Rapid Scoping Review: Empathy in Health Sciences Curriculum

Empathy, the process of coming to know, understand, and care for another person, is a skill that can be learned; however, there is not a shared definition of empathy or understanding of how to operationalize empathy into practice. Healthcare worker empathy has been shown to have a beneficial effect on both patient health outcomes and the emotional wellness of healthcare workers. Empathic care is associated with more efficient, cost-effective, improved healthcare, and increased provider trust. The purpose of this rapid scoping review is to identify, compare, and contrast empathy training offered to select healthcare professional students (e.g., nurses, nurse practitioners, and pharmacists) as part of the general curriculum or as an elective. We utilized a rapid scoping review approach to identify potentially relevant peer-reviewed articles and studies for inclusion. Six electronic databases were searched, including: MEDLINE; EMBASE; PUBMed; CINAHL; EBSCOHOST; and ERIC, covering the past 10 years. A total of 4977 citations, 3480 abstracts, and 428 papers were screened. Fifty studies fulfilled the eligibility criteria. Of those, 21 primarily non-randomized experimental studies published between 2012 and 2021 were included in the final review. Over 80 percent of the training took place in the classroom setting and utilized active learning strategies. There is little consensus on how to best train future healthcare providers to provide empathic care to patients.

Our Patients Need Empathy Training across Healthcare Professions

Vulnerable populations are those who experience disparity at a disproportionate rate. For this article, specific vulnerable populations of interest include people who experience intellectual or developmental disorders, mental illness, or substance misuse. Vulnerable populations are some of the most stigmatized populations in our society. Research shows that vulnerable populations receive less empathic care than general health care populations, resulting in reduced quality of care and disparities in health outcomes. Empathy, a necessary health care competency, is associated with improved patient outcomes, enhanced job satisfaction, and increased retention and resilience across health care professions. However, there is no current standard for how empathy is taught, assessed, or sustained. Even when empathy education is implemented in healthcare professions curricula, research has demonstrated that it appears to erode with experience and time. In addition, the COVID-19 pandemic has exacerbated inequities in health care systems, with consequences for both patients and providers. There is an urgent need to develop efficacious training in empathy across health care professions to foster and sustain a robust workforce and improve health care experiences and outcomes.

Brain Glucose-Sensing Mechanism and Energy Homeostasis

The metabolic and energy state of the organism depends largely on the availability of substrates, such as glucose for ATP production, necessary for maintaining physiological functions. Deregulation in glucose levels leads to the appearance of pathological signs that result in failures in the cardiovascular system and various diseases, such as diabetes, obesity, nephropathy, and neuropathy. Particularly, the brain relies on glucose as fuel for the normal development of neuronal activity. Regions adjacent to the cerebral ventricles, such as the hypothalamus and brainstem, exercise central control in energy homeostasis. These centers house nuclei of neurons whose excitatory activity is sensitive to changes in glucose levels. Determining the different detection mechanisms, the phenotype of neurosecretion, and neural connections involving glucose-sensitive neurons is essential to understanding the response to hypoglycemia through modulation of food intake, thermogenesis, and activation of sympathetic and parasympathetic branches, inducing glucagon and epinephrine secretion and other hypothalamic-pituitary axis-dependent counterregulatory hormones, such as glucocorticoids and growth hormone. The aim of this review focuses on integrating the current understanding of various glucose-sensing mechanisms described in the brain, thereby establishing a relationship between neuroanatomy and control of physiological processes involved in both metabolic and energy balance. This will advance the understanding of increasingly prevalent diseases in the modern world, especially diabetes, and emphasize patterns that regulate and stimulate intake, thermogenesis, and the overall synergistic effect of the neuroendocrine system.

Expression of a Novel Ciliary Protein, IIIG9, During the Differentiation and Maturation of Ependymal Cells

IIIG9 is the regulatory subunit 32 of protein phosphatase 1 (PPP1R32), a key phosphatase in the regulation of ciliary movement. IIIG9 localization is restricted to cilia in the trachea, fallopian tube, and testicle, suggesting its involvement in the polarization of ciliary epithelium. In the adult brain, IIIG9 mRNA has only been detected in ciliated ependymal cells that cover the ventricular walls. In this work, we prepared a polyclonal antibody against rat IIIG9 and used this antibody to show for the first time the ciliary localization of this protein in adult ependymal cells. We demonstrated IIIG9 localization at the apical border of the ventricular wall of 17-day-old embryonic (E17) and 1-day-old postnatal (PN1) brains and at the level of ependymal cilia at 10- and 20-day-old postnatal (PN10-20) using temporospatial distribution analysis and comparing the localization with a ciliary marker. Spectral confocal and super-resolution Structured Illumination Microscopy (SIM) analysis allowed us to demonstrate that IIIG9 shows a punctate pattern that is preferentially located at the borders of ependymal cilia in situ and in cultures of ependymocytes obtained from adult rat brains. Finally, by immunogold ultrastructural analysis, we showed that IIIG9 is preferentially located between the axoneme and the ciliary membrane. Taken together, our data allow us to conclude that IIIG9 is localized in the cilia of adult ependymal cells and that its expression is correlated with the process of ependymal differentiation and with the maturation of radial glia. Similarly, its particular localization within ependymal cilia suggests a role of this protein in the regulation of ciliary movement.

Incorporation of an Explicit Critical-Thinking Curriculum to Improve Pharmacy Students' Critical-Thinking Skills

Objective. The Health Sciences Reasoning Test (HSRT) is a validated instrument to assess critical-thinking skills. The objective of this study was to determine if HSRT results improved in second-year student pharmacists after exposure to an explicit curriculum designed to develop critical-thinking skills. Methods. In December 2012, the HSRT was administered to students who were in their first year of pharmacy school. Starting in August 2013, students attended a 16-week laboratory curriculum using simulation, formative feedback, and clinical reasoning to teach critical-thinking skills. Following completion of this course, the HSRT was readministered to the same cohort of students. Results. All students enrolled in the course (83) took the HSRT, and following exclusion criteria, 90% of the scores were included in the statistical analysis. Exclusion criteria included students who did not finish more than 60% of the questions or who took less than 15 minutes to complete the test. Significant changes in the HSRT occurred in overall scores and in the subdomains of deduction, evaluation, and inference after students completed the critical-thinking curriculum. Conclusions. Significant improvement in HSRT scores occurred following student immersion in an explicit critical-thinking curriculum. The HSRT was useful in detecting these changes, showing that critical-thinking skills can be learned and then assessed over a relatively short period using a standardized, validated assessment tool like the HSRT.

Alignment of pharmacotherapy course assessments with course objectives

OBJECTIVE

To determine whether instructor-prepared classroom examinations for pharmacotherapy courses were aligned with course goals and objectives.

DESIGN

Assessment items from examinations in 2 pharmacotherapy courses were evaluated. Four categories of alignment (depth of knowledge, categorical concurrence, range of knowledge, and balance of representation) were used to match course assessments with objectives.

ASSESSMENT

While assessments met the criteria for acceptable alignment, there were areas for improvement. Goals and objectives were unevenly assessed, with 1 goal aligning with 45% of all assessment items. The assessments covered all content categories and the range of knowledge established by the objectives, but objectives under specific goals were not evenly assessed.

CONCLUSION

This alignment study provided quantitative data useful for review and revision of pharmacotherapy course objectives and assessments and demonstrated the usefulness of alignment assessment as a tool for continuous quality improvement.