Experiences of empathy training in healthcare: A systematic review of qualitative studies

Socio-ecological Determinants of Detectable Viremia among Pregnant People Living with HIV in South Brazil: The Role of Stimulant Use Disorder and Homelessness

Pregnant patients living with HIV are a priority group for the recruitment into the HIV healthcare cascade to prevent adverse maternal and neonatal health outcomes. Understanding the structural, interpersonal, and individual factors that are associated with detectable HIV viremia is of importance to guide outreach and intervention priorities. This was a retrospective cohort study of pregnant patients living with HIV who delivered from January 1, 2017, to December 31, 2023, at a tertiary-level hospital and referral institution for HIV care in Porto Alegre, Brazil. The socio-ecological model was used to guide hypothesis testing regarding associations with detectable viremia. In total, 549 patients were included, of whom 110 (20%) were found to have detectable viremia. Significant differences between detectable and undetectable viremia included prenatal care, homelessness, having a sero-different partner, and stimulant use. Multivariable associations included prenatal care (adjusted Risk Ratio [aRR] = 0.20, 95% Confidence Interval [95% CI] = 0.15-0.26), homelessness (aRR = 4.02, 95% CI = 2.74-0.26), stimulant use disorder (aRR = 3.30, 95% CI = 2.23-4.87), crack use (aRR = 2.82, 95% CI = 1.85-4.29), and cocaine use (aRR = 1.89, 95% CI = 1.17-3.06). Intervention research should focus on housing and mental health services, and how to mitigate their impact on HIV healthcare. Intervention research is greatly needed as current tools may not be sufficient to tackle the issue of stimulant use disorder and its effects on ART adherence.

"To Be or Not to Be" a Conscientious Objector to Voluntary Abortion: An Italian Web-Survey of Healthcare Workers

Background and Objectives: Conscientious objection to voluntary abortion remains a hot debate topic. This could affect the accessibility to pregnancy termination. Our aim is to evaluate the possible aspects related to an operators' choice about objection for voluntary abortion, such as the following: the abolition of the time limit, the instruction of a multi-collegiate commission, the introduction of pharmacological rather than surgical procedures, the fetal/maternal illness and the case of sexual violence. Materials and Methods: This is an observational, descriptive study that involves a cohort of Italian healthcare workers who answered a web-survey. Results: Of the total 352 respondents, only 20.8% affirmed to be objectors versus 79.2% of non-objectors. For the objectors, 72.2% declared that they would not change status in case of pharmacological abortion; 79.7% would not suspend their choice for interruption in the second trimester; 63.3% would suspend the objection with a multi-collegiate commission, and 69.0% would discontinue their objection in the case of sexual violence. 72.0% of the total participants declared that the abolition of the time limit could have a resecuring impact on women's choice. Conclusions: Most operators declared that the abolition of the time limit could have beneficial effects. Among the objectors, the status would change especially with the introduction of a multi-collegiate commission, and in case of serious maternal/fetal illness and/or sexual violence.

Impact of interprofessional education on empathy of pre-licensure healthcare students: A mixed-studies systematic review

BACKGROUND

In the age of automation and technology, incorporating empathy in pre-licensure healthcare education is essential in providing empathic care to patients and co-workers. This can be achieved through interprofessional education (IPE).

OBJECTIVE

To consolidate evidence to evaluate interprofessional education's impact on pre-licensure healthcare students' empathy levels.

DESIGN

A mixed-studies systematic review following a convergent segregated approach.

METHODS

Ten electronic databases were searched from their inception until 30 November 2023. Quantitative, qualitative, and mixed-method studies that explored the impact of IPE on the change in empathy level in pre-licensure healthcare students were reviewed. The methodological quality of the included studies was assessed using the Mixed-Method Appraisal Tool. Findings from the qualitative and quantitative aspects were analysed and synthesized separately using thematic and narrative synthesis. The findings were integrated by convergent synthesis.

RESULTS

A total of 36 studies involving 3887 participants were included in this review, consisting of five quantitative, 14 qualitative and 17 mixed-methods studies. This review found that IPE enhanced the empathy level of students by improving their understanding of empathy and various empathic responses. Through IPE activities, students demonstrated empathy towards both patients and interprofessional peers. Three themes were generated through the synthesis of qualitative and quantitative results: (1) Empathy Awareness, (2) Internal Empathic Processes, and (3) Intentional Actions. The results showed that healthcare students exhibited empathic care behaviours towards patients and their interprofessional peers.

CONCLUSION

The findings of this review suggested that IPE was effective in improving awareness and knowledge of empathy and in providing empathy care to patients and interprofessional peers. This review encourages educators to implement IPE to pre-licensure healthcare students to increase their knowledge of the importance of providing empathic patient care and interprofessional empathy. Future research could explore more on the processes of interprofessional empathy in students.

Developing empathy in healthcare professions students: protocol of a mixed-methods non-controlled longitudinal intervention study

Despite the necessary focus on clinical skills and knowledge during the tertiary education of healthcare professionals, the literature highlights the importance of developing psycho-social competencies. Empathy, a cognitive-behavioral attribute linked to various benefits for patients and healthcare professionals, is one such competency. Pedagogical approaches to successfully develop empathy in tertiary healthcare students are available. However, these approaches are often integrated piecemeal throughout the tertiary education journey. Research on a more empathy-focused curriculum is scarce. This manuscript describes the design of a study that aims to examine the effects of a more empathy-focused curriculum on empathy in tertiary healthcare profession students in Singapore. Freshmen dentistry, medicine, nursing, and pharmacy students enrolled in a novel curriculum with a strong empathy focus will be recruited for the study and followed for the program's extent. Mixed-methods data collection at various time points will be conducted. Quantitative data will be collected on cognitive-behavioral empathy, intentions to provide empathic care, and engagement in courses of the curriculum. Qualitative data on perceptions of patient care and empathy in relation to relevant courses of the curriculum will be collected to provide context for quantitative findings. Ethics approval was granted by the Departmental Ethics Review Committee of the Saw Swee Hock School of Public Health, National University of Singapore (Ethics ID: SSHSPH-214).

Empathy in Nutrition and Dietetics: A Scoping Review

BACKGROUND

Empathy is fundamental to the provision of efficacious patient-centered health care. Currently, there is no comprehensive synthesis of peer-reviewed empirical research related to empathy in the nutrition and dietetics profession. Understanding empathy in the context of nutrition and dietetics care may lead to improved teaching practices that support nutrition and dietetics students and practitioners to provide high-quality, empathic, patient-centered care.

OBJECTIVE

This scoping review aimed to understand the approaches through which empathy is conceptualized, measured, and taught in the field of nutrition and dietetics.

METHODS

Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Reviews Statement and Checklist, a scoping review process was undertaken. Five databases were searched in February 2023: Cumulative Index to Nursing and Allied Health, Embase, Medline, PsycInfo, and Scopus, with no date limits. Eligible studies were English language-based, peer-reviewed, empirical research exploring or measuring empathy as an outcome in primary data stratified to nutrition and dietetics. Extracted qualitative data were synthesized and analyzed thematically with an inductive, interpretivist approach applied to conceptualize the interrelationship between empathy and dietetic practice. Quantitative data were extracted and summarized in a table.

RESULTS

Twenty-six studies were included in the scoping review. Analysis identified 2 overarching themes underpinning the current literature on empathy in nutrition and dietetics that described empathy as a key skill in the application of patient-centered care, which was supported by approaches to lifelong cultivation of empathy in the nutrition and dietetics profession. A range of tools has measured empathy in nutrition and dietetics students and practitioners with no clear consensus in findings across studies.

CONCLUSIONS

This review identified the extent and nature of empathy within nutrition and dietetics, from both practitioner and patient perspectives, and the vast array of approaches used to teach and quantify empathy in students and practitioners. Insights from this review inform the need for future studies. The results of this review suggest that future research include exploring implications of empathic dietetics care on patient outcomes and identification of best practice, evidence-based curricula and strategies to support sustainable cultivation and maintenance of empathic care across the career span of nutrition and dietetics practitioners.

Neurocognitive Remediation Therapy: A Promising Approach to Enhance Cognition in Community Living Pilots with Depression and Anxiety

Depression and anxiety are pervasive mental health issues, affecting millions globally and often accompanied by cognitive impairments with significant repercussions in daily life and professions, particularly in safety-critical roles like community-living pilots. This exploration assesses Neurocognitive Remediation Therapy (NRT) as an innovative solution for addressing cognitive deficits linked to depression and anxiety in these pilots. Theoretical underpinnings of NRT draw from cognitive rehabilitation, neuropsychology, and neuroplasticity principles. Depression and anxiety often manifest as cognitive deficits, impacting attention, memory, executive functions, and decision-making. NRT interventions aim to address these impairments by enhancing cognitive flexibility, attentional control, and memory through training exercises and cognitive restructuring, empowering individuals to regain cognitive functionality and adaptability. Empirical evidence supports NRT's efficacy in enhancing cognitive functioning, showing significant improvements in attention, memory, and executive functions. This review focuses on NRT's potential to improve cognition in community pilots, demonstrating its effectiveness in reducing cognitive deficits and enhancing job performance, even in high-pressure environments like aviation. The practical implications of NRT for pilots are profound. Tailored programs can address specific cognitive challenges, such as maintaining vigilance and decision-making under stress. Integrating NRT into training regimens enhances skill sets and mental resilience, contributing to safety and success. Additionally, NRT positively impacts emotional well-being, reducing stress and improving overall quality of life. In Conclusion, NRT emerges as a promising intervention for enhancing cognitive functioning in community-living pilots with depression and anxiety. Evidence suggests its potential to improve performance, job satisfaction, and overall well-being. Further research and implementation are crucial to fully realize its benefits and ensure pilots' safety and success.

Is there an association among spirituality, resilience and empathy in medical students?

BACKGROUND

Spirituality has religious and nonreligious dimensions and is often linked to well-being, positive emotions, connection and meaning in life. Both empathy and resilience are important in medical training and future professional practice since they are considered core skills related to professionalism and patient care. Our study aimed to understand the relationships among spirituality, resilience, and empathy in medical students. We also aimed to determine whether there are differences by gender and between medical students in different years of a medical program.

METHODS

Medical students (n = 1370) of the first to fourth years of a six-year medical program, from six medical schools, completed questionnaires to assess empathy (Jefferson Empathy Scale and Davis Multidimensional Interpersonal Reactivity Scale) and resilience (Wagnild & Young Scale) and to rate their spirituality.

RESULTS

Medical students with high spirituality showed higher scores for both resilience and empathy (p < 0.001). In addition, we observed higher levels of both spirituality and empathy, but not resilience, in female medical students than in male medical students. In contrast, we did not detect significant differences in spirituality, empathy, or resilience between students in different years of medical school.

CONCLUSION

Medical students with high levels of spirituality have also higher scores for both empathy and resilience. Spirituality, empathy and resilience have similar values for students in different years of a medical program.

Characteristics and Influencing Factors of Post-Traumatic Growth: A Cross-Sectional Study of Psychiatric Nurses Suffering from Workplace Violence in Guangdong China

Background

Workplace violence (WPV) had become an important issue that endangered the occupational safety of psychiatric nurses. A growing number of studies showed positive post-traumatic growth (PTG) resulting from coping with trauma.

Objective

To investigate the characteristics of PTG in psychiatric nurses who experienced violence in the workplace and analyze its influencing factors.

Methods

A total of 1202 psychiatric nurses participated in the study. From October 2022 to December 2022, this cross-sectional study collected data on psychiatric nurses from five tertiary hospitals in Guangdong Province, China. Twenty-item Chinese version post-traumatic growth inventory (PTGI), Jefferson Scale of Empathy Health Professional (JSE-HP), Confidence in Coping with Patient Aggression Instrument (CCPAI), Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Connor-Davidson Resilience Scale (CD-RISC) measured PTG level, empathy, the confidence in coping with WPV, post-traumatic stress disorder, and resilience, respectively. Bivariate analysis and multiple linear regression explored potential influencing factors of PTG. This study complies with the EQUATOR (STROBE) checklist.

Results

The sample was composed of a total of 1202 psychiatric nurses suffering from WPV. The average score of PTGI in psychiatric nurses was above average (65.75 points; SD = 20.20). Linear regression analyses showed from single-child family (β=0.052,95% CI=0.342,5.409, P<0.05), education background (β=0.108,95% CI=1.833,5.097, P<0.001), the confidence in coping with patient aggression (β=0.106,95% CI=1.385,4.317, P<0.001), empathy (β=0.057,95% CI=0.312,4.374, P<0.05), and resilience (β=0.484,95% CI=7.737,9.575, P<0.001) were associated with PTG level.

Conclusion

Psychiatric nurses who were non-single child, had received higher education, had confidence in coping with patient aggression, had good resilience and strong empathy were prone to PTG after experiencing WPV. The study findings could help hospitals and nursing managers identify vulnerable individuals and take early intervention measures against such populations.

The Effect of Practitioner Empathy on Patient Satisfaction : A Systematic Review of Randomized Trials

BACKGROUND

Practitioners who deliver enhanced empathy may improve patient satisfaction with care. Patient satisfaction is associated with positive patient outcomes ranging from medication adherence to survival.

PURPOSE

To evaluate the effect of health care practitioner empathy on patient satisfaction, using a systematic review of randomized trials.

DATA SOURCES

Ovid MEDLINE, CINAHL, PsycInfo, Cochrane Central Register of Controlled Trials, and Scopus to 23 October 2023.

STUDY SELECTION

Randomized trials published in any language that evaluated the effect of empathy on improving patient satisfaction as measured on a validated patient satisfaction scale.

DATA EXTRACTION

Data extraction, risk-of-bias assessments, and strength-of-evidence assessments were done by 2 independent reviewers. Disagreements were resolved through consensus.

DATA SYNTHESIS

Fourteen eligible randomized trials (80 practitioners; 1986 patients) were included in the analysis. Five studies had high risk of bias, and 9 had some concerns about bias. The trials were heterogeneous in terms of geographic locations (North America, Europe, Asia, and Africa), settings (hospital and primary care), practitioner types (family and hospital physicians, anesthesiologists, nurses, psychologists, and caregivers), and type of randomization (individual patient or clustered by practitioner). Although all trials suggested a positive change in patient satisfaction, inadequate reporting hindered the ability to draw definitive conclusions about the overall effect size.

LIMITATIONS

Heterogeneity in the way that empathy was delivered and patient satisfaction was measured and incomplete reporting leading to concerns about the certainty of the underpinning evidence.

CONCLUSION

Various empathy interventions have been studied to improve patient satisfaction. Development, testing, and reporting of high-quality studies within well-defined contexts is needed to optimize empathy interventions that increase patient satisfaction.

PRIMARY FUNDING SOURCE

Stoneygate Trust. (PROSPERO: CRD42023412981).

The current state of empathy, compassion and person-centred communication training in healthcare: An umbrella review

OBJECTIVES

This umbrella review consolidates evidence available on empathy training, its effectiveness and design mechanisms that contribute to effectiveness.

METHODS

We conducted an umbrella review (review of reviews) of empathy, compassion and person-centred communication training in healthcare published between 2018 and 2022. One reviewer screened titles, abstracts and full-text articles, with a second reviewer at full-text stage. Quality appraisal was done in duplicate. Data extraction was piloted by two reviewers and conducted by one reviewer with a quality check of all extracted data. All reviewers provided input into synthesis of results and analysis.

RESULTS

Twenty-five reviews were included. We provide an overview of the definitions of empathy, compassion and person-centred communication, outcome measures used, a synthesis of findings on the mechanisms and effectiveness of training and a summary of review recommendations.

CONCLUSIONS

For policy and practice, we advise the inclusion of empathic communication into the curriculum; longitudinal and sequenced learning; debriefing, targeted feedback, enabling self-reflection, deliberate practice, experiential learning; improving motivation by teaching the benefits of empathy and teaching sustainable empathy. Future research should involve patients in training and research and study the effect of targeting interventions at healthcare practitioners and patients.

Knowledge and attitudes of primary care physicians regarding childhood hearing loss in Malaysia

BACKGROUND

Childhood hearing loss is a significant health concern. Early identification and intervention are essential to maximize hearing potential and developmental outcomes, with primary care physicians (PCPs) playing a pivotal role in this process.

OBJECTIVES

This study aimed to assess PCPs' knowledge and attitudes toward childhood hearing loss, investigate the association between knowledge and attitudes, and examine the influence of demographic factors on PCPs' knowledge and attitudes towards childhood hearing loss.

METHODS

This cross-sectional study was conducted from 30 November 2017 to 30 July 2018 at three public health clinics in Malaysia, specifically in the Federal Territory of Kuala Lumpur, Selangor, and Terengganu. A self-administered questionnaire assessed PCPs' knowledge of general facts, diagnosis and intervention, and risk factors for childhood hearing loss. Additionally, the questionnaire evaluated PCPS' attitudes across cognitive, affective, and behavioural domains regarding childhood hearing loss.

RESULTS

Most participants lacked sufficient knowledge about childhood hearing loss, with 61.4% not seeing it as a major health issue. Almost half (45.9%) didn't know that children with hearing loss can succeed in regular schools, and 78% were unaware that hearing aids don't fully restore normal hearing. Participants' awareness of risk factors varied widely, ranging from 24.6% to 90.3%. Despite these knowledge gaps, participants generally had positive attitudes towards childhood hearing loss, especially in cognitive and behavioural aspects. The study found a strong positive link between knowledge and attitudes, but demographic factors didn't significantly affect them.

CONCLUSIONS

This study highlights the urgent need to address knowledge gaps among Malaysian PCPs regarding childhood hearing loss. While these knowledge gaps exist, PCPs' positive attitudes form a foundation for developing targeted educational interventions to improve PCPs' knowledge and skills in managing childhood hearing loss. Collaborative efforts are essential to translate these findings into meaningful improvements in paediatric audiological care.

Positive contact and empathy as predictors of primary care providers' willingness to prescribe medications for opioid use disorder

Introduction

Patients with opioid use disorder (OUD) have a heightened need for quality health care, including access to evidence-based medications to reduce cravings and prevent overdose. However, primary care providers (PCPs) are reluctant to work with patients with OUD and implement medication prescribing into primary care practice. Previous studies have sought to identify potential ways to overcome these barriers, but often utilize interventions that facilitate both positive contact with as well as empathy for patients with OUD. In this study, we jointly assess positive contact and empathy to determine their unique impact on treatment attitudes and behaviors among PCPs, after controlling for other known predictors.

Methods

We surveyed 409 PCPs currently practicing in Ohio in 2022. Our primary dependent variables were willingness to work with patients with OUD, receipt of an X-waiver to prescribe buprenorphine, and interest in receiving an X-waiver. Our primary independent variables were positive contact and empathy toward patients with OUD. We computed bivariate correlations and multivariable linear regression (for continuous dependent variables) and logistic regression (for binary dependent variables) to understand the relationship between positive contact, empathy, and our outcome variables while accounting for other known predictors and relevant participant demographics.

Results

Positive contact was positively correlated with willingness to work with patients with OUD, receipt of the X-waiver, an interest in receiving the X-waiver, more frequent checking with patients about the need for naloxone, and higher odds of naloxone prescribing. These relationships held after accounting for PCP demographics, explicit bias toward patients with OUD, and overall levels of contact with patients with OUD. Empathy, conversely, was not a significant predictor of any treatment outcomes in the fully adjusted models.

Conclusion

Interventions and medical education programs aimed at improving treatment outcomes for patients with OUD should facilitate positive contact between PCPs and patients with OUD.

Empathy among health science undergraduates toward the diagnosis of chronic pain: An experimental study

OBJECTIVES

To analyse the empathetic response of future health professionals toward people diagnosed with chronic pain differentiated by the degree of visibility and credibility of symptoms.

METHODS

A total of 203 undergraduates performed an experimental task using vignettes depicting different diagnoses of chronic pain and completed questionnaires measuring dispositional and situational empathy. A MANCOVA analysis was conducted.

RESULTS

The main effects of chronic pain diagnoses did not significantly affect situational empathy (p = .587, η2 = 0.007, d = 0.229). The dispositional empathy variables perspective-taking and personal distress affected the situational empathy scores (p = .002, η2 = 0.072, d = 0.906, and p = .043, η2 = 0.032, d = 0.547, respectively).

CONCLUSIONS

It would seem appropriate to foster intra-individual empathy factors among health science undergraduates such that they can more readily understand the process of individual adaptation to chronic pain and thus manage it more effectively.

PRACTICE IMPLICATIONS

It would be useful for dispositional empathy to form part of the transversal competences of the training programmes of future health professionals from the beginning of their studies.

Impact of telenutrition protocols in a web-based nutrition counseling program on adult dietary practices: Randomized controlled pilto study

OBJECTIVE

To analyze the effectiveness of two different telenutrition protocols on the dietary practices of adults.

METHODS

This was a 12-week, randomized controlled trial, involving the application of different telenutrition protocols with online nutritional counseling. Two protocols were used, the multicomponent (MT), composed of multiple strategies combined, synchronously and asynchronously, and the traditional (TD), with only one synchronous strategy, in addition to the control group (CT). The primary outcome was assessed by the eating practices score.

RESULTS

Eighty-six individuals participated, 35 in the MT group, 30 in the TD group, and 21 in the CT group. After 12 weeks, the MT and TD groups showed a significant increase in their eating practices score (p = 0.049), and both were different from the control (MT × CT: p < 0.001; η2: 0.21); (TD × CT: p = 0.002; η2: 0.21). The MT group showed significant changes in four items assessing eating practices, while the TD group showed significant results in two, both compared to the CT group.

CONCLUSION AND PRACTICAL IMPLICATIONS

The multicomponent and traditional methodologies were effective in improving eating practices, with the combined methods standing out. The protocols tested may be useful to guide nutritionists regarding the methodologies in telenutrition.

On the need for empathy in the acute hospital setting

This article reviews the need for empathy, and what happens in its absence in an acute hospital setting, using the example of a homeless man in an emergency department. Three simple but meaningful changes that all healthcare practitioners can make are recommended to promote empathy.

Caregivers' experiences of caring for non-COVID-19 patients during the pandemic: A qualitative systematic review

OBJECTIVE

To investigate caregivers' experiences of caring for non-coronavirus disease (COVID-19) patients to determine their challenges and needs.

METHODS

Five electronic databases (PubMed, Web of Science, Ovid, CINAHL, and ClinicalKey) were searched from January 2020 to June 2022. Two authors independently reviewed all studies for eligibility and extracted information on the study aim, sample characteristics, study design, data collection, analysis methods, and so on.

RESULTS

Finally, 13 studies were included. Four themes were determined: impacts on physical and psychosocial well-being of caregivers, perceived risk of the virus, negative impacts on employment and financial statuses, and changes in support networks.

CONCLUSION

This is the first qualitative systematic review to describe caregivers' experiences of caring for non-COVID-19 patients during the pandemic. The four themes should be focused on to ease caregivers' physical, psychological, and financial burdens; to provide them with better assistance in terms of formal and informal supports to cope with the epidemic more effectively; and to ensure that their loved ones are much healthier.

PRACTICE IMPLICATIONS

The findings can be used by healthcare policymakers, social policymakers, and governments to better support caregivers of non-COVID-19 patients. Additionally, it provides suggestions for related medical institutions to pay more attention to caregivers' experiences.

The Effect of Empathy on Team Members' Moqi in Virtual Teams: A Moderated Mediation Model

Purpose

Moqi can help team members facilitate communication without all interlocutors present, so the researchers speculate it can be an efficient communication tool for virtual teams to compensate for its lack of synchronous communication and in-person contact. However, the only study on the predictors of team members' moqi believed that shared understandings could only arise from team tasks. Based on social exchange theory, the current study emphasizes the social and emotional benefits exchanged among team members and explores moqi-making among virtual team members through a lens of relationship-building.

Methods

With a two-wave time-lagged survey design, a total of 381 team members from 86 virtual teams in China participated in the study. Hierarchical regression analysis was performed to test the hypotheses.

Results

Results confirmed that virtual team members' empathy is conducive to their experiences of high-quality interpersonal relationships (HQIR) and moqi. Relationship closeness positively moderates the link between empathy and experiences of HQIR and the mediating effect.

Conclusion

This study helps unveil the significance of compassionate communication and life-giving connections in cultivating virtual team members' moqi and offers meaningful insights for facilitating virtual collaborations.

Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies

BACKGROUND

Several studies suggest that medical student empathy declines throughout medical school. However, no studies have synthesised the evidence regarding why empathy declines.

OBJECTIVE

To conduct a systematic review and thematic synthesis of qualitative studies investigating why student empathy may change throughout medical school.

METHODS

We included any qualitative study that investigated why empathy might change during medical school. We searched the Medline, Scopus, CINAHL, ERIC, and APA PsycInfo databases for relevant studies. All databases were searched from their inception to 18 July 2022. We also searched the reference lists of the included studies and contacted experts to identify additional studies. We used the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. Overall confidence in our results was assessed using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. We used thematic methods to synthesise our findings.

RESULTS

Our searches yielded 2523 records, and 16 studies involving a total of 771 students were eligible for analysis. Most studies (n = 11) were from Europe or North America. The descriptive themes and sub-themes were identified for each study. Increased complexity in patients and their diseases, together with the 'hidden curriculum' (including a stressful workload, prioritisation of biomedical knowledge, and (sometimes) poor role models), led to student adaptations, such as cynicism and desensitisation. Students' prior lives and professional experiences appeared to exacerbate the decline in empathy. However, there were bias concerns for most of the included studies.

DISCUSSION

Many of the included studies included were small, and some did not include demographic participant data. Given the likely benefits of providing empathic care for patients and practitioners, medical education interventions should focus on developing an 'empathic hidden curriculum' that mitigates the decline in medical student empathy.

TRIAL REGISTRATION

A protocol for this systematic review was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on 28 July 2022 (registration number CRD42022347856).

The New Renaissance of Family Medicine: Myth or Reality

Renaissance is the term used for the societal movement that marked the end of the Middle Ages. With the development of science came the rediscovery of the works and values of ancient scholars. This brought enormous development in all areas of society, including education. Man became the measure of all things, humanism became important again, and there was a blossoming of science and art. The 'renaissance of family medicine' took place approximately 50 years ago as a response to over-technical (even inhumane) medicine. Family medicine focused on the patient and was, as such, rediscovered and developed as a scientific discipline. In 2022 Wonca Europe launched a new document that set out the core values of family medicine, initiating a discussion about the 'new' renaissance of family medicine. The idea implies that, due to the changes brought about by rapid technical advances and recent global events, family medicine will develop further. However, the really intriguing question is whether these rapid and dramatic changes will actually result in a new renaissance of family medicine or whether they will result in its decline.