Milestones and Clinical Competency Committees. J Grad Med Educ 2021; 13:127-131. [PMID: 33936547 PMCID: PMC8078076 DOI: 10.4300/jgme-d-20-00851.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Janae K. Heath
- Janae K. Heath, MD, MSCE, is Assistant Professor of Medicine, Division of Pulmonary and Critical Care, University of Pennsylvania
| | - Jonathan E. Davis
- Jonathan E. Davis, MD, is Professor and Academic Chair, Emergency Medicine, Georgetown University Medical Center, and System Physician Chair for GME, Medstar Health
| | - C. Jessica Dine
- C. Jessica Dine, MD, MSHP, is Associate Professor of Medicine, Division of Pulmonary and Critical Care, and Associate Dean of Faculty Development, Perelman School of Medicine, University of Pennsylvania
| | - Jamie S. Padmore
- Jamie S. Padmore, DM, is Professor and Senior Associate Dean for Medical Education, Georgetown University Medical Center, and Vice President, Academic Affairs, and Designated Institutional Official, MedStar Health
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Yeo S, Kim KJ. A validation study of the Korean version of the Toronto empathy questionnaire for the measurement of medical students' empathy. BMC MEDICAL EDUCATION 2021; 21:119. [PMID: 33607995 PMCID: PMC7893770 DOI: 10.1186/s12909-021-02561-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/10/2021] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study aimed to validate the Korean version of the Toronto Empathy Questionnaire (TEQ) and to determine its suitability for the measurement of empathy in medical students. METHODS The study sample was Year 1 and 2 medical students at two medical schools on six-year undergraduate medical programs in South Korea. The study participants completed the Korean TEQ, which has a single factor structure and consists of 16 items; responses are scored using a 5-point Likert scale, giving a maximum possible score of 64. Psychometric validation of the questionnaire was performed by exploratory and confirmatory factor analyses and the goodness of fit test. Average variance extracted was calculated to establish convergent validity, and associations between factors and construct reliability were analyzed to establish discriminant validity. Cronbach's alpha values were utilized for reliability analysis. RESULTS A total of 279 students completed and returned the questionnaire (a 96.2% response rate). Participant empathy scores ranged from 20 to 60 (M = 44.6, SD = 7.36). Empathy scores were higher for females than males (p < .05). The cumulative variance of the Korean TEQ was 32%, indicating that its explanatory power was rather weak. Consequently, goodness-of-fit testing was performed on four hypothetical models, among which a three-factorial structure consisting of 14 items demonstrated satisfactory fit indices and explained 55% of the variance. Reliability estimates of the three subscales were also satisfactory (Cronbach's α = .71-.81). This three-factorial model was validated by confirmatory factor analysis and demonstrated adequate convergent and discriminant validity. CONCLUSIONS This study demonstrated psychometric validation of the Korean TEQ for measuring medical students' empathy. We suggest a modified 14-item model with a three-factorial structure, which demonstrated better psychometric properties than the original scale.
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Affiliation(s)
- Sanghee Yeo
- Department of Medical Education, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kyong-Jee Kim
- Department of Medical Education, Dongguk University School of Medicine, 32 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10326 South Korea
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Roshal JA, Chefitz D, Terregino CA, Petrova A. Comparison of self and simulated patient assessments of first-year medical students' Interpersonal and Communication Skills (ICS) during Objective Structured Clinical Examinations (OSCE). BMC MEDICAL EDUCATION 2021; 21:107. [PMID: 33596892 PMCID: PMC7887830 DOI: 10.1186/s12909-021-02540-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/04/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Interpersonal and communication skills (ICS) are important core competencies in medical education and certification. In this study, we identified self- and simulated patient (SP)-reported ratings of US first-year medical students' ICS and the influence of age and gender on performance appraisal during the Objective-Structured Clinical Examination (OSCE). METHODS OSCE participants, including 172 first-year medical students and 15 SPs were asked to evaluate the students' ICS using the American Board of Internal Medicine-Patient-Satisfaction Questionnaire (ABIM-PSQ), electronically and via paper, respectively. Self- and SP-reported ratings of students' ICS were presented as the median on a 5-point Likert-scale and as three categories defined as "good," "very good," and "inadequate." RESULTS SPs assessed all 172 students in the OSCE, while 43.6% of students assessed their own performance. The majority of students and SPs evaluated the students' ICS as very good. 23.3% of SPs and 5.3% of students rated the medical students' ability to encourage patient question-asking and answer questions as inadequate (P < 0.002). Neither age nor gender influenced the medical students' self-assessment of ICS. Female SPs assigned lower scores to students in regard to respecting patients and encouraging patient question-asking and answering. Older SPs was more likely to assign lower scores on all survey questions. CONCLUSIONS In the present study, self- and SP-reported ratings of first-year medical students' ICS were mainly "very good" with no influence of students' age or gender. Older age and female gender among the SPs were associated with a reduction in SP-reported ratings of students' ICS.
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Affiliation(s)
- Joshua A Roshal
- Rutgers Robert Wood Johnson Medical School, Medical Education Building, MEB 202, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Dalya Chefitz
- Rutgers Robert Wood Johnson Medical School, Medical Education Building, MEB 202, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Carol A Terregino
- Rutgers Robert Wood Johnson Medical School, Medical Education Building, MEB 202, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Anna Petrova
- Rutgers Robert Wood Johnson Medical School, Medical Education Building, MEB 202, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
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Allahyari Bouzanjani A, Bahadori P, Nikoonam P. Nurses' Empathetic Behaviors: The Direct and Indirect Effect of Their Spiritual Orientation. JOURNAL OF RELIGION AND HEALTH 2021; 60:134-152. [PMID: 31894520 DOI: 10.1007/s10943-019-00966-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Spirituality and its role in nurses' performance has gained much attention from the nursing researchers. But there is still some ambiguity about its role in improving the nurses' empathetic behaviors and factors that mediate this relation. To fill these research gaps, a sample of 247 Muslim nurses in a hospital at Shiraz, Iran, were selected and studied. Data were gathered by distributing the standard questionnaires among all of the nurses. Also, structural equation modeling and ANOVA test were used to analyze the data. It was found that nurses' spiritual orientation has a positive effect on their psychological capital and empathetic behaviors. Also, it was found that their work engagement has been affected by their level of psychological capital. Moreover, there was a significant difference between the spirituality of single and married nurses, in a way that married nurses were more spiritual. As a conclusion, it can be said that nurses' empathetic behaviors are a reflection of their spiritual orientation and marriage status.
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Reed BN, Haines ST, Holmes ER. The Impact of Two Longitudinal Professionalism Courses on Student Pharmacists' Empathy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2021; 85:8083. [PMID: 34283738 PMCID: PMC7926277 DOI: 10.5688/ajpe8083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/30/2020] [Indexed: 06/13/2023]
Abstract
Objective. To determine whether empathy increased in first-year student pharmacists after completing longitudinal professionalism courses at two schools of pharmacy, identify potential moderators, and assess whether students' conceptualization of empathy changed with time.Methods. Surveys to assess empathy and other variables were administered to student pharmacists at baseline and at the end of two professionalism courses. Baseline and follow-up scores were compared to detect changes over time. Multivariable analysis was used to identify predictors of empathy scores. Factor analysis was performed to ascertain changes in the dimensionality of empathy.Results. Students' demographics and baseline empathy scores differed between the two schools. Predictors of empathy at baseline included age, female gender, prior health care experience, and altruism score. A small increase in empathy was observed at one school but not in the combined cohort. Empathy was more likely to increase among female students, those with less health care experience, and those who did not work during the school year. Factor analyses suggested that students' conceptual clarity about empathy improved over time and became more consistent with existing models.Conclusion. Although an increase in empathy was not observed in the overall cohort, subgroups of students who may derive greater benefit from empathy-related interventions were identified. Factor analyses suggested that students' conceptual understanding of empathy improved, representing a potential alternative outcome assessment for affective domains. Given differences in demographics, instructional methodologies, and changes in empathy at each school, this study reinforces the importance of replication and multicenter studies to understand the generalizability of educational research.
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Affiliation(s)
- Brent N Reed
- University of Maryland, School of Pharmacy, Baltimore, Maryland
| | - Stuart T Haines
- University of Mississippi, School of Pharmacy, Jackson, Mississippi
| | - Erin R Holmes
- University of Mississippi, School of Pharmacy, Jackson, Mississippi
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Baugh RF, Baugh AD. Cultural influences and the Objective Structured Clinical Examination. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2021; 12:22-24. [PMID: 33507878 PMCID: PMC7883802 DOI: 10.5116/ijme.5ff9.b817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Reginald F. Baugh
- Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Aaron D. Baugh
- Pulmonary, Critical Care, Allergy, Sleep Medicine, Department of Internal Medicine University of California San Francis-co Medical School, University of California San Francisco Medical Center, San Francisco, CA, USA
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Mallory L, Floyed R, Doughty C, Thompson T, Lopreiato J, Chang TP. Validation of a Modified Jefferson Scale of Empathy for Observers to Assess Trainees. Acad Pediatr 2021; 21:165-169. [PMID: 32540426 DOI: 10.1016/j.acap.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE "Demonstrate insight and understanding into emotion" is a competency amenable to simulation-based assessment. The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) has validity evidence for patients to assess provider empathy. A version adapted for a third-party observers does not exist. Our aim was to modify the JSPPPE and use recorded standardized encounters to obtain validity evidence. METHODS This cross-sectional study used video and data collected from 2 pediatric residencies. In 2018, 4 raters reviewed 24 videos of 12 interns communicating with standardized patients (SP) in 2 encounters and completed a modified JSPPE for observers (JSEO). Reliability between raters was established using Intraclass Correlations (ICC). JSEO mean scores were correlated to Essential Elements of Communication (EEC), JSPPPE, and faculty composite interpersonal communication (IC) scores using Spearman Rank. RESULTS The mean ICC for all 4 raters was 0.573 (0.376-0.755). When ICC was calculated for pairs of raters, Rater 1 was an outlier. ICCs for mean scores for pairs among the 3 remaining raters was 0.81 to 0.84. Mean JSEO scores from the four raters correlated with the JSPPPE (rho = 0.45, P = .03) and IC (rho = 0.68, P < .001), but not the EEC (rho = 0.345, P = .1). CONCLUSIONS We found validity evidence for the use of a modified JSPPPE for an observer to assess empathy in a recorded encounter with a SP. This may be useful as medical educators shift toward competency-based tracking. The brevity of this tool and potential assessment using video are also appealing.
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Affiliation(s)
- Leah Mallory
- Tufts University School of Medicine (L Mallory), The Hannaford Simulation Center at Maine Medical Center, Maine.
| | - Rebecca Floyed
- Dell Medical School (R Floyed), University of Texas at Austin, Tex
| | - Cara Doughty
- Baylor College of Medicine (C Doughty), Texas Children's Hospital Simulation Center, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex
| | - Tonya Thompson
- University of Arkansas for Medical Sciences (T Thompson), Little Rock, Ark
| | - Joseph Lopreiato
- Uniformed Services University of the Health Sciences (J Lopreiato), The Val G. Hemming Simulation Center, Silver Spring, Md
| | - Todd P Chang
- Keck School of Medicine of USC (TP Chang), Children's Hospital Los Angeles, Los Angeles, Calif
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Kim KJ. Project-based learning approach to increase medical student empathy. MEDICAL EDUCATION ONLINE 2020; 25:1742965. [PMID: 32197574 PMCID: PMC7170272 DOI: 10.1080/10872981.2020.1742965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/02/2020] [Accepted: 02/25/2020] [Indexed: 05/30/2023]
Abstract
This study investigated the impact of empathy training on medical students using a project-based learning approach on the development of their empathic abilities. Study participants were Year 2 students in the six-year medical program, to whom a one credit-hour course on empathic communication was offered over a semester. In this course, students worked on collaborative team projects in which they were asked to interview a person and to report the empathy that they shared with the interviewee. Development in student empathy was measured using the Interpersonal Reactivity Index inventory in a pre- and post-test format over the semester and their reflective reports were qualitatively analyzed to identify emerging themes on the lessons they learned from the project experience. A total of 45 students completed the questionnaires (a 97.8% response rate). Students' overall empathy scores did not change over time (t = 1.943, p = .06). Still, students with lower empathy in the pre-test improved significantly in their empathy scores (t = 3.44, p < .01). Students reported that the empathy project was beneficial in improving their understanding of empathy and enhancing their empathic communication skills. This study shows the project-based learning approach was effective in developing medical student empathy especially for those with lower empathy.
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Affiliation(s)
- Kyong-Jee Kim
- Department of Medical Education, Dongguk University School of Medicine, Goyang-si, Korea
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Ibrahim H, Harhara T, Al Marshoodi R, Kamour A, Nair SC. An exploratory analysis of factors contributing to resident pass rates on a national licensure OSCE in the United Arab Emirates. J Family Med Prim Care 2020; 9:3470-3473. [PMID: 33102315 PMCID: PMC7567255 DOI: 10.4103/jfmpc.jfmpc_332_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose To explore resident perceptions of factors contributing to pass rates on a high-stake licensing objective structured clinical exam (OSCE). Materials and Methods A cross-sectional survey was administered to all 51 applicants of the April 2019 internal medicine Arab Board OSCE examination in Abu Dhabi, United Arab Emirates (UAE), and included questions on preparedness, stress level, and prior educational experiences. Exposures were evaluated for correlation against Arab Board pass rates using Pearson correlation and the two-tailed significance was recorded. Results All 51 examinees completed the survey (100% response rate). Participants were primarily female n = 35 (67%) and all completed residency training in the UAE. Gender differences were noted, with higher pass rates for the male residents (13/35, 37% females vs. 8/16, 50% males, P < 0.05). Further, 65% (P < 0.001) of female examinees reported higher levels of anxiety than male residents. Examinees reported regular exposure during residency to clinical skills training (74%), standardized patients (71%), simulation (66%), and OSCEs (72%) but none of these educational modalities correlated with higher pass rates. Of multiple exam preparation modalities, only self-directed learning with deliberate practice, the intentional repetition of a task with feedback, was associated with higher pass rates. Conclusion Clinical exam skills are vital for trainees to deliver high-quality primary healthcare services. National licensure OSCEs have become the norm in the Arab world for assessing resident clinical exam skills. Our results suggest that residency programs should encourage residents' intentional deliberate practice and mastery learning in the acquisition and retention of physical examination techniques.
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Affiliation(s)
- Halah Ibrahim
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Thana Harhara
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | | | - Ashraf Kamour
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Satish C Nair
- Department of Academic Affairs, Tawam Hospital Johns Hopkins Medicine, College of Medicine, UAE University, Al Ain, UAE
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Ratelle JT, Halvorsen AJ, Mandrekar J, Sawatsky AP, Reed DA, Beckman TJ. Internal Medicine Resident Professionalism Assessments: Exploring the Association With Patients' Overall Satisfaction With Their Hospital Stay. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:902-910. [PMID: 31809293 DOI: 10.1097/acm.0000000000003114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Successful training of internal medicine (IM) residents requires accurate assessments. Patients could assess IM residents in a hospital setting, but medical educators must understand how contextual factors may affect assessments. The objective was to investigate relationships between patient, resident, and hospital-encounter characteristics and the results of patient assessments of IM resident professionalism. METHOD The authors performed a prospective cohort study of postgraduate year 1 (PGY-1) IM residents and their patients at 4 general medicine inpatient teaching services at Mayo Clinic Hospital-Rochester, Saint Marys Campus in Rochester, Minnesota, from July 1, 2015, through June 30, 2016. Patient assessments of resident professionalism were adapted from validated instruments. Multivariable modeling with generalized estimating equations was used to determine associations between patient assessment scores and characteristics of residents, residents' clinical performance and evaluations (including professionalism assessments in other settings), patients, and hospital encounters and to account for repeated assessments of residents. RESULTS A total of 409 patients assessed 72 PGY-1 residents (mean [SD], 5.7 [3.0] patient assessments per resident). In the multivariable model, only the highest rating out of 5 levels for overall satisfaction with hospital stay was significantly associated with patient assessment scores of resident professionalism (β [SE], 0.80 [0.08]; P < .001). Hospitalized patients' assessment scores of resident professionalism were not significantly correlated with assessment scores of resident professionalism in other clinical settings. CONCLUSIONS Hospitalized patients' assessment scores of in-hospital resident professionalism were strongly correlated with overall patient satisfaction with hospital stay but were not correlated with resident professionalism in other settings. The limitations of patient evaluations should be considered before incorporating these evaluations into programs of assessment.
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Affiliation(s)
- John T Ratelle
- J.T. Ratelle is a consultant, Division of Hospital Internal Medicine, Mayo Clinic, and assistant professor of medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. A.J. Halvorsen is a statistician, Internal Medicine Residency Office, Mayo Clinic, and assistant professor of medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. J. Mandrekar is a consultant, Division of Biomedical Statistics and Informatics, Mayo Clinic, and professor of biostatistics and neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. A.P. Sawatsky is a consultant, Division of General Internal Medicine, Mayo Clinic, and assistant professor of medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. D.A. Reed is a consultant, Division of Community Internal Medicine, Mayo Clinic, and associate professor of medical education and professor of medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota. T.J. Beckman is a consultant, Division of General Internal Medicine, Mayo Clinic, and professor of medical education and medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Hojat M, DeSantis J, Shannon SC, Speicher MR, Bragan L, Calabrese LH. Empathy as related to gender, age, race and ethnicity, academic background and career interest: A nationwide study of osteopathic medical students in the United States. MEDICAL EDUCATION 2020; 54:571-581. [PMID: 32083747 PMCID: PMC7317910 DOI: 10.1111/medu.14138] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/27/2020] [Accepted: 02/17/2020] [Indexed: 05/09/2023]
Abstract
CONTEXT Research on associations between medical student empathy and demographics, academic background and career interest is limited, lacks representative samples and suffers from single institutional features. This study was designed to fill the gap by examining associations between empathy in patient care, and gender, age, race and ethnicity, academic background and career interest in nationwide, multi-institutional samples of medical students in the United States and to provide more definitive answers regarding the aforementioned associations, with more confidence in the internal and external validity of the findings. METHODS Four nationwide samples participated in this study (n = 10 751). Samples 1, 2, 3 and 4 included 3616 first-year, 2764 second-year, 2413 third-year and 1958 fourth-year students who completed a web-based survey at the end of the 2017-2018 academic year. The survey included questions on demographics, academic background and career interest, the Jefferson Scale of Empathy, and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire to control for the effect of 'good impression' response bias. RESULTS Statistically significant and practically important associations were found between empathy scores and gender (in favour of women), race and ethnicity (in favour of African-American and Hispanic/Latino/Spanish), academic background (in favour of 'Social and Behavioural Sciences' and 'Arts and Humanities' in Samples 1 and 2) and career interest (in favour of 'People-Oriented' and 'Psychiatry' specialties). CONCLUSIONS Special features of this study (eg, nationwide representative samples, use of a validated instrument for measuring empathy in patient care, statistical control for the effect of 'good impression' response bias, and consistency of findings in different samples from multiple institutions) provide more definitive answers to the issue of correlates of empathy in medical students and increase our confidence in the validity, reliability and generalisability of the results. Findings have implications for career counselling and targeting students who need more guidance to enhance their empathic orientation.
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Affiliation(s)
- Mohammadreza Hojat
- Asano‐Gonnella Center for Research in Medical Education and HealthcareSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Jennifer DeSantis
- Asano‐Gonnella Center for Research in Medical Education and HealthcareSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Stephen C. Shannon
- American Association of Colleges of Osteopathic MedicineBethesdaMarylandUSA
| | - Mark R. Speicher
- American Association of Colleges of Osteopathic MedicineBethesdaMarylandUSA
| | - Lynn Bragan
- American Association of Colleges of Osteopathic MedicineBethesdaMarylandUSA
| | - Leonard H. Calabrese
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandOhioUSA
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Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Does Empathy Decline in the Clinical Phase of Medical Education? A Nationwide, Multi-Institutional, Cross-Sectional Study of Students at DO-Granting Medical Schools. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:911-918. [PMID: 31977341 PMCID: PMC7242173 DOI: 10.1097/acm.0000000000003175] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
PURPOSE To examine differences in students' empathy in different years of medical school in a nationwide study of students of U.S. DO-granting medical schools. METHOD Participants in this cross-sectional study included 10,751 students enrolled in 41 of 48 campuses of DO-granting medical schools in the United States (3,616 first-year, 2,764 second-year, 2,413 third-year, and 1,958 fourth-year students). They completed a web-based survey at the end of the 2017-2018 academic year that included the Jefferson Scale of Empathy and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire for measuring "good impression" response bias. Comparisons were made on empathy scores among students in different years of medical school using analysis of covariance, controlling for the effect of "good impression" response bias. Also, comparisons were made with preexisting data from students of U.S. MD-granting medical schools. RESULTS A statistically significant decline in empathy scores was observed when comparing students in the preclinical (years 1 and 2) and the clinical (years 3 and 4) phases of medical school (P < .001); however, the magnitude of the decline was negligible (effect size =0.13). Comparison of findings with MD students showed that while the pattern of empathy decline was similar, the magnitude of the decline was less pronounced in DO students. CONCLUSIONS Differences in DO-granting and MD-granting medical education systems, such as emphasis on provision of holistic care, hands-on approaches to diagnosis and treatment, and patient-centered care, provide plausible explanations for disparity in the magnitude of empathy decline in DO compared with MD students. More research is needed to examine changes in empathy in longitudinal study and explore reasons for changes to avert erosion of empathy in medical school.
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Affiliation(s)
- Mohammadreza Hojat
- M. Hojat is research professor of psychiatry and human behavior, Department of Psychiatry and Human Behavior, and director, Jefferson Longitudinal Study of Medical Education, Asano-Gonnella Center for Research in Medical Education and Health Care, and Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; ORCID: https:///orcid.org/0000-0002-8841-3269
| | - Stephen C. Shannon
- S.C. Shannon is emeritus president, American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
| | - Jennifer DeSantis
- J. DeSantis is senior research study analyst, Asano-Gonnella Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark R. Speicher
- M.R. Speicher is senior vice president for medical education and research, American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
| | - Lynn Bragan
- L. Bragan is project manager, American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
| | - Leonard H. Calabrese
- L.H. Calabrese is professor of medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, R.J. Fasenmyer Chair of clinical immunology, Theodore F. Classen DO Chair of osteopathic research and education, and vice chair, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
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Fragkos KC, Crampton PES. The Effectiveness of Teaching Clinical Empathy to Medical Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:947-957. [PMID: 31688037 DOI: 10.1097/acm.0000000000003058] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Clinical empathy is a necessary trait to provide effective patient care, despite differences in how it is defined and constructed. The aim of this study was to examine whether empathy interventions in medical students are effective and how confounding factors potentially moderate this effect. METHOD The authors performed a systematic review and meta-analysis. They searched the literature published between 1948 and 2018 for randomized controlled trials that examined empathy interventions in medical students. The search (database searching, citation tracking, hand-searching relevant journals) yielded 380 studies, which they culled to 16 that met the inclusion criteria. For the meta-analysis, they used a random effects model to produce a pooled estimate of the standardized mean difference (SMD), then completed subgroup analyses. RESULTS The authors found evidence of the possibility of response and reporting bias. The pooled SMD was 0.68 (95% confidence interval 0.43, 0.93), indicating a moderately positive effect of students developing empathy after an intervention compared with those in the control groups. There was no evidence of publication bias, but heterogeneity was significantly high (I = 88.5%, P < .01). Subgroup analyses indicated that significant moderating factors for developing empathy were age, country, scope of empathy measurement, type of empathy intervention, and presence of rehearsal. Moderating factors with limited evidence were sex, study quality, journal impact factor, and intervention characteristics. CONCLUSIONS Despite heterogeneity and biases, empathy interventions in medical students are effective. These findings reinforce arguments in the literature and add considerable rigor from the meta-analysis. The authors propose a conceptual model for educators to follow when designing empathy interventions in medical students.
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Affiliation(s)
- Konstantinos C Fragkos
- K.C. Fragkos is clinical fellow in gastroenterology, University College London Hospitals, National Health Service Foundation Trust, London, United Kingdom; ORCID: https://orcid.org/0000-0002-7677-7989. P.E.S. Crampton is lecturer, Health Professions Education Unit, Hull York Medical School, York, United Kingdom, adjunct research fellow, University College London Medical School, London, United Kingdom, and adjunct research fellow, Monash Centre for Scholarship in Health Education, Monash University, Victoria, Australia; ORCID: https://orcid.org/0000-0001-8744-930X
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Comparison of Resident Self-Evaluation to Standardized Patient Evaluators in a Multi-Institutional Objective Structured Clinical Examination: Objectively Measuring Residents' Communication and Counseling Skills. Simul Healthc 2020; 15:69-74. [PMID: 32044855 DOI: 10.1097/sih.0000000000000404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND For the past 30 years, there has been a growing emphasis on communication and self-evaluation skills training in graduate medical education. This is reflected in the Next Accreditation System. The Objective Structured Clinical Examination (OSCE) is widely used in graduate medical education for assessing dimensions of interpersonal communication and counseling skills. The OSCEs may be developed to target challenging clinical scenarios difficult to capture in clinical practice and can be used as a medium for resident self-evaluation. OBJECTIVES The aims of the study were to evaluate residents' interpersonal, communication, and counseling skills using Kalamazoo Essential Elements Communication Checklist in 4 clinically challenging scenarios and to compare standardized patient (SP) evaluations to residents' self-evaluation by category of medical school. METHODS South East Michigan Center for Medical Education is a consortium of teaching hospitals. Member residents participate in 4 OSCEs as part of their postgraduate 1 curriculum. The OSCEs were developed to evaluate clinically relevant but difficult to capture scenarios including: (a) error disclosure/counseling an angry patient; (b) delivering bad news/end of life; (c) domestic violence; and (d) counseling a patient with colon cancer requesting alternative treatments. At the conclusion of each OSCE, SPs evaluated and residents self-evaluated their performance. Once evaluations were completed, SPs provided residents with feedback. RESULTS Six member institutions and 344 residents participated during the 2014, 2015, and 2016 academic years. There were more international medical graduates (59%) than graduates of Liaison Committee for Medical Education-accredited medical schools. There were more males (62.2%) than females. Standardized patients rated residents higher than residents rated themselves in 2014 (<0.001), but not in 2015 or 2016. When combining all years and all residents, there was no correlation of SP and resident scores. Standardized patients rated female residents higher than female residents rated themselves (P < 0.0001). Male residents scored themselves similarly to the SPs, but male residents rated themselves higher than female residents rated themselves (P < 0.001). Standardized patient scores for male and female residents were not significantly different. CONCLUSIONS Targeted OSCEs provide an objective format to evaluate residents in challenging clinical scenarios. Resident self-evaluations did not correlate with SPs. In addition, female residents rated themselves lower than male residents and lower than SPs. There is need to develop interventions and curricula to improve resident's self-evaluation skills and in particular address lower self-evaluation by female trainees.
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Vinson AH, Underman K. Clinical empathy as emotional labor in medical work. Soc Sci Med 2020; 251:112904. [PMID: 32151886 DOI: 10.1016/j.socscimed.2020.112904] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
The ongoing social transformation of the American healthcare system brings both structural and interpersonal changes to the delivery of healthcare. Some of these changes have been motivated by patients, who increasingly desire emotionally warm interactions with physicians. This is a departure from the detached concern that characterized physician-patient interactions in the mid-twentieth century. Concurrently, medical training continually adapts to trends in medical practice so that future physicians are prepared to enter practice. In this paper, we examine the rise of clinical skills training courses and assessments in medical school, highlighting the changing role of emotion in training about communication in the doctor - patient relationship. Drawing on an interpretive analysis of interviews with and ethnographic observations of medical students and residents from two United States medical schools, we elaborate the concept of clinical empathy to describe the character of emotional engagement in the contemporary clinical encounter. In the analysis we show how standards of emotional conduct are taught in medical school, how clinical empathy is operationalized in the patient encounter, and how clinical empathy may be used instrumentally to smooth the physician's work. Finally, we position the consistent performance of clinical empathy as a form of emotional labor, expanding the reach of studies of emotional labor in professions.
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Affiliation(s)
- Alexandra H Vinson
- Department of Learning Health Sciences, University of Michigan, 1111 E. Catherine St., Suite 209, Ann Arbor, MI, 48109, USA.
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Duñó R, Oliva JC, Tobeña A, Palao D, Labad J. Religiosity and Psychotic Ideation in Stable Schizophrenia: A Role for Empathic Perspective-Taking. Behav Sci (Basel) 2020; 10:bs10020053. [PMID: 32033456 PMCID: PMC7071488 DOI: 10.3390/bs10020053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 01/10/2023] Open
Abstract
The relationship between religiosity and different components of empathy was explored in schizophrenia patients. A total of 81 stable schizophrenia patients and 95 controls from the nearby community completed self-reported questionnaires assessing religiosity and empathy (through the Interpersonal Reactivity Index, IRI). Patients with schizophrenia showed higher religiousness than controls and they presented less perspective-taking and empathic concern but increased personal distress in IRI scores. Regression analyses unveiled an association between religiosity and perspective-taking in schizophrenics after adjusting for age, gender, and psychotic symptoms. In conclusion, religiosity in patients with schizophrenia may be linked to variations in perspective- taking as a component of empathy.
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Affiliation(s)
- Rosó Duñó
- Servei de Salut Mental, Parc Taulí Hospital Universitari, CIBERSAM, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain; (D.P.); (J.L.)
- Unitat de Neurociència Traslacional, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
- Correspondence: ; Tel.: +34-93-7231010; Fax: +34-93-7237181
| | - Joan Carles Oliva
- Unitat d’Estadística i Avaluació, Institut d’Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain;
| | - Adolf Tobeña
- Unitat de Neurociència Traslacional, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
- Institut de Neurociències, Departament de Psiquiatria i Medicina Legal (Facultat de Medicina-Bellaterra Campus), Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - Diego Palao
- Servei de Salut Mental, Parc Taulí Hospital Universitari, CIBERSAM, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain; (D.P.); (J.L.)
- Unitat de Neurociència Traslacional, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - Javier Labad
- Servei de Salut Mental, Parc Taulí Hospital Universitari, CIBERSAM, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain; (D.P.); (J.L.)
- Unitat de Neurociència Traslacional, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
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Chen JY, Chin WY, Tsang JPY. How clinician examiners compare with simulated patients in assessing medical student empathy in a clinical exam setting. MEDICAL TEACHER 2020; 42:86-91. [PMID: 31558085 DOI: 10.1080/0142159x.2019.1665635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Empathy is an important clinical attribute to be assessed during clinical examinations. While simulated patients (SPs) are well positioned to assess empathy in such settings, clinician-examiners are objective observers who are also experts in assessment. In this study, the assessments of student empathy from both examiners and SPs in clinical examinations were compared.Methods: The 10-item CARE measure were used for the assessment of empathy in 158 medical students in the Family Medicine specialty clerkship clinical competency test. The ratings from examiners and SPs were analyzed together with genders of students, examiners and patients, and the examination results.Results: SPs empathy ratings were higher than those from examiners across all ten items of CARE. A weak positive correlation was found between both ratings. Female SPs were more likely to give higher ratings, and examiners were more likely to give higher ratings to female students. SPs rating was moderately correlated with student examination score, while the correlation with examiners rating was strong.Conclusion: Although the inter-rater reliability was weak between the empathy rating from simulated patients and examiners, the evaluation of empathy from the patient's perspective was seen to be more authentic as they are in interaction with the students.
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Affiliation(s)
- Julie Yun Chen
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong, Hong Kong, Hong Kong
| | - Weng-Yee Chin
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong, Hong Kong, Hong Kong
| | - Joyce Pui Yan Tsang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong, Hong Kong, Hong Kong
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Diaz T, Navarro JR, Chen EH. An Institutional Approach to Fostering Inclusion and Addressing Racial Bias: Implications for Diversity in Academic Medicine. TEACHING AND LEARNING IN MEDICINE 2020; 32:110-116. [PMID: 31566010 DOI: 10.1080/10401334.2019.1670665] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Issue: While an increasingly diverse workforce of clinicians, researchers, and educators will be needed to address the nation's future healthcare challenges, underrepresented in medicine (UIM) perspectives remain relatively absent from academic medicine. Evidence: Prior studies have identified differential experiences within the learning environment, lack of social supports, and implicit bias in evaluations as barriers to the academic interests and successes of UIM learners. The UCSF Differences Matter initiative has shown that interventions focused on recruiting diverse academic faculty, building strong social communities, facilitating cross-cultural communication and understanding, and mitigating disparities in summative assessments can positively affect the educational experience for UIM learners and contribute to their academic success. Implications: Institution-level initiatives are needed to foster a culture of inclusion, teach cultural humility, and build a culture of trust within academic medicine. Such initiatives should aim to teach a common language to discuss diversity issues and place the responsibility of fostering inclusion on all members of the academic community. Our own institutional experience with systemic cultural reform challenges others to develop novel approaches toward fostering inclusion in academic medicine.
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Affiliation(s)
- Tomas Diaz
- Department of Emergency Medicine, University of California - San Francisco, San Francisco, California, USA
| | - J Renee Navarro
- Diversity and Outreach, University of California - San Francisco, San Francisco, California, USA
| | - Esther H Chen
- Department of Emergency Medicine, University of California - San Francisco, San Francisco, California, USA
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Cotta Filho CK, Miranda FBG, Oku H, Machado GCC, Pereira Junior GA, Mazzo A. Cultura, ensino e aprendizagem da empatia na educação médica: scoping review. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2020. [DOI: 10.1590/interface.180567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Este estudo teve o objetivo de identificar, na literatura, como a empatia é influenciada pelos diferentes fatores culturais no contexto de ensino e aprendizagem em saúde. Realizado por meio de scoping review , conforme a proposta de Joanna Briggs Institute (JBI), a busca foi realizada nas bases de dados PubMed, Lilacs, Scopus e Web of Science e executada entre o período de dezembro de 2017 a janeiro de 2018. Observou-se, pelas pesquisas, que os estudantes ocidentais têm maior nível de empatia quando comparados aos estudantes orientais. Além disso, há diferença na empatia entre diferentes etnias, raças, sexo e religião. Sua avaliação dá-se por meio de diferentes instrumentos. Assim, entre os fatores que influenciam a empatia, identificou-se a cultura como sendo um deles. São necessários novos estudos a fim de compreender da melhor forma a empatia entre as diversas profissões da saúde.
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Affiliation(s)
| | | | - Hiromi Oku
- St. Luke’s International University, Japão
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Spatoula V, Panagopoulou E, Montgomery A. Does empathy change during undergraduate medical education? - A meta-analysis. MEDICAL TEACHER 2019; 41:895-904. [PMID: 31060405 DOI: 10.1080/0142159x.2019.1584275] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Purpose: The aim of this meta-analysis was to synthesize the existing evidence examining how empathy changes during undergraduate medical education and assess whether different types of measures produce different results. Method: Three electronic bibliographic databases were last searched on 28 November 2018. Quantitative studies including a measure of empathy in medical undergraduate students and a comparison of the results among the different years of study were included. All analyses were guided by Lipsey and Wilson and conducted using Comprehensive Meta-Analysis software. Results: The overall sample size for the twelve studies (n = 12) was 4906 participants. Results indicate a significant effect (g = 0.487, SE = 0.113, 95% CI = 0.265, 0.709), suggesting that there is moderate evidence that empathy scores changed. Studies using the Jefferson's Scale for Physician Empathy (JSPE) reported higher effect sizes (g = 0.834, SE = 0.219, 95% CI = 0.406, 1.263), while the effect size for studies using other scales was smaller and non-significant (g = 0.099, SE = 0.052, 95% CI = -0.003, 0.201). Conclusions: This review indicated significant evidence that self-ratings of empathy changed across the years of medical education. However, we need to be cautious because this effect was only significant when empathy was assessed using the JSPE.
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Affiliation(s)
- Vasiliki Spatoula
- Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | | | - Anthony Montgomery
- School of Social Science, Humanities and Arts, University of Macedonia , Thessaloniki , Greece
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Schmid KL, Hopkins S, Huynh T. Involving patients in the development of interpersonal skills of optometry students. Clin Exp Optom 2019; 103:361-367. [PMID: 31309608 DOI: 10.1111/cxo.12939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/04/2019] [Accepted: 05/28/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Providing patients an opportunity to give feedback to optometry students on their communication and interpersonal skills allows for a unique learning opportunity. The aim of the current project was to determine if the Doctors' Interpersonal Skills Questionnaire (DISQ) was suitable for use with optometry students in a large teaching clinic and if it provided useful feedback to the students for learning purposes. METHODS The DISQ is a 12-item questionnaire that utilises a five-point Likert scale; a higher score indicates better performance. The DISQ was modified for an optometry context and developed into an online questionnaire. Patients were invited to complete the survey following their consultation with a final year student. Patients provided feedback on the interpersonal skills of the student optometrist who conducted the consultation under supervision. Students were provided with both individual and collated feedback obtained for the entire student group; strategies for improving communication were discussed. This activity did not form part of the grades of the students. RESULTS Patients were very satisfied with the interpersonal skills of final year optometry students. Highest scores were given for questions relating to the warmth of greeting, respect shown and time given. Lowest scores were for questions relating to explanations, reassurance and confidence. There was a significant improvement in the communication and interpersonal skills of students following the provision of patient feedback and strategies for improving these skills, and an additional period of clinical experience. CONCLUSION Patients can provide feedback on the interpersonal skills of optometry students using the DISQ. This feedback results in further skill development for students and makes patients feel valued within the teaching clinic environment. This activity assisted in ensuring that graduating optometrists have the interpersonal skills required to communicate clearly and effectively with patients, a requirement for practising with a patient-centred focus.
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Affiliation(s)
- Katrina L Schmid
- School of Optometry and Vision Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shelley Hopkins
- School of Optometry and Vision Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tina Huynh
- School of Optometry and Vision Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Fragkos KC, Sotiropoulos I, Frangos CC. Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016). World J Meta-Anal 2019; 7:1-30. [DOI: 10.13105/wjma.v7.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/16/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.
AIM To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.
METHODS A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I2 statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis.
RESULTS Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained.
CONCLUSION The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales.
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Affiliation(s)
- Konstantinos C Fragkos
- GI Services, University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
- Medical School, University College London, London WC1E 6BT, United Kingdom
| | - Ioannis Sotiropoulos
- Department of Accounting and Finance, University of Ioannina, Psathaki 481 00 Preveza, Greece
| | - Christos C Frangos
- Greek Research Institute for the Study of Quantitative, Social and Biomedical Problems, Athens 141 21, Greece
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