1
|
Holmes SM. Learning Language, Un/Learning Empathy in Medical School. Cult Med Psychiatry 2023:10.1007/s11013-023-09830-8. [PMID: 37725219 DOI: 10.1007/s11013-023-09830-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/21/2023]
Abstract
This article considers the ways in which empathy for patients and related solidarity with communities may be trained out of medical students during medical school. The article focuses especially on the pre-clinical years of medical school, those that begin with orientation and initiation events such as the White Coat Ceremony. The ethnographic data for the article come from field notes and recordings from my own medical training as well as hundreds of hours of observant participation and interviews with medical students over the past several years. Exploring the framework of language socialization, I argue that learning the verbal, textual and bodily language of medical practice contributes to the increasing experience of separation between physicians and patients. Further considering the ethnographic data, I argue that we also learn a form of empathy limited to performance that short circuits clinical care and the possibility for solidarity for health equity. The article concludes with implications for medical education and the medical social sciences and humanities.
Collapse
Affiliation(s)
- Seth M Holmes
- University of California, Berkeley, 50 University Hall, MC 7360, Berkeley, CA, 94720, USA.
- University of Barcelona, Barcelona, Spain.
- ICREA Catalan Institution for Research and Advanced Study, Barcelona, Spain.
| |
Collapse
|
2
|
B J, Kesavadev J, Shrivastava A, Saboo B, Makkar BM. Evolving Scope of Clinical Empathy in the Current Era of Medical Practice. Cureus 2023; 15:e40041. [PMID: 37425530 PMCID: PMC10324523 DOI: 10.7759/cureus.40041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Clinical empathy is one of the most essential tools of medical practice, and it is an act of correctly acknowledging the emotional state of another without experiencing that state oneself. Empathy comprises four components. Mounting evidence exists to support the use of clinical empathy as a tactic for effective health care. Resolving the multi-fold barriers of clinical empathy is important. Clinical empathy is very important in the current era, and a trust-based relationship in patient care is a way to optimal clinical outcomes that can be achieved through better communication and treatment-compliance plans between health care professionals and patients.
Collapse
Affiliation(s)
- Jayakrishnan B
- Department of Medicine, Educare Institute of Dental Sciences, Malappuram, IND
| | - Jothydev Kesavadev
- Department of Diabetes and Endocrinology, Jothydev's Diabetes and Research Center, Trivandrum, IND
| | | | - Banshi Saboo
- Department of Endocrinology, Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, IND
| | - Brij Mohan Makkar
- Department of Endocrinology, Dr. Makkar's Diabetes & Obesity Centre, New Delhi, IND
| |
Collapse
|
3
|
Elfaki A, AlQarni AM, AlGhamdi AA, AlShammari MA, Nasir F, Alabdulqader R. Arabic Validity of the (CARE) Measure for Improving Medical and Mental Health Services. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6530019. [PMID: 35479607 PMCID: PMC9038396 DOI: 10.1155/2022/6530019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
Results The majority of the item's responses showed high level of satisfaction. The coronach alpha of our study that examines the Arabic version of the CARE measurement tool 10 items was 0.96 showing an excellent internal consistency. The Kaiser-Meyer-Olkin measure was 0.96 indicating the adequacy of the data for factor analysis and the Bartlett test of sphericity shows (x2(45) = 8743.126, p < 0.001) indicating the adequacy of the correlation matrix for analysis. Conclusion The Arabic version of CARE Measure seems to be consistent and reliable in the primary health care setting.
Collapse
Affiliation(s)
- Abdelaziz Elfaki
- Department of Psychiatry, College of Medicine, Imam Abdurrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amani M AlQarni
- Department of Family and Community Medicine, College of Medicine, Imam Abdurrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amal A. AlGhamdi
- Department of Family and Community Medicine, College of Medicine, Imam Abdurrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Malak A. AlShammari
- Department of Family and Community Medicine, College of Medicine, Imam Abdurrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Farheen Nasir
- Department of Basic Science, King Saud Bin Abdulaziz University for Health Science, AlAhsa, Saudi Arabia
| | - Rana Alabdulqader
- Medical Intern, King Fahd Hospital of the University, AlKhobar, Saudi Arabia
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Guidi C, Traversa C. Empathy in patient care: from 'Clinical Empathy' to 'Empathic Concern'. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:573-585. [PMID: 34196934 PMCID: PMC8557158 DOI: 10.1007/s11019-021-10033-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 06/07/2023]
Abstract
As empathy gains importance within academia, we propose this review as an attempt to bring clarity upon the diverse and widely debated definitions and conceptions of empathy within the medical field. In this paper, we first evaluate the limits of the Western mainstream medical culture and discuss the origins of phenomena such as dehumanization and detached concern as well as their impacts on patient care. We then pass on to a structured overview of the debate surrounding the notion of clinical empathy and its taxonomy in the medical setting. In particular, we present the dichotomous conception of clinical empathy that is articulated in the debate around cognitive empathy and affective empathy. We thus consider the negative impacts that this categorization brings about. Finally, we advocate for a more encompassing, holistic conception of clinical empathy; one that gives value to a genuine interest in welcoming, acknowledging and responding to the emotions of those suffering. Following this line of reasoning, we advance the notion of 'empathic concern', a re-conceptualization of clinical empathy that finds its source in Halpern in Med Health Care Philos (2014) 17:301-311 engaged curiosity. We ultimately advance Narrative Medicine as an approach to introduce, teach and promote such an attitude among medical trainees and practitioners.
Collapse
|
6
|
Sobczak K, Zdun-Ryżewska A, Rudnik A. Intensity, dynamics and deficiencies of empathy in medical and non-medical students. BMC MEDICAL EDUCATION 2021; 21:487. [PMID: 34507587 PMCID: PMC8429476 DOI: 10.1186/s12909-021-02927-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Empathy is an important competence in the professional development of medical students. The purpose of our study was to compare the levels and scales of empathy in people studying in different educational strategies. METHODS The study was conducted between April 2019 and March 2020. Medicine, nursing, midwifery, physiotherapy, psychology, pedagogy and sociology students were the participants of this study. University students preparing for medical professions (n = 1001) and students of programs unrelated to medicine (n = 700) underwent the Empathy Quotient test (EQ-40). We have compared results in both study groups with the use of the distribution of density, analysis of variance and student's t-test. RESULTS The average results received by students of the university preparing for medical professions were lower (M = 42.6) than those of the non-medical university students (M = 45.3) and the differences between the universities turned out to be statistically important (t = - 5.15, df = 1699, p < 0.001). As many as 14.6% of the students in the 1st EQ class were preparing for various medical professions while 9% studied social sciences. 18.2% of all medical programme students (n = 412) manifested the lowest empathy class. Our research has revealed that the students with Asperger profile (AP) and high-functioning autism (HFA) studied at universities preparing for medical professions (n = 18) more frequently than at non-medical universities (n = 5). CONCLUSIONS We have noticed a serious indicator of erosion in the levels of empathy in medical students and an increase in the number of people with AP and HFA. Empathy decreases in students after the third year of their studies, regardless of the kind of university. We recommend an introduction of career counselling when specialization is being chosen.
Collapse
Affiliation(s)
- Krzysztof Sobczak
- Department of Sociology of Medicine and Social Pathology, Faculty of Health Sciences, Medical University of Gdansk, Tuwima 15 Str., 80-210, Gdansk, Poland.
| | - Agata Zdun-Ryżewska
- Department of Quality of Life Research, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Agata Rudnik
- Institute of Psychology, University of Gdansk, Gdansk, Poland
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Chaudhuri JD. Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach. ANATOMICAL SCIENCES EDUCATION 2020; 13:250-271. [PMID: 31021529 DOI: 10.1002/ase.1884] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 06/09/2023]
Abstract
There has been a fundamental change in health care pedagogy to address the demands and challenges posed by the present generation of millennial students. There is also a growing recognition of the role of intrinsic motivation as a catalyst in a positive learning experience. The term intrinsic motivation refers to energizing behavior that comes from within an individual and develops due to an inherent interest in the activity at hand. However, stimulating intrinsic motivation in the present generation of millennial health care students is a daunting task, considering their diverse and disparate nature. In addition, the inherent generational differences between educators and students, and an increasing emphasis on technological tools have resulted in a dichotomy in the educational environment leading to the development of a greater incidence of burnouts among students. Hence, numerous innovative techniques have been introduced in health care education to enhance the levels of intrinsic motivation in these students. Unfortunately, most of these approaches have only been moderately successful due to their limited ability to address the unique educational expectations of millennial students. The cumulative evidence suggests that specific approaches to stimulate intrinsic motivation should aim at nurturing the learning efforts of students, bridging the generational barriers between educators and students, and ameliorating the stress associated with health care education. Hence, the specific aim of this narrative review is to suggest empirically proven curricular strategies and institutional reforms to enhance intrinsic motivation in health care students belonging to the Millennial Generation.
Collapse
Affiliation(s)
- Joydeep Dutta Chaudhuri
- School of Occupational Therapy, College of Health Sciences, Husson University, Bangor, Maine
| |
Collapse
|
9
|
Huang L, Thai J, Zhong Y, Peng H, Koran J, Zhao XD. The Positive Association Between Empathy and Self-Esteem in Chinese Medical Students: A Multi-Institutional Study. Front Psychol 2019; 10:1921. [PMID: 31496978 PMCID: PMC6712570 DOI: 10.3389/fpsyg.2019.01921] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/05/2019] [Indexed: 12/30/2022] Open
Abstract
Background Empathy is an important element of the physician-patient relationship and is a critical personality trait for medical students. However, research has shown that it declines during undergraduate medical education. It is still unclear how empathy interrelates with the psychological elements of medical students, in particular, self-esteem. This study examined the relationship between empathy and self-esteem to explore other possible methods to improve medical students’ empathy. Methods A stratified sampling strategy was used to select 1690 medical students from 3 medical institutions in Shanghai as study participants. The questionnaires used to collect data included the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), the Rosenberg Self-esteem Scale (RSES), and a self-made inventory on personal information. Descriptive analysis, independent t-test, One-Way ANOVA, and linear regression were used to analyze the data. Results The mean empathy score among medical students was 102.73 with SD = 12.64. Multiple regression analysis revealed that, “age,” “perception of the importance of empathy,” “academic pressure,” “desire to be a doctor after graduation,” and “self-esteem” were significant predictors of empathy (P < 0.05) and the adjusted R2 was 0.462. The correlation matrix between empathy and self-esteem was significant (r = 0.510, P < 0.01). Self-esteem explained 15.5% of the variation of empathy in the final regression model. Conclusion There was a positive association between self-esteem and empathy. Self-esteem is one of many factors which contribute to medical students’ empathy. Age, academic pressure, attitude toward empathy and future career also play a critical role in medical student empathy. Enhancing medical students’ self-esteem may be an efficacious way to improve medical students’ empathy.
Collapse
Affiliation(s)
- Lei Huang
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Medical Education Division, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jessica Thai
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Yuan Zhong
- Medical Education Division, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao Peng
- School of Medicine, Tongji University, Shanghai, China
| | - Jessica Koran
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Xu-Dong Zhao
- School of Medicine, Tongji University, Shanghai, China.,Shanghai East Hospital Affiliated to Tongji University, Shanghai, China.,Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
10
|
Schoonover KL, Hall-Flavin D, Whitford K, Lussier M, Essary A, Lapid MI. Impact of Poetry on Empathy and Professional Burnout of Health-Care Workers: A Systematic Review. J Palliat Care 2019; 35:127-132. [PMID: 31354038 DOI: 10.1177/0825859719865545] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Narrative medicine (NM) interventions have positively influenced empathy and burnout to varying degrees in health-care workers. We systematically reviewed the impact of poetry, a form of NM, on empathy and professional burnout. METHODS A comprehensive search of Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus, from inception to September 25, 2018, for articles published in English, was conducted using search terms related to NM, empathy, professional burnout, and health-care personnel. RESULTS Of the 401 abstracts independently screened for inclusion by 2 reviewers, 2 quantitative, 3 qualitative studies, and 1 research letter were included. One research letter, focusing on the use of poetry, found it to increase empathy as measured by a nonvalidated questionnaire. All other studies used mixed NM interventions: 2 quantitative studies, using validated surveys, showed an increase in empathy and 2 qualitative studies showed limited to a prominent finding of increased empathy. There were no studies that used poetry exclusively to assess impact on professional burnout. One quantitative study, utilizing a validated survey, revealed no overall reduced burnout among residents, although high attendance participants had moderately reduced burnout postintervention, and one qualitative study noted limited reduction in burnout. CONCLUSION There is evidence that poetry as part of a NM intervention may increase empathy and limited evidence that it may reduce professional burnout among health-care workers.
Collapse
Affiliation(s)
| | - Daniel Hall-Flavin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Kevin Whitford
- Mayo Clinic Hospice, Mayo Clinic, Rochester, MN, USA.,Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark Lussier
- Department of English, Arizona State University, Tempe, AZ, USA
| | - Alison Essary
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Hospice, Mayo Clinic, Rochester, MN, USA.,Center for Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
11
|
Jeffrey D. Communicating with a human voice: developing a relational model of empathy. J R Coll Physicians Edinb 2019; 48:251-256. [PMID: 29465105 DOI: 10.4997/jrcpe.2017.312] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The medical profession has adopted a cognitive model of empathy, or detached concern, in its professionalism and practice. As a consequence there is now an empathy gap which has been demonstrated by lapses in patient care in the UK. There may also be an empathy gap developing in medical students during their training. This paper argues for the adoption of a relational view of empathy which embraces emotional and moral dimensions of the concept, acknowledges the importance of the clinical context and prioritises the relationship between the doctor and patient. A relational model extends to encompass the patient's family and all members of the healthcare team. By exploring the process of empathising in clinical practice I develop a relational model that is more appropriate for modern patterns of patient care and medical education than detached concern. Adoption of a relational model of empathy in training and practice can help bridge the empathy gap.
Collapse
Affiliation(s)
- D Jeffrey
- D Jeffrey, Department of Primary Palliative Care, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| |
Collapse
|
12
|
Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty. J Prof Nurs 2019; 36:28-33. [PMID: 32044049 DOI: 10.1016/j.profnurs.2019.06.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/13/2019] [Accepted: 06/03/2019] [Indexed: 12/19/2022]
Abstract
As the demographics in the United States continue to change, nurses must deliver care to patients from diverse cultural backgrounds. Cultural humility is a lifelong process of self-reflection which is also defined by that individual. It allows an individual to be open to other people's identities, which is core to the nursing standard of providing holistic care. Embracing and incorporating cultural humility is essential for creating a comprehensive and individualized plan of care. One of the ways to achieve cultural humility in nursing is to train future faculty to become agents of cultural humility. This also helps to create a pipeline of nurses who have respect and empathy for the patients they serve. The aims of this paper include: 1) define cultural humility and its importance to healthcare professionals; 2) explore the intrapersonal, interpersonal, and system levels of cultural humility; 3) provide insight on how to promote cultural humility; 4) reflect on best practices across a variety of healthcare disciplines; and 5) provide suggestions for practice.
Collapse
|
13
|
Oka R, Nomura A, Yasugi A, Kometani M, Gondoh Y, Yoshimura K, Yoneda T. Study Protocol for the Effects of Artificial Intelligence (AI)-Supported Automated Nutritional Intervention on Glycemic Control in Patients with Type 2 Diabetes Mellitus. Diabetes Ther 2019; 10:1151-1161. [PMID: 30877556 PMCID: PMC6531593 DOI: 10.1007/s13300-019-0595-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Nutritional intervention is effective in improving glycemic control in patients with type 2 diabetes but requires large inputs of manpower. Recent improvements in photo analysis technology facilitated by artificial intelligence (AI) and remote communication technologies have enabled automated evaluations of nutrient intakes. AI- and mobile-supported nutritional intervention is expected to be an alternative approach to conventional in-person nutritional intervention, but with less human resources, although supporting evidence is not yet complete. The aim of this study is to test the hypothesis that AI-supported nutritional intervention is as efficacious as the in-person, face-to-face method in terms of improving glycemic control in patients with type 2 diabetes. METHODS This is a multicenter, unblinded, parallel, randomized controlled study comparing the efficacy of AI-supported automated nutrition therapy with that of conventional human nutrition therapy in patients with type 2 diabetes. Patients with type 2 diabetes mainly controlled with diet are to be recruited and randomly assigned to AI-supported nutrition therapy (n = 50) and to human nutrition therapy (n = 50). Asken, a mobile application whose nutritional evaluation has been already validated to that by the classical method of weighted dietary records, has been specially modified for this study so that it follows the recommendations of Japan Diabetes Society (total energy restriction with proportion of carbohydrates to fat to protein of 50-60, 20, and 20-30%, respectively). PLANNED OUTCOMES The primary outcome is the change in glycated hemoglobin levels from baseline to 12 months, and this outcome is to be compared between the two groups. The secondary outcomes are changes in fasting plasma glucose, plasma lipid profile, body weight, body mass index, waist circumference, blood pressures, and urinary albumin excretion. The results of this randomized controlled trial will fill the gap between the demand for support of AI in nutritional interventions and the scientific evidence on its efficacy. TRIAL REGISTRATION UMIN000032231.
Collapse
Affiliation(s)
- Rie Oka
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
- Department of Internal Medicine, Hokuriku Central Hospital, Toyama, Japan.
| | - Akihiro Nomura
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
- Innovative Clinical Research Center (iCREK), Kanazawa University Hospital, Kanazawa, Japan
- CureApp Institute, Karuizawa, Japan
| | - Ayaka Yasugi
- Asken Medical Division, WIT Co., Ltd., Tokyo, Japan
| | - Mitsuhiro Kometani
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yuko Gondoh
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center (iCREK), Kanazawa University Hospital, Kanazawa, Japan
| | - Takashi Yoneda
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
- Institutes of Liberal Arts and Science, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
14
|
Rossi P, Little P, De La Torre ER, Palmaro A. If you want to understand what it really means to live with cluster headache, imagine... fostering empathy through European patients' own stories of their experiences. FUNCTIONAL NEUROLOGY 2018; 33:57-59. [PMID: 29633698 DOI: 10.11138/fneur/2018.33.1.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cluster headache (CH) is arguably the most severe pain condition that afflicts humans. The severity of the pain has earned it the nickname "suicide headache". Understanding how CH impacts on those who suffer from it is essential, because this understanding creates empathy, which is so valuable to these patients. On the occasion of Cluster Headache Day 2017, we asked CH patients from different European countries to share their experiences, in order to help people to imagine what it means to live with the condition. Here, we look at some extracts from their stories. These CH patients' direct accounts provide an important illustration of the clinical features and consequences of the disease, helping to contextualise it and its psychological and social consequences. Reports of CH patients' first-person accounts might help to underline the physicians' role and responsibility with regard to the psychological and social consequences of this disease.
Collapse
|
15
|
Wellbery C, Saunders PA, Kureshi S, Visconti A. Medical Students' Empathy for Vulnerable Groups: Results From a Survey and Reflective Writing Assignment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1709-1714. [PMID: 28953564 DOI: 10.1097/acm.0000000000001953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
PURPOSE As medical education curricula increasingly acknowledge the contributions of the social determinants of health to individual health, new methods of engaging students in the care of vulnerable groups are needed. Empathy is one way to connect students with patients, but little is known about how to nurture students' empathy on behalf of populations. This study examined the relationship between individual and social empathy as groundwork for cultivating students' empathy for vulnerable groups. METHOD In 2014-2015, first-year medical students completed the Social Empathy Index at the start and end of a two-semester population health course, and they completed a reflective writing assignment exploring the challenges of caring for vulnerable patients. Pre- and posttest mean survey scores were compared, and reflective writing assignments were analyzed for themes concerning social empathy. RESULTS Data from 130 students were analyzed. Scores for the contextual understanding of systemic barriers domain increased significantly. There was a trend toward increased cumulative social empathy scores that did not reach statistical significance. Students' essays revealed three themes relating to individual empathy as the foundation for social empathy; civic and moral obligations; and the role of institutional practices in caring for vulnerable groups. CONCLUSIONS This study extends understanding of empathy beyond care for the individual to include care for vulnerable groups. Thus, social empathy may function as a valuable concept in developing curricula to support students' commitment to care for the underserved. Educators first need to address the many barriers students cited that impede both individual and social empathy.
Collapse
Affiliation(s)
- Caroline Wellbery
- C. Wellbery is professor, Department of Family Medicine, Georgetown University Medical Center, Washington, DC. P.A. Saunders is associate professor, Department of Neurology, Georgetown University Medical Center, Washington, DC. S. Kureshi is assistant professor, Department of Family Medicine, Georgetown University Medical Center, Washington, DC. A. Visconti is assistant professor, Department of Family and Community Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | | | | | | |
Collapse
|
16
|
Buffel du Vaure C, Lemogne C, Bunge L, Catu-Pinault A, Hoertel N, Ghasarossian C, Vincens ME, Galam E, Jaury P. Promoting empathy among medical students: A two-site randomized controlled study. J Psychosom Res 2017; 103:102-107. [PMID: 29167035 DOI: 10.1016/j.jpsychores.2017.10.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the effects of Balint groups on empathy measured by the Consultation And Relational Empathy Measure (CARE) scale rated by standardized patients during objective structured clinical examination and self-rated Jefferson's School Empathy Scale - Medical Student (JSPE-MS©) among fourth-year medical students. METHODS A two-site randomized controlled trial were planned, from October 2015 to December 2015 at Paris Diderot and Paris Descartes University, France. Eligible students were fourth-year students who gave their consent to participate. Participants were allocated in equal proportion to the intervention group or to the control group. Participants in the intervention group received a training of 7 sessions of 1.5-hour Balint groups, over 3months. The main outcomes were CARE and the JSPE-MS© scores at follow-up. RESULTS Data from 299 out of 352 randomized participants were analyzed: 155 in the intervention group and 144 in the control group, with no differences in baseline measures. There was no significant difference in CARE score at follow-up between the two groups (P=0.49). The intervention group displayed significantly higher JSPE-MS© score at follow-up than the control group [Mean (SD): 111.9 (10.6) versus 107.7 (12.7), P=0.002]. The JSPE-MS© score increased from baseline to follow-up in the intervention group, whereas it decreased in the control group [1.5 (9.1) versus -1.8 (10.8), P=0.006]. CONCLUSIONS Balint groups may contribute to promote clinical empathy among medical students. TRIAL REGISTRATION NCT02681380.
Collapse
Affiliation(s)
- Céline Buffel du Vaure
- Université Paris Descartes, Sorbonne Paris Cité, Faculté 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 de Notre Dame, 75004 Paris, France.
| | - Cédric Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; AP-HP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, 20 Rue Leblanc, 75015 Paris, France; Inserm, U894, Centre Psychiatrie et Neurosciences, 2 ter, rue d'Alésia, 75014 Paris, France
| | - Lucie Bunge
- Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Département de Médecine Générale, 16 rue Henri Huchard, 75018 Paris, France
| | - Annie Catu-Pinault
- Université Paris Descartes, Sorbonne Paris Cité, Faculté 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
| | - Nicolas Hoertel
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; AP-HP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, 20 Rue Leblanc, 75015 Paris, France; Inserm, U894, Centre Psychiatrie et Neurosciences, 2 ter, rue d'Alésia, 75014 Paris, France
| | - Christian Ghasarossian
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Département de Médecine Générale, 24 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Marie-Eve Vincens
- Société Médicale Balint, 10 Route de Thionville, 57140 Woippy, France; Université Paris 13, Sorbonne Paris Cité, Département de Médecine Générale, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France
| | - Eric Galam
- Université Paris Diderot, Sorbonne Paris Cité, Faculté de Médecine, Département de Médecine Générale, 16 rue Henri Huchard, 75018 Paris, France
| | - Philippe Jaury
- Université Paris Descartes, Sorbonne Paris Cité, Faculté 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
| |
Collapse
|
17
|
Stein N, Brooks K. A Fully Automated Conversational Artificial Intelligence for Weight Loss: Longitudinal Observational Study Among Overweight and Obese Adults. JMIR Diabetes 2017; 2:e28. [PMID: 30291087 PMCID: PMC6238835 DOI: 10.2196/diabetes.8590] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/11/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background Type 2 diabetes is the most expensive chronic disease in the United States. Two-thirds of US adults have prediabetes or are overweight and at risk for type 2 diabetes. Intensive in-person behavioral counseling can help patients lose weight and make healthy behavior changes to improve their health outcomes. However, with the shortage of health care providers and associated costs, such programs do not adequately service all patients who could benefit. The health care system needs effective and cost-effective interventions that can lead to positive health outcomes as scale. This study investigated the ability of conversational artificial intelligence (AI), in the form of a standalone, fully automated text-based mobile coaching service, to promote weight loss and other health behaviors related to diabetes prevention. This study also measured user acceptability of AI coaches as alternatives to live health care professionals. Objective The objective of this study was to evaluate weight loss, changes in meal quality, and app acceptability among users of the Lark Weight Loss Health Coach AI (HCAI), with the overarching goal of increasing access to compassionate health care via mobile health. Lessons learned in this study can be applied when planning future clinical trials to evaluate HCAI and when designing AI to promote weight loss, healthy behavior change, and prevention and self-management of chronic diseases. Methods This was a longitudinal observational study among overweight and obese (body mass index ≥25) participants who used HCAI, which encourages weight loss and healthy diet choices through elements of cognitive behavioral therapy. Weight loss, meal quality, physical activity, and sleep data were collected through user input and, for sleep and physical activity, partly through automatic detection by the user’s mobile phone. User engagement was assessed by duration and amount of app use. A 4-question in-app user trust survey assessed app usability and acceptability. Results Data were analyzed for participants (N=70) who met engagement standards set forth by the Centers for Disease Control and Prevention criteria for Diabetes Prevention Program, a clinically proven weight loss program focused on preventing diabetes. Weight loss (standard error of the mean) was 2.38% (0.69%) of baseline weight. The average duration of app use was 15 (SD 1.0) weeks, and users averaged 103 sessions each. Predictors of weight loss included duration of AI use, number of counseling sessions, and number of meals logged. Percentage of healthy meals increased by 31%. The in-app user trust survey had a 100% response rate and positive results, with a satisfaction score of 87 out of 100 and net promoter score of 47. Conclusions This study showed that use of an AI health coach is associated with weight loss comparable to in-person lifestyle interventions. It can also encourage behavior changes and have high user acceptability. Research into AI and its application in telemedicine should be pursued, with clinical trials investigating effects on weight, health behaviors, and user engagement and acceptability.
Collapse
Affiliation(s)
- Natalie Stein
- Division of Public Health, College of Human Medicine, Michigan State University, Flint Campus, MI, United States
| | - Kevin Brooks
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| |
Collapse
|
18
|
Huang CD, Liao KC, Chung FT, Tseng HM, Fang JT, Lii SC, Kuo HP, Yeh SJ, Lee ST. Different perceptions of narrative medicine between Western and Chinese medicine students. BMC MEDICAL EDUCATION 2017; 17:85. [PMID: 28490362 PMCID: PMC5424351 DOI: 10.1186/s12909-017-0925-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 05/04/2017] [Indexed: 05/29/2023]
Abstract
BACKGROUND Western medicine is an evidence-based science, whereas Chinese medicine is more of a healing art. To date, there has been no research that has examined whether students of Western and Chinese medicine differentially engage in, or benefit from, educational activities for narrative medicine. This study fills a gap in current literature with the aim of evaluating and comparing Western and Chinese Medicine students' perceptions of narrative medicine as an approach to learning empathy and professionalism. METHODS An initial 10-item questionnaire with a 5-point Likert scale was developed to assess fifth-year Western medical (MS) and traditional Chinese medical (TCMS) students' perceptions of a 4-activity narrative medicine program during a 13-week internal medicine clerkship. Exploratory factor analysis was undertaken. RESULTS The response rate was 88.6% (412/465), including 270 (65.5%) MSs and 142 (34.5%) TCMSs, with a large reliability (Cronbach alpha = 0.934). Three factors were extracted from 9 items: personal attitude, self-development/reflection, and emotional benefit, more favorable in terms of enhancement of self-development/reflection. The perceptions of narrative medicine by scores between the two groups were significantly higher in TCMSs than MSs in all 9-item questionnaire and 3 extracted factors. CONCLUSIONS Given the different learning cultures of medical education in which these student groups engage, this suggests that undertaking a course in Chinese medicine might enhance one's acceptance to, and benefit from, a medical humanities course. Alternatively, Chinese medicine programmes might attract more humanities-focused students.
Collapse
Affiliation(s)
- Chien-Da Huang
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, 199 Tun Hua N. Rd, Taipei, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
- Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Kuo-Chen Liao
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, 199 Tun Hua N. Rd, Taipei, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
- General Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Fu-Tsai Chung
- Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Hsu-Min Tseng
- Chang Gung Medical Education Research Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, 199 Tun Hua N. Rd, Taipei, Taiwan
- Department of Health Care Management, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Ji-Tseng Fang
- Nephrology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Shu-Chung Lii
- Department of Medical Humanities and Social Sciences, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Han-Pin Kuo
- Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - San-Jou Yeh
- Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
- Cardiology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Shih-Tseng Lee
- Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| |
Collapse
|
19
|
Salmon P, Young B. A new paradigm for clinical communication: critical review of literature in cancer care. MEDICAL EDUCATION 2017; 51:258-268. [PMID: 27995660 PMCID: PMC5324633 DOI: 10.1111/medu.13204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/18/2016] [Accepted: 08/15/2016] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. METHODS A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve. RESULTS The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education. CONCLUSIONS Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.
Collapse
Affiliation(s)
- Peter Salmon
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
| | - Bridget Young
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
| |
Collapse
|
20
|
Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs. Br J Gen Pract 2016; 66:e887-e895. [PMID: 27884917 DOI: 10.3399/bjgp16x687565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/08/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Current daily general practice has become increasingly technical and somatically oriented (where attention to patients' feelings is decreased) due to an increase in protocol-based guidelines. Priorities in GP-patient communication have shifted from a focus on listening and empathy to task-oriented communication. AIM To explore what barriers GPs experience when applying empathy in daily practice, and how these barriers are managed. DESIGN AND SETTING Thirty Dutch GPs with sufficient heterogeneity in sex, age, type of practice, and rural or urban setting were interviewed. METHOD The consolidated criteria for reporting qualitative research (COREQ) were applied. The verbatim transcripts were then analysed. RESULTS According to participating GPs, the current emphasis on protocol-driven care can be a significant barrier to genuineness in communication. Other potential barriers mentioned were time pressures and constraints, and dealing with patients displaying 'unruly behaviour' or those with personality disorders. GPs indicated that it can be difficult to balance emotional involvement and professional distance. Longer consulting times, smaller practice populations, and efficient practice organisation were described as practical solutions. In order to focus on a patient-as-person approach, GPs strongly suggested that deviating from guidelines should be possible when necessary as an element of good-quality care. Joining intercollegiate counselling groups was also discussed. CONCLUSION In addition to practical solutions for barriers to behaving empathically, GPs indicated that they needed more freedom to balance working with protocols and guidelines, as well as a patient-as-person and patient-as-partner approach. This balance is necessary to remain connected with patients and to deliver care that is truly personal.
Collapse
|
21
|
Toto RL, Man L, Blatt B, Simmens SJ, Greenberg L. Do empathy, perspective-taking, sense of power and personality differ across undergraduate education and are they inter-related? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:23-31. [PMID: 24677070 DOI: 10.1007/s10459-014-9502-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/19/2014] [Indexed: 05/04/2023]
Abstract
Empathy is desirable in all health care professionals in their interactions with patients and each other. Empathy in its cognitive (perspective-taking) and affective forms has been well-studied in the literature and in fact, is shown in most studies to decline during undergraduate and graduate medical education. Empathy has also been shown to be inversely proportional to one's sense of power (SOP) in the business literature. In addition, the relationship of empathy to personality traits has not been examined. This cross-sectional study of four cohorts of undergraduate medical students at a private mid-Atlantic medical school compares the empathy of first, second, third and fourth year medical students to see if there is a decline across the medical school experience. It also examines the relationship among empathy, SOP and personality type across the 4 years of medical school. Unlike in many previous studies, we found no decline in student empathy. We found no significant relationship between SOP and empathy. Finally, there were no significant differences in power perception and personality measures across all educational years surveyed.
Collapse
Affiliation(s)
- Regina L Toto
- School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | | | | |
Collapse
|
22
|
Airagnes G, Consoli SM, De Morlhon O, Galliot AM, Lemogne C, Jaury P. Appropriate training based on Balint groups can improve the empathic abilities of medical students: a preliminary study. J Psychosom Res 2014; 76:426-9. [PMID: 24745786 DOI: 10.1016/j.jpsychores.2014.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/15/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although empathy is critical in a doctor-patient relationship, empathic abilities seem to decline throughout medical school. This study aimed at examining changes in empathic abilities of fourth-year medical students who participated in an optional certificate based on Balint groups. METHODS Thirty-four students were included in the "Balint group" certificate and compared with 129 participating in other certificates. Before the training sessions and 4 months later, they filled up the interpersonal reactivity index (IRI) and were asked to rate their emotional reactions in response to two case-reports: the first described a woman with diabetes, borderline- personality traits and a history of childhood trauma; the second, a woman with histrionic traits suffering from multiple sclerosis and hospitalized for functional symptoms. A principal component analysis extracted four factors from the 8 questions asked: empathic-approach (e.g. finding the patient touching), rejecting-attitude, intellectual-interest and fear of emotion contagion. RESULTS At baseline, there were no socio-demographic or psychological differences between groups. At follow-up, an increase of IRI fantasy-scale (p=0.02) and a decrease of IRI empathic-concern (p=0.006) were observed, regardless of the group. Empathic-approach only increased in the "Balint group" and for the first case-report (p=0.023), with a difference between the groups at follow-up (p=0.003). CONCLUSION Results suggest that Balint groups may enable medical students to better handle difficult clinical situations such as those presented by borderline personalities. Our findings encourage assessing training initiatives designed at helping young medical students to take into account the emotional component of a doctor-patient relationship.
Collapse
Affiliation(s)
- Guillaume Airagnes
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Paris, France
| | - Silla M Consoli
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Paris, France.
| | | | - Anne-Marie Galliot
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Paris, France
| | - Cédric Lemogne
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service universitaire de Psychiatrie de l'adulte et du sujet âgé, Paris, France; INSERM U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Philippe Jaury
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
23
|
Chen I, Forbes C. Reflective writing and its impact on empathy in medical education: systematic review. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2014; 11:20. [PMID: 25112448 PMCID: PMC4309942 DOI: 10.3352/jeehp.2014.11.20] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/15/2014] [Indexed: 05/06/2023]
Abstract
PURPOSE Medical schools are increasingly aware of the ways in which physician empathy can have a profound impact on patients' lives and have developed humanities initiatives to address this concern. Reflective writing in particular is more commonly promoted in medical curricula, but there is limited research on the impact of reflective writing on medical student empathy levels. It aims to find the emotional effects of reflective writing interventions on medical and healthcare students by systemic review. METHODS Two investigators independently reviewed educational publications for critical analysis. This review focused systematically on quantitative papers that measure the impact of reflective writing on empathy. RESULTS Of the 1,032 studies found on Medline and CINAHL, only 8 used quantitative measures pre- and postwritten reflection to measure any impact on empathy outcomes. The outcomes measured included impact of reflective writing exercises on student wellness, aptitude, and/or clinical skills. Of these studies, a significant change in student empathy was observed in 100% of the studies, demonstrating a significant change in outcomes. CONCLUSION Although the lack of homogeneity in outcome measurement in the literature limits possible conclusion from this review, the overwhelmingly positive reporting of outcomes suggests that reflective writing should be considered in any medical curriculum.
Collapse
Affiliation(s)
- Isabel Chen
- University of British Columbia Faculty of Medicine, Vancouver, Canada
- Yale University, New Haven, CT, USA
| | - Connor Forbes
- University of British Columbia Faculty of Medicine, Vancouver, Canada
- Corresponding
| |
Collapse
|
24
|
Garden R. Distance learning: empathy and culture in Junot Diaz's "Wildwood". THE JOURNAL OF MEDICAL HUMANITIES 2013; 34:439-450. [PMID: 23996054 DOI: 10.1007/s10912-013-9244-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This essay discusses critical approaches to culture, difference, and empathy in health care education through a reading of Junot Diaz's "Wildwood" chapter from the 2007 novel The Brief Wondrous Life of Oscar Wao. I begin with an analysis of the way that Diaz's narrative invites readers to imagine and explore the experiences of others with subtlety and complexity. My reading of "Wildwood" illuminates its double-edged injunction to try to imagine another's perspective while recognizing the limits to-or even the impossibility of-that exercise. I draw on post-colonial theory and feminist science studies to illuminate a text that is created and interpreted in a post-colonial context-the Dominican diaspora in the United States. The essay offers a model of historical and critical analysis that health care educators can use to frame the concept of empathy in the classroom and the clinic.
Collapse
Affiliation(s)
- Rebecca Garden
- Center for Bioethics and Humanities, Upstate Medical University, 618 Irving Avenue, Syracuse, NY, 13210, USA,
| |
Collapse
|
25
|
Braun UK, Gill AC, Teal CR, Morrison LJ. The utility of reflective writing after a palliative care experience: can we assess medical students' professionalism? J Palliat Med 2013; 16:1342-9. [PMID: 23937062 DOI: 10.1089/jpm.2012.0462] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Medical education leaders have called for a curriculum that proactively teaches knowledge, skills, and attitudes required for professional practice and have identified professionalism as a competency domain for medical students. Exposure to palliative care (PC), an often deeply moving clinical experience, is an optimal trigger for rich student reflection, and students' reflective writings can be explored for professional attitudes. OBJECTIVE Our aim was to evaluate the merit of using student reflective writing about a PC clinical experience to teach and assess professionalism. METHODS After a PC patient visit, students wrote a brief reflective essay. We explored qualitatively if/how evidence of students' professionalism was reflected in their writing. Five essays were randomly chosen to develop a preliminary thematic structure, which then guided analysis of 30 additional, randomly chosen essays. Analysts coded transcripts independently, then collaboratively, developed thematic categories, and selected illustrative quotes for each theme and subtheme. RESULTS Essays revealed content reflecting more rich information about students' progress toward achieving two professionalism competencies (demonstrating awareness of one's own perspectives and biases; demonstrating caring, compassion, empathy, and respect) than two others (displaying self-awareness of performance; recognizing and taking actions to correct deficiencies in one's own behavior, knowledge, and skill). CONCLUSIONS Professional attitudes were evident in all essays. The essays had limited use for formal summative assessment of professionalism competencies. However, given the increasing presence of PC clinical experiences at medical schools nationwide, we believe this assessment strategy for professionalism has merit and deserves further investigation.
Collapse
Affiliation(s)
- Ursula K Braun
- 1 HSRD Center of Excellence, Michael E. DeBakey VA Medical Center , Houston, Texas
| | | | | | | |
Collapse
|
26
|
Bazarko D, Cate RA, Azocar F, Kreitzer MJ. The Impact of an Innovative Mindfulness-Based Stress Reduction Program on the Health and Well-Being of Nurses Employed in a Corporate Setting. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2013; 28:107-133. [PMID: 23667348 PMCID: PMC3646311 DOI: 10.1080/15555240.2013.779518] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study implemented an innovative new model of delivering a Mindfulness-Based Stress Reduction (MBSR) program that replaces six of the eight traditional in-person sessions with group telephonic sessions (tMBSR) and measured the program's impact on the health and well-being of nurses employed within a large health care organization. As part of a nonrandomized pre–post intervention study, 36 nurses completed measures of health, stress, burnout, self-compassion, serenity, and empathy at three points in time. Between baseline (Time 1) and the end of the 8-week tMBSR intervention (Time 2), participants showed improvement in general health, t(37) = 2.8, p < .01, decreased stress, t(37) = 6.8, p < .001, decreased work burnout, t(37) = 4.0, p < .001, and improvement in several other areas. Improvements were sustained 4 months later (Time 3), and individuals who continued their MBSR practice after the program demonstrated better outcomes than those that did not. Findings suggest that the tMBSR program can be a low cost, feasible, and scalable intervention that shows positive impact on health and well-being, and could allow MBSR to be delivered to employees who are otherwise unable to access traditional, on-site programs.
Collapse
Affiliation(s)
- Dawn Bazarko
- Center for Nursing Advancement, UnitedHealth Group, Minnetonka, Minnesota, USA
| | | | | | | |
Collapse
|
27
|
Wear D, Zarconi J, Garden R, Jones T. Reflection in/and writing: pedagogy and practice in medical education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:603-9. [PMID: 22450174 DOI: 10.1097/acm.0b013e31824d22e9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
During the past decade, "reflection" and "reflective writing" have become familiar terms and practices in medical education. The authors of this article argue that the use of the terms requires more thoughtfulness and precision, particularly because medical educators ask students to do so much reflection and reflective writing. First, the authors discuss John Dewey's thoughts on the elements of reflection. Then the authors turn the discussion to composition studies in an effort to form a more robust conception of reflective writing. In particular, they examine what the discipline of composition studies refers to as the writing process. Next, they offer two approaches to teaching composition: the expressivist orientation and the critical/cultural studies orientation. The authors examine the vigorous debate over how to respond to reflective writing, and, finally, they offer a set of recommendations for incorporating reflection and reflective writing into the medical curriculum.
Collapse
Affiliation(s)
- Delese Wear
- Northeast Ohio Medical University, Rootstown, Ohio 44272, USA.
| | | | | | | |
Collapse
|
28
|
Passalacqua SA, Segrin C. The effect of resident physician stress, burnout, and empathy on patient-centered communication during the long-call shift. HEALTH COMMUNICATION 2012; 27:449-56. [PMID: 21970629 DOI: 10.1080/10410236.2011.606527] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
During the long-call shift medical residents experience a number of stressors that could compromise the quality of care they provide to their patients. The aim of this study was to investigate how perceived stress and burnout affect changes in empathy over the long-call shift and how those changes in empathy are associated with patient-centered communication practices. Residents (n=93) completed self-report measures of stress, burnout, and empathy at the start of their long-call shift and then completed measures of empathy and patient-centered communication at the end of the same shift. There was a significant decline in physician empathy from the beginning to the end of the long-call shift. Perceived stress was significantly associated with higher burnout, which was, in turn, significantly associated with declines in empathy from pre- to posttest. Declines in empathy predicted lower self-reported patient-centered communication during the latter half of the shift. This study suggests that residents who perceive high levels of stress are at risk for burnout and deterioration in empathy toward their patients, both of which may compromise the quality of their interactions with patients.
Collapse
Affiliation(s)
- Stacey A Passalacqua
- School of Communication Studies, James Madison University, MSC 2106, Harrisonburg, VA 22807, USA.
| | | |
Collapse
|
29
|
Garden R. Sympathy, disability, and the nurse: female power in Edith Wharton's The Fruit of the Tree. THE JOURNAL OF MEDICAL HUMANITIES 2010; 31:223-242. [PMID: 20383569 DOI: 10.1007/s10912-010-9115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The nursing profession's emphasis on empathy as essential to nursing care may undermine nurses' power as a collective and detract from perceptions of nurses' analytical skills and expertise. The practice of empathy may also obscure and even compound patients' suffering when it does not fully account for their subjectivity. This essay examines the relation of empathy to women's agency and explores the role empathy plays in obscuring rather than empowering the suffering other, particularly people who are disabled, through a close reading of Edith Wharton's 1907 novel, The Fruit of the Tree, and through discussions of empathy and sympathy from literary and disability studies.
Collapse
Affiliation(s)
- Rebecca Garden
- Center for Bioethics and Humanities, Upstate Medical University, Syracuse, NY 13210, USA.
| |
Collapse
|
30
|
CQ sources/bibliography. Camb Q Healthc Ethics 2010; 19:527-9. [PMID: 20803819 DOI: 10.1017/s0963180110000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|