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Cairns P, Isham AE, Zachariae R. The association between empathy and burnout in medical students: a systematic review and meta-analysis. BMC MEDICAL EDUCATION 2024; 24:640. [PMID: 38849794 PMCID: PMC11157786 DOI: 10.1186/s12909-024-05625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Burnout levels in medical students are higher than in other student groups. Empathy is an increasingly desired outcome of medical schools. Empathy is negatively associated with burnout in physicians. Our objective was to quantitatively review the available literature on associations between empathy and burnout in medical students, and to explore associations between specific empathy aspects (cognitive and affective) and burnout sub-dimensions (emotional exhaustion, depersonalization and personal accomplishment). METHODS A comprehensive search of the literature published up until January 2024 was undertaken in the PubMed, EMBASE, CINAHL, The Cochrane Library, and PsycINFO databases. Two independent reviewers screened 498 records and quality-rated and extracted data from eligible studies. The effect size correlations (ESr) were pooled using a random-effects model and between-study variation explored with meta-regression. The review was preregistered with PROSPERO (#CRD42023467670) and reported following the PRISMA guidelines. RESULTS Twenty-one studies including a total of 27,129 medical students published between 2010 and 2023 were included. Overall, empathy and burnout were negatively and statistically significantly associated (ESr: -0.15, 95%CI [-0.21; -0.10], p < .001). When analyzing sub-dimensions, cognitive empathy was negatively associated with emotional exhaustion (ESr: -0.10, 95%CI [-0.17; -0.03], p = .006) and depersonalization (ESr: -0.15, 95%CI [-0.24; 0.05], p = .003), and positively associated with personal accomplishment (ESr: 0.21, 95%CI [0.12; 0.30], p < .001). Affective empathy was not statistically significantly associated with emotional exhaustion, depersonalization or personal accomplishment. Supplementary Bayesian analysis indicated the strongest evidence for the positive association between cognitive empathy and personal accomplishment. Response rate and gender moderated the relationship so that higher response rates and more male respondents strengthen the negative association between empathy and burnout. CONCLUSION Greater empathy, in particular cognitive empathy, is associated with lower burnout levels in medical students. This appears to be primarily driven by cognitive empathy's positive association with personal accomplishment. PROTOCOL REGISTRATION #CRD42023467670.
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Affiliation(s)
- P Cairns
- Unit for Psycho-Oncology & Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
| | - A E Isham
- Research and Development Department, Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478, Nordbyhagen, Norway
| | - R Zachariae
- Unit for Psycho-Oncology & Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Sattar K, Yusoff MSB, Arifin WN, Mohd Yasin MA, Mat Nor MZ. A scoping review on the relationship between mental wellbeing and medical professionalism. MEDICAL EDUCATION ONLINE 2023; 28:2165892. [PMID: 36621960 PMCID: PMC9833410 DOI: 10.1080/10872981.2023.2165892] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/01/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Mental wellbeing issues among medical students are common, and their relationship to medical professionalism is debated. Few studies have attempted to link such issues with undergraduate medical education. This review aimed to advance the knowledge on this matter by exploring the relationship between mental wellbeing and medical professionalism in undergraduate medical education. METHODS We collected the literature about mental wellbeing and medical professionalism (published from 1 January 1986 to 31 March 2021) from the Web of Science, PubMed, Scopus and ScienceDirect databases using the search terms 'mental wellbeing' and 'medical professionalism'.We included all peer-reviewed articles in which mental wellbeing and medical professionalism in the undergraduate medical education context were the central topics regardless of the age range, nationality, race and gender of the participants. RESULTS From the 13,076 Iinitially found articles, 16 were included. These 16 articles were from nine countries in four different continents, which all together helped us find answer to our research question using extracted points relating to the main study themes (mental wellbeing and medical professionalism). Under theme 1 (mental wellbeing), six subthemes emerged: burnout, stress, depression, disappointment, depersonalisation and conscientiousness. Theme 2 (medical professionalism), on the other hand, had five subthemes: empathy, academic performance, compassion, unprofessional behaviour and professionalism. A significant inverse association was found between empathy and burnout. Academic performance was also related to burnout. At the same time, empathy was found to have a varied association with stress. Moreover, compassion was found to alleviate burnout and nurture professional gratification. CONCLUSION The medical professionalism attributes were found to deteriorate as the mental wellbeing issues grow. This can harm medical students' overall health, current learning abilities and future attitudes towards their patients. Explicit primary research is thus required to examine and intervene in the cause-effect relationship between medical professionalism and mental wellbeing.
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Affiliation(s)
- Kamran Sattar
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Muhamad Saiful Bahri Yusoff
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Wan Nor Arifin
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Azhar Mohd Yasin
- Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Zarawi Mat Nor
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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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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Rafaqat W, Sami A, Ibrahim MT, Ibad H, Awais S, Memon A, Shahbaz FF, Ahmed D, Zindani S, Leghari AL, Saleem S. Impact of Perfectionism and Resilience on Empathy in Medical Students: A Cross-Sectional Study. J Patient Exp 2022; 9:23743735221106603. [PMID: 35694014 PMCID: PMC9185014 DOI: 10.1177/23743735221106603] [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] [Indexed: 12/01/2022] Open
Abstract
Empathy is a cognitive attribute that forms the cornerstone for good
doctor–patient encounters. The formative period for the development of empathy
toward patients begins with clinical encounters within medical school. An
individual medical student's empathy levels may in part be a product of their
resilience and perfectionist attitudes. A cross-sectional study with 320 medical
students across all years of study was conducted to determine the correlation of
perfectionism and resilience with clinical empathy in medical students. The
JSE-S, CD-RISC 10, and APS-R scales were used to assess levels of empathy,
resilience, and perfectionism, respectively. The study found that a positive
correlation exists between resilience (r = 0.174) and academic
year with empathy, and a negative correlation exists between maladaptive
perfectionism and empathy (r = −0.138). The resilience score
declined progressively as the year of study progressed with a statistically
significant. Mean empathy scores were lowest in fifth-year students
(96.8 ± 12.5) and highest in third-year students (107.8 ± 13.2). Further
longitudinal studies are necessary to better understand the impact of resilience
and perfectionism on empathy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sarah Saleem
- Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
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The Spatiotemporal Patterns of Climate Asymmetric Warming and Vegetation Activities in an Arid and Semiarid Region. CLIMATE 2020. [DOI: 10.3390/cli8120145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Asymmetric warming was bound to have a major impact on terrestrial ecosystems in arid regions during global warming. Further study was necessary to reveal the spatiotemporal patterns of asymmetric warming in Xinjiang; this study analyzed the climate and normalized difference vegetation index (NDVI) data (2000–2020). The change trends of the day and nighttime warming (DNW), seasonal warming, and the diurnal temperature range in northern Xinjiang (S1) and southern Xinjiang (S2) were determined. The findings indicated that the DNW rate showed a significant (p < 0.05) upward trend, especially in winter. The nighttime warming rate (0.65 °C (decade)−1) was faster than the daytime warming rate (0.4 °C (decade)−1), and the diurnal temperature range between daytime and nighttime exhibited a decreasing trend. The diurnal temperature range was the highest in spring and the lowest in winter. Extreme values of the diurnal temperature range appeared in autumn (48.6 °C) and winter (12.3 °C) and both in S1. The Tmin in S1 had an abruption trend in 2006–2017, the Tmax in S2 had an abruption trend in 2005–2011, and the probability of spatial abruption in S1 was higher than that in S2. The partial correlation between the NDVI and Tmin was significantly higher than that between the NDVI and Tmax in the area where the significance test passed; therefore, asymmetric nighttime warming had a greater impact on the NDVI than the asymmetric daytime warming.
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