Empathy in MedicineCultivating an Empathetic Professional Identity in Osteopathic Medical Students Through Service Learning: A Qualitative Analysis of Reflective Essays

Impact of a Service Learning Curriculum that Emphasizes Bidirectional Learning on Medical Students' Professional Identity Formation

Introduction

Despite the many known benefits of service learning, little is known about the impact of service learning on medical students' professional identity formation.

Purpose

The objective of our study was to assess the impact of a service learning curriculum that emphasized bidirectional learning on the professional identity of medical students.

Methods

The community-based participatory research (CBPR) conceptual model, a model which emphasizes bidirectional learning between academic and community stakeholders, was utilized as a curricular framework for a required service-learning course at a single institution in North America. All 45 third year medical students enrolled in the course were included. Using a qualitative data analysis framework and the constant comparative method, the two researchers independently reviewed all 45 individual student reflections to identify themes that emerged and to iteratively create a codebook. A thematic analysis of the codes was then undertaken to answer the research question.

Results

Themes from student reflections revealed the following: (1) The process of perspective-taking during bidirectional learning promotes becoming an empathetic physician. Enabling factors are empathy with stakeholders and seeing oneself as a future change agent. (2) The process of perspective-taking and reconciliation of learner/stakeholder beliefs with a goal of unifying around a common mission was expressed in several different ways: Learner pivots from their original belief to stakeholder's beliefBoth learner and stakeholder beliefs are incorporated into the final goalLearner keeps original beliefsEnabling factors are empathy, humility, and discernment.

Conclusion

Bidirectional or reciprocal learning in service learning can promote professional characteristics such as empathy, humility, and discernment.

Effectiveness of empathy portfolios in developing professional identity formation in medical students: a randomized controlled trial

BACKGROUND

Medical education requires innovative strategies to enhance empathic skills and the formation of professional identities among students. However, evidence-based teaching of empathy and professional identity formation is inadequately represented, particularly in medical curricula. This study investigated the effectiveness of empathy portfolios in developing Professional Identity Formation (PIF) among medical students and the correlation between empathy and PIF. The objectives of this study were to determine the effectiveness of empathy portfolios for teaching and nurturing PIF in medical students and to investigate the correlation between empathy and PIF.

METHODS

A randomized controlled trial was conducted at Peshawar Medical College, Pakistan. The protocol adhered to CONSORT guidelines. A total of 120 students participated in the study. Empathy and PIF were assessed using two validated questionnaires JSPE-S and PIQ before randomization. The participants were randomized in a stratified fashion into the experimental (n = 60) and control (n = 60) groups. The Participants in the intervention group attended a training workshop on portfolio use. Students maintained their portfolios and wrote reflections on incidents that evoked empathy. Independent t-tests were performed to determine whether the control and experimental groups differed in terms of mean empathy and PIF scores, and Pearson's correlation analyses were used to investigate the relationships between pre- and post-empathy, and pre-post-PIF.

RESULTS

The mean post-test scores on the Empathy and PIF showed a statistically insignificant difference of 0.75 +-17.6 for empathy and 0.45 ± 8.36 for PIF. The intervention had little influence on empathy and PIF scores, as evidenced by nonsignificant effect sizes of 0.32 and 0.36 for empathy and PIF respectively.A strong positive correlation was found between Pre-Empathy and the PIF-Total score (0.519), and between Post- empathy and the PIF-Total score (0.395) (p < 0.001).

CONCLUSIONS

Empathy had a positive linear correlation with PIF; however, the use of empathy portfolios as a three-week single-point intervention was ineffective at nurturing PIF.

Wikipedia as an academic service-learning tool in science and technology: higher education case from Siberia

Wikipedia, the open crowdsourced encyclopedia that anyone can edit, ranks among the top ten most-visited websites globally. Its integration into university curriculum as an innovative educational tool is a slowly growing trend; however, many higher education institutions have yet to fully grasp its potential. In response, a specific optional module for Wikipedia editing, designed for the selected undergraduate science courses at the School of Advanced Studies, Russia, was implemented as an optional extra credit service-learning activity, a teaching methodology combining meaningful service to the community with curriculum-based learning. Students who chose to participate and those who preferred not to participate in the activity were invited to participate in a research project to explore their perspectives and experiences. In total, five sessions of focus group discussions were conducted with participants (12 females and 2 males) in one set and non-participants (5 females and 4 males) in another to identify students' perspectives on themes such as their interest in science, reasons for their choices, and their expectations before the activity while post-experience focus group discussions were used to identify the perspectives of participant students on themes, encompassing contribution of the service-learning activity, acquisition of new skills, and the development of prosocial behaviors. Students' opinions on integrating social responsibility topics into the curriculum were also explored. The results extracted from these focus group discussions, analyzed through consensual coding, revealed factors promoting student participation, like interest in the subject, novelty of the activity, and grade improvement opportunities, as well as factors deterring participation, such as concerns about academic benefits, workload, and time constraints. Furthermore, the results demonstrated that Wikipedia editing serves as a novel teaching methodology, promoting student learning and development in digital literacy and information literacy, which are among the twenty-first-century skills. Interestingly, at the same time, not all students could address the value of contributing to open, crowdsourced knowledge for public service or interpret this activity as an academic service-learning. These suggest that Wikipedia editing is an innovative teaching approach, fostering students' learning and development while also indicating its potential to enhance students' understanding of responsible citizenship and public service in the digital age.

Professionalism and professional identity formation in dental students: Revisiting the professional role orientation inventory (PROI)

OBJECTIVE

Professionalism is a hallmark of health professions education. Professional identity formation is a growing field of exploration in medical education, and the dental literature is sparse on just how professional identity formation is developed and assessed within dental education.

METHODS

The validated professional role orientation inventory (PROI) was administered to 2nd year dental students during a spring semester ethics course. The PROI includes four 10-item scales representing four attitudinal factors: Authority, Responsibility, Agency, and Autonomy.

RESULTS

When compared to a historical sample of dental students in the early 1990s, dental students today scored significantly higher on Responsibility (p = 0.0309) and lower on the Agency factor (p = 0.0001). Authority scores in the current sample of dental students were significantly associated with age and race, with an increase in age associated with a decrease in Authority (p = 0.0504) and Caucasian respondents demonstrating significantly higher scores than Asian or Other races. Debt was associated with differences in Autonomy (p = 0.0683) and Agency (p = 0.0106), with those in the 100k-300k anticipated debt range demonstrating lower levels of both Autonomy and Agency. Race was marginally associated with Responsibility with those in the Other race category (Hispanic, Black/African American, Other/Multiracial) demonstrating higher levels than Caucasian (p = 0.0513).

CONCLUSION

Dental students' scores denote a continued commitment to others yet a feeling of less sense of control as a practicing professional. A redefining of professionalism to include social activism and advancing health equity is required given their altruism and commitment to others, which remains high.

Empathy development and volunteering for undergraduate healthcare students: A scoping review

OBJECTIVES

Empathy in healthcare benefits patients and healthcare providers. However, empathy decline is a recent trend within healthcare education. There is a paucity of literature that investigates the impact of volunteering on the empathy levels of undergraduate healthcare students. This scoping review explores the literature regarding empathy and volunteering for healthcare students.

DESIGN

The Joanna Briggs Institute methodology for scoping reviews guided this study.

DATA SOURCES

The electronic databases MEDLINE, CINAHL, ProQuest, JBI, Cochrane, PubMed, PsychInfo, and PsychNurses were searched from January 2001 to August 2021. The original search was developed in MEDLINE and then adapted to the other databases.

REVIEW METHODS

This scoping review used the Joanna Briggs Institute scoping review methodology. The search retrieved a total of 310 articles. Following deduplication, 271 articles were reviewed by title and abstract. Thirty articles were reviewed in full text with twelve articles meeting the criteria for inclusion. Included studies were assessed using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Five qualitative, four quantitative and three mixed method studies were included. A variety of volunteering interventions for undergraduate healthcare students were identified from countries including the United States of America, Singapore, Australia, and Brazil. Thematic analysis identified that volunteer undergraduate healthcare students practiced and developed empathy, and experienced professional and personal development.

CONCLUSIONS

Volunteering interventions were primarily in a service-learning modality within community health and palliative healthcare settings. Inconsistencies exist in empathy definitions and empirical empathy measurement. There is a need for more research that explores empathy development through volunteer activities in acute care settings.

A Systematic Review of Educational Interventions and Their Impact on Empathy and Compassion of Undergraduate Medical Students

Introduction: A compassionate and patient-centered care leads to improved clinical outcomes. Promoting empathy and compassion of medical students is a forerunner of their well-being, emotional stability, and a patient-centered care. However, there is slender evidence about best educational interventions that can inculcate empathy and compassion skills. Our objective was to conduct a systematic review of research evaluating the associations between spectrum, effectiveness, frequency of teaching modalities and their outcomes on compassion and empathy to highlight best practices.

Methods: We searched the Web of Science, PubMed, Scopus, and EBSCO Host on 22nd July 2020. We adapted our search strategy from a previously published systematic review on education for compassion and empathy. Selected studies were required to have used unique educational interventions for promoting empathy and compassion of medical students. The research questions were based on Participants (medical students), Intervention (empathy and/or compassion related teaching), Comparison, and Outcome.

Results: We analyzed 24 articles from the initial yield of 2,861. Twenty-two were quantitative studies with a mean of 12.8 on MERSQI. Twelve were randomized controlled trials while 5 measured outcomes with single group pre- and post-tests. There was no association found between duration, frequency and complexity of an educational intervention and its effectiveness. Twenty used multimodality curricula, and of those 18 reported statistically significant positive improvement in empathy, while 3 of 4 single modality were effective. Only three studies looked for long-term effects of educational interventions. Fourteen studies evaluated Kirkpatrick's level one (self-reported knowledge), 2 level three (behavior), and 6 level four (patient outcomes). We identified six major educational constructs of teaching empathy and compassion; communication, mindfulness, early clinical exposure, technology-enhanced learning, comics and arts and culture.

Discussion: Our review couldn't identify a standard teaching construct in place and highlighted that different teaching tools carry similar impact in promoting compassion and empathy and a sustainable program rather than a single training activity is essential.

A qualitative analysis of third-year medical students' reflection essays regarding the impact of COVID-19 on their education

BACKGROUND

The COVID-19 pandemic fundamentally changed every aspect of healthcare delivery and training. Few studies have reported on the impact of these changes on the experiences, skill development, and career expectations of medical students.

METHOD

Using 59 responses to a short reflection essay prompt, 3rd year medical students in Philadelphia described how the COVID-19 pandemic affected their education in mid-2020. Using conventional content analysis, six main themes were identified across 14 codes.

RESULTS

Students reported concerns regarding their decreased clinical skill training and specialty exposure on their career development due to the loss of in-person experience during their family medicine clerkship. A small number felt very let down and exploited by the continued high cost of tuition while missing clinical interactions. However, many students also expressed professional pride and derived meaning from limited patient and mentorship opportunities. Many students developed a new sense of purpose and a call to become stronger public health and patient advocates.

CONCLUSIONS

The medical field will need to adapt to support medical students adversely impacted by the COVID-19 pandemic, from an educational and mental health standpoint. However, there are encouraging signs that this may also galvanize many students to engage in leadership roles in their communities, to become more empathetic and thoughtful physicians, and to redesign healthcare in the future to better meet the needs of their most vulnerable patients.

Impact of Student-Run Clinics on Students' Attitudes Toward People Experiencing Homelessness

Introduction

Student-run clinics can supplement medical education by exposing students to diverse clinical scenarios and collaborating with underresourced populations. We examined the impact of volunteering at THRIVE, a student-run bridge clinic located within sheltered housing for individuals with substance use disorder, on students' attitudes toward people experiencing homelessness (PEH).

Methods

This cohort study analyzed pre- and postsurvey matched responses from nonvolunteer and volunteer first-year medical students utilizing the Health Professional Attitudes Towards the Homeless (HPATHI) tool, totaled into three subcategories: Cynicism, Social Advocacy, and Personal Advocacy. We evaluated the association between change in scores and volunteering utilizing Student t tests and adjusting for participant characteristics using multivariable regression analysis.

Results

We received 106 responses (53% response rate); 58 students (55%) volunteered at the clinic and were mostly female (62%), White (52%), and had previous experience working with PEH (71%). The mean change in Personal Advocacy scores was higher for volunteers compared to nonvolunteers, even when adjusting for respondent characteristics (P=.02). Additionally, students who held a prior advanced degree and/or current enrollment in the master of bioethics program (Higher Education Students) had a positive association with change in Personal Advocacy scores (P=.02).

Conclusion

Volunteering at the THRIVE Clinic appears to impact the Personal Advocacy scores of medical students. This suggests that interacting with PEH early in students' career may be associated with a commitment to working with this population. However, our study has multiple limitations, including self-selection bias, limited sample size, and unclear permanence of students' attitudes over time. Further studies of this cohort could help clarify the significance and permanence of volunteering in student-run clinics.