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Can Distance Communication Skills Training Increase the Empathy Levels in Medical Students? An Application During the Pandemic Period. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1082337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background and Purpose: The aim is to determine the effect of the communication skills training (CST) using interactive synchronous and asynchronous methods, which was applied for the first time on medical students’ empathy levels.
Methods: This study is a cross-sectional-analytical, self-controlled intervention.
The distance CST program was applied to first-year medical students. The change in students’ empathy levels was measured with the student version of the Jefferson Empathy Scale.
Results: 241 students’ forms were included. Empathy mean score increased significantly, this increase was higher in women.
Conclusion: The distance CST produced a positive effect on empathy levels. While interactive
PowerPoint® presentations, videos, movie clips, cartoons, real-life examples, written/audio question-
answer activities, surveys, feedback and, small group work were used in live lessons; in the
asynchronous process, student-based techniques (self-assessment, homework, WhatsApp® sharing)
were used to support the online learning climate. We believe that all of them support the cognitive and
social existence of students throughout the training. We propose our program as a model that can be
used during situations where face-to-face education is not possible and to support face-to-face
education in medical education.
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Voultsos P, Chatzinikolaou F, Papana A, Deliligka A. Reliability of Greek version of the Toronto empathy questionnaire in medical students and associations with sociodemographic and lifestyle factors. BMC Psychol 2022; 10:113. [PMID: 35501889 PMCID: PMC9063083 DOI: 10.1186/s40359-022-00824-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/26/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Empathy is an important key driver of any therapeutic relationship. It is beneficial for both physicians and patients. Enhancing physician's empathy should be an important goal of medical education. As there was a literature gap regarding the topic of empathy among medical students in Greece, this study aimed to contribute to filling this gap. METHODS A cross-sectional study was conducted. A socio-demographic questionnaire and the 52-item Greek version of the Toronto composite empathy scale (TCES) for measuring the cognitive and emotional aspects of empathy in both personal and professional life was administered to all the medical students in the Aristotle University of Thessaloniki, in Greece. Descriptive statistics were displayed for demographics. The associations of the variables were quantified by Chi-2 independence tests and Pearson's Correlation Coefficient. The reliability and validity of the questionnaire was determined by Cronbach's α, Hotelling's T-Squared Test, and Pearson correlation. Paired and Independent Sample T-Tests and One-way ANOVAs indicated statistically significant mean differences among the variables or subgroups of the variables. RESULTS The 52-item TCES, 26 for the personal (Per) setting and another 26 for professional (Pro) life, equally divided into cognitive (Cog) and emotional (Emo) empathy in each case. The overall reliability of the TCES questionnaire was found to be high (Cronbach's α = 0.895, significant positive correlations between the subscales). The mean total score of empathy showed that students had a moderately high empathy. Further, there was a statistically significant difference in means between the Per-Cog and Per-Emo settings (p < 0.001), the Pro-Cog and Pro-Emo (p < 0.001), the Per-Cog and Pro-Cog (p = 0.004), and the Per-Emo and Pro-Emo (p < 0.001). Females had significantly higher empathy scores (mean score 208.04) than males (192.5) on the Per-Cog, Per-Emo and Pro-Emo subscales. Furthermore, a positive correlation was found between empathy and factors such as love for animals, interest in medical ethics, belief in God, having an ill person in the family, class year or carrier intention. CONCLUSIONS The TCES is applicable to medical students. For the most part our findings were consistent with previous literature. However, we identified some nuances that might draw researchers' attention. The results of this study may contribute to plan interventions in the curriculum to enhance empathy in the medical students.
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Affiliation(s)
- Polychronis Voultsos
- Laboratory of Forensic Medicine and Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece.
| | - Fotios Chatzinikolaou
- Laboratory of Forensic Medicine and Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece
| | - Angeliki Papana
- Department of Economics, School of Economics and Regional Studies, University of Macedonia, Egnatia Str 156, 546 36, Thessaloniki, Greece
| | - Aspasia Deliligka
- AHEPA University Hospital, Kiriakidi Str 1, 546 21, Thessaloniki, Greece
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Roberts BW, Roberts MB, Mazzarelli A, Trzeciak S. Validation of a 5-Item Tool to Measure Patient Assessment of Clinician Compassion in Hospitals. J Gen Intern Med 2022; 37:1697-1703. [PMID: 33835313 PMCID: PMC8034051 DOI: 10.1007/s11606-021-06733-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND We previously validated a 5-item compassion measure to assess patient experience of clinician compassion in the outpatient setting. However, currently, there is no validated and feasible method for health care systems to measure patient experience of clinician compassion in the inpatient setting across multiple hospitals. OBJECTIVE To test if the 5-item compassion measure can validly and distinctly measure patient assessment of physician and nurse compassion in the inpatient setting. DESIGN Cross-sectional study between July 1 and July 31, 2020, in a US health care network of 91 community hospitals across 16 states consisting of approximately 15,000 beds. PATIENTS Adult patients who had an inpatient hospital stay and completed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. MEASUREMENTS We adapted the original 5-item compassion measure to be specific for physicians, as well as for nurses. We disseminated both measures with the HCAHPS survey and used confirmatory factor analysis for validity testing. We tested reliability using Cronbach's alpha, as well as convergent validity with patient assessment of physician and nursing communication and overall hospital rating questions from HCAHPS. RESULTS We analyzed 4756 patient responses. Confirmatory factor analysis found good fit for two distinct constructs (i.e., physician and nurse compassion). Both measures demonstrated good internal consistency (alpha > 0.90) and good convergent validity but reflected a construct (compassionate care) distinct from what is currently captured in HCAHPS. CONCLUSION We validated two 5-item tools that can distinctly measure patient experience of physician and nurse compassion for use in the inpatient hospital setting in conjunction with HCAHPS.
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Affiliation(s)
- Brian W Roberts
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA. .,Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA. .,Cooper University Hospital, Camden, NJ, USA.
| | - Michael B Roberts
- Institutional Research and Outcomes Assessment, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Anthony Mazzarelli
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA.,Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA.,Cooper University Hospital, Camden, NJ, USA
| | - Stephen Trzeciak
- Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA.,Cooper University Hospital, Camden, NJ, USA.,Department of Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
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Kumar N, Parsa AD, Rahman E. A Core Curriculum for Postgraduate Program in Non-Surgical Aesthetics: A Cross-sectional Delphi Study. AESTHETIC SURGERY JOURNAL OPEN FORUM 2022; 4:ojac023. [PMID: 35662906 PMCID: PMC9154017 DOI: 10.1093/asjof/ojac023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The desire for portraying a young and beautiful face and body is driving people to seek aesthetic treatment and accelerating the exponential growth of nonsurgical aesthetic (NSA) procedures. Unfortunately, despite impressive advances, NSA is yet to have a formal clinical education program. Objectives This study aimed to identify the content and structure of an evidence-based postgraduate curriculum in NSA. Methods The Delphi questionnaire was developed after a comprehensive literature review and a focus group discussion. The questionnaire was emailed to 40 experts and 20 trainee physicians worldwide through the online survey platform and was asked to assign a rating on a 4-point Likert scale. A “1” represents a strong disagreement about integrating a topic in the NSA curriculum, and a “4” indicates a firm agreement. A pre-fixed percentage agreement of 80% and Cronbach’s α = 0.90 was established to represent a consensus for the current study. Results The response rate for the Delphi study was 90.0%, 88.8%, and 90% in the first, second, and third rounds, respectively. The experts and trainee physicians agreed with all the proposed topics (≥80%) and considered them critical for the proposed NSA curriculum. The mean score for each was ≥ 3, and Cronbach’s α value for the Delphi was 0.94, confirming internal consistency and reliability. Conclusions The consensus demonstrates significant advances toward developing an evidence-based curriculum for a postgraduate program in NSA, which is essential to support the growing demand for trained aesthetic physicians.
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Affiliation(s)
- Narendra Kumar
- Division of Biosciences, Department of Cell and Developmental Biology, University College London, London, WC1E6BT, United Kingdom
| | - Ali Davod Parsa
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, East Road, Cambridge, CB1 1PT, United Kingdom
| | - Eqram Rahman
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, United Kingdom
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Yu CC, Tan L, LE MK, Tang B, Liaw SY, Tierney T, Ho YY, Lim BEE, Lim D, Ng R, Chia SC, Low JA. The development of empathy in the healthcare setting: a qualitative approach. BMC MEDICAL EDUCATION 2022; 22:245. [PMID: 35379249 PMCID: PMC8981670 DOI: 10.1186/s12909-022-03312-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/24/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Healthcare professionals' empathetic behaviors have been known to lead to higher satisfaction levels and produce better health outcomes for patients. However, empathy could decrease over time especially during training and clinical practice. This study explored factors that contributed to the development of empathy in the healthcare setting. Findings could be used to improve the effectiveness and sustainability of empathy training. METHOD A qualitative approach, informed by aspects of grounded theory, was utilized to identify factors that enabled the development of empathy from the perspectives of doctors, nurses, allied healthcare workers and students. Twelve sessions of focus group discussions were conducted with 60 participants from two hospitals, a medical school, and a nursing school. Data was analyzed independently by three investigators who later corroborated to refine the codes, subthemes, and themes. Factors which influence the development of empathy were identified and categorized. This formed the basis of the creation of a tentative theory of empathy development for the healthcare setting. RESULTS The authors identified various personal (e.g. inherent characteristics, physiological and mental states, professional identity) and external (e.g. work environment, life experience, situational stressors) factors that affected the development of empathy. These could be further categorized into three groups based on the stability of their impact on the individuals' empathy state, contributed by high, medium, or low stability factors. Findings suggest empathy is more trait-like and stable in nature but is also susceptible to fluctuation depending on the circumstances faced by healthcare professionals. Interventions targeting medium and low stability factors could potentially promote the development of empathy in the clinical setting. CONCLUSIONS Understanding factors that impact the development of empathy allows us to develop measures that could be implemented during training or at the workplace leading to improve the quality of care and higher clinical work satisfaction.
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Affiliation(s)
- Chou Chuen Yu
- Geriatric Education and Research Institute Ltd, Singapore, Singapore
| | - Laurence Tan
- Geriatric Education and Research Institute Ltd, Singapore, Singapore
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Mai Khanh LE
- Geriatric Education and Research Institute Ltd, Singapore, Singapore
| | - Bernard Tang
- Geriatric Education and Research Institute Ltd, Singapore, Singapore.
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tanya Tierney
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yun Ying Ho
- Ministry of Health Holdings, Singapore, Singapore
| | - Beng Eng Evelyn Lim
- School of Health & Social Sciences, Nanyang Polytechnic, Singapore, Singapore
| | - Daphne Lim
- School of Health & Social Sciences, Nanyang Polytechnic, Singapore, Singapore
| | - Reuben Ng
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
| | | | - James Alvin Low
- Geriatric Education and Research Institute Ltd, Singapore, Singapore
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
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Pereira AT, Brito MJ, Cabaços C, Carneiro M, Carvalho F, Manão A, Araújo A, Pereira D, Macedo A. The Protective Role of Self-Compassion in the Relationship between Perfectionism and Burnout in Portuguese Medicine and Dentistry Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2740. [PMID: 35270432 PMCID: PMC8910448 DOI: 10.3390/ijerph19052740] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023]
Abstract
Recent studies have documented the high prevalence of burnout among medicine and dentistry students, with potentially catastrophic consequences for both students and patients. Both environmental and personality factors play a part in burnout; perfectionism, a common trait in medicine students' personalities, has been linked to psychological distress and increasing students' vulnerability to burnout. Self-compassion, i.e., treating oneself kindly through hardship, has recently emerged as a buffer between perfectionism and psychological distress. While using a novel three-factor conceptualization of perfectionism (BIG3), this study aims to analyze if self-compassion has a protective role in the relationship between perfectionism and burnout, in a sample of medicine and dentistry students, through mediation analysis. We found that self-compassion significantly mediated the relationship between all three forms of perfectionism and burnout: as a partial mediator in self-critical and rigid perfectionism, as well as a full mediator in narcissistic perfectionism. Our findings underline self-compassion's relevance in burnout prevention and management, supporting its use as an intervention target in burnout reduction programs and strategies.
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Affiliation(s)
- Ana Telma Pereira
- Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; (M.J.B.); (C.C.); (M.C.); (F.C.); (A.M.); (A.A.); (D.P.); (A.M.)
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Abdulkader RS, Venugopal D, Jeyashree K, Al Zayer Z, Senthamarai Kannan K, Jebitha R. The Intricate Relationship Between Client Perceptions of Physician Empathy and Physician Self-Assessment: Lessons for Reforming Clinical Practice. J Patient Exp 2022; 9:23743735221077537. [PMID: 35128044 PMCID: PMC8814954 DOI: 10.1177/23743735221077537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objectives: Clinical empathy is an important predictor of patient outcomes. Several factors affect physician’s empathy and client perceptions. We aimed to assess the association between physician and client perception of clinical empathy, accounting for client, physician, and health system factors. Methods: We conducted a hospital-based cross-sectional study in 3 departments (family medicine, internal medicine, and surgery) of King Saud Medical City in Riyadh, Saudi Arabia. We interviewed 30 physicians and 390 clients from 3 departments. Physicians completed the Jefferson Scale of Empathy (JSE) and the clients responded to the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). We used a hierarchical multilevel generalized structural equation approach to model factors associated with JSE and JSPPPE and their inter-relationship. Results: Mean (SD) score of client-rated physician empathy was 26.6 (6) and that of physician self-rated was 111 (12.8). We found no association between the 2 (b = 0.06; 95% confidence intervals CI: −0.1, 0.21), even after adjusting for client, physician, and health system factors. Physician's nationality (0.49; 0.12, 0.85), adequate consultation time (1.05; 0.72, 1.38), and trust (1.33; 0.9, 1.75) were positively associated whereas chronic disease (−0.32; −0.56, −0.07) and higher waiting times (−0.26; −0.47, −0.05) were negatively associated. Conclusion: A physician's self-assessed empathy does not correlate with clients’ perception. We recommend training and monitoring to enhance clinical empathy.
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Affiliation(s)
- Rizwan Suliankatchi Abdulkader
- Manonmaniam Sundaranar University, Abishekapatti, Tirunelveli, India.,ICMR-National Institute of Epidemiology, Chennai, India
| | | | | | | | | | - R Jebitha
- Manonmaniam Sundaranar University, Abishekapatti, Tirunelveli, India
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Pieris D, Jafine H, Neilson S, Amster E, Zazulak J, Lam C, Grierson L. Understanding moral empathy: A verbatim-theatre supported phenomenological exploration of the empathy imperative. MEDICAL EDUCATION 2022; 56:186-194. [PMID: 34612521 DOI: 10.1111/medu.14676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/05/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Several studies have measured a decline in empathy during medical training, speculating that factors within the formal, informal and hidden curricula are responsible for this phenomenon. Although the medical education literature describes the moral domain of empathy as most fundamental to the empathic response, most research into the decline has examined the cognitive, affective and behavioural domains. This study distinguishes itself by focusing on how moral empathy is affected through training. METHODS Ten medical residents from core education specialties at McMaster University participated in lightly structured interviews concerning their training experiences. Interview transcripts were analysed by way of a descriptive phenomenological approach. Analyses afforded descriptions of the way medical training influences moral empathy. These descriptions were then used to generate a verbatim theatre play that was performed for an audience of residents, educators, learners, researchers and scholars. Following the play, audience participants completed a survey to member-check the descriptions and to glean other reflective experiences in resident training that impact moral empathy. The survey results informed revisions to the codebook that was subsequently used to re-analyse the interview transcripts. This resulted in a final, refined version of the influence of training on learner moral empathy. RESULTS The findings suggest that a resident's sense of moral empathy relies upon the notion of an innate capacity for empathy, and is influenced by their clinical and classroom education, and specific experiences with patients during training. Importantly, these factors are rarely experienced as having a direct deleterious impact on residents' moral empathy but rather are experienced as challenges to their ability to act on their moral empathy. CONCLUSIONS The study promotes reflection of what it means to experience empathy in the moral domain. The description offers a new perspective from which to view empathic declines that have been previously reported, while also highlighting a moral-behavioural tension that has implications for competency-based assessment and the way empathy is conceptualised in medical education.
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Affiliation(s)
- Dilshan Pieris
- Health Sciences Education Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Hartley Jafine
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Shane Neilson
- Department of English and Cultural Studies, Faculty of Humanities, McMaster University, Hamilton, Canada
| | - Ellen Amster
- Department of Family Medicine, Faculty of Health Sciences, Department of Religious Studies, McMaster University, Hamilton, Canada
| | - Joyce Zazulak
- Department of Family Medicine, Faculty of Health Sciences, Department of Religious Studies, McMaster University, Hamilton, Canada
| | - Connie Lam
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lawrence Grierson
- Health Sciences Education Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Family Medicine, Faculty of Health Sciences, Department of Religious Studies, McMaster University, Hamilton, Canada
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The Effects of Physicians' Communication and Empathy Ability on Physician-Patient Relationship from Physicians' and Patients' Perspectives. J Clin Psychol Med Settings 2022; 29:849-860. [PMID: 35089529 PMCID: PMC8795960 DOI: 10.1007/s10880-022-09844-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 12/30/2022]
Abstract
Physician communication (PC) is central to influencing physician–patient relationship (PPR), and physician empathy (PE) is central to PC. A comprehensive and objective assessment of the mechanisms underlying PPR from the two-way perspective of physicians and patients are important for social development. However, the relationship between these three variables under the two-way perspective is not clear. To examine the effectiveness of PC in predicting PPR from a two-way perspective of physicians and patients and the underlying mechanisms that influence PPR. We selected 2665 physicians and 2983 patients in China and examined the effect of physician empathy on PPR and the mediating role of PC between PE and PPR using structural equation modeling. The results of the physician self-assessment showed that the link between PC and PPR was not significant, while the results of the patient other assessment showed that physician communication was not only effective in predicting the doctor–patient relationship but also mediated the relationship between physician empathy and PPR; further analysis of the underlying mechanisms affecting PPR revealed that the results of the physician self-assessment showed that PC mediated the relationship between perspective-taking and PPR; however, the results of the patient other assessment showed that physician However, patient ratings showed that PC mediated the relationship between perspective-taking and PPR, as well as between empathic concern and PPR. However, patient ratings indicate that PC mediates the relationship between perspective-taking and PPR and between empathic concern and the PPR.
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Abstract
The accelerating integration of telehealth technologies in neurology practice has transformed traditional interactions between neurologists and patients, allied clinicians and society. Despite the immense promise of these technologies to improve systems of neurological care, the infusion of telehealth technologies into neurology practice introduces a host of unique ethical challenges. Proactive consideration of the ethical dimensions of teleneurology and of the impact of these innovations on the field of neurology more generally can help to ensure responsible development and deployment across stages of implementation. Toward these ends, this article explores key ethical dimensions of teleneurology practice and policy, presents a normative framework for their consideration, and calls attention to underexplored questions ripe for further study at this evolving nexus of teleneurology and neuroethics. To promote successful and ethically resilient development of teleneurology across diverse contexts, clinicians, organizational leaders, and information technology specialists should work closely with neuroethicists with the common goal of identifying and rigorously assessing the trajectories and potential limits of teleneurology systems.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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Román-Sánchez D, Paramio-Cuevas JC, Paloma-Castro O, Palazón-Fernández JL, Lepiani-Díaz I, de la Fuente Rodríguez JM, López-Millán MR. Empathy, Burnout, and Attitudes towards Mental Illness among Spanish Mental Health Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:692. [PMID: 35055513 PMCID: PMC8776222 DOI: 10.3390/ijerph19020692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
Mental health nurses, together with psychiatrists, are the healthcare professionals who display the highest levels of empathy and the best attitudes towards patients with mental disorders. However, burnout is a common problem among these professionals. The aim of our study is to describe the association between empathy, burnout, and attitudes towards patients with mental disorders among mental health nurses in Spain. A descriptive cross-sectional design was used involving a sample of 750 specialist nurses working in mental health facilities in Spain. An intentional, non-probability, non-discriminative, exponential snowball sampling method was used. The Jefferson Scale of Empathy, the Maslach Burnout Inventory, and the Community Attitudes towards Mental Illness Inventory were used to measure the study variables. A positive correlation was observed between empathy and all the study variables, with the exception of the personal accomplishment dimension of burnout and the social restrictiveness and authoritarianism dimensions of attitudes towards mental illness, where a negative relation was observed. Our findings suggest that empathy is associated with an increase in positive attitudes towards patients with mental disorders, decreasing associated stigma, but did not act as a protective factor against burnout in the study sample.
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Affiliation(s)
- Daniel Román-Sánchez
- Nursing Faculty “Salus Infirmorum”, University of Cadiz, 11001 Cadiz, Spain; (D.R.-S.); (J.C.P.-C.); (J.L.P.-F.); (I.L.-D.); (J.M.d.l.F.R.)
| | - Juan Carlos Paramio-Cuevas
- Nursing Faculty “Salus Infirmorum”, University of Cadiz, 11001 Cadiz, Spain; (D.R.-S.); (J.C.P.-C.); (J.L.P.-F.); (I.L.-D.); (J.M.d.l.F.R.)
| | | | - José Luis Palazón-Fernández
- Nursing Faculty “Salus Infirmorum”, University of Cadiz, 11001 Cadiz, Spain; (D.R.-S.); (J.C.P.-C.); (J.L.P.-F.); (I.L.-D.); (J.M.d.l.F.R.)
| | - Isabel Lepiani-Díaz
- Nursing Faculty “Salus Infirmorum”, University of Cadiz, 11001 Cadiz, Spain; (D.R.-S.); (J.C.P.-C.); (J.L.P.-F.); (I.L.-D.); (J.M.d.l.F.R.)
| | - José Manuel de la Fuente Rodríguez
- Nursing Faculty “Salus Infirmorum”, University of Cadiz, 11001 Cadiz, Spain; (D.R.-S.); (J.C.P.-C.); (J.L.P.-F.); (I.L.-D.); (J.M.d.l.F.R.)
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Jewell C, Kraut A, Miller D, Ray K, Werley E, Schnapp B. Metrics of Resident Achievement for Defining Program Aims. West J Emerg Med 2022; 23:1-8. [PMID: 35060852 PMCID: PMC8782131 DOI: 10.5811/westjem.2021.12.53554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Resident achievement data is a powerful but underutilized means of program evaluation, allowing programs to empirically measure whether they are meeting their program aims, facilitate refinement of curricula and improve resident recruitment efforts. The goal was to provide an overview of available metrics of resident achievement and how these metrics can be used to inform program aims. Methods A literature search was performed using PubMed and Google Scholar between May and November of 2020. Publications were eligible for inclusion if they discussed or assessed “excellence” or “success” during residency training. A narrative review structure was chosen due to the intention to provide an examination of the literature on available resident achievement metrics. Results 57 publications met inclusion criteria and were included in the review. Metrics of excellence were grouped into larger categories, including success defined by program factors, academics, national competencies, employer factors, and possible new metrics. Conclusions Programs can best evaluate whether they are meeting their program aims by creating a list of important resident-level metrics based on their stated goals and values using one or more of the published definitions as a foundation. Each program must define which metrics align best with their individual program aims and mission.
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Affiliation(s)
- Corlin Jewell
- University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
| | - Aaron Kraut
- University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
| | - Danielle Miller
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Kaitlin Ray
- University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
| | - Elizabeth Werley
- PennState College of Medicine, Department of Emergency Medicine, Hershey, Pennsylvania
| | - Bejamin Schnapp
- University of Wisconsin School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
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Pettit K, Messman A, Scott N, Puskarich M, Wang H, Alanis N, Dehon E, Konrath S, Welch RD, Kline J. Multi-institutional intervention to improve patient perception of physician empathy in emergency care. Emerg Med J 2021; 39:420-426. [PMID: 34933917 DOI: 10.1136/emermed-2020-210757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 10/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Physician empathy has been linked to increased patient satisfaction, improved patient outcomes and reduced provider burnout. Our objective was to test the effectiveness of an educational intervention to improve physician empathy and trust in the ED setting. METHODS Physician participants from six emergency medicine residencies in the US were studied from 2018 to 2019 using a pre-post, quasi-experimental non-equivalent control group design with randomisation at the site level. Intervention participants at three hospitals received an educational intervention, guided by acognitivemap (the 'empathy circle'). This intervention was further emphasised by the use of motivational texts delivered to participants throughout the course of the study. The primary outcome was change in E patient perception of resident empathy (Jefferson scale of patient perception of physician empathy (JSPPPE) and Trust in Physicians Scale (Tips)) before (T1) and 3-6 months later (T2). RESULTS Data were collected for 221 residents (postgraduate year 1-4.) In controls, the mean (SD) JSPPPE scores at T1 and T2 were 29 (3.8) and 29 (4.0), respectively (mean difference 0.8, 95% CI: -0.7 to 2.4, p=0.20, paired t-test). In the intervention group, the JSPPPE scores at T1 and T2 were 28 (4.4) and 30 (4.0), respectively (mean difference 1.4, 95% CI: 0.0 to 2.8, p=0.08). In controls, the TIPS at T1 was 65 (6.3) and T2 was 66 (5.8) (mean difference -0.1, 95% CI: -3.8 to 3.6, p=0.35). In the intervention group, the TIPS at T1 was 63 (6.9) and T2 was 66 (6.3) (mean difference 2.4, 95% CI: 0.2 to 4.5, p=0.007). Hierarchical regression revealed no effect of time×group interaction for JSPPPE (p=0.71) nor TIPS (p=0.16). CONCLUSION An educational intervention with the addition of text reminders designed to increase empathic behaviour was not associated with a change in patient-perceived empathy, but was associated with a modest improvement in trust in physicians.
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Affiliation(s)
- Katie Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Anne Messman
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | | | | | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA
| | - Naomi Alanis
- Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, Texas, USA.,Department of Emergency Medicine, Integrative and Computational Neurosciences Research Unit, Dallas, Texas, USA
| | - Erin Dehon
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sara Konrath
- Indiana University, Purdue University at Indianapolis Lilly Family School of Philanthropy, Indianapolis, Indiana, USA
| | - Robert D Welch
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jeffrey Kline
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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Avlogiari E, Maria Karagiannaki S, Panteris E, Konsta A, Diakogiannis I. Improvement of Medical Students' Empathy Levels After an Intensive Experiential Training on Empathy Skills. PSYCHIAT CLIN PSYCH 2021; 31:392-400. [PMID: 38765648 PMCID: PMC11079646 DOI: 10.5152/pcp.2021.21098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/28/2021] [Indexed: 05/22/2024] Open
Abstract
Background EMPATHY IN HEALTHCARE is an intensive 20-hour experiential training program based on mediation techniques and specialized healthcare role-play for clinicians and medical students. It is hypothesized that the training will improve empathy via the intensive experiential techniques implemented. Methods A total of 50 medical students (25 males/25 females) took the course voluntarily. Empathy was measured using the Jefferson Scale of Empathy-Medical Students Version (JSE-S) (Greek version), before and after the 20-hour training, along with a 6-month follow-up. Gender, age, preferred medical specialty and baseline empathy score were explored as possible moderator variables of the training effect. Results Empathy increased after training, with a mean JSE-S score improvement of 11.25 points (±8.848) (P < .001). After 6 months, the mean JSE-S score maintained a difference of 6.514 points (±12.912) (P < .005). No differences were recorded with regard to gender, age group or medical specialty for the pooled data. Women in the 22-24 year-old age group had a 5-point mean difference (P = .05), and higher post-training scores than men. Lower initial scorers were the ones that mostly improved, with a 3-fold mean score difference from the higher scorers regardless of gender (P < .001), while also showing a smaller drop in empathy levels 6 months after the training compared to the higher scorers. Conclusion Intensive experiential training can improve empathy in a clinical setting. EMPATHY IN HEALTHCARE is a successful training program in improving empathy in medical students, as measured by the JSE-S. A score of 110 and below could be used for selecting medical student candidates who will benefit most from empathy training.
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Affiliation(s)
- Efpraxia Avlogiari
- 1st Psychiatry Clinic, Aristotle University of Thessaloniki Faculty of Health Sciences, School of Medicine
| | | | - Eleftherios Panteris
- 1st Psychiatry Clinic, Aristotle University of Thessaloniki Faculty of Health Sciences, School of Medicine
| | - Anastasia Konsta
- 1st Psychiatry Clinic, Aristotle University of Thessaloniki Faculty of Health Sciences, School of Medicine
| | - Ioannis Diakogiannis
- 1st Psychiatry Clinic, Aristotle University of Thessaloniki Faculty of Health Sciences, School of Medicine
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Scott J. Does compassion matter in the fast-paced environment of emergency medicine? Emerg Med Australas 2021; 33:1110-1112. [PMID: 34725932 DOI: 10.1111/1742-6723.13896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- John Scott
- Emergency Department, Central Coast Local Health District, Central Coast, New South Wales, Australia
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Praharaj SK, Salagre S, Sharma PSVN. Stigma, Empathy, and Attitude (SEA) educational module for medical students to improve the knowledge and attitude towards persons with mental illness. Asian J Psychiatr 2021; 65:102834. [PMID: 34508946 DOI: 10.1016/j.ajp.2021.102834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective was to develop an educational module on stigma, empathy, and attitude towards mental illness and evaluate its effectiveness among undergraduate medical students. METHODS In phase I, the authors developed the Stigma, Empathy, and Attitude (SEA) module consisting of interactive teaching-learning components through an experts-based consensus (two rounds of Delphi). In phase II, the effectiveness of the module was evaluated. SEA module (one-hour interactive lecture and three hours' small group teaching) was delivered to the fifth-semester undergraduate medical students (N = 240) once during their psychiatry rotation. Students were assessed with the Mental Health Knowledge Schedule (MHKS), Mental Illness: Clinician's Attitudes (MICA) scale, Jefferson Scale for Empathy (JSE), and Social Distance scale (SDS), to measure mental health knowledge, attitude, empathy, and stigma, at baseline and after delivery of the module. Feedback on the module was obtained from the participating students and faculty. RESULTS Baseline data was obtained for 157 students, and post-intervention assessment was completed for 66 students. There was a significant increase in MHKS score (p < 0.001, Cohen's d = 0.59) and a significant reduction in the MICA score (p = 0.016, Cohen's d = 0.31) after the intervention. However, there was no change in empathy and social distance, as measured by JSE (p = 0.23) and SDS (p = 0.31). A majority of the faculty and students were satisfied with the module and felt it should be part of the psychiatry curriculum. CONCLUSIONS The SEA module was found to improve medical students' knowledge and attitude towards mental illness and could be integrated as part of the psychiatry curriculum. However, it was ineffective in changing empathy and stigma in the students.
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Affiliation(s)
- Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Santosh Salagre
- Department of Medicine, Seth GS Medical College, Mumbai, Maharashtra, India
| | - Podila S V N Sharma
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Garrote-Caparrós E, Bellosta-Batalla M, Moya-Albiol L, Cebolla A. Effectiveness of mindfulness-based interventions on psychotherapy processes: A systematic review. Clin Psychol Psychother 2021; 29:783-798. [PMID: 34687581 DOI: 10.1002/cpp.2676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/09/2022]
Abstract
In the field of psychotherapy, scientific research has highlighted the importance of empathy and therapeutic alliance in regard to the effectiveness and better results of psychological treatments. In recent years, mindfulness-based interventions (MBIs) have shown to be effective at increasing empathy and therapeutic alliance and how this could affect the patients' symptomatology. In this study, we conducted a systematic review of the effectiveness of MBIs applied to psychotherapists to improve their empathy, the therapeutic alliance and the patients' symptomatology. Sixteen studies evaluating the impact of an MBI on some of these variables were identified, of which six included measures evaluated by the patients whose ahe MBI. The risk of bias of the included studies was analysed following the methodological standards. We found very different designs and methodologies in the studies included in this review, with few of them including a control group. The results show a limited increase in empathy, measured by the psychotherapist, after an MBI. However, the results in therapeutic alliance are not conclusive, as well as the improvements in the perception of patients about their symptomatology. It is concluded that MBIs can have a beneficial effect on the psychotherapeutic practice, through the development of psychotherapists' empathy. Future research would require new studies with a higher methodological quality, and in which the effects of MBIs on empathy, therapeutic alliance and patients' symptomatology and the relationships between them are analyzed.
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Affiliation(s)
| | - Miguel Bellosta-Batalla
- El Arte de Escuchar, Psychotherapy and Mindfulness, Valencia, Spain.,Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Luis Moya-Albiol
- Department of Psychobiology, University of Valencia, Valencia, Spain
| | - Ausiàs Cebolla
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain.,Ciber Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
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68
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Kornilova T, Zhou Q. Cross-Cultural Comparison of Relationships between Empathy and Implicit Theories of Emotions (in Chinese and Russians). Behav Sci (Basel) 2021; 11:137. [PMID: 34677230 PMCID: PMC8533593 DOI: 10.3390/bs11100137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 12/16/2022] Open
Abstract
The current manuscript presents the results of a cross-cultural comparison of the relationships between empathy and implicit theories of emotion in individuals from China and Russia. We hypothesized that the members of the Chinese culture would differ from the more Western Russian participants in terms of relationships between the various components of the emotional domain. Thus, we aimed to identify latent personality profiles while hypothesizing that the Chinese sample would demonstrate more prominent links between empathy and implicit theories regarding the possibility of controlling emotions. We also assumed that immediate social context could affect the results, and therefore, we compare two groups of Chinese participants-those living in China and those living in Russia, predominantly studying in Russian universities. The initial sample included Russians (N = 523), Chinese living in Russia (N = 376), and Chinese living in China (N = 423). However, following matching procedures to enable the sociodemographic comparability of samples, the final comparison was reduced to a final sample of Russians (N = 400), a sample of Chinese living in Russia (N = 363), and a sample of Chinese living in China (N = 421). We used latent class analysis and correlation analyses to test the study hypotheses. The study found that, unlike Russians, the Chinese participants demonstrated a positive correlation between incremental implicit theories of emotions and empathy. We also established significant group and gender differences. Russian women reported higher affective empathy than men, whereas Chinese women demonstrated higher affective empathy and cognitive empathy, as well as incremental implicit theories of emotion.
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Affiliation(s)
- Tatiana Kornilova
- General Psychology Department, Lomonosov Moscow State University, Mokhovaya Street, 11/9, 125009 Moscow, Russia;
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Waddimba AC, Bennett MM, Fresnedo M, Ledbetter TG, Warren AM. Resilience, Well-being, and Empathy Among Private Practice Physicians and Advanced Practice Providers in Texas: A Structural Equation Model Study. Mayo Clin Proc Innov Qual Outcomes 2021; 5:928-945. [PMID: 34585086 PMCID: PMC8456060 DOI: 10.1016/j.mayocpiqo.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate structural relationships of latent constructs such as occupational wellbeing, resilience, work meaningfulness, and psychological empowerment with affective and cognitive clinical empathy among a community of physicians and advanced practice providers. Methods We conducted a cross-sectional observational study. We gathered data by an anonymous self-administered multidimensional questionnaire disseminated electronically between March and May 2016. Participants were physicians and advanced practice providers belonging to the Health Texas Provider Network, a group private practice affiliated with the Baylor Scott and White Health system. We excluded allied health care staff (eg, nurses) and trainees (eg, residents, medical students). We pursued a 3-step strategy: (1) confirmatory factor analysis of a theory-driven measurement model, (2) a modified structural equation model from which pathways with nonsignificant path coefficients were deleted, and (3) multigroup analyses of the modified model. Results Cognitive empathy was the strongest predictor of affective empathy. We observed modest positive associations of resilience with cognitive and affective empathy and of well-being and meaning with affective but not with cognitive empathy. Resilience, meaning, and psychological empowerment were surprisingly negatively associated with well-being, suggesting diminished self-care among practitioners. Effects of psychological empowerment on empathy and well-being were mediated by resilience and meaning. Conclusion Cognitive empathy directly influenced affective empathy; well-being and meaningfulness exerted direct positive effects on affective but not on cognitive empathy, whereas resilience had direct positive associations with both empathy dimensions. Resilience and meaning manifested direct, negative associations with well-being, revealing clinicians’ disproportionate focus on patient care at the expense of self-care.
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Key Words
- APP, advanced practice provider
- AVE, average variance extracted
- BIC, Bayesian information criterion
- CD-RISC, Connor-Davidson Resilience Scale
- CD-RISC-10, 10-item short form of the Connor-Davidson Resilience Scale
- CFA, confirmatory factor analysis
- CFI, comparative fit index
- GFI, goodness of fit index
- HTPN, Health Texas Provider Network
- IRI, Interpersonal Reactivity Index
- LPA, latent profile analysis
- MCPWBI, Mayo Clinic Physician Well-being Index
- PEI, Psychological Empowerment Instrument
- RMSEA, root mean square error of approximation
- SE, standard error
- SRMR, standardized root mean square residual
- TIPI, 10-Item Personality Inventory
- TLI, Tucker-Lewis Index
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Affiliation(s)
- Anthony C Waddimba
- Baylor Scott and White Research Institute, Dallas, TX.,Health Systems Science, Department of Surgery, Baylor University Medical Center, Dallas, TX
| | | | - Michelle Fresnedo
- Baylor Scott and White Research Institute, Dallas, TX.,Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, TX
| | - Thomas G Ledbetter
- Chief Medical Office, Baylor Scott and White Medical Center, Waxahachie, TX
| | - Ann Marie Warren
- Baylor Scott and White Research Institute, Dallas, TX.,Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, TX
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Saeed F, Shah AY, Allen RJ, Epstein RM, Fiscella KA. Communication principles and practices for making shared decisions about renal replacement therapy: a review of the literature. Curr Opin Nephrol Hypertens 2021; 30:507-515. [PMID: 34148978 PMCID: PMC8373782 DOI: 10.1097/mnh.0000000000000731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the skill set required for communication and person-centered decision making for renal replacement therapy (RRT) choices, especially conservative kidney management (CKM). RECENT FINDINGS Research on communication and decision-making skills for shared RRT decision making is still in infancy. We adapt literature from other fields such as primary care and oncology for effective RRT decision making. SUMMARY We review seven key skills: (1) Announcing the need for decision making (2) Agenda Setting (3) Educating patients about RRT options (4) Discussing prognoses (5) Eliciting patient preferences (6) Responding to emotions and showing empathy, and (7) Investing in the end. We also provide example sentences to frame the conversations around RRT choices including CKM.
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Affiliation(s)
- Fahad Saeed
- Departments of Medicine and Public Health, Division of Nephrology
- Division of Palliative Care
- University of Rochester School of Medicine, National University of Medical Sciences
| | - Amna Yousaf Shah
- Rawalpindi, Pakistan; CITE Center, Department of Behavioral and Natural Sciences
| | | | - Ronald M Epstein
- Division of Palliative Care
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kevin A Fiscella
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Chua JYX, Ang E, Lau STL, Shorey S. Effectiveness of simulation-based interventions at improving empathy among healthcare students: A systematic review and meta-analysis. NURSE EDUCATION TODAY 2021; 104:105000. [PMID: 34146845 DOI: 10.1016/j.nedt.2021.105000] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/13/2021] [Accepted: 05/31/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine the effectiveness of simulation-based interventions in improving empathy among healthcare students. DESIGN A systematic review and meta-analysis of randomized controlled trials and clinical controlled trials. DATA SOURCES Studies in English language were sourced from seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations & Theses Global) from their respective inception dates until October 2020. REVIEW METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect meta-analyses were conducted. Heterogeneity was assessed using the I2 statistics and Cochran's Q chi-squared test. Quality appraisal was conducted using the Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation approach. Publication bias was assessed using funnel plots. RESULTS Sixteen studies were included in this review. Meta-analysis reported statistically significant small, medium and very large effect sizes for empathy reported by healthcare students (SMD = 0.46, 95% CI: 0.25 to 0.66), simulated patients (SMD = 0.65, 95% CI: 0.41 to 0.89) and other personnel (independent observers, faculty members and examiners) (SMD = 1.27, 95% CI: 0.64 to 1.90) respectively, showing the effectiveness of simulation-based interventions in improving empathy among healthcare students. Subgroup analyses found that role-play was more effective than simulated patient and disease-state simulations. Multi-sessional interventions conducted for up to seven months and group-based simulation delivery were found to be more effective. CONCLUSION Educational institutions should conduct regular simulation-based interventions to continuously develop healthcare students' empathy during their academic journey. Future trials should involve students from more diverse healthcare disciplines. Empathy should be measured in a standardized manner and rely less on self-reported measures. Role-play segments and group-based simulations could be added to increase interventions' effectiveness. Studies should conduct longer follow-up assessments to determine the sustainability of students' empathy following intervention. Future research is needed to corroborate the current findings.
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Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Emily Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Siew Tiang Lydia Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
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Clinical Empathy for the Surgical Patient: Lessons From W.H. Auden's Prose and Poetry. ANNALS OF SURGERY OPEN 2021; 2:e083. [PMID: 36590850 PMCID: PMC9770127 DOI: 10.1097/as9.0000000000000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/27/2021] [Indexed: 01/04/2023] Open
Abstract
Clinical empathy is a professional skill, representing a conscious commitment to showing patients that they are heard, understood, and accepted. Here, we explore ways in which masters of language, such as the mid-20th century poet W. H. Auden, use prose and poetry to teach us the patient's expectations of a truly empathic physician and surgeon.
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Sukhera J, Poleksic J. Adapting Compassion Education Through Technology-Enhanced Learning: An Exploratory Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1013-1020. [PMID: 33464741 DOI: 10.1097/acm.0000000000003915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Compassion is central to health care. Efforts to promote compassion through educational interventions for health professionals show promise, yet such education has not gained widespread dissemination. Adapting compassion education through technology-enhanced learning may provide an opportunity to enhance the scale and spread of compassion education. However, challenges are inherent in translating such curricula for online delivery. In this study, the authors explored how technology influences the delivery of compassion education for health professionals. METHOD Using constructivist grounded theory methodology, the authors conducted semistructured interviews with 13 participants from across Ontario, Canada, from March to October 2019. The sample consisted of individuals who had experience with the design and evaluation of compassion education for health professionals. The interviews were coded and inductively analyzed to identify pertinent themes using constant comparative analysis. The study originated at the Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. RESULTS Participants provided a range of responses regarding technology and compassion education. While participants revealed concerns about the constraints of technology on human interaction, they also described technology as both inevitable and necessary for the delivery of future compassionate care curricula. Participants also shared ways in which technology may enhance compassion education for health professionals by increasing accessibility and learner comfort with vulnerability. Addressing technological ambivalence, improving facilitation, and maintaining a balance between face-to-face instruction and technology-enhanced learning were identified as elements that could advance compassion education into the future. CONCLUSIONS Compassion education can be enhanced by technology; however, evidence-informed adaptation may require deliberate efforts to maintain some level of face-to-face interaction to ensure that technology does not erode human connection. Further research is required to address the uncertainties surrounding technology and compassion education as identified by participants. These findings provide educators with guidance for adapting compassionate care curricula into a digital domain.
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Affiliation(s)
- Javeed Sukhera
- J. Sukhera is associate professor, Departments of Psychiatry and Paediatrics and scientist, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jelena Poleksic
- J. Poleksic is a medical student, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Kobayashi M, Ito M, Iwasa Y, Motohashi Y, Edahiro A, Shirobe M, Hirano H, Gineste Y, Honda M. The effect of multimodal comprehensive care methodology training on oral health care professionals' empathy for patients with dementia. BMC MEDICAL EDUCATION 2021; 21:315. [PMID: 34082730 PMCID: PMC8176594 DOI: 10.1186/s12909-021-02760-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The prevalence of oral diseases in people with dementia has increased, and patients with dementia have worse oral health than people without dementia. However, in the provision of oral care, these patients often exhibit care-resistant behaviours. Empathy is important for health care professionals who provide dental care for people with dementia. A study was conducted to assess whether a multimodal comprehensive care methodology training programme, Humanitude™, was associated with an improvement in empathy for people with dementia among oral health care professionals. METHODS This research was a pre-post prospective study. A total of 45 dentists and dental hygienists participated in a 7-h multimodal comprehensive care methodology training programme. Participants' empathy for their patients was evaluated with the Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) before the training and 1 month after the training (primary outcome). Each participant listed 3 patients with poor oral health due to the refusal of usual oral care or dental treatment from his or her clinical practice. The oral health of the 3 care-resistant patients listed by each participant was evaluated by the Oral Health Assessment Tool (OHAT) before the training and 1 month after the training (secondary outcome). RESULTS The post-training response rate was 87% (21 dentists and 18 dental hygienists). From pre-training to post-training, the multimodal comprehensive care methodology training significantly increased the mean empathy score (from 113.97 to 122.95, P < 0.05, effect size = 0.9). Regardless of gender, profession and years of clinical experience, all post-training subgroup scores were higher than the pre-training subgroup scores. The tongue, natural teeth, and oral hygiene scores of patients with dementia who resisted usual oral care or dental treatment, as assessed by the OHAT, were significantly improved compared with those before the training. CONCLUSIONS The multimodal comprehensive care methodology training was associated with an improvement in oral health professionals' empathy for patients with dementia. These findings suggest that randomized controlled trials with large sample sizes will be needed. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR), UMIN000041687 . Registered 4 September 2020 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047586.
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Affiliation(s)
- Masaki Kobayashi
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, 152-8902, Japan.
| | - Mio Ito
- Gunma University Graduate School of Health Science, Maebashi-City, Gunma, 371-8514, Japan
| | - Yasuyuki Iwasa
- Department of Dentistry, Haradoi Hospital, Fukuoka-City, Fukuoka, 813-8588, Japan
| | - Yoshiko Motohashi
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Ayako Edahiro
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Maki Shirobe
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Hirohiko Hirano
- Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Yves Gineste
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, 152-8902, Japan
- IGM-France, 66250, Saint-Laurent-de-la-Salanque, France
| | - Miwako Honda
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, 152-8902, Japan
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Kikukawa M, Taketomi K, Yoshida M. Does the hospitalization immersion experience improve medical students' understanding of patients' perspectives? A qualitative study. KOREAN JOURNAL OF MEDICAL EDUCATION 2021; 33:97-106. [PMID: 34062641 PMCID: PMC8169374 DOI: 10.3946/kjme.2021.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Although many studies have assessed the impact of interventions to increase medical students' empathy by improving their understanding of patients' perspectives and feelings, the impact of hospitalization experiences remains unclear. METHODS Fifth-year medical students at Kyushu University from 2009-2013 participated in a 2-day/1-night course to provide a hospitalization experience. After the course, participants answered an online, anonymous, open-ended questionnaire created by the authors. RESULTS Of 488 participants, 462 provided responses (95% response rate), which were evaluated by thematic analysis. Students understood inpatients not only through their own hospitalization experience, but also through observations of and conversations with the inpatients they encountered, from a shared perspective of both. Students experienced the realities of hospital life, stress and psychological states of being an inpatient, and psychological pressure from physicians. In addition, students observed the distress of other inpatients and dedication of medical staff. Furthermore, through communication with these inpatients, students understood other inpatients' anxiety about illness and empathy as one of the requirements of health care providers from the patients' perspective. CONCLUSION This qualitative study investigated the effectiveness of a course on the hospitalization experience. Results showed that medical students understood the perspectives, distress, and anxiety of being an inpatient, not only from their own experiences but also from observation and communication with other inpatients they encountered during their hospitalization. This experience appeared to be an effective teaching strategy for enhancing medical students' empathy by improving their understanding of patients' perspectives and feelings.
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Affiliation(s)
- Makoto Kikukawa
- Department of Medical Education, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Motofumi Yoshida
- Medical Education, Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
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Yang YS, Liu PC, Lin YK, Lin CD, Chen DY, Lin BYJ. Medical students' preclinical service-learning experience and its effects on empathy in clinical training. BMC MEDICAL EDUCATION 2021; 21:301. [PMID: 34039327 PMCID: PMC8157642 DOI: 10.1186/s12909-021-02739-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/10/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Service learning (SL) is an educational methodology presumed to help medical students be more empathetic and compassionate. We longitudinally investigated the level of empathy in medical students and how preclinical SL experience was related to their level of empathy in their clinical clerkships. METHODS Our cohort comprised fifth-year medical students engaged in clerkships as part of a 7-year medical programme at one medical school in Taiwan. Surveys were conducted at the beginning of the clerkship in September 2015 (T1) to collect data on the medical students' preclinical SL experience in curriculum-based service teams (CBSTs) and extracurricular service teams (ECSTs) and their SL self-efficacy, demographic characteristics, and empathy level. Subsequently, three follow-up surveys were conducted once every 3 months to determine the empathy level of the students during their clinical clerkships (T2-T4). Seventy students who returned the written informed consent and completed the baseline (T1) and two or more follow-up surveys (T2-T4) were included in our analysis with the response rate of 34%. In total, 247 responses across the 1-year clerkship were analysed. Descriptive statistics, paired t tests, and generalised estimating equations were employed. RESULTS Our study revealed that changes in empathy level in the dimensions of perspective taking, compassionate care, and standing in patients' shoes in their clinical clerkships. Relative to that at T1, their empathy decreased in perspective taking and compassionate care at T2-T4 but increased in standing in patients' shoes at T3. Additionally, our study verified the positive effect of medical students' preclinical SL experience in CBSTs and ECSTs on empathy in terms of compassionate care and perspective taking, respectively, but not on that of standing in patients' shoes. CONCLUSIONS Separate investigations into subconstructs of empathy, such as perspective taking, compassionate care, and standing in patients' shoes, in medical students may be necessary for exploring the various driving forces or barriers to developing empathy in medical students. Moreover, SL experience through both CBSTs and ECSTs at medical academies may have positive effects on medical students' empathy in their clinical clerkships and should be promoted at medical schools.
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Affiliation(s)
- Yi-Sheng Yang
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Pei-Chin Liu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Yung Kai Lin
- Department of Surgery, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan, Republic of China
- Division of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Der Lin
- Department of Otolaryngology-Head & Neck Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China
- School of Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan, Republic of China
- College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Blossom Yen-Ju Lin
- Department of Medical Humanities and Social Sciences, School of Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan, Republic of China.
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Zhou YC, Tan SR, Tan CGH, Ng MSP, Lim KH, Tan LHE, Ong YT, Cheong CWS, Chin AMC, Chiam M, Chia EWY, Lim C, Wijaya L, Chowdhury AR, Kwek JW, Fong W, Somasundaram N, Ong EK, Mason S, Krishna LKR. A systematic scoping review of approaches to teaching and assessing empathy in medicine. BMC MEDICAL EDUCATION 2021; 21:292. [PMID: 34020647 PMCID: PMC8140468 DOI: 10.1186/s12909-021-02697-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/21/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed. METHODS This systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data. RESULTS In total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum. CONCLUSIONS Nurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one's professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.
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Affiliation(s)
- Yi Cheng Zhou
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Shien Ru Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Chester Guan Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Matthew Song Peng Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Lorraine Hui En Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore Blk MD6, Centre for Translational Medicine, 14 Medical Dr, #05-01, Singapore, 117599, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Elisha Wan Ying Chia
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Crystal Lim
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Medical Social Services, Singapore General Hospital, 16 College Road, Block 3 Level 1, Singapore, 169854, Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Department of Infectious Diseases, Singapore General Hospital, 16 College Road, Block 6 Level 7, Singapore, 169854, Singapore
| | - Anupama Roy Chowdhury
- Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Jin Wei Kwek
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Division of Oncologic Imaging, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Warren Fong
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854, Singapore
| | - Nagavalli Somasundaram
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Blk MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Prevalence and predictors of burnout symptoms in multidisciplinary pain clinics: a mixed-methods study. Pain 2021; 162:503-513. [PMID: 32826756 DOI: 10.1097/j.pain.0000000000002042] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Frequent exposure to patient distress is associated with a higher prevalence of clinician distress and burnout. Patients with chronic pain often present with high levels of emotional distress. The current study examined the prevalence of burnout symptoms among a multidisciplinary sample of pain clinicians in Australia, the relationship between clinician confidence managing emotions and symptoms of burnout, and clinicians' perspectives on sources of stress and wellbeing at work. One hundred seventy-six clinicians from 58 multidisciplinary pain clinics across Australia completed a survey including the 22-item Maslach Burnout Inventory, a measure of clinician confidence managing patient emotions and their own emotions, and open-ended questions probing clinician perspectives on sources of stress and wellbeing at work. High levels of emotional exhaustion and depersonalisation were reported by 21.6% and 14.2% of respondents, respectively. These burnout symptoms were predicted by clinician confidence managing their own emotions. Low levels of personal accomplishment were reported by 18.8% of respondents and were predicted by clinician confidence managing patients' emotions. Consistent with these quantitative findings, qualitative data revealed that emotionally challenging patient encounters were common sources of stress. Working with a multidisciplinary team and supportive relationships with colleagues were commonly reported sources of clinician wellbeing. The results of this study are discussed in light of previous reports of burnout in pain medicine physicians. Implications for clinician training in pain management and the prevention of burnout in pain clinicians are discussed.
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Elzie CA, Shaia J. A Pilot Study of the Impact of Virtually Embodying a Patient with a Terminal Illness. MEDICAL SCIENCE EDUCATOR 2021; 31:665-675. [PMID: 34457919 PMCID: PMC8368971 DOI: 10.1007/s40670-021-01243-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 05/12/2023]
Abstract
Compassionate end-of-life care matters deeply for patients and their caregivers, but studies continue to demonstrate ways in which physicians fall short. Despite specific training during medical school, many patients report lack of empathy in their providers with respect to end-of-life conversations. This is likely because empathy is simply hard to teach. Numerous activities have been tried to combat the decline in empathy during medical training with little to moderate success. However, virtual reality, which allows users to viscerally experience anything from another person's point of view, could be a game changer for building empathy within medicine. This type of perspective-taking has previously shown to improve understanding, reduce biases, facilitate empathy, and promote prosocial behaviors. In this pilot study, virtual reality was used to allow students to "become a patient" virtually embodying their daily activities, symptoms, and interactions with caregivers. Using the Embodied Labs modules, first-year medical students were able to experience first-hand having a terminal illness, being told no further treatments are available and witnessing loved ones' reactions. Data generated through surveys and reflections indicated a high level of place illusion, plausibility, and embodiment of users. This high level of immersion generated an increase in comfortability with talking about end-of-life issues, produced a better understanding of what patients and their families experience, and promoted a change in the way students would approach clinical skills. Analysis of reflections indicated a high level of empathy for the patient and his family members. Overall, the activity was highly received by students as a valuable learning activity. As such, we propose that virtual reality could be a useful pedagogical tool to facilitate empathy and clinical skills within medical education.
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Affiliation(s)
- Carrie A. Elzie
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA USA
| | - Jacqueline Shaia
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA USA
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Nursing Students' Experiences with Computer Simulation-Based Communication Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063108. [PMID: 33803034 PMCID: PMC8003003 DOI: 10.3390/ijerph18063108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/23/2021] [Accepted: 03/13/2021] [Indexed: 11/20/2022]
Abstract
Simulation-based communication education has improved nursing students’ communication knowledge and skills. However, communication patterns that students commonly exhibit in simulated situations and students’ responses to specific clinical situations have not been systematically examined. The specific aims of the present study were (1) to identify non-therapeutic communication patterns that nursing students exhibit in simulated situations in the computer simulation-based education (ComEd) program, and (2) explore students’ responses to challenging clinical situations. This study used a mixed-method research design and a convenience sampling method to recruit participants. Frequency analysis and a conventional content analysis method were used to analyze answers provided by participants. A total of 66 students from four Korean nursing schools participated in the study. “False reassurance” was found to be the most common non-therapeutic communication pattern used by nursing students. Nursing students had difficulty in clinical situations such as reporting a patient’s condition to a doctor, communicating with a patient and perform basic nursing skills at the same time, and managing conflicts between patients. Technology-based communication simulation programs, which reflect various clinical situations, are considered a new alternative that can supplement the limitations of clinical practicum and improve the quality of nursing education.
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de Sousa Mata ÁN, de Azevedo KPM, Braga LP, de Medeiros GCBS, de Oliveira Segundo VH, Bezerra INM, Pimenta IDSF, Nicolás IM, Piuvezam G. Training in communication skills for self-efficacy of health professionals: a systematic review. HUMAN RESOURCES FOR HEALTH 2021; 19:30. [PMID: 33676515 PMCID: PMC7937280 DOI: 10.1186/s12960-021-00574-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/24/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Communication skills are essential for health professionals to establish a positive relationship with their patients, improving their health and quality of life. In this perspective, communication skills training can be effective strategies to improve the care provided by professionals in patient care and the quality of health services. OBJECTIVE To identify the best available evidence on training programs in communication skills to promote changes in attitude and behavior or self-efficacy of health professionals. METHODS Systematic searches were performed in eight databases, evaluating Randomized Controlled Trials and quasi-experimental studies with a control group, focusing on training communication skills for health professionals, who assessed self-efficacy or behaviors related to these skills. The phases of study selection and data extraction were carried out by two independent researchers, and the conflicts were resolved by a third. The risk of bias was assessed using the Cochrane method. RESULTS Eight studies were included in the review. Most programs lasted between 4½ h and 2 days, involved information about communication skills and the content was applied to the health professionals' context. Several teaching strategies were used, such as lectures, videos and dramatizations and the evaluation was carried out using different instruments. Improvements in the performance and in the self-efficacy of communication skills were observed in the trained groups. The RCT had a low risk of bias and the quasi-experimental studies had a moderate risk. CONCLUSION Training in communication skills can improve the performance and self-efficacy of health professionals. Programs that approach the conceptual issues and promote the space for experiential learning could be effective in communication skills training for professionals. PROSPERO CRD42019129384.
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Affiliation(s)
- Ádala Nayana de Sousa Mata
- Multicampi School of Medical Sciences of Rio Grande do Norte, Federal University of Rio Grande do Norte, Av. Coronel Martiniano, 541, Centro, Caicó, RN ZIP Code: 59300-000 Brazil
| | - Kesley Pablo Morais de Azevedo
- Post-Graduate Program in Public Health, Health Science Center, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 - Lagoa Nova, Natal, RN ZIP Code: 59056-000 Brazil
| | - Liliane Pereira Braga
- Multicampi School of Medical Sciences of Rio Grande do Norte, Federal University of Rio Grande do Norte, Av. Coronel Martiniano, 541, Centro, Caicó, RN ZIP Code: 59300-000 Brazil
| | | | - Victor Hugo de Oliveira Segundo
- Post-Graduate Program in Public Health, Health Science Center, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 - Lagoa Nova, Natal, RN ZIP Code: 59056-000 Brazil
| | - Isaac Newton Machado Bezerra
- Academic Center of Vitória, Federal University of Pernanmbuco, R. Aldo do reservatório, s/n, Bela Vista, Vitória de Santo Antão, PE ZIP Code: 55608-680 Brazil
| | - Isac Davidson Santiago Fernandes Pimenta
- Post-Graduate Program in Public Health, Health Science Center, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 - Lagoa Nova, Natal, RN ZIP Code: 59056-000 Brazil
| | - Ismael Martinez Nicolás
- Department of Health Sciences, Catholic University San Antonio de Murcia, San Antonio de Murcia, Campus de los Jerónimos, 135, 30107 Guadalupe, Murcia Spain
| | - Grasiela Piuvezam
- Department of Public Health, Federal University of Rio Grande do Norte, University Campus, Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN ZIP Code: 59.078-970 Brazil
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Gilligan C, Powell M, Lynagh MC, Ward BM, Lonsdale C, Harvey P, James EL, Rich D, Dewi SP, Nepal S, Croft HA, Silverman J. Interventions for improving medical students' interpersonal communication in medical consultations. Cochrane Database Syst Rev 2021; 2:CD012418. [PMID: 33559127 PMCID: PMC8094582 DOI: 10.1002/14651858.cd012418.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies. OBJECTIVES To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations. SEARCH METHODS We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE. MAIN RESULTS We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence). Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported. AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.
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Affiliation(s)
- Conor Gilligan
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | - Martine Powell
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, Brisbane, Australia
| | - Marita C Lynagh
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | | | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australia
| | - Pam Harvey
- School of Rural Health, Monash University, Bendigo, Australia
| | - Erica L James
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | - Dominique Rich
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Sari P Dewi
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Smriti Nepal
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Darlington, Australia
| | - Hayley A Croft
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
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Han A, Kim TH. A Simulation-Based Empathy Enhancement Program for Non-Medical Care Providers of Older Adults: A Mixed-Methods Study. Psychiatry Investig 2021; 18:132-139. [PMID: 33517619 PMCID: PMC7960746 DOI: 10.30773/pi.2020.0290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/14/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Studies using simulation-based programs for empathy enhancement have been conducted mostly for health profession students and medical care providers in Western countries. No empirical research has been conducted for non-medical care providers of older adults in community settings in Asian countries. The purposes of this mixed-methods study were: to explore experiences and perceived usability of non-medical care providers of older adults in a simulation-based empathy enhancement program; and to examine if the program is effective in improving empathy and relevant outcomes. METHODS 104 non-medical care providers of older adults in South Korea participated in a simulation-based empathy enhancement program in 2018. Data were collected using self-reported questionnaires for effectiveness testing, a program evaluation questionnaire, and individual interviews and analyzed using statistical tests and thematic analysis. RESULTS Care providers showed higher levels of empathy and lower levels of stress and burnout after the program participation (p<0.05). Qualitative findings supported the improved attitude and care strategies, increased empathy towards older adults, preparing for their own aging, and restoration of emotional stability through the participation in the program. CONCLUSION This study suggests that the simulation-based program is useful in promoting empathic responses of non-medical care providers working with older adults.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Bibl K, Wagner M, Steinbauer P, Gröpel P, Wimmer S, Olischar M, Berger A, Hladschik-Kermer B. NeoAct: A Randomized Prospective Pilot Study on Communication Skill Training of Neonatologists. Front Pediatr 2021; 9:675742. [PMID: 34055701 PMCID: PMC8158577 DOI: 10.3389/fped.2021.675742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background: This randomized interventional study evaluated the impact of a 1-day experiential communication skills training on neonatologists' performance in doctor-parents-communication. Methods: 17 neonatologists with different levels of professional experience from the Medical University of Vienna were randomized into one of two study groups: The intervention group (IG) as opposed to the control group (CG) participated in a 1-day experiential communication training. Eight weeks after the training, participants' communication skills were assessed during an objective structured clinical examination (OSCE). Neonatologists were assessed in a simulated conversation by how effectively they performed when conveying complex health-related information to parents of ill infants. Participants in the control group (CG) were assessed first during the OSCE and received their communication training later on. Self-assessment questionnaires before and after the workshop and OSCE were completed. Results: The study determined that neonatologists in the IG subjectively perceived that their competence level regarding their communication skills had increased after the workshop, while this was not reflected by their performance during the OSCE assessment. Discussion: A 1-day experiential communication skills training significantly increased physicians' self-evaluation concerning their communicative competence. This perceived competence did not manifest itself in increased communication skills during the OSCE. Conclusion: Repeated training is needed.
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Affiliation(s)
- Katharina Bibl
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Peter Gröpel
- Division of Sport Psychology, Department of Sport Science, University of Vienna, Vienna, Austria
| | - Sabrina Wimmer
- Department for Medical Psychology, Department for Public Health, Medical University Vienna, Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Birgit Hladschik-Kermer
- Department for Medical Psychology, Department for Public Health, Medical University Vienna, Vienna, Austria
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85
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Blanco JM, Caballero F, Álvarez S, Plans M, Monge D. Searching for the erosion of empathy in medical undergraduate students: a longitudinal study. BMJ Open 2020; 10:e041810. [PMID: 33384394 PMCID: PMC7780525 DOI: 10.1136/bmjopen-2020-041810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To analyse the trajectory of empathy throughout the degree programme of medicine in a Spanish school of medicine. DESIGN Longitudinal, prospective 5-year study, between October 2014 and June 2019. SETTING Students from a Spanish university of medicine. PARTICIPANTS Two voluntary cohorts of undergraduate medical students from two different school years were invited to participate (n=135 (cohort 1, C1) and 106 (cohort 2, C2) per school year). Finally, a total number of 174 students (102 (C1, 71.6% women) and 72 (C2, 70.8% women) students, respectively) were monitored for 5 years. Each cohort was divided in two subcohorts of paired and unpaired students that were analysed to check possible social desirability bias. PRIMARY OUTCOME MEASURE The Jefferson Scale of Empathy (JSE). RESULTS The cohort of 102 students (C1) monitored between their first and fifth years of study (71.6% women) showed an improvement among paired women of 2.15 points in total JSE score (p=0.01) and 2.39 points in cognitive empathy (p=0.01); in the unpaired female cohort the increase was of 2.32 points (cognitive empathy) (p=0.02). The cohort of 72 students (C2) monitored between their second and sixth years of study (70.8% women) displayed a cognitive empathy increase of 2.32 points (p=0.04) in the paired group of women. There were no significant differences between paired and unpaired results for either cohort. Empathy scores among men did not decrease. CONCLUSIONS The empathy of medical students at our school did not decline along grade years. In fact, it improved slightly, particularly cognitive empathy, among women. This paper contributes to enlarge data from Europe, where longitudinal studies are scarce. It supports the idea that there may be global geo-sociocultural differences; however, more studies comparing different school settings are needed.
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Affiliation(s)
- José Manuel Blanco
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
- Valle de la Oliva Healthcare Centre, Madrid, Spain
| | | | - Santiago Álvarez
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Diana Monge
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
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[Communication and Mental Health: Characteristics related to empathy in primary care physicians in Chapecó, Santa Catarina, Brazil]. Salud Colect 2020; 16:e3034. [PMID: 33374090 DOI: 10.18294/sc.2020.3034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
In Brazil, the provision of mental health care in primary care centers has gained strategic importance, as it ensures that users will be able to attend these services within their communities, and empathy is a key aspect in the development of the doctor-patient relationship. The aim of this study was to identify characteristics related to empathy in physicians who work in primary care centers and who provide care to individuals with mental disorders. Qualitative research was carried out in 2016, based on semi-structured interviews with eight general and family physicians. Material from the interviews was analyzed using content analysis techniques and three categories emerged: empathy in the active listening of the physician, strategies that allow for better patient care, and the mobilization of emotions. The use of empathy is intrinsically linked to the resolutive capacity of care, and the characteristics identified were active listening, resource management, and the development of methods to overcome the structural obstacles of daily routines.
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87
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Tisdale CE, Black AC, Jain S, Lowther E, Madeline L, Troup C, Nathaniel T, Fowler LA. The Impact of Meeting Patients with Neurological Disorders on Medical Student Empathy. MEDICAL SCIENCE EDUCATOR 2020; 30:1561-1568. [PMID: 34457824 PMCID: PMC8368363 DOI: 10.1007/s40670-020-01102-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 06/13/2023]
Abstract
PURPOSE Empathy tends to decline during medical education, typically beginning in the third year of medical school and often continuing throughout residency and the physician's medical career. The purpose of this study was to determine if first year medical student empathy is affected by small group interactions with patients with neurological disorders, and to investigate if changes in empathy persisted over time. MATERIALS AND METHODS Eighty first year medical students participating in a Neuroscience Module interacted with a variety of neurological patients in a small group informational session. Prior to the experience, participants completed the Jefferson Scale of Physician Empathy-Student (JSPE-S) version. After the experience, students completed a post-test JSPE-S questionnaire, and a final post-post-test JSPE-S questionnaire was completed 5 weeks later. Empathy scores were compared with a repeated measures MANOVA. The relationship between gender and empathy, and the effect of the age of the neurological patients on empathy scores were also examined. RESULTS Empathy scores for seventy-one students who completed the JSPE-S questionnaires were analyzed. Students had significantly higher empathy immediately after the patient interaction experience, and the change in empathy was sustained over the course of 5 weeks (p = 0.015). The age of the neurological patients had a significant effect on empathy scores. There was no significant difference between empathy scores and gender. CONCLUSIONS This study supports the incorporation of a group patient interaction experience into the medical school curriculum as an inexpensive and practical method of enhancing medical student empathy in a non-clinical setting.
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Affiliation(s)
| | - Asa C. Black
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Sandip Jain
- Department of Medicine, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Ervin Lowther
- Department of Radiology, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Lee Madeline
- Department of Radiology, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Chris Troup
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Thomas Nathaniel
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - L. A. Fowler
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC USA
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Gomez S, White B, Browning J, DeLisser HM. Medical Students' Experience in a Trauma Chaplain Shadowing Program: A Mixed Method Analysis. MEDICAL EDUCATION ONLINE 2020; 25:1710896. [PMID: 31900090 PMCID: PMC6968636 DOI: 10.1080/10872981.2019.1710896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/02/2019] [Accepted: 12/29/2019] [Indexed: 06/10/2023]
Abstract
Despite the importance of spirituality to health and patient care, there remains a lack of educational opportunities for medical students to learn about and engage the spiritual needs of patients. Shadowing of hospital chaplains has been employed as a means of providing instruction in spirituality, but published experiences of this pedagogy are limited. This study therefore analyzed an elective, first-year medical student, eight-hour, trauma chaplain shadowing experience, the objectives of which are to increase students' knowledge and understanding of (i) the role of chaplains/pastoral care in patient care; (ii) strategies for engaging patients and/or families in difficult situations; and (iii) approaches for discussing issues of spirituality with patients and families. Aquestionnaire was sent to participants after the experience assessing the value of the experience. Two focus groups provided additional qualitative data. Of the 148 participants over 6 years, 100 completed the questionnaire (68%). Participants on average engaged 1.78 trauma patients or their families and experienced 3.63 overall patient/family interactions during their shadowing. Over 90% of respondents agreed or strongly agreed that the experience provided agreater understanding of the role of the chaplain, and was educationally, professionally, and personally useful. Over 60% of respondents agreed or strongly agreed that the experience improved their understanding of discussing difficult or spiritual topics with patients and families. Nearly all respondents (98%) would recommend asimilar shadowing experience to fellow medical students. Qualitative remarks echoed these findings, revealing themes surrounding the educational benefits, surprise, and awe experienced by participants, and indicating appreciation for the interprofessional aspect of the experience. These data demonstrate that trauma chaplain shadowing may be effective for introducing first-year medical students to healthcare chaplaincy, educating them about the challenges of navigating difficult spiritual conversations with patients and families, and exposing them to interprofessional collaboration.
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Affiliation(s)
- Sofia Gomez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Betty White
- Department of Pastoral Care and Education, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - James Browning
- Department of Pastoral Care and Education, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Horace M. DeLisser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Ronan LK, Czerwiec MK. A Novel Graphic Medicine Curriculum for Resident Physicians: Boosting Empathy and Communication through Comics. THE JOURNAL OF MEDICAL HUMANITIES 2020; 41:573-578. [PMID: 32809157 DOI: 10.1007/s10912-020-09654-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Curricular design that addresses residency physician competencies in communication skills and professionalism remains a challenge. Graphic Medicine (GM) uses comics, a medium combining text and images, to communicate healthcare concepts. Narrative Medicine, in undergraduate medical education, has limited reported usage in Graduate Medical Education (GME). Given the time constraints and intensity of GME, we hypothesized that comics as a form of narrative medicine would be an efficient medium to engage residents.The authors created a novel curriculum to promote effective communication and professionalism, focusing on empathy, compassion and cultural competency. A four-week curriculum was delivered in a neurology residency program. Excerpts from non-fiction graphic memoirs about neurological conditions were read, discussed, and paired with prompt-driven drawing exercises. Qualitative surveys were used to assess acceptability of comics, usefulness of comics to convey patient illness experience, and perception of patient needs for physician-patient communication.Ninety-seven percent of residents reported the sessions were a good use of their time. Residents identified new symptoms of neurologic disorders, articulated patient communication needs, and expressed increased empathy after participation. Residents participated in drawing exercises, but these were not formally analyzed. Graphic medicine is a well received format that may build communication skills and increase empathy.
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Affiliation(s)
- Lara K Ronan
- Dartmouth College Geisel School of Medicine, Lebanona, NH, USA.
| | - M K Czerwiec
- Northwestern University School of Medicine, Chicago, IL, USA
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Kazimi M, Terndrup T, Tait R, Frey JA, Strassels S, Emerson G, Todd KH. Cultivating emergency physician behavioral empathy to improve emergency department care for pain and prescription opioid misuse. J Am Coll Emerg Physicians Open 2020; 1:1480-1485. [PMID: 33392553 PMCID: PMC7771829 DOI: 10.1002/emp2.12086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/30/2022] Open
Abstract
Clinical empathy is the ability to understand the patient's experience, communicate that understanding, and act on it. There is evidence that patient and physician benefits are associated with more empathic communications. These include higher patient and physician satisfaction, improved quality of life, and decreased professional burnout for physicians, as well as increased patient compliance with care plans. Empathy appears to decline during medical school, residency training, and early professional emergency medicine practice; however, brief training has the potential to improve behavioral measures of empathy. Improvements in emergency department physician empathy seems especially important in managing patients at elevated risk for opioid-related harm. We describe our conceptual approach to identifying and designing a practice improvement curriculum aimed to cultivate and improve behavioral empathy among practicing emergency physicians. Emergent themes from our preliminary study of interviews, focus groups, and workshops were identified and analyzed for feasibility, sensitivity to change, and potential impact. A conceptual intervention will address the following key categories: patient stigmatization, identification of problematic pain-subtypes, empathic communication skills, interactions with family and friends, and techniques to manage inappropriate patient requests. The primary outcomes will be the changes in behavioral empathy associated with training. An assessment battery was chosen to measure physician psychosocial beliefs, attitudes and behavior, communication skills, and burnout magnitude. Additional outcomes will include opioid prescribing practice, naloxone prescribing, and referrals to addiction treatment. A pilot study will allow an estimation of the intervention impact to help finalize a curriculum suitable for web-based national implementation.
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Affiliation(s)
- Maher Kazimi
- Department of Emergency MedicineOhio State UniversityColumbusOhioUSA
| | - Thomas Terndrup
- Department of Emergency MedicineOhio State UniversityColumbusOhioUSA
| | - Raymond Tait
- Department of PsychiatrySt. Louis UniversitySt. LouisMissouriUSA
| | - Jennifer A. Frey
- Department of Emergency MedicineOhio State UniversityColumbusOhioUSA
| | | | - Geremiah Emerson
- Department of Emergency MedicineOhio State UniversityColumbusOhioUSA
| | - Knox H. Todd
- Department of Emergency MedicineOhio State UniversityColumbusOhioUSA
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Baugh RF, Hoogland MA, Baugh AD. The Long-Term Effectiveness of Empathic Interventions in Medical Education: A Systematic Review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:879-890. [PMID: 33244286 PMCID: PMC7685355 DOI: 10.2147/amep.s259718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/17/2020] [Indexed: 06/09/2023]
Abstract
The Association of American Medical Colleges recognizes that empathy is an important part of providing excellent patient care and lists empathy as a Core Entrustable Professional Attribute for physicians. This study is a review of the literature focusing on studies with an educational intervention to promote empathy and at least one year follow-up data. After reviewing the 4910 abstracts retrieved from PubMed, PsycInfo, Cochrane, Web of Science, CINAHL, and Embase; the coauthors selected 61 articles for full-text review and completed a medical education research study quality instrument (MERSQI) to ensure all selected studies scored at least 7 or above. Five studies from the US and seven international studies met our inclusion criteria and formed the basis for the study. Few longitudinal studies with a post-intervention follow-up exist to confirm or disprove the effectiveness and durability of empathy training. Of the published studies that do conduct long-term follow-up, study design and measures used to test empathy are inconsistent. Despite the high degree of heterogeneity, the overwhelming majority demonstrated declining empathy over time. Little evidence was identified to support the ability to augment the empathy of physician trainees in sustained fashion. A model is presented which explains the observed changes. Alternative solutions are proposed, including the selection of more prosocial candidates.
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Affiliation(s)
- Reginald F Baugh
- Admissions, University of Toledo College of Medicine and Life Sciences, Toledo, OH43623, USA
| | - Margaret A Hoogland
- Library, University of Toledo College of Medicine and Life Sciences, Toledo, OH43623, USA
| | - Aaron D Baugh
- Pulmonary, Critical Care, Allergy, Sleep Medicine, University of California San Francisco Medical Center, San Francisco, CA94131, USA
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Lemogne C, Buffel du Vaure C, Hoertel N, Catu-Pinault A, Limosin F, Ghasarossian C, Le Jeunne C, Jaury P. Balint groups and narrative medicine compared to a control condition in promoting students' empathy. BMC MEDICAL EDUCATION 2020; 20:412. [PMID: 33167952 PMCID: PMC7654605 DOI: 10.1186/s12909-020-02316-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/18/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND The perceived importance of clinical empathy may decline among students during medical training. Several interventions have been shown to be effective in promoting or preserving medical students' empathic abilities, such as empathy skills training or Balint groups. Although narrative medicine training shares some features with these interventions, no randomized study to date examined the efficacy of narrative medicine training. This study aimed to assess the effects of Balint groups and narrative medicine training on clinical empathy measured by the self-rated Jefferson's School Empathy Scale - Medical Student (JSPE-MS©) among fourth-year medical students. METHODS Students who gave their consent to participate were randomly allocated in equal proportion to Balint groups, narrative medicine training or to the control group. Participants in the intervention groups received either seven sessions of 1.5-h Balint groups or a 2-h lecture and five sessions of 1.5-h narrative medicine training from October 2015 to December 2015. The main outcome was the change in JSPE-MS© score from baseline to one week after the last session. RESULTS Data from 362 out of 392 participants were analyzed: 117 in the control group, 125 in the Balint group and 120 in the narrative medicine group. The change in JSPE-MS© score from baseline to follow-up was significantly higher in the Balint group than in the control group [mean (SD): 0.27 (8.00) vs. -2,36 (11.41), t = 2.086, P = 0.038]. The change in JSPE-MS© score in the narrative medicine group [mean (SD): - 0.57 (8.76)] did not significantly differ from the changes in the control group (t = 1.355, P = 0.18) or the Balint group (t = 0.784, P = 0.43). Adjusting for participants' characteristics at baseline, Balint groups remained associated with better outcomes compared to the control group (β = 2.673, P = 0.030). CONCLUSIONS Balint groups may promote clinical empathy to some extent among medical students, at least in the short run.
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Affiliation(s)
- Cédric Lemogne
- Université de Paris, Faculté de Santé, UFR de Médecine, 15 rue de l’Ecole-de-Médecine, 75006 Paris, France
- AP-HP.Centre-Université de Paris, Hôpital Hôtel-Dieu, Service de Psychiatrie de l’adulte, 1 place du parvis Notre-Dame, 75004 Paris, France
- Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, 102-108 rue de la Santé, 75014 Paris, France
| | - Céline Buffel du Vaure
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France
- METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité, Research Center UMR 1153, Inserm, 1 place du parvis Notre-Dame, 75004 Paris, France
| | - Nicolas Hoertel
- Université de Paris, Faculté de Santé, UFR de Médecine, 15 rue de l’Ecole-de-Médecine, 75006 Paris, France
- Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, 102-108 rue de la Santé, 75014 Paris, France
- AP-HP.Centre-Université de Paris, Hôpital Corentin-Celton, Service de Psychiatrie et d’Addictologie de l’adulte et du sujet âgé, 4 parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - Annie Catu-Pinault
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France
- Société Médicale Balint, 10 Route de Thionville, 57140, Woippy, France
| | - Frédéric Limosin
- Université de Paris, Faculté de Santé, UFR de Médecine, 15 rue de l’Ecole-de-Médecine, 75006 Paris, France
- Université de Paris, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, 102-108 rue de la Santé, 75014 Paris, France
- AP-HP.Centre-Université de Paris, Hôpital Corentin-Celton, Service de Psychiatrie et d’Addictologie de l’adulte et du sujet âgé, 4 parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - Christian Ghasarossian
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Claire Le Jeunne
- Université de Paris, Faculté de Santé, UFR de Médecine, 15 rue de l’Ecole-de-Médecine, 75006 Paris, France
- AP-HP.Centre-Université de Paris, Hôpital Cochin, Service de Médecine Interne, Paris, France
| | - Philippe Jaury
- Université de Paris, Faculté de Santé, UFR de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France
- Société Médicale Balint, 10 Route de Thionville, 57140, Woippy, France
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Goh YS, Seetoh YTM, Chng ML, Ong SL, Li Z, Hu Y, Ho CMR, Ho SHC. Using Empathetic CAre and REsponse (ECARE) in improving empathy and confidence among nursing and medical students when managing dangerous, aggressive and violent patients in the clinical setting. NURSE EDUCATION TODAY 2020; 94:104591. [PMID: 32932056 DOI: 10.1016/j.nedt.2020.104591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/18/2020] [Accepted: 08/09/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND The use of physical restraint to curtail dangerous or extremely disruptive behaviours in patients has been an established practice to help ensuring safety in healthcare providers' work environment. However, many have deemed it unnecessary and overused with reported negligence on patients' basic needs during its implementation. Studies have shown that having empathy and non-judgmental attitudes are vital in reducing and eliminating the use of restraint. OBJECTIVES To explore whether experiential learning will improve empathy and confidence, among nursing and medical students when managing dangerous, aggressive, and violent patients. DESIGN A pre- and post-test, same group quasi-experimental design was used to explore the effectiveness of using the Empathetic CAre and REsponse (ECARE), an experiential learning session to equip nursing and medical students on managing dangerous, aggressive, and violent patients. Outcome measures include students' confidence when using verbal de-escalation, physical and chemical restraint techniques. Empathy scores were also compared. SETTINGS A University offering both medical and nursing program from undergraduate to postgraduate level. PARTICIPANTS 249 nursing and 50 medical students undergoing the mental health nursing module in Year 2 of their nursing program and psychiatry rotation in Year 3 of their medical education. RESULTS Results showed that, for both student populations, the empathy and confidence scores significantly improved after attending ECARE. ANCOVA conducted on the post-intervention Jefferson empathy score between the populations with an adjusted baseline score revealed a statistically significant adjusted mean difference between them. CONCLUSIONS This study demonstrated that experiential learning could improve the learners' empathy through the integration of hands-on learning. This in turn could enhance future healthcare professionals' care quality. Experiential learning opportunities should be incorporated into existing pedagogies as this helps to improve students' confidence in managing dangerous, aggressive and violent patients, reducing the use of physical restraint, thereby enhancing the quality of patient care.
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Affiliation(s)
- Yong-Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Alice Lee Centre for Nursing Studies, National University Health System, Singapore.
| | - Yu-Ting Michelle Seetoh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Alice Lee Centre for Nursing Studies, National University Health System, Singapore
| | - Mui-Lee Chng
- National University Hospital, National University Health System, Singapore
| | - Siang Loong Ong
- National University Hospital, National University Health System, Singapore
| | | | - Yanan Hu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Alice Lee Centre for Nursing Studies, National University Health System, Singapore
| | - Chun-Man Roger Ho
- National University Hospital, National University Health System, Singapore
| | - Su Hui Cyrus Ho
- National University Hospital, National University Health System, Singapore
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Standage H, Kelley K, Buxton H, Wetzel C, Brasel KJ, Hoops H. Revitalizing the Patient-Surgeon Relationship: Surgical Curriculum Including the Patient Perspective. JOURNAL OF SURGICAL EDUCATION 2020; 77:e146-e153. [PMID: 32868227 DOI: 10.1016/j.jsurg.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/23/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE General Surgery residents have increasing obligations that limit time with patients. This affects the patient-physician relationship, decreases meaning in work and increases burnout. Patient-Centric Resident Conferences (PCRC)1 incorporate patients in resident didactics to promote meaning in work and improve resident confidence in counseling and consenting patients for surgery. DESIGN Prospective cohort study of General Surgery residents who participated in standard didactic conferences (control) and modified conferences (PCRC) between 2017 and 2019. Control conferences covered a relevant surgical topic. PCRC had shortened didactics and discussions with patients who had undergone the relevant index operation. Pre- and postconference surveys measured teaching effectiveness, confidence in counseling and consenting, and resident perception of how well the conference supported their decision to pursue surgery. Survey data was compared using chi-squared tests. Qualitative data analysis used ground theory methodology. SETTING This study was performed by the Department of Surgery at Oregon Health and Science University in Portland, Oregon. PARTICIPANTS All active General Surgery residents were asked to participate in conferences. RESULTS Eighty-one residents completed 136 surveys over 5 control conferences and 207 surveys over 7 PCRC. Residents reported increased confidence in counseling and consenting for surgery following control conferences (p < 0.0001) and PCRC (p < 0.0001). Residents' perception of effectiveness of teaching pathophysiology (p = 0.008) and operative steps (p = 0.013) was greater in control conferences whereas effectiveness of teaching surgical complications was greater in PCRC (p = 0.006). Resident responses indicated greater support for a surgical career following PCRC compared to control conferences (p = 0.013). Themes like "patient perspective," "impact on surgeon," and "psychological effects of surgery" were common in PCRC and rare in control conferences. CONCLUSIONS PCRC were associated with stronger motivations for a surgical career and included patient-centered themes, which can enhance meaning in work. These conferences complement but do not replace standard didactics.
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Affiliation(s)
- Hayley Standage
- Department of Surgery, Oregon Health and Science University, Portland, Oregon.
| | - Katherine Kelley
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Heather Buxton
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
| | - Cate Wetzel
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Karen J Brasel
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Heather Hoops
- Department of Surgery, Oregon Health and Science University, Portland, Oregon; Department of Surgery, University of Pittsburgh, UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania
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Brekalo Prso I, Mocny-Pachońska K, Trzcionka A, Pezelj-Ribaric S, Paljevic E, Tanasiewicz M, Persic Bukmir R. Empathy amongst dental students: An institutional cross-sectional survey in Poland and Croatia. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:687-694. [PMID: 33462930 DOI: 10.1111/eje.12557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/21/2020] [Accepted: 05/29/2020] [Indexed: 06/12/2023]
Abstract
AIM To determine and compare levels of empathy and its dimensions in Polish and Croatian dental students. METHODS Fourth- and fifth-year dental students (N = 193) at the University of Rijeka and University of Silesia completed questionnaires to determine levels of overall empathy and its dimensions: compassionate care (CC), perspective taking (PT) and ability to stand in someone else's shoes (ASSES). Total empathy and its dimensions were analysed depending on the country of origin, year of study and gender of the participants. The HPS version of the Jefferson Scale of Physician Empathy was used to conduct the research. Statistical analysis was performed using the Mann-Whitney U test. RESULTS The analysis showed no significant differences in total empathy level between Polish and Croatian students (P = .838). However, separate analysis of empathy items showed significant differences between the two groups. Croatian students obtained significantly higher average PT values (P = .021), whilst Polish students had significantly higher CC scores (P < .001). Analysis of Croatian respondents revealed significantly higher ASSES scores in the fourth- and fifth-year students (P = .047). Analysis in the Polish group demonstrated an increase in PT scores from the fourth to the fifth year of study (P = .008). CONCLUSION Croatian students scored higher on items associated with cognitive empathy, whilst Polish students displayed higher values in the aspect of emotional empathy. The present results demonstrated an increase in cognitive empathy level in Polish students, whilst in their Croatian colleagues, the level of cognitive empathy decreased with the progression of the academic programme.
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Affiliation(s)
- Ivana Brekalo Prso
- Department of Endodontics and Restorative Dentistry, Faculty of Dental medicine, University of Rijeka, Rijeka, Croatia
- University of Osijek, Osijek, Croatia
| | - Katarzyna Mocny-Pachońska
- Department of Conservative Dentistry with Endodontics, School of Medicine with the Division of Dentistry, Medical University of Silesia in Katowice, Bytom, Poland
| | - Agata Trzcionka
- Department of Conservative Dentistry with Endodontics, School of Medicine with the Division of Dentistry, Medical University of Silesia in Katowice, Bytom, Poland
| | - Sonja Pezelj-Ribaric
- University of Osijek, Osijek, Croatia
- Department of Oral Medicine and Periodontology, Faculty of Dental medicine, University of Rijeka, Rijeka, Croatia
| | - Ema Paljevic
- Department of Endodontics and Restorative Dentistry, Faculty of Dental medicine, University of Rijeka, Rijeka, Croatia
| | - Marta Tanasiewicz
- Department of Conservative Dentistry with Endodontics, School of Medicine with the Division of Dentistry, Medical University of Silesia in Katowice, Bytom, Poland
| | - Romana Persic Bukmir
- Department of Endodontics and Restorative Dentistry, Faculty of Dental medicine, University of Rijeka, Rijeka, Croatia
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96
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Lauden SM, Wilson PM, Faust MM, Webber S, Schwartz A, Mahan JD, Batra M, Schubert CJ. Global Health Experiences, Well-Being, and Burnout: Findings From a National Longitudinal Study. Acad Pediatr 2020; 20:1192-1197. [PMID: 32437879 DOI: 10.1016/j.acap.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/25/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Describe the demographics of pediatric and internal medicine/pediatric residents participating in global health (GH) experiences and examine relationships between GH involvement and self-perceived burnout, resilience, mindfulness, empathy, and spirituality. METHODS The Pediatric Resident Burnout and Resilience Study Consortium developed a national longitudinal study through collaboration with the Association of Pediatric Program Directors' Longitudinal Educational Assessment Research Network. Electronic surveys were administered to pediatric trainees annually (2016-2018). GH and well-being data were extracted. Descriptive statistics were calculated. RESULTS Of 9653 eligible pediatric and medicine/pediatric residents from 55 institutions, 6150 responded to the survey in 1 or more years, with average completion rate of 63.7% over a 3-year period. Controlling for repeat survey-takers, 12.7% (536/4213) of residents reported involvement in a GH-specific pathway, curricula, or track. GH participants were significantly more likely to be unmarried (P < .001), childless (P = .003), and medicine/pediatric trainees (P < .001). Controlling for repeated measures and demographic factors, GH participants demonstrated higher levels of empathic concern (P < .001) and higher spirituality scores in 2 of 3 domains (P < .01/<.05). GH involvement was not associated with lower reports of burnout or improved resilience/mindfulness. CONCLUSION Although GH involvement is associated with increased levels of empathy and spirituality, it was not protective against burnout in this study. This highlights the need to study and promote the well-being of all residents, and perhaps especially those experiencing the challenges of working in low-resource settings. Future efforts should determine the impact of predeparture training, programmatic support, and post-trip debriefing on resident well-being.
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Affiliation(s)
- Stephanie M Lauden
- Department of Pediatrics, The Ohio State University (SM Lauden, MM Faust, and JD Mahan), Columbus, Ohio.
| | - Paria M Wilson
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati (PM Wilson and CJ Schubert), Cincinnati, Ohio
| | - Maureen M Faust
- Department of Pediatrics, The Ohio State University (SM Lauden, MM Faust, and JD Mahan), Columbus, Ohio
| | - Sarah Webber
- Department of Pediatrics, University of Wisconsin-Madison (S Webber)
| | | | - John D Mahan
- Department of Pediatrics, The Ohio State University (SM Lauden, MM Faust, and JD Mahan), Columbus, Ohio
| | - Maneesh Batra
- Seattle Children's Hospital (M Batra), Seattle, Wash
| | - Charles J Schubert
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati (PM Wilson and CJ Schubert), Cincinnati, Ohio
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Smith KA, Bishop FL, Dambha-Miller H, Ratnapalan M, Lyness E, Vennik J, Hughes S, Bostock J, Morrison L, Mallen C, Yardley L, Everitt H, Little P, Howick J. Improving Empathy in Healthcare Consultations-a Secondary Analysis of Interventions. J Gen Intern Med 2020; 35:3007-3014. [PMID: 32666488 PMCID: PMC7572919 DOI: 10.1007/s11606-020-05994-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
A recent systematic review of randomised trials suggested that empathic communication improves patient health outcomes. However, the methods for training healthcare practitioners (medical professionals; HCPs) in empathy and the empathic behaviours demonstrated within the trials were heterogeneous, making the evidence difficult to implement in routine clinical practice. In this secondary analysis of seven trials in the review, we aimed to identify (1) the methods used to train HCPs, (2) the empathy behaviours they were trained to perform and (3) behaviour change techniques (BCTs) used to encourage the adoption of those behaviours. This detailed understanding of interventions is necessary to inform implementation in clinical practice. We conducted a content analysis of intervention descriptions, using an inductive approach to identify training methods and empathy behaviours and a deductive approach to describe the BCTs used. The most commonly used methods to train HCPs to enhance empathy were face-to-face training (n = 5), role-playing (n = 3) and videos (self or model; n = 3). Duration of training was varied, with both long and short training having high effect sizes. The most frequently targeted empathy behaviours were providing explanations of treatment (n = 5), providing non-specific empathic responses (e.g. expressing understanding) and displaying a friendly manner and using non-verbal behaviours (e.g. nodding, leaning forward, n = 4). The BCT most used to encourage HCPs to adopt empathy behaviours was "Instruction on how to perform behaviour" (e.g. a video demonstration, n = 5), followed by "Credible source" (e.g. delivered by a psychologist, n = 4) and "Behavioural practice" (n = 3 e.g. role-playing). We compared the effect sizes of studies but could not extrapolate meaningful conclusions due to high levels of variation in training methods, empathy skills and BCTs. Moreover, the methods used to train HCPs were often poorly described which limits study replication and clinical implementation. This analysis of empathy training can inform future research, intervention reporting standards and clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Lucy Yardley
- University of Southampton , Southampton, UK
- University of Bristol , Bristol, UK
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98
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Winter R, Issa E, Roberts N, Norman RI, Howick J. Assessing the effect of empathy-enhancing interventions in health education and training: a systematic review of randomised controlled trials. BMJ Open 2020; 10:e036471. [PMID: 32978187 PMCID: PMC7520826 DOI: 10.1136/bmjopen-2019-036471] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To estimate the effect of empathy interventions in health education and training from randomised controlled trials (RCTs). METHODS MEDLINE, PsycINFO, EMBASE, CINAHL and Cochrane databases were searched from inception to June 2019 for RCTs investigating the effect of empathy-enhancing interventions in medical and healthcare students and professionals. Studies measuring any aspect of 'clinical empathy' as a primary or secondary outcome were included. Two reviewers extracted data and assessed the risk of bias of eligible studies using the Cochrane Risk of Bias Tool. Random effects meta-analyses of the impact of empathy training on participants' empathy levels were performed. RESULTS Twenty-six trials were included, with 22 providing adequate data for meta-analysis. An overall moderate effect on participant empathy postintervention (standardised mean difference 0.52, 95% CI 0.36 to 0.67) was found. Heterogeneity across trial results was substantial (I2=63%). Data on sustainability of effect was provided by 11 trials and found a moderate effect size for improved empathy up until 12 weeks (0.69, 95% CI 0.23 to 1.15), and a small but statistically significant effect size for sustainability at 12 weeks and beyond (standardised mean difference 0.34, 95% CI 0.11 to 0.57). In total, 15 studies were considered to be either unclear or high risk of bias. The quality of evidence of included studies was low. CONCLUSION Findings suggest that empathy-enhancing interventions can be effective at cultivating and sustaining empathy with intervention specifics contributing to effectiveness. This review focuses on an important, growing area of medical education and provides guidance to those looking to develop effective interventions to enhance empathy in the healthcare setting. Further high-quality trials are needed that include patient-led outcome assessments and further evaluate the long-term sustainability of empathy training. PROTOCOL REGISTRATION NUMBER PROSPERO (CRD42019126843).
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Affiliation(s)
- Rachel Winter
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Eyad Issa
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Robert I Norman
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
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99
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Ren Y, Song H, Li S, Xiao F. Mediating effects of nursing organizational climate on the relationships between empathy and burnout among clinical nurses. J Adv Nurs 2020; 76:3048-3058. [PMID: 32885476 DOI: 10.1111/jan.14525] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 06/27/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To investigate how nurses who worked in Guangdong province in China perceived empathy, nursing organization climate and burnout. DESIGN A cross-sectional quantitative research design was used. We carried out the research in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. METHODS The study was carried out from August-October of 2018 using a structured electronic questionnaire. A total of 965 participants were selected with convenience sampling in Guangdong province. RESULTS A total of 786 valid questionnaires were collected in this study. The average burnout score of participants was 38.19 (SD 13.32) and 67.4% of them rated their burnout as more than 30 points, while 5.7% were higher than 60 points. The multi-variable linear regression model explained 9.4% of the variance in burnout related to sociodemographic variables (p < 0.001). Empathy was significantly and positively associated with nursing organizational climate and emotional exhaustion while negatively associated with reduced personal accomplishment. In addition, nursing organizational climate mediated the relationship between empathy and reduced personal accomplishment. CONCLUSION Our findings suggest that both empathy and nursing organizational climate are protective factors that prevent burnout in this population. Managers can alleviate nurses' burnout through developing empathy and improving the organizational climate. IMPACT This study demonstrates that empathy is not the cause of burnout; rather, it can prevent nurses from experiencing burnout. Nursing organizational climate is another protective factor that has a mediating effect on empathy and burnout. Improving empathy and nursing organizational climate could help reduce nurse burnout.
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Affiliation(s)
- Ying Ren
- Nanfang Hospital of Southern Medical University, Guangdong, PR China
| | - Huijuan Song
- Nanfang Hospital of Southern Medical University, Guangdong, PR China
| | - Shuang Li
- Nanfang Hospital of Southern Medical University, Guangdong, PR China
| | - Feng Xiao
- Nanfang Hospital of Southern Medical University, Guangdong, PR China
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100
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Starr LT, Magan KC. Model of Empathic Pain Assessment and Treatment in Persons With Dementia. Res Gerontol Nurs 2020; 13:264-276. [PMID: 32286670 DOI: 10.3928/19404921-20200402-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/04/2020] [Indexed: 12/21/2022]
Abstract
The current article presents an evidence-based model for understanding clinical empathy's relationship with the assessment and treatment of pain in persons with advanced dementia. A literature review informed creation of an interdisciplinary conceptual framework of clinician empathy in pain assessment and treatment among persons with advanced dementia. Driven by observation of behaviors indicating pain in persons with dementia unable to self-report, the model represents the cognitive, affective, ethical, and behavioral components of clinical empathy involved in assessing and treating pain, relevant patient outcomes, and contextual factors influencing empathy and outcomes; and provides a framework for testing clinical empathy interventions to improve adverse outcomes in persons with advanced dementia. Understanding the relationship between clinician empathy and the assessment and treatment of pain in persons with advanced dementia may improve care quality and help reduce pain behaviors in this patient population. This model may be used to inform pain research in persons with dementia and develop clinical interventions and clinician education programs. [Research in Gerontological Nursing, 13(5), 264-276.].
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