Development of student empathy during medical education: changes and the influence of context and training

Transforming healthcare with integrated inter-professional education in a research-driven medical school

Singapore, located strategically at the meeting point of the Malacca Strait and the South China Sea, has established itself as a global financial and economic hub. Despite its small geographical size, Singapore is home to over 5 million people from diverse cultural backgrounds. The city-state's medical education landscape has evolved significantly over the past century. Originally, Singapore had only one undergraduate medical school, the NUS Yong Loo Lin School of Medicine, established in 1905. Over time, this institution has grown into Singapore's largest and oldest medical school. NUS Medicine's vision centres on developing highly competent, values-driven, and inspired healthcare professionals to transform the practice of medicine and improve health worldwide. A curriculum overhaul in 2020 introduced new educational components to prepare future healthcare professionals for the challenges of Singapore's resilient healthcare system. This includes proficiency in integrated care, collaboration across disciplines, and leveraging AI and data science in clinical decision-making. The introduction of a common curriculum in August 2023 for Medicine, Nursing, Dentistry, and Pharmacy undergraduates further aligns with Singapore's 'Healthier SG' vision, ensuring that graduates are well-equipped to meet the evolving needs of the healthcare landscape. The common curriculum aims to address professional hierarchies and foster interprofessional collaboration among students from diverse academic backgrounds. By promoting frequent interaction and a team-oriented mindset, the curriculum seeks to instil a collective approach to healthcare, emphasising the importance of interprofessional practice in achieving the broader goals of healthcare delivery. This paper describes the reforms that took place and how the challenges were mitigated in a research-intensive top-ranked academic medical institution. This strategic alignment of medical education with national healthcare priorities underscores NUS Medicine's commitment to transforming medical practice and improving health outcomes in Singapore and beyond.

Developing empathy in healthcare professions students: protocol of a mixed-methods non-controlled longitudinal intervention study

Despite the necessary focus on clinical skills and knowledge during the tertiary education of healthcare professionals, the literature highlights the importance of developing psycho-social competencies. Empathy, a cognitive-behavioral attribute linked to various benefits for patients and healthcare professionals, is one such competency. Pedagogical approaches to successfully develop empathy in tertiary healthcare students are available. However, these approaches are often integrated piecemeal throughout the tertiary education journey. Research on a more empathy-focused curriculum is scarce. This manuscript describes the design of a study that aims to examine the effects of a more empathy-focused curriculum on empathy in tertiary healthcare profession students in Singapore. Freshmen dentistry, medicine, nursing, and pharmacy students enrolled in a novel curriculum with a strong empathy focus will be recruited for the study and followed for the program's extent. Mixed-methods data collection at various time points will be conducted. Quantitative data will be collected on cognitive-behavioral empathy, intentions to provide empathic care, and engagement in courses of the curriculum. Qualitative data on perceptions of patient care and empathy in relation to relevant courses of the curriculum will be collected to provide context for quantitative findings. Ethics approval was granted by the Departmental Ethics Review Committee of the Saw Swee Hock School of Public Health, National University of Singapore (Ethics ID: SSHSPH-214).

Levels of Empathy in Students and Professors with Patients in a Faculty of Dentistry

BACKGROUND

Empathy is an attribute that plays an essential role in the dentist-patient therapeutic relationship, clinical care, and treatment adherence, along with providing other benefits. The main objective of this research was to establish the validity, reliability, and invariance of the Jefferson Scale of Empathy and then characterize the empathy levels of students and teachers at a dental school.

MATERIALS AND METHODS

An observational and cross-sectional study analyzed a sample of undergraduate students and professors from the Universidad Andrés Bello Faculty of Dentistry (Chile) (n = 1727 and n = 267, respectively). The Empathy Scale for Health Professionals (HP) and the same scale for students (HPS) were applied.

RESULTS

The Jefferson Empathy Scale presents adequate psychometric properties. The empathy measure has adequate reliability and construct validity, confirming a fit of the three-factor empathy model to the data. The measurement is invariant within the university campus, the sex of the student, and between teacher and student. Teachers present greater empathy than students except in the Perspective Adoption dimension.

CONCLUSIONS

The Jefferson Empathy Scale is reliable, valid, and invariant among Chilean dental students and professors. Students do not differ from their professors in the cognitive component of empathy, but they present a lower score in the affective component and global empathy. It is inferred that students can develop the affective component of empathy in their interactions with their professors, increasing their overall empathy. Understanding and fostering empathy in dental students and professors can significantly improve patient care and treatment adherence and increase patient and dentist satisfaction.

Cognitive empathy variations during internship: a study from Iran

OBJECTIVE

Despite the critical role of empathy in medical students, various studies have provided conflicting evidence regarding changes in empathy during medical study. The present study was designed to investigate changes in cognitive empathy during the internship.

METHOD

A study was conducted at the Afzalipour School of Medicine, Kerman University of Medical Sciences. All medical students at the beginning of their internship were entered the study as a cohort and asked to complete a two-part questionnaire including demographic characteristics and the Persian version of the Jefferson Scale of Empathy-Student Version (JSE-S). The questionnaire was completed again at the end of the internship. Data were analyzed using SPSS software using paired t- test and one-way repeated measures.

RESULTS

A total of 108 interns participated with a mean age of 23.85 ± 1.47 years, and a female majority (61.1%). The mean score of standing in the patient's shoe increased significantly (P < 0.001) during the internship, whereas the mean score of compassionate care decreased (P < 0.001). The overall score of empathy decreased during the internship, but the difference was not statistically significant. (P = 0.105). No statistically significant difference was found in the mean score of empathy and its subscales based on demographic characteristics in the two phases of the study.

CONCLUSION

our results revealed that the level of cognitive empathy in the current study was higher than that in previous studies. The changes were consistent with some studies and contradictory to others. Considering that similar changes were observed in the subgroup analysis, it is necessary to focus more on the factors that cause this feeling to fade during the internship through appropriate assessment and timely intervention.

The impact of empathy on medical students: an integrative review

INTRODUCTION

Empathy is considered the ability to understand or feel others emotions or experiences. As an important part of medical education, empathy can affect medical students in many ways. It is still lacking a comprehensive evaluation of the existing articles on empathy's impact on medical students, despite the existence of many articles on the topic.

OBJECTIVES

To summarize the impact of empathy on medical students during medical education from four perspectives: mental health, academic performance, clinical competence, and specialty preference.

METHODS

The search terms used for retrieval were "empathy", "medical student", "mental health", "depression", "anxiety", "burnout", "examinations", "academic performance", "clinical competence", "specialty preference" on PubMed, EBSCO, and Web of Science before January 2024. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed based on inclusion/exclusion criteria. A consensus was drawn on which articles were included.

RESULTS

Our results indicated that high empathy was a positive factor for mental health, However, students with high affective empathy were more likely to suffer from depression, anxiety, and burnout. Empathy was found to be unrelated to academic performance, but positively correlated with clinical competence, particularly in terms of communication skills. Medical students with high levels of empathy tended to prefer people-oriented majors.

CONCLUSIONS

Medical students who score higher on the self-reported empathy scales often have better mental health, better communication skills, and tend to choose people-oriented specialties. But empathy is not related to academic performance. Additionally, the different dimensions of empathy have different impacts on medical students. It is necessary to design targeted courses and training for medical students to enhance their empathy.

Applying narrative medicine to prepare empathetic healthcare providers in undergraduate pharmacy education in Singapore: a mixed methods study

BACKGROUND

Narrative medicine demonstrated positive impact on empathy in medicine and nursing students. However, this pedagogical approach had not been evaluated in pharmacy education. This study sought to apply and evaluate the narrative medicine approach in extending empathy in Asian undergraduate pharmacy students.

METHODS

Narrative medicine was applied through workshops which used narratives of people with different experiences and perspectives. First-year undergraduate pharmacy students who volunteered and attended these workshops formed the intervention group (N = 31) and the remaining first-year cohort formed the control group (N = 112). A sequential explanatory mixed methods approach was adopted in which quantitative methods were first used to measure impact on pharmacy students' empathy using the Jefferson Scale of Empathy- Health Professions Student (JSE-HPS), and qualitative methods (i.e. group interviews) were then used to assess pharmacy students' emotional responses to narratives, and the perspectives of pharmacy students and faculty of this pedagogical approach.

RESULTS

There was no difference in JSE-HPS scores between intervention and control groups across baseline (i.e. upon matriculation), pre-intervention, and post-intervention timepoints. Pharmacy students in the intervention group had lower scores in Factor 3 ("Standing in People's Shoes") following the intervention. Five themes, guided by internal and external factors in cognition, emerged from the Group Interviews: (1) incongruence between students' motivation and faculty's perception, (2) learning context, (3) academic context, (4) cognitive system, and (5) affective system. Themes 1, 4 and 5 referred to internal factors such as students' motivation, perceived learnings, and feelings. Themes 2 and 3 referred to external factors including workshop materials, activities, content, and facilitation.

CONCLUSION

This study is the first to demonstrate that pharmacy students engaged with the narrative medicine approach as narratives elicited emotional responses, exposed them to diverse perspectives, and deepened their appreciation of the importance of empathy and complexities of understanding patients' perspectives. Scaffolded educational interventions using narratives and real-life patient encounters, alongside longitudinal measurements of empathy, are necessary to bring about meaningful and sustained improvements in empathy.

Empathy levels among undergraduate medical students in Karachi, Pakistan: a cross-sectional study

Empathy is a concept native to the field of medicine. However, over the course of medical school, empathy levels are expected to decline. The aim of this study was to assess the empathy levels among medical students in relation to their year of study and specialties of choice in the future.

MATERIALS AND METHODS

A cross-sectional study was conducted to assess empathy levels among students from medical colleges in Karachi, Pakistan, using an online survey. The total duration of the study was 2 months. The authors analyzed the data using SPSS version 20.

RESULTS

A total of 463 undergraduate medical students participated in this survey. The overall mean empathy score was 101.9±16.3 with 104.6±14.1 for females, which was significantly higher than the male participants. The highest empathy levels were demonstrated in fourth-year medical students with a mean empathy score of 104.1±16.3, whereas, the lowest empathy levels were found in second-year medical students with a mean empathy score of 99.8±9.4. Study participants considering emergency medicine, neurology, obstetrics/gynecology, and oncology as their specialty of choice demonstrated the highest empathy levels followed by pediatrics and internal medicine.

CONCLUSION

On average, there was a female preponderance in empathy levels among undergraduate medical students. Empathy levels among fourth-year students involved in clinical practice were greater as compared to students in their initial years of study. Further investigations are required to validate the findings of this study.