Underlying construct of empathy, optimism, and burnout in medical students

Association between burnout and empathy in medical residents

BACKGROUND

Burnout is a work-related syndrome that can affect physicians' performance. Empathy is one of the clinical competencies in whose formation many factors play a role. Empathy and burnout are important topics of research in medical sciences, and both are related to the communication between the patient and the physician. This study investigated the relationship between occupational burnout and empathy among medical residents.

METHOD

This cross-sectional study was conducted on 297 medical residents in Ahvaz Jundishapur University of Medical Sciences from January to March 2021. The data collection tools were the Jefferson Scale of Empathy (JSE) and the Maslach Burnout Inventory (MBI). The reliability of the instruments was measured by calculating Cronbach's alpha. Data were analyzed by SPSS-18, using the Pearson correlation test and linear regression models.

RESULTS

The average age of the study population was 33.06 ±4.7 years, with more than half being females (57.6%) and married (51.9%). The residents' mean scores of empathy and overall burnout were 102.87 out of 140 and 55.90 out of 132, respectively. The burnout scores showed an inverse correlation with the overall empathy scores (r = -0.123, P = 0.035), and the score of standing in the patient's shoes (r = -0.165, P = 0.004). Linear regression test was used to detect which dimension of empathy was a better predictor for the reduction of burnout scores. Results showed that the best predictor was standing in the patient's shoes (P = 0.014).

CONCLUSION

The findings showed a negative association between empathy and burnout among medical residents, which suggests the need for adjustment of the existing burnout management at the institutional level. Therefore, residents should be supported by managers to reduce burnout and improve their empathic behavior.

On the correlation between gratitude and resilience in medical students

Objective

Medical students' health and resilience have increasingly been the subject of current research in recent years. A variety of interventions are recommended to strengthen resilience or its known or suspected influencing factors, although the literature shows that the evidence on the effectiveness of the interventions is inconsistent. The present study investigated whether gratitude is a direct protective factor for resilience in medical students or whether resilience factors (optimism, self-efficacy, social support) and stress mediate the effects of gratitude on resilience.

Methods

90 medical students at Witten/Herdecke University took part in the study that determined their gratitude, resilience, optimism, self-efficacy, social support and stress levels using validated questionnaires (GQ-6, RS-25, LOT-R, SWE, F-SozU, PSS). Correlations were analyzed using Pearson correlation coefficients. In addition, a multivariate regression analysis and a path analysis were calculated to determine the direct and indirect effects of gratitude on resilience.

Results

Multivariate regression analysis showed that only optimism, social support and stress were significantly associated with resilience (B=0.48, 95% CI: 0.31, 0.66; B=0.23, 95% CI: 0.01, 0.44 and B=-0.02, 95% CI: -0.03, -0.001, respectively). The direct effect of gratitude on resilience was minimal and not significant in the path analysis. However, there was an indirect effect of gratitude on resilience (B=0.321; p<0.05). Mediation via the optimism variable was mainly responsible for this effect (indirect effect B=0.197; p<0.05).

Conclusion

This study shows that gratitude has only a minimal direct influence on resilience. However, results indicate that optimism as a mediating factor strengthens the resilience of medical students. Against this background, it may be useful to integrate interventions that promote an optimistic attitude into medical studies in order to strengthen the mental health of future doctors in the long term.

The Language of Compassion: Hospital Chaplains' Compassion Capacity Reduces Patient Depression via Other-Oriented, Inclusive Language

Objectives

Although hospital chaplains play a critical role in delivering emotional and spiritual care to a broad range of both religious and non-religious patients, there is remarkably little research on the best practices or "active ingredients" of chaplain spiritual consults. Here, we examined how chaplains' compassion capacity was associated with their linguistic behavior with hospitalized inpatients, and how their language in turn related to patient outcomes.

Methods

Hospital chaplains (n = 16) completed self-report measures that together were operationalized as self-reported "compassion capacity." Next, chaplains conducted consultations with inpatients (n = 101) in five hospitals. Consultations were audio-recorded, transcribed, and analyzed using Linguistic Inquiry Word Count (LIWC). We used exploratory structural equation modeling to identify associations between chaplain-reported compassion capacity, chaplain linguistic behavior, and patient depression after the consultation.

Results

We found that compassion capacity was significantly associated with chaplains' LIWC clout scores, a variable that reflects a confident leadership, inclusive, and other-oriented linguistic style. Clout scores, in turn, were negatively associated with patient depression levels controlling for pre-consult distress, indicating that patients seen by chaplains displaying high levels of clout had lower levels of depression after the consultation. Compassion capacity exerted a statistically significant indirect effect on patient depression via increased clout language.

Conclusions

These findings inform our understanding of the linguistic patterns underlying compassionate and effective chaplain-patient consultations and contribute to a deeper understanding of the skillful means by which compassion may be manifest to reduce suffering and enhance well-being in individuals at their most vulnerable.

Disability, program access, empathy and burnout in US medical students: A national study

OBJECTIVE

The objective of this study is to investigate whether self-disclosed disability and self-reported program access are associated with measures of empathy and burnout in a national sample of US medical students.

METHODS

The authors obtained data from students who responded to the Association of Medical Colleges (AAMC) Year 2 Questionnaire (Y2Q) in 2019 and 2020. Data included demographic characteristics, personal variables, learning environment indicators, measures of burnout (Oldenburg Burnout Inventory for Medical Students), empathy (Interpersonal Reactivity Index) and disability-related questions, including self-reported disability, disability category and program access. Associations between disability status, program access, empathy and burnout were assessed using multivariable logistic regression models accounting for YQ2 demographic, personal-related and learning environment measures.

RESULTS

Overall, 23 898 (54.2%) provided disability data and were included. Of those, 2438 (10.2%) self-reported a disability. Most medical students with disabilities (SWD) self-reported having program access through accommodations (1215 [49.8%]) or that accommodations were not required for access (824 [33.8%]). Multivariable models identified that compared with students without disabilities, SWD with and without program access presented higher odds of high exhaustion (1.50 [95% CI, 1.34-1.69] and 2.59 [95% CI, 1.93-3.49], respectively) and lower odds of low empathy (0.75 [95% CI, 0.67-.85] and 0.68 [95% CI, 0.52-0.90], respectively). In contrast, multivariable models for disengagement identified that SWD reporting lack of program access presented higher odds of high disengagement compared to students without disabilities (1.43 [95% CI, 1.09-1.87], whereas SWD with program access did not (1.09 [95% CI, 0.97-1.22]).

CONCLUSIONS

Despite higher odds of high exhaustion, SWD were less likely to present low empathy regardless of program access, and SWD with program access did not differ from students without disabilities in terms of disengagement. These findings add to our understanding of the characteristics and experiences of SWD including their contributions as empathic future physicians.

Program Leaders' and Educators' Perspectives on the Factors Impacting the Implementation and Sustainment of Compassion Training Programs: A Qualitative Study

PHENOMENON

Training programs have been used to improve compassion in healthcare, but the factors necessary to make such programs successful and sustainable have not been identified. This thematic analysis aimed to bridge the gap between theory and practice by drawing on the experiences of international leaders and educators of compassion training programs to develop a clear understanding of what is relevant and effective and how compassion training is implemented and sustained.

APPROACH

International leaders and educators of compassion training programs (N = 15) were identified through convenience sampling based on academic and gray literature searches. Semi-structured face-to-face interviews with these participants were conducted between June 2020 and November 2020 in order to identify facilitators, barriers, and environmental conditions influencing the implementation and maintenance of compassion training programs. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis.

FINDINGS

Six categories affecting the operationalization of compassion training programs were identified 1) origins, foundational principles and purpose, 2) curricular content, 3) methods of teaching and learning, 4) trainer qualities, 5) challenges and facilitators, and 6) evaluation and impact.

INSIGHTS

Compassion training should be rooted in the construct of interest and incorporate patients' needs and their experience of compassion, with patient-reported compassion scores integrated before and after training. Compassion training should be delivered by highly qualified educators who have an understanding of the challenges associated with integrating compassion into clinical practice, a dedicated contemplative practice, and a compassionate presence in the classroom. Prior to implementing compassion training, leadership support should be secured to create an ethos of compassion throughout the organization.

Stress and Resilience of Nursing Students in Clinical Training During the COVID-19 Pandemic: Palestinian Perspective

Introduction

Stress reduces nursing students' capacity to think critically, impedes decision-making, and eventually lowers academic performance and limits success. The circumstances surrounding the COVID-19 outbreak drove students into new virtual learning settings, adding stress to their academic responsibilities.

Objectives

The purpose of this study was to assess the perceived stress and resilience among nursing students in clinical training during the COVID-19 pandemic.

Method

A cross-sectional study was conducted on 315 students studying nursing. Data collection utilized the Perceived Stress Scale and the Connor-Davidson Resilience Scale.

Results

The analysis revealed that the stress score mean was 75.2 ± 6.6 and the resilience score mean was 26.0 ± 3.4. Also, there was a weak negative association between nursing students' stress and their resilience (p < 0.05). Additionally, the results indicated statistically significant differences between stress and gender, study year level, and age (p < 0.05).

Conclusion

Stress was high and resilience was moderate during the COVID-19 pandemic among nursing students.

Millennials Medical Students Generation at the Crosswalks: Motivations and Attitudes Towards Study and Future Career - A Mixed-Method Study

BACKGROUND AND OBJECTIVES

The aim of this study was to investigate in the millennium medical student generation the influence of the curriculum (problem-based curriculum [PBC] vs science-based curriculum [SBC]), gender and semester level on medical students' motives to study medicine, their attitudes toward their career and in this regard their view about their study condition in university.

METHODS

Semi-structured qualitative interviews with 28 medical students were performed and analyzed using Mayring's content analysis. Based on these results, a quantitative questionnaire for a nationwide survey was developed using a mixed-method-approach and send to most medical faculties in Germany. Data from n=1053 students entered statistical analysis.

RESULTS

Humanistic ideals prevailed in the choice to enter medical school and to become a physician. PBC students were found to be significantly (p<0.001) more idealistic and patient oriented, and they regard their curriculum more competitive than SBC-students (p<0.001). A balanced work and family life is essential for all students but particularly important for the PBC - group, male and undergraduate students. The majority of students wanted to work with patients and omitted patient-distant line of work. Undergraduate SBC-students saw their studies as old-fashioned citing lack of patient contact (p<0.001 compared to PBC), which eased in the graduate study part.

CONCLUSION

This study found major differences in student's perceptions depending on curriculum type. PBC-students were more idealistic, and humanistic ideals prevailed in comparison to SBC. For both, close patient contact is essential in their training. Particularly for female students, lifestyle factors and a balanced work-life-integration outweigh career ambitiousness. This study offers an important insight to policy makers and educators to understand the motivation and perceptions of the millennial student generation regarding their studies and future career plans, which should be considered in educational policies.

Weak inclusion of the medical humanities in medical education: a qualitative study among Danish medical students

BACKGROUND

The modern medical education is predominantly grounded in the biomedical sciences. In recent years, medical humanities have been included into the medical curricula in many countries around the world one of the objectives being to promote patient-centred, empathic care by future physicians. Studies have been made of the impact of inclusion of medical humanities components within the medical curriculum. Although some results suggest increased empathy, others remain inconclusive. To gain insight into the depth, context, and impact of inclusion of the medical humanities for future physicians, this study aimed to explore Danish medical students' understanding of and reflections on how the medical humanities relate to the medical education, including the clinic.

METHODS

We conducted a qualitative research study, involving semi-structured interviews with twenty-three Danish medical students across years of curriculum and medical schools. Interviews were recorded, transcribed verbatim and analyzed using Braun and Clarke's thematic analysis.

RESULTS

The findings demonstrate the subordinate role of the medical humanities in the medical educational system. Students prioritize biomedical knowledge building in the preclinical curriculum, partly as a reaction to an unbalanced institutional inclusion of the medical humanities. Observing how structural empathy incentives are lacking in the clinical curriculum, the values inherent in the medical humanities are undermined.

CONCLUSION

Danish medical students become part of an educational environment with lacking institutional conditions and structures to promote the strong inclusion of the medical humanities. A focus is therefore needed on the values, norms and structures of the medical educational systems that undermine a strong inclusion of the medical humanities into medical education.

Empathy as a learning objective in medical education: using phenomenology of learning theory to explore medical students' learning processes

BACKGROUND

Clinical empathy has been associated with a range of positive patient- and clinician outcomes. Educating medical students to become empathic physicians has in recent years become a clearly pronounced learning objective in medical education in many countries worldwide. Research knowledge about how medical students experience the learning processes conveyed by empathy-enhancing educational interventions is lacking. Our study aimed to explore Danish medical students' perspectives on which experiences allowed learning processes to take place in relation to empathy and empathic communication with patients.

METHODS

We conducted a qualitative research study, involving semi-structured interviews with twenty-three Danish medical students across years of curriculum and universities. Braun and Clarke's reflexive thematic analysis (RTA) guided the analytical process, moving on a continuum from inductive to deductive, theoretical approaches. Key concepts in regard to learning processes deriving from Amadeo Giorgi's learning theory were applied to analyse the data.

RESULTS

Learning processes in relation to clinical empathy occured: 1. when theoretical knowledge about empathy became embodied and contextualied within a clinical context 2. through interpersonal interactions, e.g., with peers, faculty members and clinicians, that conveyed behavior-mobilizing positive and negative affect and 3. when new learning discoveries in 2. and 3. were appropriated as a personalized and adequate behavior that transcends the situational level.

CONCLUSION

Rather than being an immediate product of knowledge transmission, skill acquisition or training, learning clinical empathy is experienced as a dynamic, temporal process embedded in a daily clinical lifeworld of becoming an increasingly human professional.

Medical empathy in medical students in Madrid: A proposal for empathy level cut-off points for Spain

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.

How Does the Optimism of Students Learning a Foreign Language Affect Their Creative Self-Efficacy? The Mediating Effects of Hope and Empathy

Creative self-efficacy (CSE) is a core influencer of creative behavior and has a positive impact on well-being and development. However, the positive psychological processes that help to promote CSE in foreign-language learning (FLL) remain under-studied. Focusing specifically on FLL students, the present study examined the associations among optimism, hope, empathy, and CSE and investigated the possible mediating roles of hope and empathy in the relationship between optimism and CSE. A sample of 330 FLL students from two Chinese universities participated in this study. The results showed that (i) optimism, hope, and empathy were all positively related to CSE and that (ii) optimism did not directly predict CSE but indirectly and positively predicted CSE through hope and empathy. These findings suggest that optimism, empathy, and hope potentially play positive roles in facilitating CSE in FLL students. Based on the present results, some practical approaches are discussed that could help improve the CSE of FLL students, paying particular attention to the effects that potentially motivate their positivity.

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

PURPOSE

Empathy levels have been observed to often decrease when medical undergraduates move to the clinical years, particularly in the Western countries. However, empathy either remains similar or increases in many Asian medical schools. This study investigated the longitudinal empathy profile of medical students in Singapore.

METHODS

Two cohorts of medical students who enrolled in 2013 and 2014 to the National University of Singapore were tracked for 5 years. The Jefferson Scale of Empathy-student version was used. Analyses on the mean of the empathy level and individual factors, year-wise and gender comparison were conducted.

RESULTS

Average response rates for cohort 1 and 2 were 68.1% (n=181-263) and 55.4% (n=81-265), respectively. For both cohorts, there was no significant change across year of study in the mean empathy score. Average scores for both cohorts were 113.94 and 115.66. Though not significant, we observed mean empathy to be lowest at the end of year 5 (112.74) and highest in year 2 (114.72) for cohort 1 while for cohort 2, the lowest level of empathy was observed in year 5 (114.20) and highest in year 4 (118.42). Analysis of subcomponents of empathy only showed a significant difference for cohort one factor 1 (perspective taking) and factor 3 (standing in patients' shoes) across the study years.

CONCLUSION

No significant change in empathy score was observed during the transition from pre-clinical to clinical years, unlike many Western and Far-Eastern studies. This might be due to the curriculum and influence of the Asian values.

Training to Promote Empathic Communication in Graduate Medical Education: A Shared Learning Intervention in Internal Medicine and General Surgery

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Mindfulness practice correlates with reduced exam-induced stress and improved exam performance in preclinical medical students with the "acting with awareness", "non-judging" and "non-reacting" facets of mindfulness particularly associated with improved exam performance

Background

Medical students demonstrate higher levels of psychological distress compared with the general population and other student groups, especially at exam times. Mindfulness interventions show promise in stress reduction for this group, and in the reduction of cortisol, an established clinical marker of the body’s stress response. This study investigated the relationship of mindfulness to exam-induced stress, salivary cortisol and exam performance in undergraduate medical students.

Methods

A controlled pre-post analysis design with within-groups comparisons. 67 medical students completed the five facet mindfulness questionnaire (FFMQ) and provided saliva samples, from which cortisol was extracted, during group work (control/baseline) and immediately prior to end of year 2 examinations (experimental). Academic performance data was extracted for comparison with measures.

Results

Exam-induced salivary cortisol concentration showed a significant negative relation with exam performance. Total FFMQ score showed a significant positive relation with exam performance and a significant negative relation with exam-induced salivary cortisol. The specific mindfulness facets of acting with awareness, non-judging and non-reacting also showed a positive correlation with exam performance.

Conclusions

This study suggests that there exists an important relationship between mindfulness and the physiological biomarker of stress, cortisol, and this manifests into improved assessment outcomes potentially through healthier, more adaptive coping and stress management strategies. In particular, this study identifies the acting with awareness, non-judging and non-reacting facets of mindfulness to be significantly associated with exam performance suggesting that these may be important facets for clinical educators to target when helping students with mindfulness practice.

The relationship between medical students' empathy and burnout levels by gender and study years

OBJECTIVE

To investigate the multifaceted factors affecting empathy in medical students.

METHODS

1293 medical students from 15 South Korean medical schools participated in an online survey. Affective empathy was measured with the 'empathy concern' and 'personal distress' dimensions from the Interpersonal Reactivity Index for Medical Students (IRI-MS). Cognitive empathy was assessed with IRI-MS' 'perspective taking' and Jefferson Scales for Physician Empathy for Student (JSPE-S). Maslach Burnout Inventory for Medical Students (MBI-MS) assessed the burnout levels of the participants.

RESULTS

A significant gender difference in affective and cognitive empathy was found using JSPE-S. Different patterns were seen in the empathy dimensions between the study years and genders. Burnout scores showed no gender differences, while exhaustion and cynicism increased, and academic efficacy decreased with seniority. Academic efficacy was a consistently influential factor for both affective and cognitive empathy in both genders, all study years and the three domains of burnout.

CONCLUSION

Academic efficacy was a significant factor influencing both affective and cognitive empathy.

PRACTICAL IMPLICATIONS

The comprehensive nature of empathy in medical students may be better investigated by applying multi-dimensional empathy measurement tools and by analyzing multiple factors such as gender, study year and burnout.

Is Grit Associated with Burnout and Well-being in Orthopaedic Resident and Faculty Physicians? A Multi-institution Longitudinal Study Across Training Levels

BACKGROUND

Grit has been defined as "perseverance and passion for long-term goals" and is characterized by maintaining focus and motivation toward a challenging ambition despite setbacks. There are limited data on the impact of grit on burnout and psychologic well-being in orthopaedic surgery, as well as on which factors may be associated with these variables.

QUESTIONS/PURPOSES

(1) Is grit inversely correlated with burnout in orthopaedic resident and faculty physicians? (2) Is grit positively correlated with psychologic well-being in orthopaedic resident and faculty physicians? (3) Which demographic characteristics are associated with grit in orthopaedic resident and faculty physicians? (4) Which demographic characteristics are associated with burnout and psychologic well-being in orthopaedic resident and faculty physicians?

METHODS

This study was an institutional review board-approved interim analysis from the first year of a 5-year longitudinal study of grit, burnout, and psychologic well-being in order to assess baseline relationships between these variables before analyzing how they may change over time. Orthopaedic residents, fellows, and faculty from 14 academic medical centers were enrolled, and 30% (335 of 1129) responded. We analyzed for the potential of response bias and found no important differences between sites in low versus high response rates, nor between early and late responders. Participants completed an email-based survey consisting of the Duckworth Short Grit Scale, Maslach Burnout Inventory-Human Services (Medical Personnel) Survey, and Dupuy Psychological Well-being Index. The Short Grit Scale has been validated with regard to internal consistency, consensual and predictive validity, and test-retest stability. The Psychological Well-being Index has similarly been validated with regard to reliability, test-retest stability, and internal consistency, and the Maslach Burnout Inventory has been validated with regard to internal consistency, reliability, test-retest stability, and convergent validity. The survey also obtained basic demographic information such as survey participants' age, gender, race, ethnicity, marital status, current year of training or year in practice (as applicable), and region of practice. The studied population consisted of 166 faculty, 150 residents, and 19 fellows. Beyond the expected age differences between sub-populations, the fellow population had a higher proportion of women than the faculty and resident populations did. Pearson correlations and standardized β coefficients were used to assess the relationships of grit, burnout, psychologic well-being, and continuous participant characteristics.

RESULTS

We found moderate, negative relationships between grit and emotional exhaustion (r = -0.30; 95% CI -0.38 to -0.21; p < 0.001), depersonalization (r = -0.34; 95% CI -0.44 to -0.23; p < 0.001), and the overall burnout score (r = -0.39; 95% CI -0.48 to -0.31; p < 0.001). The results also showed a positive correlation between grit and personal accomplishment (r = 0.39; 95% CI 0.29 to 0.48; p < 0.001). We also found a moderate, positive relationship between grit and psychologic well-being (r = 0.39; 95% CI 0.30 to 0.49; p < 0.001). Orthopaedic surgeons with 21 years or more of practice had higher grit scores than physicians with 10 to 20 years of practice. Orthopaedic surgeons in practice for 21 years or more also had lower burnout scores than those in practice for 10 to 20 years. Married physicians had higher psychologic well-being than unmarried physicians did.

CONCLUSION

Among orthopaedic residents, fellows, and faculty, grit is inversely related to burnout, with lower scores for emotional exhaustion and depersonalization and higher scores for personal accomplishment as grit increases.

CLINICAL RELEVANCE

The results suggest that grit could be targeted as an intervention for reducing burnout and promoting psychologic well-being among orthopaedic surgeons. Other research has suggested that grit is influenced by internal characteristics, life experiences, and the external environment, suggesting that there is potential to increase one's grit. Residency programs and faculty development initiatives might consider measuring grit to assess for the risk of burnout, as well as offering curricula or training to promote this psychologic characteristic.

Empathy, friend or foe? Untangling the relationship between empathy and burnout in helping professions

The relationship between empathy and burnout in helping professions has been debated extensively, with some arguing the tendency to vicariously experience the emotions of another is a risk factor for burnout and others arguing that this disposition protects against burnout. We sought to aid this debate by assessing the relationship between two empathy facets, positive and negative, and burnout across three samples of helping professionals: practicing clinicians (N = 59), medical students (N = 76), and teaching assistants (N = 77). Results across all three samples consistently revealed that one's tendency to share in the positive emotions of another (i.e., positive empathy) was related to lower levels of burnout, even after controlling for several potential confounding factors. Beyond discussing the utility of the emerging study of positive empathy, we offer potential avenues for reducing burnout in helping professions by emphasizing the importance of sharing in the positive emotions of others.

Predictors of Burnout Among Physicians: Evidence From a National Study in Portugal

The aims of this research on burnout among physicians were threefold, (1) to characterize the burnout symptoms’ prevalence among Portuguese physicians, (2) to test the hypothesis that organizational demands and resources add, on top of other factors, to the explanatory level of burnout; and (3) to explore the predictors of organizational demands and resources. Data collection was conducted online at the national level in Portugal, with 9,176 complete replies and a response rate of 21%. Predictors stemming from theoretical models of an intra-individual, occupational, organizational, and socio-psychological nature were measured using an online/paper survey. Results were analyzed through a significantly modified version of the Maslach Burnout Inventory (MBI) after transformations to address the fit of this measure in this sample. Results show that 66% of physicians have high levels of emotional exhaustion, 33% high levels of depersonalization, and 39% high levels of decrease of personal accomplishment. Moreover, a first set of hierarchical multiple regression models with burnout symptoms reveals that organizational resources, demands of the relationship with the patients and of work schedule are consistently important predictors of emotional exhaustion and depersonalization on top of other theoretically relevant predictors. A second set of regression models with the organizational-level variables shows that, aside from organizational variables, other context variables, like procedural justice and teamwork, have the most substantial predictive value. These results highlight the importance of recognizing physicians’ burnout as a phenomenon that is predicted by a wide variety of factors, but also the importance of attending to the particular role of circumstancial factors that may be addressed in future interventions.

Cultural adaptation and psychometric properties of the Jefferson empathy scale health professions students' version in SpanishOccupational therapy students

BACKGROUND

In occupational therapy, empathy is a fundamental concept and has a positive impact on health and quality of care outcomes for patients. It is a basic and essential concept that should prevail in the training of occupational therapy students. The aim of this study is to validate and cross-culturally adapt the Jefferson Medical Empathy Scale, version for health professionals (JSE-HPS) in a sample of Spanish university students of occupational therapy.

METHODS

A cross-sectional descriptive study was conducted between 2019 and 2020. A convenience sample was selected, consisting of 221 students from the four courses of the Occupational Therapy degree at the Universidad Rey Juan Carlos during the 2019-20 academic year. Each of the participants voluntarily and anonymously completed a sociodemographic data sheet (including age and sex), in addition to the following assessment scales: JSE-HPS and the Interpersonal Reactivity Index (IRI).

RESULTS

A culturally adapted version of the JSE-HPS that guarantees conceptual and grammatical equivalence specific to the study population was obtained. The psychometric analysis of the translated version showed a Cronbach coefficient α of 0.786. The test-retest reliability analysis showed an intraclass correlation coefficient of 0.90 (95% CI = 0.86-0.93, p < 0.0001). Confirmatory factor analysis (CFA) showed positive results (χ² = 269.095, df = 167, p < 0.001, Confirmatory Fit Index [CFI] = 0.90, Root Mean Square Error of Approximation [RMSEA] = 0.04).

CONCLUSION

The cultural adaptation and psychometric results suggest that the Spanish version of the JSE-HPS is a valid and reliable way to evaluate the empathic ability of occupational therapy students.

Academic burnout among medical students: respective importance of risk and protective factors

OBJECTIVES

Prior research has found a high prevalence of academic burnout among medical students (33-55%), and medical education institutions have begun to address the issue. In this research, we hypothesized an increase in academic burnout during medical education, as supported by previous findings. The second purpose was to identify the significant predictors (among perceived stress, empathy, and perceived social support) of academic burnout and determine their respective importance.

STUDY DESIGN

The study design was a cross-sectional online and anonymous survey.

METHODS

We recruited medical students (N = 342) from four education year-groups (i.e. Bachelor 1 and 3; Master 1 and 3). All participants voluntarily responded to our anonymous study and filled in four questionnaires assessing academic burnout, perceived stress, empathy, and perceived social support. We performed a multivariate analysis of variance on academic burnout and hierarchical regression analyses to determine the respective importance of risk and protective factors of academic burnout.

RESULTS

We found that two academic burnout domains (i.e. emotional exhaustion and cynicism) significantly changed according to the study year. Cynicism increased as the academic years progressed (F_(3,334) = 9.50; P < 0.001), and emotional exhaustion was highest at critical graduation moments during the academic curriculum (i.e. Bachelor 3 and Master 3; F_(3,334) = 11.2; P < 0.001). Overall, women presented higher academic burnout traits than men (ᴧ = 0.963; F_(3,332) = 4.26; P = 0.006), but univariate analysis revealed that they especially displayed higher emotional exhaustion (F_(1,334) = 12.1; P < 0.001). Hierarchical regression analyses showed that perceived stress, cognitive empathy, and perceived social support were significant predictors of academic burnout. We found that perceived stress was a major predictor of academic burnout (from 10% to 28% of the part of variance) in comparison to other factors such as empathy (around 5%) and perceived social support (around 6%).

CONCLUSIONS

We found that emotional exhaustion and cynicism significantly changed over medical education and that women presented greater vulnerability than men for emotional exhaustion. Furthermore, risk and protective factors of academic burnout were identified: (1) perceived stress was a decisive risk factor; (2) paradoxically, cognitive empathy had a double edge nature (the two cognitive empathy domains had opposite effects); and (3) perceived social support was identified as a protective factor. Thus, a novel dimension of this research was to investigate and describe the importance of several predictors of academic burnout. The implications are crucial for education, and several recommendations are discussed to prevent academic burnout.

Comparison of empathy with patients between first-year and last-year medical students of Tehran University of Medical Sciences

PURPOSE

This study was conducted to assess the developmental factors of empathy among medical students of Tehran University of Medical Sciences (TUMS).

METHODS

To assess the empathy levels, 42 first-year and an equal number of last-year medical students were randomly selected. They answered a questionnaire including the medical student version of the Jefferson Scale, demographic, and some related variables. Statistical analyses were performed using the Chi-square test, T-test, univariate, and multivariate regressions.

RESULT

The study population consisted of 51 (60.7 %) men and 33 (39.3 %) women with a mean (SD) age of 22.24 (4.10) years. The Jefferson score was 110.19 ± 13.61 and 103.52 ± 20.00 in first- and last-year medical students, respectively. Moreover, medical students who completely passed at least one of the considered empathy courses of the TUMS curriculum had higher empathy scores compared to their counterparts (109.83 ± 15.54 vs. 103.68 ± 19.02). There was no significant association between empathy and gender, self-experience of illness, marital status, family history of chronic disease, and parents' education (all P-values > 0.05). After adjusting for the effects of confounders, the empathy scores were significantly associated with the academic year level (p = 0.04), level of interest in medicine (p = 0.001), and passing the empathy courses (p = 0.04).

CONCLUSIONS

The data provided from a top Iranian medical school indicated that the academic year level, level of interest in medicine, and passing the empathy courses were significantly associated with the empathy level. Further studies are recommended.

What works for whom in compassion training programs offered to practicing healthcare providers: a realist review

BACKGROUND

Patients and families want their healthcare to be delivered by healthcare providers that are both competent and compassionate. While compassion training has begun to emerge in healthcare education, there may be factors that facilitate or inhibit the uptake and implementation of training into practice. This review identified the attributes that explain the successes and/or failures of compassion training programs offered to practicing healthcare providers.

METHODS

Realist review methodology for knowledge synthesis was used to consider the contexts, mechanisms (resources and reasoning), and outcomes of compassion training for practicing healthcare providers to determine what works, for whom, and in what contexts.

RESULTS

Two thousand nine hundred ninety-one articles underwent title and abstract screening, 53 articles underwent full text review, and data that contributed to the development of a program theory were extracted from 45 articles. Contexts included the clinical setting, healthcare provider characteristics, current state of the healthcare system, and personal factors relevant to individual healthcare providers. Mechanisms included workplace-based programs and participatory interventions that impacted teaching, learning, and the healthcare organization. Contexts were associated with certain mechanisms to effect change in learners' attitudes, knowledge, skills and behaviors and the clinical process.

CONCLUSIONS

In conclusion this realist review determined that compassion training may engender compassionate healthcare practice if it becomes a key component of the infrastructure and vision of healthcare organizations, engages institutional participation, improves leadership at all levels, adopts a multimodal approach, and uses valid measures to assess outcomes.

The direct and indirect effects of clinical empathy on well-being among pre-medical students: a structural equation model approach

BACKGROUND

Empathy is a well-established facet of clinical competency that research suggests is associated with enhanced medical student well-being. Since little is known about empathy and well-being before students enter medical school-during pre-medical education-the main goal of this study is to test a conceptual model of how clinical empathy is related to two indicators of well-being, depression, and burnout among pre-medical students. The theoretical model hypothesizes that three dimensions of clinical empathy-Perspective-Taking, Compassionate Care, and Standing in Patients' Shoes- will be directly and negatively related to depression, as well as indirectly through its inverse relationship with three facets of burnout, Emotional Exhaustion, Poor Academic Efficacy, and Cynicism.

METHODS

Using survey data from a sample of 132 pre-medical students at an American Midwestern university, this study employs structural equation modeling (SEM) to test the theoretical model of the relationships between empathy, burnout, and depression among pre-medical students. We identify the direct effects of the three dimensions of the Jefferson Scale of Physician Empathy (JSE-S) on depression (CES-D), as well as the indirect effects of clinical empathy on depression through the three dimensions of the Maslach Burnout Inventory (MBI-S).

RESULTS

SEM analyses show that while none of the three dimensions of the JSE-S are directly related to depression, clinical empathy does significantly affect depression indirectly through burnout. Specifically, as predicted, we find that Perspective-Taking decreases Emotional Exhaustion, but, contrary to expectations, Compassionate Care increases it. And, the positive relationship between Compassionate Care and Emotional Exhaustion is particularly strong. In turn, Perspective-Taking and Compassionate Care are associated with depression in opposite directions and to different degrees.

CONCLUSIONS

Findings suggest that clinical empathy as measured by the JSE-S produces both positive and negative effects on personal well-being. We conclude that further conceptual clarity of clinical empathy is needed to better discern how the different dimensions impact different indicators of well-being. Given that pre-medical education is a crucial time for emotional socialization, the challenge for medical education will be fostering the positive, cognitive aspects of clinical empathy while simultaneously mitigating the adverse effects of affective empathy on medical student well-being.

Burnout syndrome in Spanish medical students

BACKGROUND

Burnout syndrome is a frequent syndrome related to people that feel a deterioration in their daily activities due to highly demandant psychological requirements in their workplaces. Within last decades, this syndrome has been studied across medical professionals, concluding that stress levels that physicians suffer is high enough to make them develop burnout syndrome. In the case of medical students, there are some recent studies, although with small samples. For this reason, given that this phenomenon may produce a huge impact in medical students' development, the aim of this study is to analyze the influential factors that may contribute to its occurrence.

METHODS

The necessary information was gathered through a web-based questionnaire, divided in two parts. The first part of the survey included questions related to personal aspects of the students. Burnout related questions (second part) were divided in three subscales to evaluate exhaustion, cynicism, and academic efficacy levels.

RESULTS

Family support for studying medicine is associated with lower burnout levels in all three scales of the Maslach Burnout Inventory. The number of years spent in the degree show the opposite trend: the more years in the degree, the higher score in all burnout scales.

CONCLUSIONS

Burnout syndrome is a problem among medical students in Spain that increases with the number of years studying medicine. It should be also noticed that family support and vocational studies are independent factors related to lower levels of burnout.

An Exploratory Cross-Sectional Study on the Relationship between Dispositional Mindfulness and Empathy in Undergraduate Medical Students

There is a growing interest in identifying the psychological variables that promote and sustain empathy in medical students during their studies. Dispositional mindfulness has been shown to be empirically associated with socio-demographic characteristics and empathy among the general population. This research aimed to assess dispositional mindfulness in a sample of undergraduate medical students and to investigate its association with gender, age, and empathy. Hypotheses: It is hypothesized that male medical students would show, on average, higher dispositional mindfulness than their female counterparts, and that older students would exhibit higher dispositional mindfulness than younger ones. Dispositional mindfulness was also expected to be positively associated with the ability to feel compassion for others and to adopt their perspective, and negatively associated with the personal distress in tense interpersonal settings. Method: An exploratory cross-sectional study was conducted. Data were gathered from a large sample (N = 933) of Italian non-meditating second- and fifth-year medical students. Dispositional mindfulness and empathy were assessed using the Five-Facet Mindfulness Questionnaire and the Interpersonal Reactivity Index, respectively. Gender and age differences in dispositional mindfulness scores were calculated by analyses of variance, whereas hierarchical multiple regression models were used to assess the association between dispositional mindfulness and empathy scores. RESULTS Female medical students were more able to Act with Awareness than males, whereas males had higher levels than females of Describing and Nonreactivity to their feelings. When compared to their older counterparts, younger students scored higher on Observing and lower on Nonreactivity facets. Dispositional mindfulness facets correlated differently with both emotional and cognitive empathy dimensions, beyond the effects of gender and age. Medical students who displayed higher dispositional mindfulness appeared to be less emotionally distressed in tense interpersonal settings and more able to take others' cognitive perspective. Conclusions: The findings support the notion that dispositional mindfulness is related to empathy and may have implications for the design of mindfulness-based training for use in the medical educational setting. Tailored interventions that cultivate specific dispositional mindfulness facets may be implemented along the medical curriculum to prevent the emotional distress in tense interpersonal settings and to sustain the cognitive capability to take others' viewpoints among medical students.

A validation study of the Korean version of the Toronto empathy questionnaire for the measurement of medical students' empathy

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.

Personal values as early predictors of emotional and cognitive empathy among medical students

The present study contributes to the literature by examining the association between personal values (PVs), assessed with the Schwartz’s Portrait Values Questionnaire, and empathy, assessed with the Davis’ Interpersonal Reactivity Index, in a sample of first-year medical students. We also examined medical students’ PVs profile and gender differences in terms of PVs. All participants (N = 398) were Italian, young (average age = 19.62 years, SD = 1.22), and unmarried; none had children. Zero-order correlations and hierarchical multiple regression models were performed to verify the association between PVs and empathy; in contrast, t-tests were run to explore gender differences in scoring on PVs. Benevolence and Universalism correlated positively with both the emotional and cognitive dimensions of empathy, whereas Power, Achievement, Hedonism, and Security were negatively associated with empathy. The three most important PVs in the whole sample were Benevolence, Self-Direction, and Universalism. Male medical students outscored their female counterparts on Power, Achievement, and Hedonism, whereas female students outscored the males on Benevolence, Universalism, Conformity, and Tradition. Our findings highlight the importance of fostering self-transcending PVs and discouraging self-enhancing PVs in medical students during the early years of medical school, as a means of supporting other-oriented responses such as empathy in future doctors.

The Effect of 12 Hour Shifts, Time of Day, and Sleepiness on Emotional Empathy and Burnout in Medical Students

Sleepiness decreases alertness and results in decrements in performance. This is especially problematic in the healthcare field due to restricted sleep from shift-work. Sleepiness increases medical errors, but it also affects emotions and interpersonal interactions. Empathy in physicians is a desirable trait which is associated with increased patient recovery rates and patient satisfaction, and decreased use of pain medication. Shift-work may alter empathy in physicians and affect patient outcomes, but the effects of sleepiness on empathy are unknown. Empathy, which is related to burnout, declines during medical school, while incidence of burnout increases. This study assessed the effect of sleepiness from time of day (TOD) and 12 h shifts on empathy and burnout in medical students. Participants were tested on sleepiness and empathy prior to and immediately following a 12 h Emergency Medical Technician shift. Burnout was assessed following each shift to determine if it was affected by sleepiness, empathy, and shift. TOD affected empathy, with empathy highest in the evening. Sleepiness from working 12 h shifts resulted in decreased empathy and increased burnout, with females showing higher rates on the exhaustion component of burnout. This research demonstrates that TOD affects empathy, and sleepiness decreases empathy and increases burnout in medical students.

Risk and protective factors for burnout among physicians from standardized residency training programs in Shanghai: a cross-sectional study

Background

High burnout has been reported in physician populations. Although the standardized residency training (SRT) in China includes components that might put residents at a higher risk for burnout, the burnout of Chinese medical residents is unknown. This study aimed to evaluate the prevalence of burnout and the associated risk and protective factors for medical residents in the SRT program in Shanghai, China.

Methods

This study was a prospective cross-sectional design. A random sampling strategy was used to recruit 330 resident physicians from four SRT sites in Shanghai, and 318 completed questionnaires were returned. Respondents completed a self-made questionnaire including demographic and work characteristics, four burnout and wellness-specific surveys. Bivariate analyses and hierarchical multiple regression models were used to analyze factors associated with three sub-scales of burn out separately.

Results

The overall burnout rate was 71.4%. Low level rate of personal accomplishment (PA) was extremely high at 69.5%. Night shift experience, high occupational stress, and low social support were significant predictors, which explained 49.1% variance of emotional exhaustion (EE) (F = 26.528, P < 0.01). Factors that significantly predicted depersonalization (DP) included male gender, senior residents, night shift experience, high occupational stress, and low psychological empathy, which explained 51.5% variance totally (F = 29.004, P < 0.01). Senior residents, high income, low occupational stress, and high empathy were also significant predictors of decreased personal achievement (PA), which explained 18.4% variance totally (F = 12.897, P < 0.01).

Conclusions

There was a high burnout rate among SRT residents in Shanghai. Occupational stress and several work-related factors were significant and strong risk factors for burnout, while empathy and social support were mild protective factors. Decreased work-related demands and increased access to resources could assist residents in reducing their work stress and improving their well-being.

Relationship between level of empathy during residency training and perception of professionalism climate

BACKGROUND

Empathy is one of the vital personality attributes for all physicians. It is essential for establishing general interpersonal relationships among doctors and patients. Unfortunately, there is evidence for the decline of physician's empathy during the clinical training phase and is a major concern for medical educators worldwide. One of the major factors reported for the decline of this trait is an unprofessional learning environment.

OBJECTIVE

This study examines the relationship between empathy level and perception of climate of professionalism among residents.

METHOD

The study participants included 70 residents of Obstetrics & Gynecology and Pediatrics departments of a private sector tertiary care hospital in Karachi, Pakistan. Two self-administered internet based surveys - Jefferson Scale of Physician Empathy (JSPE) and "Professionalism Climate Instrument"(PCI) - were administered to assess the level of empathy among the participants and their perception of professionalism in the learning environment. The relationship between the level of empathy and professionalism was analyzed using Spearman rank correlation.

RESULTS

The overall response rate was 81.4% with mean empathy level of 103 ± 13. The internal consistency of each scale measured by Cronbach's coefficient α was 0.76 for JSPE and 0.65 for PCI. No significant difference was observed in the mean empathy scores between senior and junior residents of both specialties. Statistically significant difference in empathy scores existed between female and male residents (p = 0.012; 95% CI, 2.27 to 17.59). The mean PCI score was 106 + 8.88 with no significant difference among residents of two specialties. Professionalism score was not found to vary with either the year of residency or gender. Empathy score and professionalism climate were not found to be correlated (r_s = 0.56, p = 0.64).

CONCLUSION

The findings suggested that empathy is a relatively stable trait that remains unchanged during residency training programs. Female residents had higher empathic concern than the male trainees, however, the empathy level of the participants was not found to be influenced by the climate of professionalism.

More Than Their Test Scores: Redefining Success with Multiple Mini-Interviews

INTRODUCTION

Medical schools are shifting to a holistic approach for admissions. As non-cognitive abilities become more valued in the medical field and admissions become more competitive, multiple mini-interviews (MMI) are becoming increasingly common in selection criteria. The purpose of this article is to examine the relationship among admissions criteria to create a predictive model of acceptance to medical school. This article also aims to examine, among matriculated students, the relationship between MMI and traditional academic success, and the relationship between MMI scores and clinical competence and academic accolades.

METHODS

This longitudinal study followed a cohort of students from the MMI process through the first two pre-clinical years at a medical school in the southeastern USA. Multiple logistic regression with backward elimination variable selection was used to examine the relationship between admission criteria and acceptance. A multivariate multinomial ordered probit model was used to assess the relationship between MMI and traditional academic success among matriculated students. Simple linear regression models were used to assess relationships between MMI and Objective Structured Clinical Examination (OSCE) scores and honors nomination.

RESULTS

MMI are among eight significant predictors of acceptance. Among matriculated students, there were weak negative associations between MMI and traditional academic success; however, all but one relationship was statistically non-significant. There was not a significant association between MMI and OSCE scores or academic accolades.

CONCLUSIONS

While MMI can identify students with non-cognitive skills needed to be a good physician, continued assessment needs to be incorporated in their education.

Use of Personality Frameworks in Health Science Education

Objectives. To review the use of personality frameworks by educators as a tool to increase self-awareness in health professions students. Findings. After screening titles, abstracts, and/or the full text of the 415 articles identified in an initial search, 71 articles involving personality frameworks were included in the study. Several different personality frameworks, including the Five-Factor Model, Myers-Briggs Type Indicator, the Rational Experiential Inventory, and the CliftonStrengths assessment, were used in various health science education disciplines, including medicine, nursing, and pharmacy. Most publications were descriptive in nature and only reported on the personality attributes of the given research cohort. Some studies correlated personality framework results with either learning or non-cognitive outcomes. Very few studies described using personality frameworks as a tool for self-awareness and growth. Summary. While some personality frameworks have been used in health science education for multiple purposes, there is currently a lack of published evidence documenting the use of these frameworks for self-awareness in students.

A systematic review of psychometric assessment of the Jefferson Scale of Empathy using the COSMIN Risk of Bias checklist

INTRODUCTION

Empathic communication in health care may enhance positive patient and health care professional relationships, patient satisfaction and can buffer professional burnout. The Jefferson Scale of Empathy (JSE) was developed based on the need to quantitatively measure levels of empathy, particularly in health care settings. Evaluating the utility of empathy is underpinned by the psychometric rigour of the instruments used to measure it. The aim of this study was to critically evaluate the current evidence on the measurement properties of the JSE.

METHODS

Two reviewers independently searched six databases for papers describing psychometric assessment of the JSE from January 2000 to July 2018 inclusive. The studies were independently assessed for methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist.

RESULTS

The search strategy resulted in the retrieval of 985 papers, of which 59 were included in this study. The majority of papers reported on measures of structural validity and internal consistency, and it was in these areas which the highest quality of reporting was demonstrated. Additionally, there was a generally very good quality in reporting of convergent validity. Reliability, measurement error, cross-cultural validity were reported with less than optimum quality.

CONCLUSION

The JSE demonstrates robust structural validity, internal consistency, and convergent validity. These measurement properties are generally well reported in the literature in studies of good methodological quality, and thus may be interpreted with relative confidence when used in empathy research. However, current evidence is limited for the properties of reliability, measurement error, and cross-cultural validity. Thus, a degree of caution should be considered in drawing conclusions when using the JSE with regard to these properties. It is recommended that future examinations of the JSE refer to the COSMIN guidelines to ensure complete and well-reported psychometric data are included.

Professional quality of life and burnout among medical physicists working in radiation oncology: The role of alexithymia and empathy

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Burnout is critical for oncology professionals, affecting quality of life and performance at work.

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Alexithymia and empathy are personality traits influencing the capacity to cope with stress.

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Alexithymia increases burnout among medical physicists with a negative impact at work.

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Higher level of empathy are correlated to a better professional quality of life.

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This data may help identifying subjects at risk to implement preventive strategies.

Background and purpose

The professional quality of life of radiation oncology professionals can be influenced by different contributing factors, including personality traits. Alexithymia involves deficits in emotion processing and awareness. Empathy is the ability to understand another’s ‘state of mind/emotion’. We investigated professional quality of life, including burnout, in radiation oncology, exploring the role of alexithymia and empathy and targeting the population of medical physicists (MPs), since this professional category is usually underrepresented in surveys exploring professional well-being in radiation oncology and MPs may experience professional distress given the increasing complexity of multimodal cancer care.

Material and methods

An online survey was addressed to ESTRO members. Participants filled out three questionnaires to evaluate alexithymia, empathy and professional quality of life: a) Toronto Alexithymia Scale (TAS-20); b) Interpersonal Reactivity Index (IRI); c) Professional Quality of Life Scale (ProQoL). Professional quality of life as per ProQoL was considered as dependent variable. The three domains of the ProQoL, namely compassion satisfaction (CS), secondary traumatic stress (STS) and burnout were correlated with alexithymia (as per TAS-20) and empathy (as per IRI with three subcategories: empathic concern, perspective taking and personal distress) and demographic/professional characteristics as independent variables. Generalized linear modeling was used. Significant covariates on univariate linear regression analysis were included in the multivariate linear regression model.

Results

A total of 308 medical physicists completed all questionnaires. Alexithymia as per TAS-20 was correlated to decreased CS (β = −0.25, p < 0 0.001), increased likelihood for STS (β = 0.26, p < 0 0.001) and burnout (β = 0.47, p < 0 0.001). With respect to empathy, the ‘Empatic Concern’ subscale of the IRI was found to be a significant predictor for increased CS (β = 0.19, p = 0 0.001) and increased STS (β = 0.19, p < 0 0.001), without significant correlation with burnout. The individual’s perception of being valued by own’s supervisor was correlated to increased CS (β = 0.23, p < 0.001), and decreased burnout (β = −0.29, p < 0.001).

Conclusions

Alexithymic personality trait increased the likelihood to develop burnout, with less professional satisfaction amongst MPs working in radiation oncology. Empathy results in higher professional fulfilment. These results may be used to benchmark preventing strategies, including peer support, debriefing sessions, leadership initiatives and work-load limitation strategies.

Assessing Burnout and Interest in Wellness Programs in Physician Assistant Students

PURPOSE

Burnout among health care professionals and preprofessional health care students is of growing concern because of its detrimental effects on performance, mental health, and physical health. Research to date has focused primarily on physicians and medical students. The purpose of this study was to assess burnout and the quality of life among physician assistant (PA) students and gauge their interest in specific wellness interventions that address those issues in their PA program.

METHODS

An online survey consisting of validated measures for burnout and quality of life was completed by 320 PA students from all 8 Virginia PA programs (n = 8). Additionally, student interest in various wellness interventions was assessed, including preferences for timing and delivery, to inform development of a tailored well-being component in the PA curriculum to reduce burnout.

RESULTS

We found burnout to be prevalent among PA students, with 79.69% reporting high levels of emotional exhaustion; 56.56% of students met the criteria for cynicism. Survey participants rated stress reduction (n = 290, 90.63%) and burnout (n = 299, 93.44%) as primary issues that need to be addressed in the PA student population. Furthermore, 77.50% of participants expressed interest in participating in a wellness intervention designed to reduce burnout.

CONCLUSION

Given the high prevalence of burnout in the PA students surveyed, resources and potential interventions that reduce burnout need to be identified. The current study identified PA students' perceived needs and interest in various aspects of potential wellness interventions in the PA program. Students preferred an emphasis on stress reduction and burnout, which can be used to develop a tailored well-being curriculum to promote work-life balance and stress management for PA students.

Does Empathy Decline in the Clinical Phase of Medical Education? A Nationwide, Multi-Institutional, Cross-Sectional Study of Students at DO-Granting Medical Schools

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.

Empathy in Medicine National Norms for the Jefferson Scale of Empathy: A Nationwide Project in Osteopathic Medical Education and Empathy (POMEE)

Context

National norms are necessary to assess individual scores from validated instruments. Before undertaking this study, no national norms were available on empathy scores. The Project in Osteopathic Medical Education and Empathy (POMEE) provided a unique opportunity to develop the first national norms for medical students.

Objective

To develop national norms for the assessments of osteopathic medical students' empathy scores on the broadly used and well-validated Jefferson Scale of Empathy (JSE) at all levels of osteopathic medical school education.

Methods

Participants were students from 41 of 48 participating campuses of osteopathic medical schools. Students were invited to complete a web-based survey, which included the JSE, in the 2017-2018 academic year.

Results

A total of 16,149 completed surveys were used to create national norm tables. Three national norm tables were developed for first-year matriculants and for students in preclinical (years 1 and 2) and clinical (years 3 and 4) phases of medical school. The norm tables allow any raw score on the JSE for male and female osteopathic medical students from matriculation to graduation to be converted to a percentile rank to assess an individual's score against national data.

Conclusions

National norms developed in this project, for men and women and at different levels of medical school education, can not only be used for the assessment of student's individual scores on the JSE, but can also serve as a supplementary measure for admissions to medical school and postgraduate medical education programs.

Orientations to Wellbeing in the Context of Medicine and Nursing-A Preliminary Study on Students' Perspective in Their Early University Years

Medicine in the 21^st century needs to be patient-or, rather, person-centered. Accordingly, medical education needs to adopt an authentic student-centered stance and also include an emphasis on wellbeing and quality of life-starting in medical students` university years. Studies on eudaimonic and hedonic aspects of wellbeing in academic contexts might offer valuable insights for conceptualizing and implementing medical teaching. Our research aimed at exploring eudaimonic and hedonic orientations in students in their first years of medical and nursing studies, in relation to outcomes like satisfaction, subjective meaning experience and engagement with university studies. We also wanted to evaluate the feasibility of using a translated version of HEMA (Hedonic and Eudaimonc Motives for Action) Scale in our university students. 120 1<sup>st</sup> and 2<sup>nd</sup> year students of our university completed HEMA and questionnaires evaluating the above-mentioned outcomes, in one session. The instrument demonstrated good reliability (assessed by Cronbach`s alpha coefficients) and also captured valuable correlations with students satisfaction, subjective sense of meaning and engagement with their studies. Importantly, eudaimonic subscores were moderately but significantly correlated with Hedonic enjoyment ones, as previously reported. Exploratory Principal Component Analysis suggested two or three factors, but a larger group would be needed to confirm the factor structure of the Romanian version of the test. Conclusions: HEMA is applicable in this academic context, in Romanian, has good reliability and promises to offer valuable insights into students` orientations, helping us support their aspirations and shape our teaching so that they could benefit the most from it.

Development in Danish medical students' empathy: study protocol of a cross-sectional and longitudinal mixed-methods study

BACKGROUND

Clinical empathy has been associated with positive outcomes for both physicians and patients such as: more accurate diagnosis and treatment, increased patient satisfaction and compliance, and lower levels of burnout and stress among physicians. International studies show mixed results regarding the development of empathy among future physicians associating medical education with decline, stability or increase in empathy levels. These mixed results are due to several study limitations. In Denmark, no investigation of Danish medical students' empathy trajectory has yet been conducted wherefore such a study is needed that optimizes the study design of earlier studies.

METHODS

The aim of the study is to examine and analyze empathy levels and empathy changes among Danish medical students from the four medical faculties in Denmark, employing a cross-sectional and longitudinal mixed-methods design including a control group of non-medical students. By supplementing cross-sectional and longitudinal questionnaire studies with a focus group interview study it is the aim to identify and analyze factors (including educational) that are perceived by medical students to influence the development of empathy and its expression in clinical care.

DISCUSSION

The results of the study will provide insight into the trajectory of medical students' empathy and in undergraduate and graduate students' experiences with and perceptions of empathy development. In addition, the study will provide evidence to support further research on how targeted educational programmes can best be designed to educate empathic and patient-centered physicians.

Burnout among nursing students: predictors and association with empathy and self-efficacy

ABSTRACT Objective: to analyze burnout, its predictors and association with empathy and self-efficacy among nursing students. Method: cross-sectional analytical study with 284 students from five state universities in the state of Parana, Brazil. The instruments applied were: social and academic questionnaire, Maslach Burnout Inventory, Interpersonal Reactivity Index and Occupational Self-Efficacy Scale (Short Form). Spearman’s correlation and univariate and multivariate logistic analysis were used. Results: 6.0% of the students presented high burnout, 36.3% presented high emotional exhaustion, 37.7% presented high depersonalization and 28.2% presented low personal accomplishment. The burnout predictors were: absence of physical activity; weekly workload >24 hours; low empathic concern. There were negative correlations between empathy (empathic concern and perspective taking) and depersonalization; self-efficacy and emotional exhaustion; and positive correlations between personal accomplishment and empathy and self-efficacy. Conclusion: Personal factors and an academic variable were burnout predictors among nursing students. The correlations suggest that self-efficacy and empathy can prevent burnout.

Psychometric properties of the Jefferson Scale of Empathy: a COSMIN systematic review protocol

BACKGROUND

Empathy is an important characteristic to possess for healthcare professionals. It has been found to improve communication between professionals and patients and to improve clinical health outcomes. The Jefferson Scale of Empathy (JSE) was developed to measure this quality and has been used extensively, and psychometrically appraised, with a variety of cohorts and in different cultural environments. However, no study has been undertaken to systematically examine the methodological quality of studies which have assessed psychometric factors of the JSE. This systematic review will examine the quality of published papers that have reported on psychometric factors of the JSE.

METHODS

A systematic review of studies which report on the psychometric properties of the JSE will be conducted. We will use a predefined search strategy to identify studies meeting the following eligibility criteria: original data is reported on for at least one of the psychometric measurement properties described in the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist, examines the JSE in a healthcare cohort (using the student, physician or health profession versions of the JSE), and is published from January 2001 and in the English language. Conference abstracts, editorials and grey literature will be excluded. Six electronic databases (Medline, EMBASE, PsychInfo, PubMed, Web of Science and CINAHL) will be systematically searched for articles meeting these criteria and studies will be assessed for eligibility by two review authors. The methodological quality of included papers will be examined using the COSMIN Risk of Bias checklist.

DISCUSSION

A narrative description of the findings will be presented along with summary tables. Recommendations for use of the JSE with various cohorts and circumstances will be offered which may inform future research in this field.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018111412.

Relationship between Psychological Correlates and Empathy in Medical Students: A Cross-Sectional Study

OBJECTIVE

Empathy is important in the education of medical students. Many psychosocial variables are related to empathy. The aim of the study was to investigate the relationship between empathy and psychosocial factors such as burnout, personality, self-esteem, and resilience.

METHODS

The participants completed a set of self-reporting questionnaires, including questions related to socio-demographic characteristics, the Korean edition of the Jefferson Scale of Empathy, student version (JSE-S-K), Maslach Burnout Inventory General Survey (MBIGS), NEO Five-Factor Inventory (NEO-FFI), Rosenberg Self-esteem Scale (R-SES), and Connor-Davidson Resilience Scale (CD-RISC). Partial correlation and regression analyses were performed.

RESULTS

In male students, there were positive correlations between JSE-S-K and R-SES (r=0.229, p=0.002); conscientiousness of the NEO-FFI (r=0.153, p=0.037) and negative correlations, specifically between JSE-S-K and depersonalization of MBI (r=-0.206, p=0.005). In female students, there was positive correlations between JSE-S-K and personal accomplishment of MBI (r=0.384, p=0.004). In the multiple regression model, the JSE-S-K was affected by conscientiousness of the NEO-FFI (adjusted R2 =0.245, β=0.201, p=0.001); depersonalization, personal accomplishment of the MBI-GS (β=-0.188, p=0.001, β=0.143, p=0.017); R-SES (β=0.176, p=0.004); sex (β=0.117, p=0.029).

CONCLUSION

The present findings suggested that conscientiousness, depersonalization, personal accomplishment, self-esteem and sex have an influence on empathy. Therefore, these must be considered in medical education and can be helpful to nurture more empathetic doctors.

Empathy, burnout, life satisfaction, correlations and associated socio-demographic factors among Chinese undergraduate medical students: an exploratory cross-sectional study

BACKGROUND

Medical education is widely known to be a demanding process that may cause various mental health problems, such as burnout, which can lead to lowered levels of life satisfaction among medical students. Research shows that empathy is negatively correlated with burnout, but there are few studies on the relationship among empathy, burnout and life satisfaction in medical students. The objective of the present study is to explore the correlations of empathy and burnout with life satisfaction and the associated socio-demographic factors among Chinese undergraduate medical students.

METHODS

In this cross-sectional study, 1271 undergraduate medical students (age 19.42 ± 1.34 years, 36% male) from 1st to 4th grades completed questionnaires including the Interpersonal Reactivity Index Chinese version (IRI-C), the Maslach Burnout Inventory Modified Chinese version (MBI-MC), the Satisfaction With Life Scale (SWLS) and socio-demographic characteristics. Statistical analyses included Student's t-test, one-way ANOVA, post hoc Bonferroni tests, hierarchical linear regression analysis and general linear model-univariate full factorial model.

RESULTS

Over four academic years, medical students' empathy levels declined, but their burnout levels almost plateaued and their life satisfaction levels witnessed an initial fall before a rebound. Empathy was correlated with students' age and grade, and burnout was associated with students' maternal education. Significant differences in life satisfaction were detected with regard to medical students' age, academic year, the number of children in the family, place of residence and parents' educational levels.

CONCLUSIONS

Empathy explained 0.6% of the variance in life satisfaction in contrast to 13.7% of the variance explained by burnout in life satisfaction. Although empathy did not have a main effect on life satisfaction, there was an interaction effect of empathy and burnout on life satisfaction among students of high and low empathy and burnout levels. Students with high levels of empathy and low levels of burnout were most satisfied with life. Medical institutions and related authorities need to find effective measures to enhance students' empathy levels and reduce burnout to improve their life satisfaction.

The Positive Association Between Empathy and Self-Esteem in Chinese Medical Students: A Multi-Institutional Study

Background

Empathy is an important element of the physician-patient relationship and is a critical personality trait for medical students. However, research has shown that it declines during undergraduate medical education. It is still unclear how empathy interrelates with the psychological elements of medical students, in particular, self-esteem. This study examined the relationship between empathy and self-esteem to explore other possible methods to improve medical students’ empathy.

Methods

A stratified sampling strategy was used to select 1690 medical students from 3 medical institutions in Shanghai as study participants. The questionnaires used to collect data included the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), the Rosenberg Self-esteem Scale (RSES), and a self-made inventory on personal information. Descriptive analysis, independent t-test, One-Way ANOVA, and linear regression were used to analyze the data.

Results

The mean empathy score among medical students was 102.73 with SD = 12.64. Multiple regression analysis revealed that, “age,” “perception of the importance of empathy,” “academic pressure,” “desire to be a doctor after graduation,” and “self-esteem” were significant predictors of empathy (P < 0.05) and the adjusted R² was 0.462. The correlation matrix between empathy and self-esteem was significant (r = 0.510, P < 0.01). Self-esteem explained 15.5% of the variation of empathy in the final regression model.

Conclusion

There was a positive association between self-esteem and empathy. Self-esteem is one of many factors which contribute to medical students’ empathy. Age, academic pressure, attitude toward empathy and future career also play a critical role in medical student empathy. Enhancing medical students’ self-esteem may be an efficacious way to improve medical students’ empathy.

Association Between Empathy and Burnout Among Emergency Medicine Physicians

Background

The association between physician self-reported empathy and burnout has been studied in the past with diverse findings. We aimed to determine the association between empathy and burnout among United States emergency medicine (EM) physicians using a novel combination of tools for validation.

Methods

This was a prospective single-center observational study. Data were collected from EM physicians. From December 1, 2018 to January 31, 2019, we used the Jefferson scale of empathy (JSE) to assess physician empathy and the Copenhagen burnout inventory (CBI) to assess burnout. We divided EM physicians into different groups (residents in each year of training, junior/senior attendings). Empathy, burnout scores and their association were analyzed and compared among these groups.

Results

A total of 33 attending physicians and 35 EM residents participated in this study. Median self-reported empathy scores were 113 (interquartile range (IQR): 105 - 117) in post-graduate year (PGY)-1, 112 (90 - 115) in PGY-2, 106 (93 - 118) in PGY-3 EM residents, 112 (105 - 116) in junior and 114 (101 - 125) in senior attending physicians. Overall burnout scores were 43 (33 - 50) in PGY-1, 51 (29 - 56) in PGY-2, 43 (42 - 53) in PGY-3 EM residents, 33 (24 - 47) in junior attending and 25 (22 - 53) in senior attending physicians separately. The Spearman correlation (ρ) was -0.11 and β-weight was -0.23 between empathy and patient-related burnout scores.

Conclusion

Self-reported empathy declines over the course of EM residency training and improves after graduation. Overall high burnout occurs among EM residents and improves after graduation. Our analysis showed a weak negative correlation between self-reported empathy and patient-related burnout among EM physicians.