Clinical empathy as emotional labor in medical work

We are all ordinary: the shared visual narratives of daily life promote the patients' positive attitudes toward doctors

BACKGROUND

Current research on the doctor-patient relationship primarily focuses on the responsibilities of doctors, with relatively less emphasis on examining the contributions patients can make. As a result, there is an urgent demand for exploring innovative approaches that highlight the active role patients play in cultivating a robust doctor-patient relationship. The purpose of this study was to devise an intervention strategy centered around patients to enhance the doctor-patient relationship. Comics were developed to depict shared narratives encompassing challenging daily life experiences between doctors and ordinary individuals. The study aimed to assess the efficacy of this approach in cultivating positive attitudes toward doctors.

METHOD

A 3-group design trial was conducted in Shanghai, China. A total of 152 participants were randomly assigned to one of three conditions: the parallel presenting group (n = 51), where narratives about a doctor and an ordinary employee were presented side by side in comics; the single presenting group (n = 50), where only narratives about a doctor were presented; and the control group (n = 51). The outcomes assessed in this study encompassed changes in identification with the doctor portrayed in the comics, perceived intimacy between doctors and patients in reality, and appraisal of the doctor in a prepared doctor-patient interaction situation.

RESULTS

The parallel presenting group exhibited significantly larger increases in identification with the doctor portrayed in the comics, perceived intimacy between doctors and patients in reality, and appraisal of the doctor in a prepared doctor-patient interaction scenario compared to the single presenting group. The observed enhancements in the appraisal of the doctor in a prepared doctor-patient interaction scenario can be attributed to the changes in identification with the doctor portrayed in the comics experienced by the participants.

CONCLUSION

Our study responds to the doctor-centric focus in existing research by exploring patients' contributions to the doctor-patient relationship. Using comics to depict shared narratives, the parallel presenting group demonstrated significantly increased identification with the depicted doctor, perceived intimacy, and positive appraisal in prepared scenarios compared to the single presenting group. This underscores the effectiveness of patient-centered interventions in shaping positive attitudes toward doctors, highlighting the pivotal role patients play in fostering a resilient doctor-patient relationship.

TRIAL REGISTRATION

Chinese Clinical Trail Registry: ChiCTR2400080999 (registered 20 February 2024; retrospectively registered).

Intraprofessionalism and Peer-to-Peer Learning in American Medical Education

As previous research has observed, medical students and physicians alike confront vast amounts of knowledge in their education and practice, such that no one clinician can know everything there is to know about biomedicine. Even before clerkships, medical students learn to cope with this impossibility by prioritizing certain information based on its perceived utility for exams and clinical practice. Many factors can shape this process, including teamwork, wherein individual medical students rely on one another to address gaps in knowledge at the level of the group. This paper will draw on qualitative data from two allopathic medical schools in the American Midwest to demonstrate that peer-to-peer learning, a widely utilized pedagogical modality in North American medical schools, is amongst the earliest places where future physicians learn how to rely on their peers in the profession as they make choices about what to know and what not to know about biomedicine: cultivating a culture of "intraprofessionalism" between students with different knowledges and values, as they prepare to enter the same profession. The paper will also consider how differences in the student populations at two field sites impact intraprofessional development. Drawing on scholarship of peer-based learning strategies and the sociology and anthropology of medical education, the authors argue that peer-to-peer learning is a key site in the professional socialization of medical students toward the effective management of medical knowledge.

Motivations of undergraduate student medical interpreters: Exposure and experience

BACKGROUND

When patients do not speak the same language as their doctors, they face poorer medical outcomes, decreased doctor-patient trust, and a diminished desire to seek medical care. It has been well established that interpretation is an essential part of an accessible healthcare system, but effective use of such language services relies on both the interpreters themselves and the healthcare teams working with them. This study presents an interdisciplinary examination of the motivations of undergraduate student medical interpreters, a group which serves as a bridge between these roles. While not full-time interpreters, they receive official training and spend time serving patients in local clinics. Further, for those who aspire to careers in medicine, interpreting provides invaluable exposure to the medical field and early professional know-how.

METHODS

Semi-structured individual interviews with undergraduate student interpreters were conducted to describe this multifaceted educational experience. A thematic analysis framework was employed to understand how and why they volunteer their time to interpret.

RESULTS

Motivations of student interpreters were found to fall under three general categories: (1) personal identity, or connection to family, language, and their career aspirations; (2) community engagement, or the opportunity to make a direct impact on patients at an early stage; and (3) pre-professional experience, both in general and specifically in healthcare. Each of these contributes to the view of a student medical interpreter as a unique contributor to language equity in medicine, as they provide language services in the short-term as well as set themselves up to be linguistically and culturally competent providers in the long-term.

CONCLUSIONS

A greater understanding of student motivations adds to knowledge about language mediation and validates the utility of students in this role, encouraging the development of more student interpreter programs. Particularly in communities with high proportions of non-English speakers, these students can contribute to making medical care as inclusive and accessible as possible.

Communication strategies for expressing empathy during family-clinician conversations in the intensive care unit: A mixed methods study

OBJECTIVES

To explore communication strategies intensive care clinicians and patients' family members prefer for expressing empathy during family-clinician conversations.

RESEARCH METHODOLOGY/DESIGN

Mixed-methods survey study.

SETTING

Two medical ICUs of a German academic tertiary care hospital.

MAIN OUTCOME MEASURES

Using a self-developed online survey with closed and open-ended questions with free-text options, the participants' preferences of communication strategies for expressing empathy were investigated. Quantifiable similarities and differences were determined by statistical analysis. Qualitative themes were derived at by directed content analysis.

FINDINGS

The responses of 94 family members, 42 nurses, and 28 physicians were analysed (response rate: 45.3 %). Four communication strategies were deduced: (1) reassuring the families that the intensive care unit team will not abandon neither them nor the patient, (2) acknowledging emotions and offering support, (3) saying that the families are welcome and cared for in the intensive care unit, (4) providing understandable information. In comparison, the families considered an expression of nonabandonment as more empathic than the physicians did (p =.031,r = 0.240), and those expressions focussing solely on the family members' well-being (p =.012,r = 0.228) or comprising evaluative wording ("good", "normal") (p =.017,r = 0.242) as less empathic than the nurses did. Unanimously advocated nonverbal communication strategies included to listen attentively and to avoid interrupting as well as being approachable and honest.

CONCLUSION

The participants' preferences supported expert recommendations and highlighted that it is not only important what the clinicians say but also how they say it. Further research is needed to elucidate ways of successfully expressing empathy during family-clinician conversations in the intensive care unit.

IMPLICATIONS FOR CLINICAL PRACTICE

Intensive care unit clinicians are encouraged to practice active listening and to express their caring and nonabandonment. It is further suggested to reflect on and adjust pertinent nonverbal behaviours and relational aspects of their communication, as applicable.

Assessment of Empathy as a Prerequisite for Holistic Nursing: Psychometric Analysis of the Jefferson Scale of Empathy-Health Profession Students for Croatian BSc and MSc Nursing Students

Purpose: To translate the original Jefferson Scale of Empathy-Health Profession Students version in a group of nursing students and asses its psychometrical characteristics according to the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Design: A descriptive cross-sectional study. Methods: The study included 345 bachelor's and master's students in the nursing degree program. Construct validity was tested by exploratory factor analysis using principal component analysis with varimax rotation. Convergent validity was tested using the Pearson correlation coefficient to test the relationship between empathy and emotional intelligence. The reliability of internal consistency was estimated using Cronbach's alpha. Findings: The final version of the 16-item scale with its three-factor structure has a high reliability with a Cronbach's alpha value of 0.86, and the Pearson correlation coefficient revealed a positive and significant relationship between emotional intelligence and the total score of the empathy scale and the three subscales. Conclusion: The contribution of the study is significant as the instrument is qualitatively validated and its content is clinically and educationally important for understanding the concept of empathy, especially in the education of nursing students. The correct assessment of empathy contributes to a better understanding and implementation of the components of holistic care.

Vicarious trauma in nursing: A hybrid concept analysis

BACKGROUND

Vicarious trauma can significantly affect the physical and mental health of nurses, as well as their ability to provide quality of care. However, the concept of vicarious trauma has received limited attention and remains controversial in the nursing context.

OBJECTIVE

The purpose of this study was to clarify and define the concept of vicarious trauma as it pertains to the nursing context.

METHODS

The Schwartz and Kim's three-stage hybrid concept analysis method was used to define the concept. In the theoretical phase, PubMed, CINAHL, OVID, Medline, Embase, Web of Science, Scopus, ProQuest, PsycINFO, CNKI database, VIP database and Wanfang database were used using keywords "nurs*"and "vicarious trauma*", resulting in a total of 25 papers. In the fieldwork phase, we conducted participatory observations in three hospitals and semi-structured in-depth interviews with 18 clinical nurses from seven cities. In the analysis phase, the results of the previous two phases were integrated to develop a comprehensive concept of vicarious trauma in nursing.

RESULTS

Based on the results of the theoretical and field phases, we propose the concept of vicarious trauma in nursing as follows: vicarious trauma is a psychological trauma impacting nurses' cognitive schema which they may experience in clinical settings or on social media, resulting from deeply empathize with the physical or emotional trauma of patients, family, or colleagues, such as patients' physical injuries or death, family's grieving feelings and colleagues' received threats and attacks. Positively, vicarious trauma can transform into vicarious post-trauma growth through repositioning and connection, nourishing nurses and promoting their personal and professional development.

CONCLUSION

The concept of vicarious trauma in nursing is multidimensional and holistic. This study clarifies the concept of vicarious trauma in nursing using the hybrid concept analysis, providing a framework for future research and practice on vicarious trauma in the nursing field.

PATIENT OR PUBLIC CONTRIBUTION

Nurses contributed to the conduct of the study by participating in the data collection via interviews.

Being kind in unkind spaces: a qualitative examination of how medical educators and first year medical students perceive empathy training

Introduction

It has become de rigueur for healthcare systems to tout their ability to provide compassionate medical care that addresses the emotional as well as physical needs of patients. Not surprisingly, then, there is considerable pressure on medical schools to train their students to be empathic. Existing literature on empathy training in medicine tends to focus on how to build emotional intelligence in individual trainees, largely ignoring the sociocultural factors that contribute to or thwart empathy development in medical school. Additionally, research tends to examine student perspectives, with little attention given to medical educators and their viewpoints.

Methods

In this paper, we adopt an "emotion practice" framework and utilize an inductive descriptive study design to qualitatively consider how first year medical students (N = 23) and their instructors (N = 9) perceive empathy training at a site we call Midtown Medical School.

Results and discussion

We find that both groups have an understanding of empathic capital but differ in their beliefs about the utility and legitimacy of this capital. Both educators and students also recognize the limitations of standardized empathy curriculum but do not agree on the implications of such rote learning. Finally, students and instructors alike find the hidden curriculum of medical school to be antithetical to empathy development, concurring that it is difficult to cultivate empathy in spaces where biomedical coursework is prioritized over social-emotional learning. In short, both groups find it difficult to be kind in an unkind place.

The words we die by

Hospice is a venue organized to provide a "good death" for patients and family. Since many hospice patients are bedridden and often incoherent or unconscious, many of this venue's interactions take place between hospice professionals and patients' families. The families of patients desire definitive prognoses because knowing what to expect can help them decide how to act, but for professionals such knowledge is characterized by doubt. In light of their needs, how then do hospice professionals use language to achieve and maintain the family's buy-in? Drawing on eight months of observation in Hospice House Interdisciplinary Team (IDT) meetings, we analyze the verbal interactions between hospice professionals and patients' families, focusing in particular on registers of prognosis, to better understand how hospice professionals use language to manage family expectations. In order to accomplish this goal central to their occupational project, hospice professionals use future grammars, primarily comprising predictive and subjunctive verbs. Imperative verbs are rarely used. We refine the enactive perspective on authoritativeness by identifying some linguistic components that mediate authority's efficacy in a venue where emotion management is central to professional work. Paying attention to the uses of these linguistic registers helps us further understand some everyday ways that death is organized, and in general, may offer a richer understanding of death itself.

Becoming futile: the emotional pain of treating COVID-19 patients

Introduction

The COVID-19 pandemic has had a profoundly detrimental impact on the emotional wellbeing of health care workers. Numerous studies have shown that their rates of the various forms of work-related distress, which were already high before the pandemic, have worsened as the demands on health care workers intensified. Yet much less is known about the specific social processes that have generated these outcomes. This study adds to our collective knowledge by focusing on how one specific social process, the act of treating critically ill COVID-19 patients, contributed to emotional pain among health care workers.

Methods

This article draws from 40 interviews conducted with intensive care unit (ICU) staff in units that were overwhelmed with COVID-19 patients. The study participants were recruited from two suburban community hospitals in Massachusetts and the interviews were conducted between January and May 2021.

Results

The results show that the uncertainty over how to treat critically ill COVID-19 patients, given the absence of standard protocols combined with ineffective treatments that led to an unprecedented number of deaths caused significant emotional pain, characterized by a visceral, embodied experience that signaled moral distress, emotional exhaustion, depersonalization, and burnout. Furthermore, ICU workers' occupational identities were undermined as they confronted the limits of their own abilities and the limits of medicine more generally.

Discussion

The inability to save incurable COVID-19 patients while giving maximal care to such individuals caused health care workers in the ICU an immense amount of emotional pain, contributing to our understanding of the social processes that generated the well-documented increase in moral distress and related measures of work-related psychological distress. While recent studies of emotional socialization among health care workers have portrayed clinical empathy as a performed interactional strategy, the results here show empathy to be more than dramaturgical and, in this context, entailed considerable risk to workers' emotional wellbeing.

Physicians as shock absorbers: The system of structural factors driving burnout and dissatisfaction in medicine

American physicians disproportionately suffer from burnout. Despite calls for systemic solutions, however, few studies have actually examined how 'the system' works-i.e. how structural factors intersect in real-time as a system to shape wellbeing. I borrow a systems theoretical approach, which explicitly recognizes the dynamic relationships and interdependencies between different actors and factors in healthcare, to examine how structural factors work together to shape physicians' wellbeing. Drawing on an eight-month ethnography in a pediatrics clinic, I show how respondents experienced pressures from multiple structural levels: societal (including broader social inequality and changing doctor-patient relationships); organizational (centralized decision-making, economic pressures, and unresponsive leadership); and professional (specialty cultures and unhealthy norms). I find that individual physicians effectively served as shock absorbers, routinely absorbing countless, interconnected structural demands ("shocks") and converting them into competent medical care, at significant cost to their mental health. In so doing, I intervene in sociological debates about the broader fate of the medical profession and conclude that if medicine remains resilient against threats to its dominance, it may well be at the expense of individual physicians' mental wellbeing.

How student healthcare providers in a communication skills course respond to standardized patient resistance

Encountering and responding to patient resistance can be especially challenging for student healthcare providers. Navigating who ultimately holds the authority to know and understand a health concern, make recommendations for a course of action, and accept or resist these recommendations are all part of how epistemic authority is negotiated in medical settings. The purpose of this paper is to systematically examine how student providers enrolled in a communication skills course at an American university responded to standardized patient resistance. The data for this study were 121 video-recorded and transcribed final objective structured clinical examinations from the fall 2019 course. We used discourse analysis informed by principles of conversation analysis to identify several discursive strategies used by the students, including: 1) asking for clarification; 2) expressing uncertainty and offering to gather additional resources; 3) aligning with and offering an account for the resistance; 4) recommending a new course of action; and 5) confronting the resistance. Our findings point to the value of including instruction for both student healthcare providers and standardized patients on how to respond to resistance they encounter in ways that may help improve healthcare outcomes.

Medical education experiences among medical students with chronic health conditions: A qualitative study

Medical students with chronic health conditions are an underrepresented and often overlooked population in medical education. Previous research describes the dual roles they hold as both healthcare recipients and providers and details challenges they face related to accommodations and accessibility. However, less is known about how having a chronic health condition shapes the day-to-day aspects of medical education. To address this gap in knowledge, I conducted semi-structured interviews with eighteen medical students with chronic conditions and examined data using reflexive thematic analysis. Findings revealed the competing demands students face between medical school expectations and the need to manage their health. They work to reconcile these demands using tools like accommodations and strategic communication and by reconstructing narratives to re-assess self-imposed expectations. These participants understand having a chronic health condition as just one piece of their larger sense of self. Participants approach this understanding in individualized and nuanced ways, yet all share a cohesive view that their experiences having chronic health conditions inform their medical practice for the better through the development of genuine empathy for patients. This paper concludes with recommendations drawn from participant interviews of how medical schools can better support students with chronic health conditions.

Family dyads, emotional labor, and holding environments in the simulated encounter: co-constructive patient simulation as a reflective tool in child and adolescent psychiatry training

BACKGROUND

Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric populations, particularly in child and adolescent psychiatry, is rare and generally does not reflect the child-caregiver dyad or the longitudinal aspects of this care, nor does it provide learners with an opportunity to engage with and reflect on these dynamics.

METHODS

We organized as an educational opportunity a series of seven observed patient simulation sessions with a cohort of a dozen child and adolescent psychiatrists (eight fellows approaching graduation and four senior educators). In these sessions, we utilized the co-constructive patient simulation model to create the simulation cases. We included the use of at least two patient actors in most sessions, and two of the case narratives were longitudinally followed across multiple simulation sessions. We approached the data collected during the simulations and their respective debriefings by using thematic analysis informed by a symbolic interactionist approach.

RESULTS

Based on data from the debriefing sessions and longitudinal narratives, we identified four overarching themes: (1) Reflecting on dyadic challenges: role reversal and individuation; (2) Centering the child, allying with the parent, and treating the family system; (3) Ambivalence in and about the parent-child dyad; and (4) Longitudinal narratives and ambivalence over time.

CONCLUSION

The emotional experience of the simulations, for interviewers and observers alike, provided an opportunity to reflect on personal and professional experiences and triggered meaningful insights and connections between participants. These simulated cases called for emotional labor, particularly in the form of creating holding environments; in this way, the simulated encounters and the debriefing sessions became dialogic experiences, in which the patient and provider, parent and child, and learner and instructor could co-construct meaning and foster professional development as reflective practitioners.

'Hallucination': Hospital Ecologies in COVID's Epistemic Instability

Historians and ethnographers have described biomedicine as a modernist project that imagines accumulating ever-more stable knowledge over time. This project broke down in heavily hit hospitals at the onset of the COVID-19 pandemic in the U.S., when bureaucratic, physical and knowledge structures collapsed. A combination of terror, a partially characterized disease entity and clinicians' inability to operate without disease models drove them to draw on rapidly changing and contradictory information via social media, changing medical practice minute-to-minute. The result was a unique form of knowing described as "hallucination": a hyperreal, unstable ecology of imagined viral particles distributed in physical spaces, transforming with each text message and tweet. The nature, experience and practice of this ecology sheds light on what happens when instability comes to otherwise stable places.

Why Your Doctor Didn't Go to Class: Student Culture, High-Stakes Testing, and Novel Coupling Configurations in an Allopathic Medical School

A clear pattern has emerged in allopathic medical schools across the United States: Most medical students have stopped going to class. While this trend among students is well known in medical education, few studies to date have examined the underlying sociological mechanisms driving this collective behavior or how these dynamics are related to institutional change in medical education. Drawing on 33 in-depth interviews with medical students in an allopathic medical school, we examine medical student culture and its role in shaping how medical students make sense of the institutionalized licensing requirement of the United States Medical Licensing Exam. We find that medical students learn to rely on digital recordings of their course content and third-party digital resources for Step 1 prep and stop attending their academic courses in person altogether. We argue that medical students create novel coupling configurations between local interaction and institutionalized licensure rules via their student cultures.

Painful Feelings: Opioids as Tools for Avoiding Emotional Labor in Hospital Work

How do clinicians manage the negative emotions that emerge when hospital patients are dissatisfied with their pain treatment? Drawing on a 21-month hospital ethnography, I show that clinicians view opioids as tools that can allow them to avoid engaging in emotional labor with dissatisfied pain patients. I detail two different strategies that clinicians pursued. Through permissive prescription, clinicians used intravenous (IV) opioids liberally to placate unhappy pain patients, temporarily minimizing patients' emotional needs. Through restrictive prescription, clinicians advocated for the more conservative use of IV opioids in the hopes that dissatisfied patients would leave the hospital, reducing their overall emotional workload. Divergent strategies for using opioids to avoid emotional labor led to hierarchical interprofessional conflict, which was itself a source of negative emotions that needed to be managed. Based on these findings, I argue that the desire to avoid emotional labor can shape patient care and workplace relationships.

Articulating the canon: The sociology of medical education from 1980 to 2000

An exciting development in the sociology of medical education has been its recent return as a distinct scholarly conversation in medical sociology. During the 1980s and 1990s, the sociology of medical education, an historically prominent subfield in sociology, seemed to disappear from the scholarly conversation despite ongoing development in this area. In this narrative review I describe this "missing period" of sociology of medical education, discussing complementary explanations for why it receded and describing what research activity did take place during those decades. In reviewing this work, I argue that articulating theoretical advances made within sociology of medical education research during these decades allows us to link foundational research from the 1950s and 1960s with the renaissance of this subfield in the early 2000s. Fundamentally, understanding the intellectual history and development of this subfield supports a broader movement to understand the import of studies of medical training for exploring questions of interest in general sociology.

How surface acting affects turnover intention among family doctors in rural China: the mediating role of emotional exhaustion and the moderating role of occupational commitment

BACKGROUND

Family doctors in rural China are the main force for primary health care, but the workforce has not been well stabilized in recent years. Surface acting is an emotional labor strategy with a disparity between inner feelings and emotional displays, provoking negative effects such as emotional exhaustion, occupational commitment reduction, and, consequently, increasing turnover rate. With the Conservation of Resources theory, this study explores how the surface acting of rural family doctors affects turnover intention through emotional exhaustion and investigates what role occupational commitment plays in this relationship.

METHODS

With a valid response rate of 93.89%, 953 valid data were collected by an anonymous self-administered questionnaire survey in December 2021 in Shandong Province, China. Cronbach's Alpha and confirmatory factor analysis (CFA) were used to estimate reliability and construct validity, respectively. The PROCESS macro in SPSS was performed to analyze the mediating and moderated mediation effects of surface acting, emotional exhaustion, occupational commitment, and turnover intention.

RESULTS

Reliability and validity indicated that the measurement instruments were acceptable. Surface acting had a direct positive effect on turnover intention (β = 0.481, 95% CI [0.420, 0.543]). Emotional exhaustion partially mediated the effect of surface acting on turnover intention (indirect effect: 0.214, 95% CI [0.175, 0.256]). Occupational commitment moderated the effect of emotional exhaustion on turnover intention (β = - 0.065, 95% CI [- 0.111, - 0.019]), and moderated the indirect effect of surface acting on turnover intention via emotional exhaustion (index of moderated mediation: - 0.035).

CONCLUSIONS

Emotional exhaustion partially mediates the relationship between surface acting and turnover intention among family doctors in rural China, and occupational commitment moderates the direct effect of emotional exhaustion on turnover intention and further moderates the mediating effect. Policymakers should pay more attention to the effects of emotional labor and emotional resource depletion on the stability of rural health human resources.

Playing the Role of a Nurse in a Virtual Reality Simulation: A Safe Environment for Emotion Management

BACKGROUND

Nurses' successful emotional coping with unpleasant emotions triggered by intense clinical situations is associated with better-quality patient care. Nursing students experience significant challenges with managing their emotions in clinical practice.

PURPOSE

To evaluate a virtual reality (VR)-based simulation as a platform for emotional management training.

METHODS

A pretest-posttest research design was used to study sophomore nursing students (n = 75) while learning with a VR simulation.

RESULTS

Playing the role of a nurse in a VR hospital triggered an emotional dissonance to uncover students' management strategies, specifically deep cognitive acting and surface acting strategies. Surface acting emphasizes emotions that are displayed but not genuinely experienced and was negatively associated with posttest knowledge scores (r =-0.34, P < .05).

CONCLUSION

Learning with VR can provide a safe environment both for acquiring knowledge and for revealing students' emotional management, which, in turn, can be leveraged by educators to redirect the emotion work required in the nursing profession.

Shared Decision-Making in Hemophilic Arthropathy Rehabilitation: A Qualitative Study

PURPOSE

To probe into the needs and barriers underlying patients' participation in shared decision-making related to rehabilitation nursing for hemophilic arthropathy.

PATIENTS AND METHODS

The phenomenological research approach was adopted to conduct a series of semi-structured, in-depth interviews with 15 patients with hemophilic arthropathy undergoing rehabilitative treatments, 10 caregivers, and 7 healthcare providers from a hemophilia treatment center in Shanxi province, China. Colaizzi's seven-step method of data analysis was applied to organize, analyze, and extract the themes from the interview materials.

RESULTS

Three main themes emerged from the analysis: the status quo of the healthcare system (insufficient decision support systems and mismatch between healthcare providers' and patients' resources), circumstances of provider-patient interactions (lack of information exchange and unbalanced power structure between healthcare providers and patients), and patient-related factors influencing participation in decision-making (lack of self-efficacy, personal characteristics, family and social decision support, and attitude toward participation in decision-making).

CONCLUSION

Participation in rehabilitation decision-making among patients with hemophilic arthropathy is affected by multiple barriers. Healthcare professionals should improve their understanding of shared decision-making, offer patients active guidance on participating in the decision-making process, prioritize their affective needs, and formulate professional and effective solutions to support shared decision-making as early as possible.

Virtual reality stimulation and organizational neuroscience for the assessment of empathy

This study aimed to evaluate the viability of a new procedure based on machine learning (ML), virtual reality (VR), and implicit measures to discriminate empathy. Specifically, eye-tracking and decision-making patterns were used to classify individuals according to their level in each of the empathy dimensions, while they were immersed in virtual environments that represented social workplace situations. The virtual environments were designed using an evidence-centered design approach. Interaction and gaze patterns were recorded for 82 participants, who were classified as having high or low empathy on each of the following empathy dimensions: perspective-taking, emotional understanding, empathetic stress, and empathetic joy. The dimensions were assessed using the Cognitive and Affective Empathy Test. An ML-based model that combined behavioral outputs and eye-gaze patterns was developed to predict the empathy dimension level of the participants (high or low). The analysis indicated that the different dimensions could be differentiated by eye-gaze patterns and behaviors during immersive VR. The eye-tracking measures contributed more significantly to this differentiation than did the behavioral metrics. In summary, this study illustrates the potential of a novel VR organizational environment coupled with ML to discriminate the empathy dimensions. However, the results should be interpreted with caution, as the small sample does not allow general conclusions to be drawn. Further studies with a larger sample are required to support the results obtained in this study.

A qualitative study of nursing practitioners' experiences with COVID-19 patients dying alone in Greece

Background

In Greece, there is still limited research on death in isolation due to COVID-19. This deserves attention because of the recent financial crisis, which profoundly impacted public health, and the high relevance of the Hippocratic tradition to the moral values of clinical practice.

Methods

A prospective qualitative study using in-depth interviews with 15 frontline nursing practitioners working in a COVID-19 ward or intensive care unit (ICU) was conducted from July 2021 to December 2021.

Results

The inability of family members to say a final goodbye before, during, or after death by performing proper mourning rituals is extremely inhuman and profoundly impacts the mental health status of patients, family members, and nursing practitioners. Patients and their family members strongly desire to see each other. Epidemiology, liability, and proper nursing performance emerged as reasons for the enforced strict visitation restrictions. Participants emphasized that visitations should be allowed on an individual basis and highlighted the need for the effective use of remote communication technology, which, however, does not substitute for in-person contact. Importantly, physicians allowed "clandestine" visits on an individual basis. Nursing practitioners had a strong empathic attitude toward both patients and their families, and a strong willingness to provide holistic care and pay respect to dead bodies. However, they also experienced moral distress. Witnessing heartbreaking scenes with patients and/or their families causes nursing practitioners to experience intense psychological distress, which affects their family life rather than nursing performance. Ultimately, there was a shift from a patient-centered care model to a population-centered care model. Furthermore, we identified a range of policy- and culture-related factors that exaggerate the negative consequences of dying alone of COVID-19.

Conclusion

These results reinforce the existing literature on several fronts. However, we identified some nuances related to political decisions and, most importantly, convictions that are deeply rooted in Greek culture. These findings are of great importance in planning tailored interventions to mitigate the problem of interest and have implications for other similar national contexts.

Beyond Competence: Efficiency in American Biomedicine

"Competence" is a longstanding value of American biomedicine. One underidentified corollary of competence is efficiency: at once a manifestation of competence, a challenge to competence, and a virtue in its own right. We will explore the social construction of efficiency in US undergraduate medical education through an analysis of its sociocultural and technological landscapes. We present qualitative data from two allopathic medical school field sites in the Midwestern United States, where medical students' careful selection of certain learning resources and overall perspectives on the curriculum underscore their focus on efficiency and pragmatic approaches to knowledge. In the discussion, we consider the ethical implications of physician efficiency, as well as future trajectories for the study of efficiency in the medical social sciences, bioethics, and medical education. We posit that efficiency is at the theoretical heart of US medical practice and education: a finding that has wide-reaching implications for how researchers conceptualize the enterprise of biomedicine across cultural contexts and interpret the lived experiences of physicians, medical students, and other clinicians.

Motivating change in resident language use through narrative medicine workshops

BACKGROUND

There are many ways that students and trainees learn to talk about patients. The way trainees and physicians use language during clinical care is important, as labeling patients can have adverse effects on patient safety. Communication is considered a core competency by The Accreditation Council on Graduate Medical Education (ACGME). Past research has shown that participants in narrative medicine curricula report developing stronger communication skills however it is not clear how these workshops motivated trainees to use language differently during patient care. To explore this, we interviewed second-year residents in academic year 19-20 about their experiences both in participating in narrative medicine workshops and giving patient care.

METHODS

The framing context for this constructivist thematic analysis is a series of narrative medicine workshops facilitated for interns in an internal medicine residency program at a large academic medical center during the 18-19 academic year. We developed a semi-structured interview study that allowed residents to reflect on their experiences in these workshops. Eighteen out of 60 residents (30%) were interviewed.

RESULTS

We found that sessions regarding language use in patient care shaped how interns thought about and used language during clinical work, a finding that arose spontaneously during interviews.

CONCLUSIONS

Our research suggests that workshops aimed specifically at addressing the use of language in healthcare can have meaningful impact on trainees. Our study makes a unique contribution to the scholarship by suggesting that training in narrative medicine can lead to a change in the way that trainees use language during their clinical work.

Online student culture as site for negotiating assessment in medical education

Classic studies of medical education have examined how professional socialization reproduces the prevailing professional culture, as well as how students actively negotiate their place in educational processes. However, sociological research has not re-examined student culture in light of structural transformations in medical education, such as the introduction of new assessment types and their use as modes of commensuration. In this paper, we examine data from two studies of online forums where medical trainees and applicants to medical school discuss their experiences preparing for tests of professional skills, including judgment, empathy, and communication. Examining how medical students talk about these tests on such forums allows us to understand the meaning-making processes at work as students negotiate the commensuration processes such tests enable. We examine how these negotiations take place in online forums, where participants confront common challenges, form common perspectives, and share common solutions, all hallmarks of student culture. Through qualitative analysis, we find that online communities are spaces where students grapple with these new forms of commensuration, interrogate the standards and quantifications that underlie them, and collectively negotiate how to approach these assessments. Using the case of online forum communities, our findings advance past work on student culture in medical sociology by theorizing student culture as an extra-organizational phenomenon that spans multiple career stages. In so doing, we highlight the importance of online forum data for studying social processes.

"Doing Good" in U.S. Cancer Genomics? Valuation practices across the boundaries of research and care in rural community oncology

Genomic Tumour Testing (GTT) is an emerging site of "experimental care" in oncology [Cambrosio, Alberto, Peter Keating, Etienne Vignola-Gagné, Sylvain Besle, and Pascale Bourret. 2018a. "Extending Experimentation: Oncology's Fading Boundary Bbetween Research and Care." New Genetics and Society 37 (3): 207-226. doi: 10.1080/14636778.2018.1487281]. Few efforts to implement GTT have reached community oncology practices or patients living in rural communities within the US. Drawing on interdisciplinary research on a state-wide cancer genomics initiative in the rural US state of Maine, this paper explores the valuation practices within community oncologist and cancer stakeholders accounts of "doing good" within genomic science and care. We contribute to STS literatures on the bio-economy by highlighting the affective dimensions of strategies for managing economic and non-economic values. Clinician and stakeholders negotiated de-economizing and capitalizing modes of doing good as they built local genomic platforms "for Maine." These situated modes of doing good and feeling good via cancer genomics shaped how they navigated the ethical ambiguities of US biomedical markets across the boundaries of research and care.

Predictive Factors of the Burnout Syndrome Occurrence in the Healthcare Workers During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic is probably the most critical epidemiological situation that human civilization has faced in the last few decades. In this context, of all the professional categories involved in the management of patients with COVID-19 are the most likely to develop burnout syndrome. The main objective of this study is to analyze specific predictive factors of the occurrence and development of the burnout syndrome in the healthcare workers involved in the diagnosis and treatment of patients with COVID-19. The study focused on determining factors of the occurrence, development and maintaining the specific burnout syndrome related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic infection. The study was conducted on a sample of 959 participants, medical personnel from all the public medical entities in Romania(including 5 hospitals): 122 male and 755 female (82 participants did not declare their gender), with a mean age of 42.29 years (SD = 9.97). The sample included 219 doctors, 477 nurses, 214 auxiliary medical personnel and 49 other types of hospital workers. A cross-sectional design was used. Three predictors of the burnout syndrome were identified: Work conditions, Fear of the consequences (including death) determined by the COVID-19 and Need for emotional support. Meaning of work had a moderating role. Several moderated mediation models were tested. The indirect relationship of Work conditions with burnout via Fear of infection was statistically significant; in addition, the indirect effect of Work conditions on burnout through both fear of infection and need for support was statistically significant. The moderation analysis showed that Meaning of work buffer the relationship between Work conditions and Fear of infection. The variance explained by the model including the moderator (30%) was higher than the variance explained by Model 1 (27%), showing that adding the moderating effect of Meaning of work to the relationship of Work conditions with burnout was relevant. The results could be used to design specific interventions to reduce the occurrence of the burnout syndrome in healthcare workers, the implementation of a strategy to motivate employees by highlighting and recognizing the high significance of the work of those in the frontline of the fight against COVID-19.

Engendering connection: The embodied emotional labor of U.S. cosmetic surgeons

Emotional labor has typically been analyzed as a gendered phenomenon in managed workers like nurses. Broadening this frame, this study analyzes how a different strata of workers perform emotional labor: surgeons. Drawing on 42 in-depth interviews with U.S. cosmetic surgeons and a content analysis of online reviews by patients, we argue that cosmetic surgeons perform both intimate and professionalized strategies of emotional labor to build long-term relationships with patients. We highlight how some surgeons strategically use their gender and bodies to forge emotional connections with patients, combining physician authority and their own embodied experiences. We identify two intimate, embodied strategies of emotional labor used by cosmetic surgeons (Paternalistic and Empathic) which are highly gendered and two additional strategies that more closely resemble professional norms (Egalitarian and Technical). Cosmetic surgeons can and do switch between strategies, subject to the constraints of gender norms and expectations; embodied strategies have different payoffs for men and women. Women surgeons, in particular, may sometimes adopt professionalized strategies of emotional labor to assert their physician authority and status and resist expectations of feminized emotional labor. In commercialized medicine, emotional labor enables elite healthcare providers to negotiate power dynamics with dependent patients. In addition to making patients feel better, embodied labor can confer meaning on surgeons' work.

Reliability of Greek version of the Toronto empathy questionnaire in medical students and associations with sociodemographic and lifestyle factors

BACKGROUND

Empathy is an important key driver of any therapeutic relationship. It is beneficial for both physicians and patients. Enhancing physician's empathy should be an important goal of medical education. As there was a literature gap regarding the topic of empathy among medical students in Greece, this study aimed to contribute to filling this gap.

METHODS

A cross-sectional study was conducted. A socio-demographic questionnaire and the 52-item Greek version of the Toronto composite empathy scale (TCES) for measuring the cognitive and emotional aspects of empathy in both personal and professional life was administered to all the medical students in the Aristotle University of Thessaloniki, in Greece. Descriptive statistics were displayed for demographics. The associations of the variables were quantified by Chi-2 independence tests and Pearson's Correlation Coefficient. The reliability and validity of the questionnaire was determined by Cronbach's α, Hotelling's T-Squared Test, and Pearson correlation. Paired and Independent Sample T-Tests and One-way ANOVAs indicated statistically significant mean differences among the variables or subgroups of the variables.

RESULTS

The 52-item TCES, 26 for the personal (Per) setting and another 26 for professional (Pro) life, equally divided into cognitive (Cog) and emotional (Emo) empathy in each case. The overall reliability of the TCES questionnaire was found to be high (Cronbach's α = 0.895, significant positive correlations between the subscales). The mean total score of empathy showed that students had a moderately high empathy. Further, there was a statistically significant difference in means between the Per-Cog and Per-Emo settings (p < 0.001), the Pro-Cog and Pro-Emo (p < 0.001), the Per-Cog and Pro-Cog (p = 0.004), and the Per-Emo and Pro-Emo (p < 0.001). Females had significantly higher empathy scores (mean score 208.04) than males (192.5) on the Per-Cog, Per-Emo and Pro-Emo subscales. Furthermore, a positive correlation was found between empathy and factors such as love for animals, interest in medical ethics, belief in God, having an ill person in the family, class year or carrier intention.

CONCLUSIONS

The TCES is applicable to medical students. For the most part our findings were consistent with previous literature. However, we identified some nuances that might draw researchers' attention. The results of this study may contribute to plan interventions in the curriculum to enhance empathy in the medical students.

A qualitative exploration of "empathic labor" in Chinese hospice nurses

Background

Hospice nurses may devote more emotional labor during the empathy process with patients, and this empathy can be used as a form of psychological behavior of emotional labor in the hospice care model. The aim of this study was to analyze hospice nurses’ empathy characteristics in the context of emotional labor theory, and explore the impact of empathy on patient care.

Methods

We conducted semi-participant observations from three hospitals and multicenter in-depth interviews with n = 26 hospice nurses from eight cities. Interviews were transcribed, and directed content analysis was applied.

Results

Two categories with four sub-categories were extracted from the data analysis. Category 1 described the “empathic labor” process which covers cognitive empathy (including empathic imagination, empathic consideration, and empathic perception) and affective empathy (including natural empathy, surface empathy, and deep empathy). The second category concerns the outcome of nurses’ “empathic labor” which incorporates both positive and negative effects.

Conclusions

The findings indicated that hospice nurses’ empathy process should be understood as emotional labor. Nursing managers should pay more attention to raising the ability of deep empathy with hospice nurses, and explore more sufficient active empowerment strategies to alleviate the negative impact of empathy on nurses and to strengthen nurses' deep empathy with terminal ill patients.

Learning to Practice Compassionate Care: Medical Students Discuss Their Most Memorable Lessons

Compassion in interactions between physicians and patients can have a therapeutic effect independent of the technical medical treatment provided. However, training physicians to effectively communicate compassion is challenging. This study explores how medical students experienced training focused on interacting with patients by examining students’ reports of particularly memorable lessons. Six focus groups were conducted with medical students (total n = 48) in their fourth year of training. We report on responses from students to the question, “What was the most memorable lesson you have learned about interacting with patients?” Students discussed lessons aimed at patient-centered physical navigation, interpersonal navigation, and perspective taking. Concerns were raised that navigation techniques felt inauthentic and that perspective taking was too time consuming to be sustainable in actual practice. While perspective-taking exercises should motivate medical students to treat every patient with dignity by demonstrating the complexity of others’ lives, if students assume that full understanding is a prerequisite to delivery of compassionate care, they may dismiss explicit techniques of patient-centered care as inauthentic and perceive compassion and efficiency as mutually exclusive.

Challenging the clinically-situated emotion-deficient version of empathy within medicine and medical education research

In this paper, we argue that the notion of a clinically-situated empathy (e.g. physician empathy), is potentially problematic as it perpetuates an emotion-deficient version of empathy within medicine and medicine education research. Utilizing classic and contemporary empathy theory from various social science disciplines, we discuss how empathy in the general sense differs conceptually from clinically-situated empathy-paying particular attention to the role of emotional contagion. To highlight this contrast, we draw upon Hojat et al.'s model of physician empathy and how this body of work reflects broader medical-cultural norms that problematize the role and impact of emotions within the clinical encounter. Alternatively, we present a more encompassing model of empathy drawing upon the fields of social-psychology and social-neuroscience in order to bring the notion of "feeling with" and emotional contagion more specifically, into medical education, medical education research, and medicine more generally.

Association of Medical Student Characteristics and Empathy After a Communication Workshop

Medical education values patient-centered communication skills of responding to patient's emotions, however, guidance is limited on how to provide a well-rounded curriculum. This study examines the effect of a 90-minute communication workshop on the level of empathy of the 116 medical students who participated in the workshop. We used three psychometric categories from the Jefferson Scale of Empathy (JSE) as dependent variables. We conducted mixed analysis of variance (ANOVA) analyses to determine the change in empathy scores after the workshop, the main effects for gender and medical specialty, and their interaction with time. We found an increase in perspective taking and compassionate care scales, although no changes on walking in patients' shoes scale. Female and people-oriented specialty students scored higher on all scales. Some gender-specialty groups showed an empathy decrease: people-oriented specialty females on compassionate care scale and people-oriented and other specialty males on walking in patients' shoes scale. We concluded that communication training requires a multidimensional approach to target various areas of building empathy. Standardization of training should be embedded with empathy development within medical education curriculum.

'The hardest job I've ever done': a qualitative exploration of the factors affecting junior doctors' mental health and well-being during medical training in Australia

Background

Medical practitioners can experience considerable stress and poor mental health during their careers, with doctors in training known to be particularly vulnerable. Previous research has documented work-related factors that may play a role in the mental health status of junior doctors. However, these and additional factors, need to be explored further by considering theory-driven, social, structural and contextual issues. This qualitative study aimed to explore the experiences of junior doctors working in Australian hospitals to identify factors that impact their mental health during medical training.

Method

Semi-structured interviews were conducted with 12 junior medical officers (JMOs) employed across six hospitals in Australia. Transcribed de-identified interviews were analysed thematically using a data-driven inductive approach.

Results

Four interrelated main themes were identified: i) professional hierarchies; ii) occupational stress; iii) emotional labour, and iv) taking distress home; which detail the complex affective, relational and professional experiences of JMOs. The accounts demonstrate how the social, professional and organisational dimensions of these experiences impact upon trainee’s well-being and mental health, both positively and negatively. Together, the findings document the dynamic, nuanced aspects of junior doctors’ experiences of medical training and practice and highlights the importance of relational connections and the workplace environment in shaping JMOs’ social and emotional well-being.

Conclusion

The current study adds to the understanding of how junior doctors navigate medical training in Australian hospitals and highlights the complexities of this experience, particularly the ways in which mental health and well-being are shaped by different elements. These findings have important implications to inform new strategies to improve JMO mental health and to leverage work and non-work contexts to better support JMOs during medical training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07381-5.

Empathy and boundary turbulence in cancer communication

OBJECTIVES

To describe and deepen our understanding of patient-centeredness, empathy, and boundary management in challenging conversations. Previous studies show frequent physician self-disclosure, while empathy and boundary management are infrequent.

METHODS

Three standardized patients (SPs) portrayed cancer patients consulting a new community-based physician, resulting in 39 audio-recorded SP visits to 19 family physicians and 20 medical oncologists. Transcripts underwent qualitative iterative thematic analysis, informed by grounded theory, followed by directed content analysis. We further defined the identified communicative categories with descriptive and correlational calculations.

RESULTS

We identified patient-centered physician response categories--empathy, affirmation, and acknowledgement; and physician-centered categories-transparency, self-disclosure, and projection. Acknowledgement and affirmation responses were frequent and empathy rare. Physician transparency and self-disclosure were common. Useful and not useful self-disclosures were highly correlated; empathy, useful and not useful transparency, and projection were moderately correlated. Most physicians used self-disclosure but few of these were judged patient-centered.

CONCLUSIONS

Physicians expressing empathy and patient-centered transparency were also more likely to use projection and physician-centered transparency, thus engaging in communication "boundary turbulence." Patients may benefit from physicians' improved use of empathy and boundary management.

Resilience, Well-being, and Empathy Among Private Practice Physicians and Advanced Practice Providers in Texas: A Structural Equation Model Study

Objective

To investigate structural relationships of latent constructs such as occupational wellbeing, resilience, work meaningfulness, and psychological empowerment with affective and cognitive clinical empathy among a community of physicians and advanced practice providers.

Methods

We conducted a cross-sectional observational study. We gathered data by an anonymous self-administered multidimensional questionnaire disseminated electronically between March and May 2016. Participants were physicians and advanced practice providers belonging to the Health Texas Provider Network, a group private practice affiliated with the Baylor Scott and White Health system. We excluded allied health care staff (eg, nurses) and trainees (eg, residents, medical students). We pursued a 3-step strategy: (1) confirmatory factor analysis of a theory-driven measurement model, (2) a modified structural equation model from which pathways with nonsignificant path coefficients were deleted, and (3) multigroup analyses of the modified model.

Results

Cognitive empathy was the strongest predictor of affective empathy. We observed modest positive associations of resilience with cognitive and affective empathy and of well-being and meaning with affective but not with cognitive empathy. Resilience, meaning, and psychological empowerment were surprisingly negatively associated with well-being, suggesting diminished self-care among practitioners. Effects of psychological empowerment on empathy and well-being were mediated by resilience and meaning.

Conclusion

Cognitive empathy directly influenced affective empathy; well-being and meaningfulness exerted direct positive effects on affective but not on cognitive empathy, whereas resilience had direct positive associations with both empathy dimensions. Resilience and meaning manifested direct, negative associations with well-being, revealing clinicians’ disproportionate focus on patient care at the expense of self-care.

Hirshfield L. The Resurgence of Medical Education in Sociology: A Return to Our Roots and an Agenda for the Future

From 1940 to 1980, studies of medical education were foundational to sociology, but attention shifted away from medical training in the late 1980s. Recently, there has been a marked return to this once pivotal topic, reflecting new questions and stakes. This article traces this resurgence by reviewing recent substantive research trends and setting the agenda for future research. We summarize four current research foci that reflect and critically map onto earlier projects in this subfield while driving theoretical development elsewhere in the larger discipline: (1) professional socialization, (2) knowledge regimes, (3) stratification within the profession, and (4) sociology of the field of medical education. We then offer six potential future directions where more research is needed: (1) inequalities in medical education, (2) socialization across the life course and new institutional forms of gatekeeping, (3) provider well-being, (4) globalization, (5) medical education as knowledge-based work, and (6) effects of the COVID-19 pandemic.

The direct and indirect effects of clinical empathy on well-being among pre-medical students: a structural equation model approach

BACKGROUND

Empathy is a well-established facet of clinical competency that research suggests is associated with enhanced medical student well-being. Since little is known about empathy and well-being before students enter medical school-during pre-medical education-the main goal of this study is to test a conceptual model of how clinical empathy is related to two indicators of well-being, depression, and burnout among pre-medical students. The theoretical model hypothesizes that three dimensions of clinical empathy-Perspective-Taking, Compassionate Care, and Standing in Patients' Shoes- will be directly and negatively related to depression, as well as indirectly through its inverse relationship with three facets of burnout, Emotional Exhaustion, Poor Academic Efficacy, and Cynicism.

METHODS

Using survey data from a sample of 132 pre-medical students at an American Midwestern university, this study employs structural equation modeling (SEM) to test the theoretical model of the relationships between empathy, burnout, and depression among pre-medical students. We identify the direct effects of the three dimensions of the Jefferson Scale of Physician Empathy (JSE-S) on depression (CES-D), as well as the indirect effects of clinical empathy on depression through the three dimensions of the Maslach Burnout Inventory (MBI-S).

RESULTS

SEM analyses show that while none of the three dimensions of the JSE-S are directly related to depression, clinical empathy does significantly affect depression indirectly through burnout. Specifically, as predicted, we find that Perspective-Taking decreases Emotional Exhaustion, but, contrary to expectations, Compassionate Care increases it. And, the positive relationship between Compassionate Care and Emotional Exhaustion is particularly strong. In turn, Perspective-Taking and Compassionate Care are associated with depression in opposite directions and to different degrees.

CONCLUSIONS

Findings suggest that clinical empathy as measured by the JSE-S produces both positive and negative effects on personal well-being. We conclude that further conceptual clarity of clinical empathy is needed to better discern how the different dimensions impact different indicators of well-being. Given that pre-medical education is a crucial time for emotional socialization, the challenge for medical education will be fostering the positive, cognitive aspects of clinical empathy while simultaneously mitigating the adverse effects of affective empathy on medical student well-being.

Perceived organizational support and emotional labour among police communicators: what can organizational context tell us about posttraumatic stress?

OBJECTIVE

As central members of the emergency response system, communicators are regularly exposed to potentially traumatic events and experience some of the highest rates of posttraumatic stress. Given elevated rates of distress, they are regularly called upon to manage emotions-their own and others'-during high-risk and high-stress situations, within a highly controlled organizational context. Emotional labour (EL) theory suggests that many individuals faced with this challenge utilize a strategy in which emotions are suppressed or faked (surface acting-SA) in keeping with organizational expectations.

METHODS

This study was designed to examine the relationships among reported EL, perceived organizational support, job stress, and severity of posttraumatic stress among a population of communicators.

RESULTS

Job pressure and perceived lack of organizational support were positively associated with posttraumatic stress. Although the highest reported levels of SA occurred when interacting with members of the public, this SA was not associated with posttraumatic stress, unlike SA with co-workers and supervisors. SA with co-workers and supervisors was further related to perceptions of lack of organizational support.

CONCLUSION

Thus, an organization perceived as unsupportive may create a culture in which individuals are dissuaded from expressing true emotions with colleagues and supervisors, potentially magnifying the traumatic effects of exposure to critical incidents.

Analysis of Real-World Implementation of the Biopsychosocial Approach to Healthcare: Evidence From a Combination of Qualitative and Quantitative Methods

Aims: The modern medical model has been transformed into a biopsychosocial model. The integration of the biopsychosocial approach in healthcare can help improve the effectiveness of diagnosis and treatment. This study explored the actual application of the biopsychosocial approach in healthcare and provides a basis for targeted interventions to promote the biopsychosocial approach in healthcare. Methods: Study 1 involved one-on-one interviews with 30 medical staff and focus group interviews with 16 recent patients. Study 2 was a cross-sectional survey of 13,105 medical staff in Hangzhou, China that analyzed the status quo implementation of the biopsychosocial approach in healthcare. Results: Study 1 found that medical staff did not welcome patients to report information unrelated to their disease, hoping patients did not express their emotions. In the treatment process, patients believed that medical staff refused to attend to or did not encourage reporting of any information other than the disease, and that patients should have reasonable expectations for medical staff. Study 2 found that medical staff had a 37.5% probability of actively paying attention to the patient's psychosocial status. Female medical staff (38.5%) were actively concerned about the patient's psychosocial status significantly more than male medical staff (34.2%) (P < 0.01). The medical staff in the psychiatric department (58.4%) paid more active attention to the patient's psychosocial status than staff in the non-psychiatric departments (37.2%). Gender, department, hospital level, and professional title were the factors associated with the medical staff's attention to the patient's psychosocial status (P < 0.05). The influence of age on the probability of medical staff actively paying attention to the psychosocial status of patients increased with the number of years of employment. Participants that were 31-40 years old, had an intermediate professional title, and 11-15 years of employment were the least likely to actively pay attention to patients' psychosocial status. Conclusion: Although the biopsychosocial approach has been popularized for many years, it has not been widely used in medical care. Medical staff pay more attention to patients' physical symptoms and less attention to patients' psychosocial status. It is recommended that training will be provided to medical personnel on implementing a biopsychosocial approach with particular attention to the sociodemographic characteristics of medical personnel. Additionally, we propose helping patients set reasonable expectations, and formulating guidelines for implementing the biopsychosocial approach.

Disciplining empathy: Differences in empathy with U.S. medical students by college major

Citing their students' low levels of empathy, medical educators have scrambled to implement curricula with the hopes of buffering against the corrosive effects of biomedical and clinical experiences in medical school. The assumption undergirding these studies by social scientists and medical educators alike is that immersion in biomedical education and clinical experience erodes students' empathic capacities, and that exposure to humanities and social sciences content will amend these losses. But we do not know if this assumption is correct. In this project, we empirically assess this assumption by utilizing a unique data set constructed from student applicant and survey data from the American Medical College Application Service (AMCAS) and the Association of American Medical Colleges (AAMC). We test whether medical school students (N = 8255) from the United States (U.S.) with different academic backgrounds represented by their college major have different levels of empathy, net of demographic control variables. We report two findings. First, we find that students who majored in humanities or interpretive social sciences disciplines have higher empathy scores than their peers who majored in the positivistic social sciences and STEM (science, technology, engineering, and mathematics) disciplines. Second, we find that the relationship between empathy and time in medical school is more nuanced than we would expect from the existing literature.