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Yousefzadeh NK, Dehkordi MK, Vahedi M, Astaneh AN, Bateni FS. The effectiveness of Balint group work on the quality of work life, resilience, and nurse-patient communication skills among psychiatric nurses: a randomized controlled trial. Front Psychol 2024; 15:1212200. [PMID: 38328376 PMCID: PMC10847344 DOI: 10.3389/fpsyg.2024.1212200] [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] [Received: 04/25/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
Background Balint group training has gained popularity in medical practices as an intervention designed to enhance the quality of life, well-being, and communication skills of healthcare practitioners. Psychiatric nurses, in particular, encounter distinct challenges and stressors inherent in their profession, necessitating the development and implementation of effective interventions to assist them in coping with the difficulties they experience. In this vein, the current study aimed to investigate the effectiveness of Balint group training on quality of work life, resilience, and nurse-patient communication skills among psychiatric nurses. Methods Thirty psychiatric nurses from Razi Hospital in Tehran were recruited via the purposeful sampling method in 2022 and were randomly assigned to either the Balint group, consisting of eight weekly one-hour training sessions, or a control group. Participants completed the Walton Quality of Work Life Questionnaire, Connor-Davidson Resilience Scale, and Communication Skills Scale before and after the intervention. The data were analyzed using the Analysis of Covariance (ANCOVA). Results The study found no significant differences between the Balint group and the control group in terms of quality of work life, resilience, and nurse-patient communication skills. Conclusion Findings suggest that Balint group training was not an effective intervention for improving the well-being and communication skills of psychiatric nurses. However, the study highlights the need for further investigation into the potential factors that may explain the lack of significant gains and offers insights for future research in this area.
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Affiliation(s)
- Negar Kiani Yousefzadeh
- School of Behavioral Sciences and Mental Health, Razi Educational and Therapeutic Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mansoureh Kiani Dehkordi
- Fellowship of Psychotherapy, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Vahedi
- Department of Biostatistics and Epidemiology, Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Nazeri Astaneh
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Sadat Bateni
- School of Behavioral Sciences and Mental Health, Razi Educational and Therapeutic Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Antoun J, Khater B, Itani H, Naous J, Romani M. Effectiveness of a modified Balint group process on empathy and psychological skills employing Kirkpatrick's evaluation framework. PeerJ 2023; 11:e15279. [PMID: 37483957 PMCID: PMC10362841 DOI: 10.7717/peerj.15279] [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] [Received: 11/29/2022] [Accepted: 04/03/2023] [Indexed: 07/25/2023] Open
Abstract
Background To evaluate, using Kirkpatrick's evaluation model, a modified Balint group (BG) by adding 5-10 min at the end of the session, where the facilitators will debrief the residents about critical themes mentioned in the session. Methods A quasi-experimental study with a mixed-method design was conducted among family medicine residents over 1 year, using focus groups and validated tools filled by residents and their corresponding patients. The residents' empathy through self and patient evaluation, psychological skills, and satisfaction with the educational activity were measured. Results The focus group revealed that the residents were aware of the change and considered it a closure to the encounter, helping decrease some uncertainty. Most of the residents did not consider the change helpful. Using validated instruments, BG was ineffective at improving the residents' empathy and psychological skills. There was a statistically significant main effect of time on Psychological Medicine Inventory (PMI) scores, F (1,13) = 7.709, p = 0.016. Conclusion Debriefing at the end of BG by the facilitators about key themes may help give the residents closure, decrease the uncertainty, and make them more aware of their feelings. Nevertheless, Balint groups are still not very well accepted by the residents, and they prefer direct feedback and support groups.
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Affiliation(s)
- Jumana Antoun
- Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Beatrice Khater
- Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Hala Itani
- Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Jihane Naous
- Family Medicine, American University of Beirut, Beirut, Lebanon
- Community Health and Family Medicine, University of Florida, Florida, United States
| | - Maya Romani
- Family Medicine, American University of Beirut, Beirut, Lebanon
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Leung KCY, Peisah C. A Mixed-Methods Systematic Review of Group Reflective Practice in Medical Students. Healthcare (Basel) 2023; 11:1798. [PMID: 37372916 DOI: 10.3390/healthcare11121798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Used primarily as a pedagogical evaluation tool for didactic teaching and skill development, reflective practice (RP) for its own merits is poorly understood. This study aimed to systematically review the literature regarding the role of group RP in fostering empathy, wellbeing, and professionalism in medical students. METHODS Electronic searches of empirical studies published between 1 January 2010 and 22 March 2022 from Medline, Embase, and PsychINFO databases were conducted. Empirical studies of any design (qualitative or quantitative) which included RP (1) involving medical students; (2) with a focus on fostering empathy, or professionalism, or personal wellbeing; and (3) provided in a group setting were included. Duplicates, non-English articles, grey literature and articles using RP to examine pedagogy and specific technical skills were excluded. Both authors screened articles independently to derive a final list of included studies, with any discrepancies resolved by discussion, until consensus reached. Articles were rated for methodological quality using the Attree and Milton checklist for qualitative studies; the Oxford Centre for Evidence-Based Medicine criteria, and the Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative studies. RESULTS Of 314 articles identified, 18 were included: 9 qualitative; 4 quantitative and 5 mixed methodology. Settings included United States (6), United Kingdom (3), Australia (3), France (2), Taiwan (2), Germany (1), and Ireland (1). Themes were (i) professionalism: bridging theoretical paradigms and practice; (ii) halting empathy decline; (iii) wellbeing: shared experience. Additional themes regarding the "successful" delivery of RP groups in facilitating these outcomes also emerged. CONCLUSIONS This first systematic review of group RP in medical students shows that RP may bring theory to life in clinical dilemmas, while fostering collegiality and mitigating against isolation amongst students, despite the absence of studies directly examining wellbeing. These findings support the value of RP integration focusing on emotive and humanitarian processes into contemporary medical education for medical students. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022322496.
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Affiliation(s)
- Kelvin C Y Leung
- Research and Education Network, Westmead Hospital, Sydney, NSW 2145, Australia
| | - Carmelle Peisah
- Research and Education Network, Westmead Hospital, Sydney, NSW 2145, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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Wolf TG, Speyer VFS, Peter B. "How obsessive are dentists?"--A personality styles & disorder inventory based prospective, controlled study. J Dent 2022; 124:104217. [PMID: 35809646 DOI: 10.1016/j.jdent.2022.104217] [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: 02/14/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to examine the typical personality traits of dentists and to discuss critically their influence on the necessary characteristics for a good dentist-patient relationship. METHODS Two groups were invited via e-mail to participate the study in 2015-2020. One group consisted of German dentists (DENT N = 580). The other group was formed by German speaking psychotherapists from Germany, Austria and Switzerland (DACH N = 1.027). The Personality Styles and Disorder Inventory was used in its short form (PSDI-S) via online survey. The normalization sample (NORM N = 3.392) of the PSDI-S was used to compare the results with a normative sample. RESULTS Dentists differed in 10 out of 14 personality styles from the normalization sample (NORM), and in 13 out of 14 personality styles compared with the psychotherapists (DACH). Female dentists differed in 7 out of 14 personality styles to their male colleagues. CONCLUSIONS The most significant differences in personality styles were willful (PN), spontaneous (BL), reserved (SZ), ambitious (NA), optimistic (RH) and conscientious (ZW), which seem to be necessary for a good dentist-patient relationship and dental procedures. The expression of personality styles is most likely to influence the choice, delivery and cost as well as patient perception of treatment. CLINICAL SIGNIFICANCE Dentist's personality has an important impact on the interpersonal, which influences the dentist-patient relationship and its therapeutic outcome.
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Affiliation(s)
- Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland; Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | - Valerie Fabienne Sonja Speyer
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Burkhard Peter
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland; MEG-Stiftung München, Munich, Germany
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Ward M, Cook S. When Communication Breaks Down: Handling Hostile Patients. Med Clin North Am 2022; 106:689-703. [PMID: 35725234 DOI: 10.1016/j.mcna.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Difficult patient encounters are common in clinical practice, with many arising from patient hostility owing to a breakdown in communication and the health care alliance. Patient anger may be a manifestation of fear, grief, or discontent with prior experiences in the health care system, but there may also be contributions from specific patient, physician, or situational factors. Physicians may intervene with specific actions based on these individual factors, while focusing on self-reflection to better understand their part in creating a hostile physician-patient dyad.
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Affiliation(s)
- Martha Ward
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322; Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322.
| | - Sarah Cook
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322
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Crawford DR. Compassion and Empathy in Basic Medical Science Teaching: A Suggested Model. Cureus 2021; 13:e20205. [PMID: 35004025 PMCID: PMC8729821 DOI: 10.7759/cureus.20205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 12/30/2022] Open
Abstract
Medical school education typically consists of two main student bodies: medical students and biomedical graduate students. For both groups, compassion and empathy represent a major component of future professional roles. For medical students, this takes the form of the all-important doctor-patient relationship and adherence to the Hippocratic Oath. For biomedical students, future research and teaching are often driven by the opportunity to contribute to treatments to help pain and suffering for those in need. For both groups, such positive contributions further extend to families, who often suffer emotional distress watching the health struggles of a loved one. Given the key role that compassion and empathy play here, including them as part of student educational development is important. Such focus, however, is limited - especially during the initial academic classroom years - with most time here dedicated to the learning of facts and foundational material. Given its importance in the future professional roles of these students, we posit that more can be done to introduce and reinforce the concept of compassion and empathy during the initial didactic course years. Modest but viable options exist for the introduction of these concepts as a part of basic teaching that will provide additional reinforcement of this all-important sensitivity for others. Here we present a model providing suggestions and recommendations for the integration of compassion and empathy in otherwise basic scientific teaching, and in a way that also includes progressive equality positions on social issues. While the focus here is medical school education since it represents this author’s expertise as well as a field where young trainees graduate to professional careers requiring compassion, it can potentially be applied to many other disciplines.
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Couillet A, Malatier M, Le Bris MP, Mastroianni B, Chvetzoff G. Issues of mindfulness implementation for oncology caregivers. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 19:791-797. [PMID: 34800928 DOI: 10.1515/jcim-2021-0372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Burn out is high in oncology. We aim to evaluate the feasibility and identify the barriers for mindfulness implementation in oncology professionals. METHODS We conducted a pilot study in which voluntary oncology caregivers entered mindfulness workshops, and complete online questionnaires. We also conducted a qualitative study to better identify the practical reasons which hamper the implementation of mindfulness in oncology caregivers having refused to participate. RESULTS 83.3% of volunteers for the workshops were women, 60.00% (16/30) of caregivers completed the program. Caregivers' resistances to mindfulness practice were: a lack of availability and information, complex organisation with limited free time, and accept spending time to take care of themselves. CONCLUSIONS This work highlights the interest of mindfulness for caregivers in oncology, we have identified specific issues hindering the implementation of such technique which can be further investigated.
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Affiliation(s)
- Audrey Couillet
- Department of Supportive Care, Léon Berard Centre, Lyon, France
| | | | | | | | - Gisèle Chvetzoff
- Department of Supportive Care, Léon Berard Centre, Lyon, France
- Claude Bernard University Lyon 1, Reshape Laboratory U1290, Lyon, France
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Sølvhøj IN, Kusier AO, Pedersen PV, Nielsen MBD. Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review. BMC Psychiatry 2021; 21:443. [PMID: 34493245 PMCID: PMC8424966 DOI: 10.1186/s12888-021-03415-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals' stigmatization toward patients with mental disorders. METHODS We conducted a scoping review using Arksey and O'Malley's framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008-2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo. RESULTS A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions. CONCLUSIONS The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.
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Affiliation(s)
- Ida Nielsen Sølvhøj
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark.
| | - Amalie Oxholm Kusier
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Pia Vivian Pedersen
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Maj Britt Dahl Nielsen
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
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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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Airagnes G, du Vaure CB, Galam E, Bunge L, Hoertel N, Limosin F, Jaury P, Lemogne C. Personality traits are associated with cognitive empathy in medical students but not with its evolution and interventions to improve it. J Psychosom Res 2021; 144:110410. [PMID: 33676151 DOI: 10.1016/j.jpsychores.2021.110410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Cognitive empathy might decrease during medical school. Factors associated with its evolution remain poorly understood, as well as whether such factors could moderate the effect of an intervention to preserve cognitive empathy. The aim was to explore the associations between personality traits and both cognitive empathy at baseline and its changes at follow-up. The possible effect of an intervention depended upon personality traits was also examined. METHODS The cohort consisted of fourth year medical students and the associations between personality traits, using the Short Big Five Inventory, and cognitive empathy changes at 3-month, using the Jefferson Scale of Empathy-Student version (JSE-S), were examined. A randomization in two groups (Balint groups versus no intervention) allowed examining whether the effect of the intervention depended upon personality traits. Linear regressions were adjusted for gender, anticipated specialty choice, parental education, living status, financial insecurity, randomization group and baseline JSE-S. RESULTS The cohort included 311 participants from October 2015 to December 2016 at Paris Diderot and Paris Descartes University. At follow-up, there was a JSE-S total score increase of 1.22(SD:9.10) in the intervention group, compared to a decrease of 1.64(SD:10.74) in the other group. Baseline JSE-S was positively associated with Extraversion and Conscientiousness and negatively with Neuroticism. In contrast, we found no associations between baseline personality traits and JSE-S change. There were no interactions between personality traits and randomization group. CONCLUSION Although personality might be linked with cognitive empathy, medical students may benefit from strategies designed for improving cognitive empathy regardless of their personality.
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Affiliation(s)
- Guillaume Airagnes
- AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Paris, France; Inserm, UMS011, Population-based Epidemiological Cohorts, Villejuif, France.
| | - Céline Buffel du Vaure
- Université de Paris, Faculté de Médecine Paris Descartes, Département de Médecine Générale, Paris, France; Inserm, Epidemiology and Statistics Sorbonne Paris Cité, UMR 1153, METHODS Team, Paris, France
| | - Eric Galam
- Université de Paris, Faculté de Médecine Paris Diderot, Département de Médecine Générale, Paris, France
| | - Lucie Bunge
- Université de Paris, Faculté de Médecine Paris Diderot, Département de Médecine Générale, Paris, France
| | - Nicolas Hoertel
- AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Paris, France; Inserm, U1266, UMR-S 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Frédéric Limosin
- AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Paris, France; Inserm, U1266, UMR-S 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Philippe Jaury
- Université de Paris, Faculté de Médecine Paris Descartes, Département de Médecine Générale, Paris, France; Société Médicale Balint, Woippy, France
| | - Cédric Lemogne
- AP-HP.Centre-Université de Paris, DMU Psychiatrie et Addictologie, Paris, France; Inserm, U1266, UMR-S 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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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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Emotion Regulation Strategies, Workload Conditions, and Burnout in Healthcare Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217816. [PMID: 33114522 PMCID: PMC7663662 DOI: 10.3390/ijerph17217816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022]
Abstract
Background: Burnout syndrome is very prevalent among healthcare residents. Initiatives addressing workload conditions have had limited impact on burnout. The present study aims to explore the contribution of two emotion regulation strategies, namely emotion suppression and cognitive reevaluation, to residents’ burnout, while accounting for workload factors. Methods: Participants were 105 residents (68.6% women; mean age = 27.5, SD = 3.0). They completed measures of workload, burnout, and emotion regulation. The study was cross-sectional. Results: Emotional suppression was associated with higher burnout (depersonalization scale; β = 0.20, p < 0.05, CI 0.15–2.48) and cognitive revaluation was linked to lower burnout (higher personal accomplishment; β = 0.35, p < 0.01, CI 0.16–2.56), even after controlling for demographic and workload factors. We found interaction effects between workload variables (supervisor support and number of patient hours) and emotion regulation (p < 0.05). Conclusions: The relationship between workload, emotion regulation, and burnout seems to be complex. That is, similar work conditions might generate different levels of burnout depending on the resident’s emotional regulation strategies. This might partly explain why existing initiatives based on workload changes have had a modest impact on burnout. Results also support including emotion regulation training in prevention and treatment programs targeting burnout during residency.
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13
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Gajree N. Can Balint groups fill a gap in medical curricula? CLINICAL TEACHER 2020; 18:158-162. [PMID: 33073928 DOI: 10.1111/tct.13298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/02/2020] [Accepted: 09/21/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Emotions play a fundamental role in the professional development of doctors. Teaching medical students about the role of emotions in illness and relationships with patients can be challenging. Balint groups involve a case presentation and discussion focussed on the emotional component of patient interactions. This study aimed to assess whether a Balint group helped medical students to gain a better understanding of the role of emotions in the doctor-patient relationship, and whether students believed that the group provided a valuable educational opportunity. METHODS Voluntary 5-week Balint groups were offered to third, fourth and fifth year medical students on clinical placement at University Hospital Hairmyres. The traditional Balint group format was adhered to. Participating students were asked to complete an anonymous questionnaire following the final group session. RESULTS Sixteen medical students participated in the Balint groups, and they all completed the questionnaire. The majority of students agreed that the groups helped them to think about the place of emotions in patient encounters, and provided a useful space to think about the doctor-patient relationship. Most students agreed that participating in a Balint group was an important part of their training as a doctor. Students overwhelmingly indicated that Balint groups provide an aspect of training that is not currently addressed elsewhere in the medical student curriculum. CONCLUSION Balint groups provide an effective means of educating students about the role of emotions in the doctor-patient relationship. They are largely valued by students as providing a relevant component of their medical education.
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Affiliation(s)
- Neera Gajree
- Department of Medical Education, NHS Lanarkshire, Scotland, UK
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14
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Kotecha A, Kaliaperumal C. Letter: Balint Groups: An Overlooked Tool in Neurosurgical Training? Neurosurgery 2020; 87:E606-E607. [PMID: 32745184 DOI: 10.1093/neuros/nyaa343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
- Akash Kotecha
- Department of Clinical Neurosciences Western General Hospital Edinburgh, United Kingdom
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15
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Crehan E, Scott A. Balint groups as a proposed support mechanism to reduce uncertainty in medical students. MEDICAL EDUCATION 2020; 54:582. [PMID: 31901176 DOI: 10.1111/medu.14052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Emily Crehan
- Medical School, St George's University of London, London, UK
| | - Aneya Scott
- Medical School, St George's University of London, London, UK
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Richards H, Polnay A, Wilkinson P, Read E, Young H. Balint-style reflective practice groups in a year 4 undergraduate general practice attachment: experience of the first two years. Scott Med J 2020; 65:52-59. [PMID: 32326825 PMCID: PMC7575308 DOI: 10.1177/0036933020918056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Many undergraduate medical curricula include reflective practice sessions based on traditional Balint-groups. Those sessions can help students to acknowledge that experiencing 'negative' feelings in relation to patients is normal and may contain important information about the clinical encounter. They may also help to protect students from some of the emotional challenges of studying medicine. The Edinburgh University scheme provides all students in their first clinical year with two dedicated reflective practice sessions. Here we report on experience of the first two years. METHODS Students' attitudes to the sessions were ascertained using a questionnaire, and views of the group leaders were assessed using a questionnaire and through informal verbal and email discussions. Practical difficulties were recorded as they arose. RESULTS Students generally rated the sessions positively with regard to exploring relationships and self-reflection, and they found the sessions interesting and helpful. The sessions did not seem to affect career choice. The free-text comments suggested four positive themes and four areas for future modification. CONCLUSION We have succeeded in providing all undergraduate students with an opportunity to take part in a reflective practice. We have highlighted aspects which have been successful and suggested future improvements.
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Affiliation(s)
- Helen Richards
- Clinical Senior Lecturer, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | - Adam Polnay
- Consultant Psychiatrist in Psychotherapy, NHS State Hospitals Board for Scotland, UK
| | - Peter Wilkinson
- Consultant Psychiatrist in Psychotherapy, South Lanarkshire Psychotherapy Service, UK
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17
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Seeberger A, Lönn A, Hult H, Weurlander M, Wernerson A. Can empathy be preserved in medical education? INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:83-89. [PMID: 32311676 PMCID: PMC7246122 DOI: 10.5116/ijme.5e83.31cf] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/31/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVES The aim of this study was to investigate changes in empathy during medical education, as well as to identify promoters and inhibitors of empathy and analyse their roles. METHODS We used qualitative content analysis to examine 69 critically reflective essays written by medical students as a part of their final examination at the end of the medical program. The essays were based on previous self-evaluations performed each term and represented retrospective reflections on their professional development. RESULTS A majority of the students felt that their empathy did not decrease during medical education. On the contrary, many felt that their empathy had increased, especially the cognitive part of empathy, without loss of affective empathy. Many of them described a professionalisation process resulting in an ability to meet patients with preserved empathy but without being overwhelmed by emotions. They identified several factors that promoted the development of empathy: a multiplicity of patients, positive role models, and educational activities focusing on reflection and self-awareness. They also identified inhibitors of empathy: lack of professional competence and a stressful and empathy-hostile medical culture. CONCLUSIONS Our analysis of these retrospective reflections by students suggests that empathy can be preserved during medical education, despite the presence of important inhibitors of empathy. This finding might be due to the presence of more potent promoters and/or to the fact that educational activities might result in a decreased susceptibility to empathy-decreasing circumstances.
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Affiliation(s)
- Astrid Seeberger
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Insti-tutet, Stockholm, Sweden
| | - Annalena Lönn
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Insti-tutet, Stockholm, Sweden
| | - Håkan Hult
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Insti-tutet, Stockholm, Sweden
| | - Maria Weurlander
- Department of Learning, School of Education and Communication in Engineering Science (ECE), KTH Royal Institute of Technology, Stockholm, Sweden
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Insti-tutet, Stockholm, Sweden
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18
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Khatri R, Knight J, Wilkinson I. Threshold concepts: A portal into new ways of thinking and practising in psychiatry. MEDICAL TEACHER 2020; 42:178-186. [PMID: 31599178 DOI: 10.1080/0142159x.2019.1670338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction: The theory of threshold concepts conjectures that there are areas in every educational curriculum that are challenging; however, mastering these areas transform the learner's view of the subject. In psychiatry, research into threshold concepts can inform educators so that they can better support students with mastering these challenging areas.Purpose: To identify threshold concepts, we conducted semi-structured interviews with six psychiatry educators and free-text surveys with medical students. To identify avenues for improving the curriculum, we discussed with educators, ways of improving understanding and looked at different approaches to learning.Materials and methods: From our analysis of all responses, we derived three threshold concepts: Therapeutic Risk-Taking, the Biopsychosocial Model, and the Concept of Diagnosis in psychiatry. The majority of students experienced difficulties grasping these concepts and applying them in their patient interactions.Results and conclusions: Hence, we propose focused teaching activities that can help students cross these thresholds: student Balint groups exploring therapeutic risk, student Balint groups exploring the role of a psychiatrist, exposure to psychological therapies/psychotherapy skills and explicit diagnostic reasoning. These activities can be integrated into the undergraduate curriculum to help medical students develop a better understanding and appreciation of psychiatry.
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Affiliation(s)
- Roshni Khatri
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Jackie Knight
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Iain Wilkinson
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
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19
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Calcides DAP, Didou RDN, Melo EVD, Oliva-Costa EFD. Burnout Syndrome in medical internship students and its prevention with Balint Group. ACTA ACUST UNITED AC 2019; 65:1362-1367. [PMID: 31800898 DOI: 10.1590/1806-9282.65.11.1362] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND We intend to estimate the Burnout Syndrome prevalence and its associated factors among medical internship students at a public university in northeastern Brasil, besides investigating the Balint Group (BG) contribution in its prevention. METHODS We conducted a cross-sectional study in February/2018 with Medical Internship Students at the University researched. We applied a structured questionnaire developed by the authors about socio-demographic data, educational process with BG participation, and current psycho-emotional experiences, in addition to the Maslach Burnout Inventory - Student Survey (MBI-SS), for Burnout Syndrome screening. We performed descriptive data analysis, logistic regression, and cluster analysis. RESULTS A total of 184 students (98%) participated in the study, with a mean age of 25.9±3.9 years, of which 54.9% were men. The prevalence of Burnout Syndrome was 10.3% based on the three-dimensional criterion and 35.9% on two-dimensional criterion (Exhaustion and Cynicism); it was higher in those who thought about quitting the program (OR=2.14), were dissatisfied with the teaching strategies (OR=2.67) and their performance (OR=2.64) and made use of licit drugs (OR=2.37). The variables associated with Burnout Syndrome allowed individuals to be discriminated, classifying them into three subgroups. Burnout Syndrome prevalence decreased, and vulnerability factors were attenuated when there was a higher frequency of students participating in BG. CONCLUSIONS The prevalence of two-dimensional Burnout Syndrome was high, with factors associated with the educational process. Participation in BG was associated with a lower Burnout rate prevalence. Longitudinal studies should be conducted.
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Affiliation(s)
| | | | | | - Edméa Fontes de Oliva-Costa
- Professora Doutora Associada II Coord. de Psiquiatria do DME/UFS, Aracaju, SE, Brasil.,Líder do Grupo de Estudos em Psiquiatria, Saúde Mental e Educação para as Profissões da Saúde (GEPS/CNPQ); Coord. do Projeto PIBIC/UFS; Aracaju, SE, Brasil.,Fellow of Foundation for Advancement of International Medical Education and Research (FAIMER- BR); Fortaleza, CE, Brasil
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20
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Hicks M, Hanes D. Naturopathic medical student empathy and burnout: A preliminary study. ADVANCES IN INTEGRATIVE MEDICINE 2019. [DOI: 10.1016/j.aimed.2018.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Curricula for empathy and compassion training in medical education: A systematic review. PLoS One 2019; 14:e0221412. [PMID: 31437225 PMCID: PMC6705835 DOI: 10.1371/journal.pone.0221412] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022] Open
Abstract
Background Empathy and compassion are vital components of health care quality; however, physicians frequently miss opportunities for empathy and compassion in patient care. Despite evidence that empathy and compassion training can be effective, the specific behaviors that should be taught remain unclear. We synthesized the biomedical literature on empathy and compassion training in medical education to find the specific curricula components (skills and behaviors) demonstrated to be effective. Methods We searched CENTRAL, MEDLINE, EMBASE, and CINAHL using a previously published comprehensive search strategy. We screened reference lists of the articles meeting inclusion criteria to identify additional studies for potential inclusion. Study inclusion criteria were: (1) intervention arm in which subjects underwent an educational curriculum aimed at enhancing empathy and/or compassion; (2) clearly defined control arm in which subjects did not receive the curriculum; (3) curriculum was tested on physicians (or physicians-in-training); and (4) outcome measure assessing the effect of the curriculum on physician empathy and/or compassion. We performed a qualitative analysis to collate and tabulate effects of tested curricula according to recommended methodology from the Cochrane Handbook. We used the Cochrane Collaboration’s tool for assessing risk of bias. Results Fifty-two studies (total n = 5,316) met inclusion criteria. Most (75%) studies found that the tested curricula improved physician empathy and/or compassion on at least one outcome measure. We identified the following key behaviors to be effective: (1) sitting (versus standing) during the interview; (2) detecting patients’ non-verbal cues of emotion; (3) recognizing and responding to opportunities for compassion; (4) non-verbal communication of caring (e.g. eye contact); and (5) verbal statements of acknowledgement, validation, and support. These behaviors were found to improve patient perception of physician empathy and/or compassion. Conclusion Evidence suggests that training can enhance physician empathy and compassion. Training curricula should incorporate the specific behaviors identified in this report.
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Establishing and evaluating a Balint group for fourth-year medical students at an Irish University. Ir J Psychol Med 2019; 37:99-105. [PMID: 31426876 DOI: 10.1017/ipm.2019.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The study was designed to establish and evaluate the impact of a 6-week Balint group on empathy and resilience in fourth-year medical students during their psychiatry rotation. METHODOLOGY This prospective study used the Jefferson Scale of Empathy - Student Version and the Brief Resilience Scale before and after 6-week Balint groups. Participating students also completed a qualitative assessment of their experience. RESULTS Students who participated were enthusiastic regarding the value of Balint groups in promoting self-reflection and gaining insight into self- and patient-care dynamics. There was a significant difference in empathy scores pre- and post-Balint intervention. There was no significant difference in resilience scores. CONCLUSION The establishment of a 6-week Balint group for fourth-year medical students was successful in increasing empathy. Students reported a positive view of Balint and its beneficial role in this study group.
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23
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Gutierrez AM, Statham EE, Robinson JO, Slashinski MJ, Scollon S, Bergstrom KL, Street RL, Parsons DW, Plon SE, McGuire AL. Agents of empathy: How medical interpreters bridge sociocultural gaps in genomic sequencing disclosures with Spanish-speaking families. PATIENT EDUCATION AND COUNSELING 2019; 102:895-901. [PMID: 30581014 PMCID: PMC7197396 DOI: 10.1016/j.pec.2018.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/26/2018] [Accepted: 12/08/2018] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To describe how linguistic tools used by interpreters during return of genomic sequencing results may have impacted communication with Spanish-speaking families, and to discuss the implications for the role of medical interpreters. METHODS Using discourse analysis, we identified and categorized the various ways hospital-based interpreters adapted clinicians' language in 37 audio-recorded sessions in which Spanish-speaking parents participating in a clinical trial received their child's genomic sequencing results from English-speaking clinicians. RESULTS We found that interpreters adapted clinicians' statements using five empathic linguistic tools: contextualization, encouragement, checking comprehension, endearment, and softening. Interpreters used an average of four linguistic tools per session, with contextualization and encouragement being the most frequently used. CONCLUSIONS Interpreters used empathic linguistic tools to alter clinicians' statements when communicating genomic information to Spanish-speaking families. Our findings demonstrate the critical role of interpreters as cultural mediators and facilitators of understanding for Spanish-speaking families. PRACTICE IMPLICATIONS This study expands upon the definition of clinical empathy in interpreter-mediated sessions. Our findings suggest that revisions of standards of medical interpretation practice may be warranted regarding interpreters' ability to adapt clinicians' language in a culturally sensitive manner during interpretation.
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Affiliation(s)
- Amanda M Gutierrez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, USA.
| | - Emily E Statham
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, USA.
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, USA.
| | - Melody J Slashinski
- School of Public Health & Health Sciences, University of Massachusetts at Amherst, Amherst, USA.
| | - Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Houston, USA; Texas Children's Cancer Center, Texas Children's Hospital, Houston, USA.
| | - Katie L Bergstrom
- Department of Pediatrics, Baylor College of Medicine, Houston, USA; Texas Children's Cancer Center, Texas Children's Hospital, Houston, USA.
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, USA; Department of Medicine, Baylor College of Medicine, Houston, USA; Center for Innovation in Healthcare Quality, Effectiveness, & Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, USA.
| | - D Williams Parsons
- Department of Pediatrics, Baylor College of Medicine, Houston, USA; Texas Children's Cancer Center, Texas Children's Hospital, Houston, USA.
| | - Sharon E Plon
- Department of Pediatrics, Baylor College of Medicine, Houston, USA; Texas Children's Cancer Center, Texas Children's Hospital, Houston, USA.
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, USA.
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Huang L, Harsh J, Cui H, Wu J, Thai J, Zhang X, Cheng L, Wu W. A Randomized Controlled Trial of Balint Groups to Prevent Burnout Among Residents in China. Front Psychiatry 2019; 10:957. [PMID: 32116808 PMCID: PMC7026367 DOI: 10.3389/fpsyt.2019.00957] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/04/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Burnout is highly prevalent among residents and is associated with negative outcomes for patients, organizations, and physicians. Balint groups have been shown to be an effective strategy to alleviate physicians' burnout. The purpose of this study was to examine the effectiveness and feasibility of Balint groups in preventing burnout among residents in training programs in China. METHODS 36 resident physicians in their first year of residency at a comprehensive hospital in China were randomly assigned to two groups. Physicians in the intervention group participated in 2 lectures and 10 Balint sessions for 6 months, while participants in the control group were placed on a waitlist for future Balint sessions. All 36 participants completed burnout and job satisfaction measures pre and post-intervention. RESULTS The mean burnout subscale scores for EE and DP decreased, and the scores for PA and job satisfaction increased after Balint group participation. However, paired t-test results revealed there were no statistically significant differences between pre and post-test scores for EE (t = -1.323, p = 0.203), DP (t = -0.727, p = 0.477), PA (t = 0.716, p = 0.484, and job satisfaction (t = 0.282, p = 0.781) for the intervention group. For the control group, the burnout subscale scores for EE (t = 2.312, p = 0.034) and DP (t = 2.898, p = 0.019) increased, and there were statistically significant differences between pre and post-test. PA (t = -0.717, p = 0.483) and job satisfaction (t = -0.241, p = 0.812) scores decreased although there were no significant differences seen between the pre and post-test. Independent t-test results demonstrated statistically significant differences in scores for EE (t = -2.662, p = 0.013) and DP (t = -2.433, p = 0.020) between intervention and control group. However, there were not statistically significant differences between groups for scores in PA (t = 1.013, p = 0.318) and job satisfaction (t = 0.367, p = 0.716). All 18 participants in the intervention group reported that Balint groups were helpful and that they would be willing to attend future sessions. Overall satisfaction with the Balint group program was over 80%. CONCLUSION Balint groups are an efficacious, feasible, standardized method of preventing resident burnout. Residents in China may benefit from Balint group implementation in residency training programs.
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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
| | - Jennifer Harsh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Haisong Cui
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiaxin Wu
- Tongji University School of Medicine, Shanghai, China
| | - Jessica Thai
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Xu Zhang
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liming Cheng
- Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenyuan Wu
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Maben J, Taylor C, Dawson J, Leamy M, McCarthy I, Reynolds E, Ross S, Shuldham C, Bennett L, Foot C. A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06370] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSchwartz Center Rounds®(Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care.ObjectivesHow, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care.Design(1) A scoping review of Rounds literature and comparison with alternative interventions; (2) mapping Rounds providers via a survey, telephone interviews and secondary data; (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being; and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation).Setting(1) International literature (English); (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data); (3) 10 survey sites; and (4 and 5) nine organisational case study sites (six of which also took part in the survey).Participants(1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) individuals at baseline and from 500 out of 1140 (44%) individuals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings.Results(1) The evidence base is limited; compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015; Rounds were implemented variably; challenges included ward staff attendance and the workload and resources required to sustain Rounds; and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly (p < 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive; four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability; (vii) provide important context for staff and patient behaviour; (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork; and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work.LimitationsRounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds.ConclusionRounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues.Future workThe adaptation of Rounds to new contexts and to increase reach needs evaluation.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jill Maben
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Cath Taylor
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Jeremy Dawson
- Institute of Work Psychology, Management School, University of Sheffield, Sheffield, UK
| | - Mary Leamy
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Imelda McCarthy
- Institute of Work Psychology, Management School, University of Sheffield, Sheffield, UK
| | - Ellie Reynolds
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | | | - Caroline Shuldham
- Faculty of Society and Health, Buckinghamshire New University, High Wycombe, UK
- Independent consultant
| | - Laura Bennett
- Policy, The King’s Fund, London, UK
- Care Quality Commission, Bristol, UK
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Jaury P, Buffel du Vaure C, Bunge L, Galam E, Vincens ME, Catu-Pinault A, Ghasarossian C, Lemogne C. Groupes Balint de Formation à la Relation Thérapeutique chez les étudiants en 4e année de médecine. Effets sur l’empathie clinique par un essai randomisé multicentrique contrôlé. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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The impact of educational interventions on the empathic concern of health professional students: A literature review. Nurse Educ Pract 2018; 31:104-111. [DOI: 10.1016/j.nepr.2018.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/08/2018] [Accepted: 05/22/2018] [Indexed: 12/30/2022]
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Ludwig B, Turk B, Seitz T, Klaus I, Löffler-Stastka H. The search for attitude-a hidden curriculum assessment from a central European perspective. Wien Klin Wochenschr 2018; 130:134-140. [PMID: 29356896 PMCID: PMC5816099 DOI: 10.1007/s00508-018-1312-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the development of the hidden curriculum in the medical education system. It refers to a conglomeration of implicit beliefs, attitudes and forms of conduct that are unwittingly transmitted from one generation of teaching physicians to the next. How can we describe this process, what are the potential positive or negative impacts, and last but not least, how can we measure it? METHODS Students of the Medical University of Vienna complete their clinical rotations in Vienna and in other accredited, mostly central European hospitals. They were subsequently invited to evaluate their rotations in an online questionnaire regarding dimensions, such as professionalism, teaching, integration and appreciation. RESULTS In total, 133 students participated in this pilot study and the average response rate was 10.1%, similar to evaluations conducted prior to that. Although the evaluation results on average were positive, several experiences of deprecation and less professional conduct were present in each evaluated rotation. Giving the students the opportunity to reflect upon their experiences could be seen as an intervention and investigation at the same time. CONCLUSIONS This survey serves as a precursor to a qualitative interview-based study, accompanying the implementation of case-based learning designed by collaborating residents and medical students. The findings of this pilot-study support the necessity of fostering a reflective capacity in the education of medical students, enabling them to speak up and live up to the expected professionalism despite shortcomings within the hidden curriculum.
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Affiliation(s)
- Birgit Ludwig
- Dept. for Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bela Turk
- Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, USA
| | | | | | - Henriette Löffler-Stastka
- Dept. for Psychoanalysis and Psychotherapy, and Teaching Center, Postgraduate Unit, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Monk A, Hind D, Crimlisk H. Balint groups in undergraduate medical education: a systematic review. PSYCHOANALYTIC PSYCHOTHERAPY 2017. [DOI: 10.1080/02668734.2017.1405361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alice Monk
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
- The Medical School, The University of Sheffield, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
- Clinical Trials Research Unit, ScHARR, The University of Sheffield, Sheffield, UK
| | - Helen Crimlisk
- The Medical School, The University of Sheffield, Sheffield, UK
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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.
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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
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Petitta L, Jiang L, Härtel CEJ. Emotional contagion and burnout among nurses and doctors: Do joy and anger from different sources of stakeholders matter? Stress Health 2017; 33:358-369. [PMID: 27723240 DOI: 10.1002/smi.2724] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/22/2016] [Accepted: 08/31/2016] [Indexed: 11/10/2022]
Abstract
The present study adds novel knowledge to the literature on emotional contagion (EC), discrete emotions, job burnout, and the management of healthcare professionals by simultaneously considering EC as both a job demand and a job resource with multiple social pathways. Integrating EC into the job demands-resource model, we develop and test a conceptual model wherein multiple stakeholder sources of emotional exchanges (i.e., leaders, colleagues, patients) play a differential role in predicting caregivers' absorption of positive (i.e., joy) and negative (i.e., anger) emotions, and in turn, burnout. We tested this nomological network using structural equation modeling and invariance analyses on a sample of 252 nurses and 102 doctors from diverse healthcare wards in three Italian hospitals. Our findings show that not all emotional exchange sources contribute to the EC experience or likelihood of burnout. Specifically, we found that doctors absorbed joy and anger from their colleagues but not from their leaders or patients. In contrast, nurses absorbed joy and anger from leaders, colleagues, and patients. Surprisingly, we found that joy-absorbed and anger-absorbed were related to doctors' exhaustion and cynicism, but only to nurses' cynicism. We conclude with suggestions for advancing research and practice in the management of emotions for preventing burnout.
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Affiliation(s)
| | - Lixin Jiang
- University of Wisconsin Oshkosh, Oshkosh, Wisconsin, 54901, USA
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de Valk S, Kuiper C, van der Helm GHP, Maas AJJA, Stams GJJM. Repression in Residential Youth Care: A Qualitative Study Examining the Experiences of Adolescents in Open, Secure and Forensic Institutions. JOURNAL OF ADOLESCENT RESEARCH 2017. [DOI: 10.1177/0743558417719188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Repression in residential youth care institutions can manifest itself openly in coercive measures or may be concealed in staff behavior that is endemic to residential youth care, such as soft power and strict behavioral control (i.e., structure), which threatens rehabilitative goals and might even violate children’s rights. To increase awareness of particularly the more hidden aspects of repression, this qualitative study follows the framework method to examine processes that cause adolescents to experience repression. Semistructured interviews were conducted with an ethnic diverse sample of 32 adolescents from open, secure, and forensic (i.e., youth prisons) residential youth care institutions in the Netherlands. Results indicated that adolescents tend to accept structure, rules, coercion, and punishments, and that they expect staff to use their power to create order and safety. However, results also showed that restrictive measures may be approved by adolescents to cope with repression, taking the form of rationalization. Staff behavior perceived as unfair or excessive by the adolescents was conceived of as repressive. Respect for autonomy and providing treatment that is experienced as meaningful by the adolescents seem to decrease experienced repression.
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Affiliation(s)
- S. de Valk
- University of Applied Sciences, Leiden, The Netherlands
| | - C. Kuiper
- University of Applied Sciences, Leiden, The Netherlands
- Horizon Youth Care and Education, Rotterdam, The Netherlands
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'Intern life': a longitudinal study of burnout, empathy, and coping strategies used by French GPs in training. BJGP Open 2017; 1:bjgpopen17X100773. [PMID: 30564657 PMCID: PMC6169958 DOI: 10.3399/bjgpopen17x100773] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background More than half of French medical GP trainees (GPTs) suffer from burnout. Aim To define and follow the evolution of risk factors, such as empathy and coping strategies, associated with burnout in this population. Design & setting Prospective longitudinal study involving volunteers of 577 Parisian university GPTs in 2012. Method Self-reported anonymous online questionnaires were sent three times every 6 months to all participants. Stress was measured using the Intern-Life scale and burnout using the Maslach Inventory, and anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS). Sociodemographic, professional, and personal data, including coping strategies and measures of empathy were also collected. Results In total 343 questionnaires were fully completed at baseline (T0): 304 were usable at baseline, 169 were usable at 6 months (T1) and 174 at 1 year (T2). Stress rates decreased sharply between T1 (scores 42.96) and T2 (17.08), while scores for burnout remained relatively stable: more than 13% of GPTs had high scores in all three dimensions of burnout. Depersonalisation increased from 61% (T1) to 66% (T2). One hundred and four paired samples were analysed between T0 and T1, and between T1 and T2. Emotion-centred coping was associated with emotional exhaustion (P<0.05), while professional support reduced it. Experiences of aggression increased depersonalisation (P<0.05). Social support, problem-centred coping, perspective-taking empathy, and professional support improved the sense of personal accomplishment (P<0.05). Conclusion Tools to help GPTs are available but are underused. More training in doctor–patient relationships and understanding of medical hidden curricula are necessary to decrease burnout among GPTs and improve their wellbeing and patient care.
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Chartonas D, Kyratsous M, Dracass S, Lee T, Bhui K. Personality disorder: still the patients psychiatrists dislike? BJPsych Bull 2017; 41:12-17. [PMID: 28184311 PMCID: PMC5288087 DOI: 10.1192/pb.bp.115.052456] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method In 1988, Lewis and Appleby demonstrated that psychiatrists hold negative attitudes towards patients with personality disorder. We assessed the attitudes of psychiatry trainees towards patients with borderline personality disorder and depression, expecting an improvement. 166 trainees were block randomised to receive one of four case vignettes that varied by diagnosis and ethnic group. We used Lewis and Appleby's original questionnaire and the Attitudes to Personality Disorder Questionnaire (APDQ). Results We received 76 responses. Lewis and Appleby's questionnaire showed more negative attitudes towards personality disorder than depression, with no significant patient ethnic group effects, and the APDQ also showed a (weak) trend towards more negative attitudes to personality disorder. In subgroup analysis, only in the White British patient group were there significantly more negative attitudes to personality disorder. Factor analysis showed significantly less sense of purpose when working with personality disorder. Clinical implications The perceived greater lack of purpose in working with personality disorder should be the target of clinical training and intervention. Targeted interventions that include training in managing personality disorder, supervision and practice in non-specialist, general psychiatry settings are important.
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Shapiro J, Rakhra P, Wong A. The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters. MEDICAL TEACHER 2016; 38:1033-1040. [PMID: 27010769 DOI: 10.3109/0142159x.2016.1147535] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients. METHODS In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections. RESULTS Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions. CONCLUSIONS These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.
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Affiliation(s)
- Johanna Shapiro
- a Department of Family Medicine , University of California Irvine School of Medicine , Orange , CA , USA
| | - Pavandeep Rakhra
- b College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine , Kansas City , MO , USA
| | - Adrianne Wong
- c California State University , Fullerton , CA , USA
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Mayorga E, Golnik K, Palis G. One-Year Progress in Ophthalmic Education: Annual Review. Asia Pac J Ophthalmol (Phila) 2015; 4:388-98. [PMID: 26716435 DOI: 10.1097/apo.0000000000000162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to update the practicing ophthalmologist on the English language literature about medical education from the prior year. DESIGN A search of English language literature was performed on PubMed from January 1, 2014, to December 31, 2014. METHODS Because the search using the main topic of the review "medical education" came up with 7394 citations, authors finally decided to narrow the search to 3 topics of their interest:1. Current state of competency-based education and teaching methods of competencies. This section included ophthalmic/ophthalmology education, core competencies, competency-based education, teaching strategies, tools and methods in medical education.2. E-learning. This section included e-learning, online learning, online teaching, Web-based teaching, Web-based learning, and flipped classroom.3. ASSESSMENTS This section included assessment of medical students, residents, fellows, faculty, attending physicians, and medical teachers, assessment of medical student ophthalmology programs, ophthalmology residency programs, residency programs, and fellowship programs. RESULTS The authors reviewed and summarized articles published in 2014 examining or describing the 3 main areas of the review described previously. CONCLUSIONS This review updates the comprehensive ophthalmologist on advances in ophthalmic medical education. Ophthalmic educators could apply the ideas presented in this review according to their possibilities in their own settings and programs.
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Affiliation(s)
- Eduardo Mayorga
- From the *International Council of Ophthalmology, San Francisco, CA; †School of Medicine and Eye Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; ‡University of Cincinnati; and §Cincinnati Eye Institute, Cincinnati, OH
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Buck E, Holden M, Szauter K. A Methodological Review of the Assessment of Humanism in Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:S14-S23. [PMID: 26505097 DOI: 10.1097/acm.0000000000000910] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Humanism is a complex construct that defies simplistic measurement. How educators measure humanism shapes understanding and implications for learners. This systematic review sought to address the following questions: How do medical educators assess humanism in medical students, and how does the measurement impact the understanding of humanism in undergraduate medical education (UME)? METHOD Using the IECARES (integrity, excellence, compassion, altruism, respect, empathy, and service) Gold Foundation framework, a search of English literature databases from 2000 to 2013 on assessment of humanism in medical students revealed more than 900 articles, of which 155 met criteria for analysis. Using descriptive statistics, articles and assessments were analyzed for construct measured, study design, assessment method, instrument type, perspective/source of assessment, student level, validity evidence, and national context. RESULTS Of 202 assessments reported in 155 articles, 162 (80%) used surveys; 164 (81%) used student self-reports. One hundred nine articles (70%) included only one humanism construct. Empathy was the most prevalent construct present in 96 (62%); 49 (51%) of those used a single instrument. One hundred fifteen (74%) used exclusively quantitative data; only 48 (31%) used a longitudinal design. Construct underrepresentation was identified as a threat to validity in half of the assessments. Articles included 34 countries; 87 (56%) were from North America. CONCLUSIONS Assessment of humanism in UME incorporates a limited scope of a complex construct, often relying on single quantitative measures from self-reported survey instruments. This highlights the need for multiple methods, perspectives, and longitudinal designs to strengthen the validity of humanism assessments.
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Atkinson D, Rosenstock J. A Role for Balint Groups in Medical Student Training. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/bf03355307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kelm Z, Womer J, Walter JK, Feudtner C. Interventions to cultivate physician empathy: a systematic review. BMC MEDICAL EDUCATION 2014; 14:219. [PMID: 25315848 PMCID: PMC4201694 DOI: 10.1186/1472-6920-14-219] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 10/03/2014] [Indexed: 05/04/2023]
Abstract
BACKGROUND Physician empathy is both theoretically and empirically critical to patient health, but research indicates that empathy declines throughout medical school and is lower than ideal among physicians. In this paper, we synthesize the published literature regarding interventions that were quantitatively evaluated to detect changes in empathy among medical students, residents, fellows and physicians. METHODS We systematically searched PubMed, EMBASE, Web of Science and PsychINFO in June of 2014 to identify articles that quantitatively assessed changes in empathy due to interventions among medical students, residents, fellows and physicians. RESULTS Of the 1,415 articles identified, 64 met inclusion criteria. We qualitatively synthesized the findings of qualified studies by extracting data for ten study metrics: 1) source population, 2) sample size, 3) control group, 4) random assignment, 5) intervention type, 6) intervention duration, 7) assessment strategy, 8) type of outcome measure, 9) outcome assessment time frame, and 10) whether a statistically significant increase in empathy was reported. Overall, the 64 included studies were characterized by relatively poor research designs, insufficient reporting of intervention procedures, low incidence of patient-report empathy assessment measures, and inadequate evaluations of long-term efficacy. 8 of 10 studies with highly rigorous designs, however, found that targeted interventions did increase empathy. CONCLUSIONS Physician empathy appears to be an important aspect of patient and physician well-being. Although the current empathy intervention literature is limited by a variety of methodological weaknesses, a sample of high-quality study designs provides initial support for the notion that physician empathy can be enhanced through interventions. Future research should strive to increase the sample of high-quality designs through more randomized, controlled studies with valid measures, explicit reporting of intervention strategies and procedures, and long-term efficacy assessments.
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Affiliation(s)
- Zak Kelm
- />Ohio University Heritage College of Osteopathic Medicine, Dublin, OH USA
| | - James Womer
- />Temple University School of Medicine, Philadelphia, PA USA
- />Department of Medical Ethics, The Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Jennifer K Walter
- />Department of Medical Ethics, The Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Chris Feudtner
- />Department of Medical Ethics, The Children’s Hospital of Philadelphia, Philadelphia, PA USA
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