Empathy in high-tech and high-touch medicine

What Prospective Applicants Look for on Otolaryngology Residency Websites

OBJECTIVE

To determine what prospective residency applicants look for on otolaryngology residency program websites.

STUDY DESIGN

Survey.

SETTING

The survey was distributed in a virtual format through Google Forms. A link to the survey was given at the University at Buffalo Otolaryngology Chautauqua, sent to Otolaryngology program directors with requests to forward to PGY1 residents and Otolaryngology interest groups, sent to medical school Otolaryngology interest group leaders, posted on Twitter through several accounts, and on otomatch.com.

METHODS

A 45 item survey was given to fourth year medical students applying to otolaryngology, re-applicants applying to otolaryngology, and first year otolaryngology residents who had recently matched. Data collected included participant's age, sex, race and ethnicity, current status in school/residency program, and their type of medical degree (MD or DO). Participants were then asked to mark the components listed that they wished to see. Components were separated into 5 categories: Application/Selection Criteria, Employment Aspects, Program Features, Social/Community, and Faculty/Contact Information. Data was analyzed using Mann-Whitney and Kruskal Wallis tests when appropriate. P value <.05 was considered statistically significant.

RESULTS

One hundred one surveys were collected. Sixty-four (63.4%) participants were fourth-year medical students, 32 (31.7%) were first-year residents, and 5 (5.0%) were re-applicants. Thirteen of the items on the survey were sought by 80% or more of respondents. Ninety-nine (98.0%) of the participants wanted to see a current resident list with photos and 97 (96.0%) wanted to see the intern year schedule online. Eighty-five percent agreed that salary and benefits information would be valuable on residency websites. Women expressed significantly more interest in salary (P = .034), benefits (P = .026), and parking information (P = .048).

CONCLUSION

Our study provides insight on key items to include on residency program websites. Websites that contain information that applicants want to use can be helpful for application decisions in the future.

Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review

BACKGROUND

Compassion in healthcare provides measurable benefits to patients, physicians, and healthcare systems. However, data regarding the factors that predict care (and a lack of care) are scattered. This study systematically reviews biomedical literature within the Transactional Model of Physician Compassion and synthesizes evidence regarding the predictors of physician empathy, compassion, and related constructs (ECRC).

METHODS

A systematic literature search was conducted in CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, OvidJournals, ProQuest, Web of Science, and Scopus using search terms relating to ECRC and its predictors. Eligible studies included physicians as participants. Methodological quality was assessed based on the Cochrane Handbook, using ROBINS-I risk of bias tool for quantitative and CASP for qualitative studies. Confidence in findings was evaluated according to GRADE-CERQual approach.

RESULTS

One hundred fifty-two included studies (74,866 physicians) highlighted the diversity of influences on compassion in healthcare (54 unique predictors). Physician-related predictors (88%) were gender, experience, values, emotions and coping strategies, quality of life, and burnout. Environmental predictors (38%) were organizational structure, resources, culture, and clinical environment and processes. Patient-related predictors (24%) were communication ease, and physicians' perceptions of patients' motives; compassion was also less forthcoming with lower SES and minority patients. Evidence related to clinical predictors (15%) was scarce; high acuity presentations predicted greater ECRC.

DISCUSSION

The growth of evidence in the recent years reflects ECRC's ongoing importance. However, evidence remains scattered, concentrates on physicians' factors that may not be amenable to interventions, lacks designs permitting causal commentary, and is limited by self-reported outcomes. Inconsistent findings in the direction of the predictors' effects indicate the need to study the relationships among predictors to better understand the mechanisms of ECRCs. The current review can guide future research and interventions.

Ward round competences in surgery and psychiatry - a comparative multidisciplinary interview study

BACKGROUND

The ward round is a key element in everyday hospital inpatient care irrespective of the medical speciality. The underperformance in conducting ward rounds of junior clinicians has already been described. Therefore, necessary skills and competences of clinicians need to be defined, taught and delivered for curricular instruction. In addition to published data on ward round competences in internal medicine this study aims to determine the common competences for surgical and psychiatric ward rounds in order to find differences depending on the speciality.

METHODS

Semi-structured interviews with surgical (N = 30) and psychiatric ward staff (N = 30) of a university hospital and five community hospitals were conducted. Competences necessary for performing ward rounds as well as structural aspects were identified by systematic content analysis and frequency analysis, supported by adequate statistics.

RESULTS

Relevant competences for both fields are: collaborative clinical reasoning, communication with the patient and the team, organization, teamwork, management of difficult situations, self-management, error-management, teaching, empathy, nonverbal communication, patient-management and professionalism. Clinical skills were mentioned more often in surgical interviews, while nonverbal communication was described more often in psychiatric interviews. Empathy and communication with the team were more frequently attributed to psychiatric residents.

CONCLUSION

The competences which were identified as necessary for conducting a ward round in surgery and psychiatry are similar and correspond to previously reported competences in internal medicine. Clinical skills are of greater importance in surgery than in psychiatry. Concerning empathy and nonverbal communication, further research is needed to determine whether they are of minor importance in surgery or whether there is a lack of awareness of these competences.

Is empathy an important attribute of midwives and other health professionals?: A review

INTRODUCTION

This paper is a report of a systematic review to identify and analyze studies of the measurement of empathy in midwives and other health professionals. Empathy has been recognized as an important factor in patient care, with positive outcomes for both patients and health professionals. There is a debate on the definition of empathy, on its measurement and on the possibility of improvement.

METHODS

Searches were made of the CINAHL, SCOPUS, PubMed and PsychINFO databases using the terms empathy, clinical, midwifery, nursing, medical students, measurement, and health professionals, singly or in combination, to identify literature published in English between 2002-2015. The included papers were critically reviewed and a narrative synthesis was conducted.

RESULTS

In all, 22 papers met the inclusion criteria by studies that were conducted to measure the levels of empathy in a variety of health professionals and students. Their scores were analyzed in correlation with their sociodemographic factors.

CONCLUSIONS

Despite numerous studies, many correlations but also differences exist, indicating the complexity of empathy and the need to further study it.

HOW TO MEASURE THE EMPATHY LEVEL OF UNDERGRADUATE NURSING STUDENTS? AN INTEGRATIVE REVIEW

ABSTRACT Objective: analyze available evidence in the literature on the measuring of empathy levels in nursing undergraduates. Method: integrative literature review developed in the databases PubMed, Web of Science, CINAHL and LILACS in September 2017. Results: among the 40 primary studies analyzed, 21 questionnaires were identified to measure the empathy levels of nursing undergraduates. Conclusion: different tools exist that are considered reliable to analyze the empathy level among nursing undergraduates.

Orthopaedic Surgeon Communication Skills: Perception of Empathy and Patient Satisfaction Through the Use of Anatomic Models

Introduction:

Patient satisfaction is an increasingly emphasized measure of patient-centered care and important component of reimbursement programs. Orthopaedic surgeons are regarded as low-empathy surgeons. Our goals were to understand the role of anatomic models during the orthopaedic appointment and how their use can affect patient satisfaction and perceived empathy.

Methods:

New patients at an outpatient clinic were asked to participate in a postencounter questionnaire to asses empathy perception (n = 304). Clinic days were randomly assigned to use anatomic models during the encounter to assist with clinical information transmission. The instrument provided contained Consultation and Relational Empathy questionnaire (ie, a person-centered process that was developed to measure empathy in the context of the therapeutic relationship during a one-on-one consultation between a clinician and a patient).

Results:

A total of 304 participants were included in the study. Analyses of the sociodemographic characteristics did not reveal any significant difference between the control and experimental groups. Consultation and Relational Empathy scores for the nonanatomic group (46.0 ± 9.0) and anatomic group (48.0 ± 7.7) were not statistically different (P = 0.482). The encounter time was significantly increased with the use of anatomic models (P < 0.005).

Discussion:

The use of anatomic models during initial orthopaedic encounter did not improve perceived empathy and satisfaction scores in our study. Longer encounter time in the orthopaedic appointment does not mean higher empathy perception.

Conclusion:

Orthopaedic surgeons have the duty to find new strategies to improve communication with the patient. Better communication has been associated with better patient satisfaction. Further investigation should be considered to use other strategies to provide better care for our patients.

Changing characteristics of the empathic communication network after empathy-enhancement program for medical students

The Empathy-Enhancement Program for Medical Students (EEPMS) comprises five consecutive weekly sessions and aims to improve medical students' empathic ability, an essential component of humanistic medical professionalism. Using a graph theory approach for the Ising network (based on l1-regularized logistic regression) comprising emotional regulation, empathic understanding of others' emotion, and emotional expressivity, this study aimed to identify the central components or hubs of empathic communication and the changed profile of integration among these hubs after the EEPMS. Forty medical students participated in the EEPMS and completed the Depression Anxiety Stress Scale-21, the Empathy Quotient-Short Form, the Jefferson Scale of Empathy, and the Emotional Expressiveness Scale at baseline and after the EEPMS. The Ising model-based network of empathic communication was retrieved separately at two time points. Agitation, self-efficacy for predicting others' feelings, emotional concealment, active emotional expression, and emotional leakage ranked in the top 20% in terms of nodal strength and betweenness and closeness centralities, and they became hubs. After the EEPMS, the 'intentional emotional expressivity' component became less locally segregated (P = 0.014) and more directly integrated into those five hubs. This study shows how to quantitatively describe the qualitative item-level effects of the EEPMS. The key role of agitation in the network highlights the importance of stress management in preserving the capacity for empathic communication. The training effect of EEPMS, shown by the reduced local segregation and enhanced integration of 'intentional emotional expressivity' with hubs, suggests that the EEPMS could enable medical students to develop competency in emotional expression, which is an essential component of empathic communication.

If You Could Read My Mind: The Role of Healthcare Providers' Empathic and Communicative Competencies in Clients' Satisfaction with Consultations

This article investigates the relationship between healthcare providers' empathic and communicative competencies and clients' overall satisfaction with consultations. Two aspects of empathy were included: empathic attitude (sensitivity to the clients' perspective) and empathic skills (ability to estimate clients' evaluations). Communicative competencies were narrowed down to the clarity of the information provided. In the context of work disability examinations, 90 healthcare providers (44% physicians, 56% vocational experts) participated. For each provider, up to 20 dyads with clients were investigated. Within every dyad, clients rated their experiences and healthcare providers estimated clients' scores. The results show that both aspects of empathy and clarity of information significantly contribute to clients' overall satisfaction and as such confirm the importance of empathy and communication in medical consultations. Specifically, healthcare providers' empathic dispositions, in addition to their overt communicative behavior, appear to contribute to clients' overall satisfaction. Of the two aspects of empathy, only empathic attitude is significantly related to the clarity of information.

A Multicenter Study Investigating Empathy and Burnout Characteristics in Medical Residents with Various Specialties

We assessed empathy in medical residents, including factors modifying empathy and the relationship between empathy and burnout. Participants (n = 317 residents, response rate = 42%) from 4 university hospitals completed a socio-demographic questionnaire, the Jefferson Scale of Empathy (Health Professional version, Korean edition), and the Maslach Burnout Inventory (MBI). Participants were classified by medical specialty: "people-oriented specialty" (POS group) or "technology-oriented specialty" (TOS group), with more women in the POS than in the TOS group, χ(2) = 14.12, P < 0.001. Being female, married, and having children were factors related to higher empathy (gender, t = -2.129, P = 0.034; marriage, t = -2.078, P = 0.038; children, t = 2.86, P = 0.005). Within specialty group, POS residents showed higher empathy scores in the fourth as compared to the first year, F = 3.166, P = 0.026. Comparing POS and TOS groups by year, fourth year POS residents had significantly higher scores than did fourth year TOS residents, t = 3.349, P = 0.002. There were negative correlations between empathy scores and 2 MBI subscales, emotional exhaustion (EE) and depersonalization (DP). Additionally, first year POS residents had higher DP scores than did first year TOS residents, t = 2.183, P = 0.031. We suggest that factors important for empathy are type of medical specialty, marriage, siblings, and children. Burnout state may be related to decreasing empathy.

The "Reading the Mind in the Eyes" Test: Complete Absence of Typical Sex Difference in ~400 Men and Women with Autism

The “Reading the Mind in the Eyes” test (Eyes test) is an advanced test of theory of mind. Typical sex difference has been reported (i.e., female advantage). Individuals with autism show more difficulty than do typically developing individuals, yet it remains unclear how this is modulated by sex, as females with autism have been under-represented. Here in a large, non-male-biased sample we test for the effects of sex, diagnosis, and their interaction. The Eyes test (revised version) was administered online to 395 adults with autism (178 males, 217 females) and 320 control adults (152 males, 168 females). Two-way ANOVA showed a significant sex-by-diagnosis interaction in total correct score (F(1,711) = 5.090, p = 0.024, η_p² = 0.007) arising from a significant sex difference between control males and females (p < 0.001, Cohen’s d = 0.47), and an absence of a sex difference between males and females with autism (p = 0.907, d = 0.01); significant case-control differences were observed across sexes, with effect sizes of d = 0.35 in males and d = 0.69 in females. Group-difference patterns fit with the extreme-male-brain (EMB) theory predictions. Eyes test-Empathy Quotient and Eyes test-Autism Spectrum Quotient correlations were significant only in females with autism (r = 0.35, r = -0.32, respectively), but not in the other 3 groups. Support vector machine (SVM) classification based on response pattern across all 36 items classified autism diagnosis with a relatively higher accuracy for females (72.2%) than males (65.8%). Nevertheless, an SVM model trained within one sex generalized equally well when applied to the other sex. Performance on the Eyes test is a sex-independent phenotypic characteristic of adults with autism, reflecting sex-common social difficulties, and provides support for the EMB theory predictions for both males and females. Performance of females with autism differed from same-sex controls more than did that of males with autism. Females with autism also showed stronger coherence between self-reported dispositional traits and Eyes test performance than all other groups.

Assessment of Korean Pharmacy Students' Empathy Using the Jefferson Scale of Empathy

OBJECTIVE

To validate the Korean-translated Jefferson Scale of Empathy-Health Professions Student version (JSE-HPS) and to investigate the empathy levels of pharmacy students in South Korea.

METHODS

The JSE-HPS and the Interpersonal Reactivity Index (IRI) were administered to 452 pharmacy students in their second and third years at 5 Korean universities. Confirmatory factor analysis (CFA), correlations, and one-way ANOVAs were conducted for data analyses.

RESULTS

The final sample size comprised 447 responses. The 3-factor model of the JSE-HPS was confirmed by CFA and the convergent validity was also supported by its correlations with the IRI subscales. The overall mean score was 80.3. Pharmacy students enrolled in women's or private universities reported significantly higher levels of overall empathy than their counterparts in co-ed or national universities.

CONCLUSION

Our findings empirically support the psychometric soundness of the Korean JSE-HPS for pharmacy students.

The eyes test is influenced more by artistic inclination and less by sex

The "Reading the Mind in the Eyes" test was developed by Baron-Cohen and his co-workers. This test provides them the unique opportunity to evaluate social cognition assessing the ability to recognize the mental state of others using only the expressions around the eyes. In healthy populations, however, it has produced conflicting results, particularly regarding sex differences and number of items to use. In this study we performed two studies: The first one investigated the presence of gender effects and the sensitivity of test stimuli; the second one considered other individual factors (i.e., artistic attitude, social empathy and personality traits) that could influence the ability to understand emotions from gaze. Our results demonstrated a sex effect, which can be more or less attenuated by the nature of the stimuli. This could be as aforementioned the result of the following, empathy or artistic attitude in being proficient in understanding the mental states of others.