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Li P, Weng L, Dong L. Empathy ability and influencing factors among pediatric residents in China: a mixed-methods study. BMC MEDICAL EDUCATION 2024; 24:955. [PMID: 39223586 PMCID: PMC11370118 DOI: 10.1186/s12909-024-05858-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Empathy is one of the fundamental factors enhancing the therapeutic effects of physician-patient relationships, but there has been no relevant research in China on the pediatric resident physicians' capacity for empathy or the influencing factors. METHODS A mixed-methods study was undertaken. The student version of the Jefferson Scale of Empathy was used to assess 181 postgraduate residents at Shanghai Children's Medical Center and Shanghai Children's Hospital. Differences in empathy ability among pediatric resident physicians of different genders and specialties were analyzed using independent sample t-tests and Mann-Whitney U tests. A one-way analysis of variance was used to analyze the differences in empathy ability at different educational levels and years of medical residency training. Seven third-year postgraduate pediatric residents from Shanghai Children's Medical Center participated in semi-structured interviews exploring the influencing factors. We analyzed the interview transcripts using thematic analysis. RESULTS The scale was completed by 154 pediatric residents. No statistically significant differences in empathy were found between educational level, postgraduate year, gender, or specialty. The factors influencing empathy in doctor-patient communication included the person who accompanied the child to see the doctor, how the children cooperated with doctors for medical treatment, the volume of pediatric outpatient and emergency visits, and the physician's ability to withstand pressure. All interviewed resident physicians regarded learning empathy as important but rarely spent extra time learning it. CONCLUSIONS The evaluation results of resident physicians on changes in empathy after improving clinical abilities vary according to their understanding of empathy, and the work environment has an important impact on pediatricians' empathy ability. Their empathy score is relatively low, and this requires exploration and intervention.
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Affiliation(s)
- Pingping Li
- Department of Pediatric Clinical Medicine School, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Ling Weng
- Department of Science and Education, Fujian Maternity and Child Health Hospital, Fujian, 350000, China
| | - Lu Dong
- Department of Pediatric Clinical Medicine School, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
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Noonan M, Brown M, Gibbons M, Tuohy T, Johnson K, Bradshaw C, Tighe SM, Atkinson S, Murphy L, Mohamad M, Imcha M, O'Dwyer N, Grealish A. Evaluation of the effectiveness of a video-based educational intervention on perinatal mental health related stigma reduction strategies for healthcare professionals: A single group pre-test-post-test pilot study. Midwifery 2024; 136:104089. [PMID: 38968682 DOI: 10.1016/j.midw.2024.104089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 06/24/2024] [Accepted: 06/30/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Healthcare professionals have a role to play in reducing perinatal mental health related stigma. AIM To assess the effectiveness of a video-based educational intervention developed to provide guidance to healthcare professionals on perinatal mental health related stigma reduction strategies. DESIGN A single group pre-test-post-test pilot study with no control group. SETTING(S) A university affiliated maternity hospital in Ireland PARTICIPANTS: A convenience sample of registered midwives, nurses and doctors (n = 60) recruited from October 2020-January 2021. INTERVENTION A twenty-minute video-based educational intervention. METHODS Respondents (n = 60) completed a pre-test (time point one) and post-test (time point-two) questionnaire, and a three-month follow-up post-test questionnaire (time point-three) (n = 39). The questionnaire included the Mental Illness Clinicians' Attitudes Scale, Reported and Intended Behaviour Scale, Reynolds Empathy Scale and open-ended questions. Wilcoxon Signed Rank Test was selected to evaluate the pre-test post-test scores. RESULTS The difference in mean Mental Illness: Clinicians' Attitudes-4 scores were statistically significant between time points one and three (z = 3.27, df=36, P = 0.0007) suggesting more positive attitudes towards people with mental health conditions after the intervention. The mean total score for the Reported and Intended Behaviour Scale increased from 18.7 (SD 1.87) at time point one to 19.2 (SD 1.60) at time point two (z= -3.368, df=59, P = 0.0004) suggesting an increase in positive intended behaviours towards those with mental health issues immediately following the intervention. These findings were also corroborated by responses to open-ended survey questions. CONCLUSIONS Further research with a larger sample of healthcare professionals evaluated over a longer period would provide further evidence for the sustainability of the intervention. TWEETABLEABSTRACT A video-based intervention can increase healthcare professionals' knowledge of perinatal #mentalhealth related stigma reduction strategies @Journal. Link to article.
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Affiliation(s)
- Maria Noonan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Melissa Brown
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Maria Gibbons
- University Maternity Hospital Limerick, Limerick, Ireland
| | - Teresa Tuohy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Kevin Johnson
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Carmel Bradshaw
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Sylvia Murphy Tighe
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Sandra Atkinson
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Louise Murphy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Mas Mohamad
- University Maternity Hospital Limerick, Limerick, Ireland
| | | | - Niamh O'Dwyer
- University Maternity Hospital Limerick, Limerick, Ireland
| | - Annmarie Grealish
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland; Kings Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK.
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Arps S, Noviski KM, Tucker L, Tutwiler A. Medical students' motivations for participating in an elective focused on social inequalities and health disparities. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1353-1378. [PMID: 38315269 PMCID: PMC11369016 DOI: 10.1007/s10459-024-10313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
In this study, we examine students' reasons for pursuing elective training focused on medical racism and systemic health inequities at a midwestern medical school. Data collection included semi-structured interviews with students who participated in an optional course focused on these topics. We analyzed their motivations, goals, and interests using reflexive thematic analysis and created three themes based on students' responses. Theme (1) "pre-existing conditions" focuses on students' knowledge, beliefs, worldviews and experience prior to the class. Theme (2) "enacting change" examines their desires to become effective physicians and improve medicine overall. Theme (3) "creating community" considers their preferences for a supportive and connected learning and social environment. We discuss the findings within the context of adult learning theory and Self-Determination Theory. The research provides insight about the overt and underlying factors that drive medical students' participation in training focused on social inequality. We also share recommendations for curriculum development and future research based on the patterns we found in students' discussions of their needs and expectations.
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Affiliation(s)
- Shahna Arps
- Department of Sociology and Anthropology, University of Toledo, Toledo, OH, USA.
| | | | - Lauren Tucker
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Ameisha Tutwiler
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Herber-Valdez CR, Blow JA, Salazar TT, Horn KV, Herrera DG, Lacy NL, Beinhoff L, de la Rosa JM. The integrated curriculum and student empathy: a longitudinal multi-cohort analysis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1131-1153. [PMID: 37946064 PMCID: PMC11368989 DOI: 10.1007/s10459-023-10292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
Research has demonstrated erosion of empathy in students during medical education. Particularly, U.S. studies have demonstrated empathy declines during clinical training in the third and fourth year of traditional medical programs. Yet, studies conducted outside the U.S. have not confirmed this trend. Timing and extent of patient interactions have been identified as empathy-protective factors. The need to examine empathy within different learning contexts has been noted, as has the need for longitudinal and time-series research designs to analyze trajectories. Between fall 2010 and spring 2019, we assessed empathy longitudinally among six student cohorts (N = 493) at a U.S. medical school, where patient interaction occurs early and throughout an integrated curriculum. Empathy levels of students in each cohort were assessed at five time points utilizing the Jefferson Scale of Physician Empathy-Student version. We hypothesized empathy levels will not degrade by program end, and trajectories will not show patterns of decline in Years Three and Four. Analysis of Variance (ANOVA) and Linear Mixed Model (LMM) analyses were used to analyze differences at baseline and changes in empathy trajectories. ANOVA analyses revealed statistically significant differences at baseline by class cohort (F(5, 487) = [23.28], p < 0.001). LMM analyses indicated empathy was either significantly higher or not different at the end of the program (F(19, 1676) = [13.97], p < 0.001). Empathy trajectories varied among cohorts; yet, none resulted in an overall empathy decline by the end of the program. Findings demonstrate empathy in U.S. medical students can be unchanged or higher by the end of medical education. Outcomes are consistent with reports of non-declining medical student empathy outside the U.S. and support the notion of context-specificity. Results further support recent research, suggesting decreases in empathy during training can stabilize or increase by program end. These findings have important implications for future empathy research context and design considerations, as well as program planning.
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Affiliation(s)
- Christiane R Herber-Valdez
- Office of Academic Affairs, Texas Tech University Health Sciences Center at El Paso, 5001 El Paso Drive, El Paso, TX, 79905, USA.
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA.
| | - Julie A Blow
- Office of Institutional Research and Effectiveness, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
| | - Tammy T Salazar
- Department of Family Medicine, Paul L. Foster School of Medicine, Office of Academic Support, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
- The University of Texas at El Paso, El Paso, TX, USA
| | - Kathryn V Horn
- Paul L. Foster School of Medicine, Office of Student Services, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
- University of Houston College of Medicine, Houston, TX, USA
| | - Dyanne G Herrera
- Office of Institutional Research and Effectiveness, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
- Texas Department of Health, Austin, TX, USA
| | - Naomi L Lacy
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
| | - Lisa Beinhoff
- Libraries of the Health Sciences, Texas Tech University Health Sciences Center at El Paso, El Paso, USA
| | - J Manuel de la Rosa
- Department of Pediatrics Paul L. Foster School of Medicine, Office of Outreach and Community Engagement, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA
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5
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Britz V, Sterz J, Koch Y, Schreckenbach T, Stefanescu MC, Zinßer U, Verboket RD, Sommer K, Ruesseler M. Impact of simulated patient-based communication training vs. real patient-based communication training on empathetic behaviour in undergraduate students - a prospective evaluation study. BMC MEDICAL EDUCATION 2024; 24:870. [PMID: 39134984 PMCID: PMC11318334 DOI: 10.1186/s12909-024-05801-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/19/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Empathy is a key competency and is essential for doctor-patient relationships. Studies have proven a continuous reduction of empathy in medical students during their study period. The use of SPs is positively evaluated for competency acquisition and real patient communication training has positive effects on empathy empowerment. Therefore, the present study focusses on the impact of simulated patient (SP) vs real patient (RP) communication training on empathetic behaviour in undergraduate medical students. METHODS The prospective evaluation took place during a 210-minute skills lab unit on medical communication for 3rd year medical students. Study participants were allocated in advance to one of three groups: one group trained with an SP (SP-group) and was informed about the fact that it was an SP; another group trained with an SP but assumed to encounter an RP (incognito patient group (IP-group)); the last group trained with an RP and was correctly informed about it (real patient group (RP-group). Self-assessed empathy was measured by using Jefferson Scale of Physician Empathy (JSPE) and Interpersonal Reactivity Index (IRI), as these are the most commonly used instruments for assessing empathy. Study participants were evaluated on empathetic behaviour by their group-associated patient using the Consultation and Relational Empathy (CARE) scale. RESULTS 146 students participated. There was no significant difference in self-assessed empathy between groups for JSPE and IRI. External assessment via CARE showed a statistically significant difference between SP-group and IP-group , as well as between SP-group and RP-group. There was no significant difference between IP-group and RP-group. This means that students training with real patients (or who believed them to be real) did receive significantly lower performance ratings on their empathy. CONCLUSION The results demonstrate a significant lower external empathy rating for students who had trained with a real patient or if they were in the belief of having encountered a real patient; this may be due to inhibitions and a lack of routine. Therefore, we recommend implementing SPs in the early study period with the gradual integration of RPs in the student's further course of study.
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Affiliation(s)
- Vanessa Britz
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany.
| | - Jasmina Sterz
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany
- Goethe-University Frankfurt, University Hospital, Department of Trauma Hand and Reconstructive Surgery, Frankfurt/Main, Germany
| | - Yannik Koch
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany
| | - Teresa Schreckenbach
- Goethe University Frankfurt, University Hospital Frankfurt, Department of General, Visceral, Transplantation and Thoracic Surgery, Frankfurt/Main, Germany
| | - Maria-Christina Stefanescu
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany
- Johannes Gutenberg University, Medical Center Mainz, Department of Pediatric Surgery, Mainz, Germany
| | - Uwe Zinßer
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany
| | - Rene Danilo Verboket
- Goethe-University Frankfurt, University Hospital, Department of Trauma Hand and Reconstructive Surgery, Frankfurt/Main, Germany
| | - Katharina Sommer
- Goethe-University Frankfurt, University Hospital, Department of Trauma Hand and Reconstructive Surgery, Frankfurt/Main, Germany
| | - Miriam Ruesseler
- Goethe University Frankfurt, Medical Faculty, Institute for Medical Education and Clinical Simulation, Frankfurt/Main, Germany
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Ardenghi S, Russo S, Rampoldi G, Bani M, Strepparava MG. Does Medical Curriculum Impact on Empathy? A Longitudinal Study in a Sample of Undergraduate Medical Students. MEDICAL SCIENCE EDUCATOR 2024; 34:873-881. [PMID: 39099873 PMCID: PMC11297006 DOI: 10.1007/s40670-024-02053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 08/06/2024]
Abstract
Empathy in medical students is receiving increasing attention as it is fundamental to build and develop a functional patient-physician relationship. When looking at its determinants, demographic and academic factors seem to concur in shaping empathy in this population. Although data show strong gender differences and changes in empathy throughout medical school, it is not clear the direction of these changes and whether gender and curriculum features modulate them. This longitudinal study examined changes in empathy and explored gender differences throughout the medical school. Four consecutive cohorts of Italian medical students (N = 336) completed the Jefferson Scale of Empathy - Student (JSE-S) and the Interpersonal Reactivity Index (IRI) in their second year of study (before any clinical clerkship and communication skills courses) and fifth year of study (after a 2-year clinical clerkship and communication skills courses). Analysis of variance for repeated-measures revealed that, beyond the effect of gender, JSE-S total score and IRI Perspective Taking increased, whereas IRI Personal Distress and IRI Fantasy significantly decreased throughout medical school. No significant change in IRI Empathic Concern emerged over time. Student's t-tests showed that female students displayed significantly higher mean scores than their male counterparts for all empathy measures in both their second and fifth years of medical training. The findings suggest that the medical curriculum affects self-reported empathy dimensions among undergraduate medical students. Further research is needed to deepen the understanding of the educational factors that promote the changes in empathy levels during medical training.
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Affiliation(s)
- Stefano Ardenghi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB Italy
- Fondazione I.R.C.C.S. San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, MB Italy
| | - Selena Russo
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB Italy
| | - Giulia Rampoldi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB Italy
| | - Marco Bani
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB Italy
| | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB Italy
- Fondazione I.R.C.C.S. San Gerardo dei Tintori, Via Pergolesi 33, 20900 Monza, MB Italy
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Fleck L, Amelung D, Fuchs A, Mayer B, Escher M, Listunova L, Schultz JH, Möltner A, Schütte C, Wittenberg T, Schneider I, Herpertz SC. Interactional competencies in medical student admission- what makes a "good medical doctor"? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10348-w. [PMID: 39008161 DOI: 10.1007/s10459-024-10348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 06/02/2024] [Indexed: 07/16/2024]
Abstract
Doctors' interactional competencies play a crucial role in patient satisfaction, well-being, and compliance. Accordingly, it is in medical schools' interest to select candidates with strong interactional abilities. While Multiple Mini Interviews (MMIs) provide a useful context to assess such abilities, the evaluation of candidate performance during MMIs is not always based on a solid theoretical framework. The newly developed selection procedure "Interactional Competencies - Medical Doctors (IC-MD)" uses an MMI circuit with five simulation patient scenarios and is rated based on the theoretically and empirically grounded construct of emotional availability. A first validation study with N = 70 first-semester medical students took place in 2021. In terms of convergent validity, IC-MD ratings showed strong correlations with simulation patients' satisfaction with the encounter (r =.57) but no association with emotional intelligence measures. IC-MD ratings were not related to high school performance or a cognitive student aptitude test, indicating divergent validity. Inter-rater reliability (ICC = 0.63) and generalizability (Eρ2 = 0.64) were satisfactory. The IC-MD proved to be fair regarding participants' age and gender. Participants with prior work experience in healthcare outperformed those without such experience. Participant acceptance of the procedure were good. The IC-MD is a promising selection procedure capable of assessing interactional competencies relevant to the medical setting. Measures of interactional competencies can complement the use of cognitive selection criteria in medical student admission. The predictive validity of the IC-MD needs to be addressed in future studies.
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Affiliation(s)
- Leonie Fleck
- Medical Faculty, Heidelberg University, Heidelberg, Germany
- Central Institute of Mental Health, Mannheim, Germany
| | | | - Anna Fuchs
- Department of Child & Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Benjamin Mayer
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Malvin Escher
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Lena Listunova
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | | | - Clara Schütte
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Tim Wittenberg
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Isabella Schneider
- Department of General Psychiatry, Heidelberg University Hospital, Voßstraße 4, 69115, Heidelberg, Germany.
| | - Sabine C Herpertz
- Medical Faculty, Heidelberg University, Heidelberg, Germany
- Department of General Psychiatry, Heidelberg University Hospital, Voßstraße 4, 69115, Heidelberg, Germany
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Teo MYK, Ibrahim H, Lin CKR, Hamid NABA, Govindasamy R, Somasundaram N, Lim C, Goh JL, Zhou Y, Tay KT, Ong RRS, Tan V, Toh Y, Pisupati A, Raveendran V, Chua KZY, Quah ELY, Sivakumar J, Senthilkumar SD, Suresh K, Loo WTW, Wong RSM, Pei Y, Sng JH, Quek SQM, Owyong JLJ, Yeoh TT, Ong EK, Phua GLG, Mason S, Hill R, Chowdhury AR, Ong SYK, Krishna LKR. Mentoring as a complex adaptive system - a systematic scoping review of prevailing mentoring theories in medical education. BMC MEDICAL EDUCATION 2024; 24:726. [PMID: 38970020 PMCID: PMC11225364 DOI: 10.1186/s12909-024-05707-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Effective mentorship is an important component of medical education with benefits to all stakeholders. In recent years, conceptualization of mentorship has gone beyond the traditional dyadic experienced mentor-novice mentee relationship to include group and peer mentoring. Existing theories of mentorship do not recognize mentoring's personalized, evolving, goal-driven, and context-specific nature. Evidencing the limitations of traditional cause-and-effect concepts, the purpose of this review was to systematically search the literature to determine if mentoring can be viewed as a complex adaptive system (CAS). METHODS A systematic scoping review using Krishna's Systematic Evidence-Based Approach was employed to study medical student and resident accounts of mentoring and CAS in general internal medicine and related subspecialties in articles published between 1 January 2000 and 31 December 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles underwent thematic and content analysis, with the themes identified and combined to create domains, which framed the discussion. RESULTS Of 5,704 abstracts reviewed, 134 full-text articles were evaluated, and 216 articles were included. The domains described how mentoring relationships and mentoring approaches embody characteristics of CAS and that mentorship often behaves as a community of practice (CoP). Mentoring's CAS-like features are displayed through CoPs, with distinct boundaries, a spiral mentoring trajectory, and longitudinal mentoring support and assessment processes. CONCLUSION Recognizing mentorship as a CAS demands the rethinking of the design, support, assessment, and oversight of mentorship and the role of mentors. Further study is required to better assess the mentoring process and to provide optimal training and support to mentors.
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Affiliation(s)
- Mac Yu Kai Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Halah Ibrahim
- Department of Medical Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Casper Keegan Ronggui Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, Singapore, #02-03, 117597, Singapore
| | - Nur Amira Binte Abdul Hamid
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Ranitha Govindasamy
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, Singapore, #02-03, 117597, Singapore
| | - Nagavalli Somasundaram
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Crystal Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Medical Social Services, Singapore General Hospital, Block 3, Singapore, 169854, Singapore
| | - Jia Ling Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Yi Zhou
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Ryan Rui Song Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Vanessa Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Youru Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Vijayprasanth Raveendran
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Jeevasuba Sivakumar
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Samyuktha Dhanalakshmi Senthilkumar
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Keerthana Suresh
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Wesley Teck Wee Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Yiying Pei
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Julia Huina Sng
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Simone Qian Min Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Ting Ting Yeoh
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Road, Singapore, 574627, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK
| | - Ruaraidh Hill
- Health Data Science, University of Liverpool, Whelan Building The Quadrangle, Liverpool, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Anupama Roy Chowdhury
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Geriatric Medicine, Singapore General Hospital, Academia, Level 3, College Road, Singapore, 169608, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, Singapore, #02-03, 117597, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK.
- Health Data Science, University of Liverpool, Whelan Building The Quadrangle, Liverpool, Brownlow Hill, Liverpool, L69 3GB, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Bansal E, Rice T. Teaching Moral Courage & Rights-Based Leadership in Medicine: A Cross-Disciplinary Exploration. TEACHING AND LEARNING IN MEDICINE 2024:1-11. [PMID: 38956858 DOI: 10.1080/10401334.2024.2369611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/24/2024] [Indexed: 07/04/2024]
Abstract
Clinical medicine's complexities and demands often surpass the scope of formal ethics and leadership training that medical schools and residency programs provide. The discrepancy between medical education and the realities of clinical work may contribute to ethical erosion among learners, namely, medical students and residents. Unlike traditional approaches to teaching professional ethics and leadership in medicine, rights-based (aspirational) pedagogies approach trainees as autonomous moral agents, whose work has moral value to themselves and others, who live with the ethical consequences of their professional choices, and whose work shapes their individual moral character. By incorporating teaching strategies that intentionally build learners' rights-based leadership through the development of moral courage, medical educators may counter important aspects of ethical erosion while promoting learner preparedness, outcomes, and well-being. Military teaching approaches offer a valuable example to medical educators seeking to create structured curricula that foster moral courage to promote rights-based leadership, given the high level of moral and managerial complexity present in both medicine and the military. Through a comparative analysis of professional ethics in the medical and military disciplines, this Observation article explores the validity of applying precedents from military ethics and leadership education to medical training. Through arguments rooted in moral philosophy, military history, and military organizational research, we explore the expansion of rights-based teaching methods within the predominantly traditional and rules-based norms of medical education. In relating these findings to real-life clinical scenarios, we offer six specific, rights-based modifications to medical ethics curricula that have potential to promote morally courageous leadership and counteract the ethical erosion medical students and residents face.
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Affiliation(s)
- Esha Bansal
- Internal Medicine Residency Program, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy Rice
- Departments of Psychiatry and Medical Education, Icahn School of Medicine at Mount Sinai, Gustave L Levy Place, New York, New York, USA
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Atkinson P, Chandra K, Pulchan K, Helman A. Saving emergency medicine, part three: compassion. CAN J EMERG MED 2024; 26:449-451. [PMID: 38703267 DOI: 10.1007/s43678-024-00708-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Paul Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada.
| | - Kavish Chandra
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada
| | - Krishna Pulchan
- Department of Emergency Medicine, The Dr Everett Chalmers Regional Hospital, Dalhousie Medicine New Brunswick, Horizon Health Network, Fredericton, NB, Canada
| | - Anton Helman
- Department of Emergency Medicine, University of Toronto, Schwartz/Reisman Emergency Medicine Institute, North York General Hospital, Toronto, ON, Canada
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11
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Mohammadi M, Peyrovi H, Fazeli N, Parsa Yekta Z. Empathic Care Culture in Intensive Care Unit Nurses: A Focused Ethnographic Study. QUALITATIVE HEALTH RESEARCH 2024:10497323241240902. [PMID: 38876482 DOI: 10.1177/10497323241240902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Empathy is one of the important components in the patient-nurse relationship. The aim of the study was to explain the culture of empathic care in intensive care unit (ICU) nurses. The present focused ethnographic study was conducted in the cardiac surgery ICU in Tehran. Three methods of observation, interview, and review of existing documents were used to collect data. From data analysis, three cultural models, "Predominance of task-based care over emotion-based care," "Empathy and lack of empathy, two ends of the spectrum of the nurse-patient relationship," and "Empathy, an interactive and reciprocal process," were extracted. The results showed that empathy creates a caring environment where nurses not only understand their patients but also relate to them, and both are affected by it. Policymakers should consider removing barriers as a means of empowering nurses to provide empathic care.
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Affiliation(s)
- Marziyeh Mohammadi
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Hamid Peyrovi
- Nursing and Midwifery Care Research Center/School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Zohreh Parsa Yekta
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
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12
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Huang R, Zhou Z, Liu Y, Lin M, Gong M, Xian S, Yin H, Meng T, Wang X, Wang Y, Chen W, Zhang C, Du E, Liu X, Lin Q, Wu H, Huang Z, Zhang J, Zhang G, Ji S. Empathy in undergraduate medical students: a multi-center cross-sectional study in China. BMC Psychiatry 2024; 24:414. [PMID: 38834981 PMCID: PMC11151548 DOI: 10.1186/s12888-023-05350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/06/2023] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Fostering empathy has been continuously emphasized in the global medical education. Empathy is crucial to enhance patient-physician relationships, and is associated with medical students' academic and clinical performance. However, empathy level of medical students in China and related influencing factors are not clear. METHODS This was a cross-sectional study among medical students in 11 universities. We used the Jefferson Scale of Empathy Student-version of Chinese version to measure empathy level of medical students. Factors associated with empathy were identified by the univariate and multivariate logistic regression analyses. Based on the variables identified above, the nomogram was established to predict high empathy probability of medical students. Receiver operating characteristic curve, calibration plot and decision curve analysis were used to evaluate the discrimination, calibration and educational utility of the model. RESULTS We received 10,901 samples, but a total of 10,576 samples could be used for further analysis (effective response rate of 97.02%). The mean empathy score of undergraduate medical students was 67.38 (standard deviation = 9.39). Six variables including gender, university category, only child or not, self-perception doctor-patient relationship in hospitals, interest of medicine, Kolb learning style showed statistical significance with empathy of medical students (P < 0.05). Then, the nomogram was established based on six variables. The validation suggested the nomogram model was well calibrated and had good utility in education, as well as area under the curve of model prediction was 0.65. CONCLUSIONS We identify factors influencing empathy of undergraduate medical students. Moreover, increasing manifest and hidden curriculums on cultivating empathy of medical students may be needed among medical universities or schools in China.
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Affiliation(s)
- Runzhi Huang
- Department of Burns, The First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Zhitong Zhou
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Yifan Liu
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Min Lin
- Mental Health Education and Consultation Center, Chongqing Medical University, 61 Daxuecheng Middle Road, Chongqing, 401331, China
| | - Meiqiong Gong
- Office of Educational Administration, Shanghai University, Shanghai, 200444, China
| | - Shuyuan Xian
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Huabin Yin
- Department of Orthopedics, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, 100 Haining Road, Shanghai, China
| | - Tong Meng
- Department of Orthopedics, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, 100 Haining Road, Shanghai, China
| | - Xiaonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Beijing, 100069, China
| | - Yue Wang
- Department of Health Statistics, School of Public Health, Air Force Medical University, No.169,Changle West Road, Xi'an, 710032, China
| | - Wenfang Chen
- Faculty of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'An, 343009, China
| | - Chongyou Zhang
- Basic Medical College, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, Heilongjiang, China
| | - Erbin Du
- Frist Clinical Medical College, Mudanjiang Medical University, 66 Tongxiang Street, Mudanjiang, 157011, China
| | - Xin Liu
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qing Lin
- Department of Human Anatomy, Laboratory of Clinical Applied Anatomy, School of Basic Medical Sciences, Fujian Medical University, 1 Xuefu North Road, Fuzhou, 350122, China
| | - Hongbin Wu
- National Centre for Health Professions Education Development, Peking University, Beijing, 100191, China
- Institute of Medical Education, Peking University, 5 YiHeYuan Road, Beijing, 100871, China
| | - Zongqiang Huang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jie Zhang
- Tongji University School of Medicine, Shanghai, 200092, China
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 2699 Gaoke West Road, Shanghai, 201204, China
| | - Guoyang Zhang
- Maastricht University School of Health Professions Education, Maastricht, the Netherlands.
| | - Shizhao Ji
- Department of Burns, The First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, 200433, China.
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Gilbert A, Carnell S, Lok B, Miles A. Using Virtual Patients to Support Empathy Training in Health Care Education: An Exploratory Study. Simul Healthc 2024; 19:151-157. [PMID: 37639216 DOI: 10.1097/sih.0000000000000742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Empathy is essential for effective patient care. Yet, research shows suboptimal empathy in patient-practitioner interactions. Intelligent virtual patient simulations may offer an effective educational tool for empathy training. This observational study explored the quality of speech pathology of students' empathy responses in virtual patient simulations. METHODS Using the 7-point Empathic Communication Coding System (ECCS), we examined 72 students' empathic communication during a 12-week virtual patient interview series as part of their standard curriculum across 4 cohorts (a total of 388 empathic responses). The ECCS data were tallied and graphically displayed. We compared year groups (cohorts from 2015 to 2018), changes over semester, and differences between virtual patients. RESULTS Median ECCS scores were 4 of a maximum of 6 (interquartile range, 3) across all interviews. Most students (89%) scored between a level 2 (implicit recognition) and level 5 (confirmation) with only a few responses scoring at the lowest 2 levels of empathy (0: denial, 0.5%; 1: automatic recognition, 2%) or the highest level of empathy (6: shared feeling or experience, 9%). Students consistently acknowledged patients' feelings and often offered an action, solution, or reassurance. However, shared feelings or experiences were infrequent. CONCLUSIONS Although virtual patient simulations do not replace experiential learning such as simulation, standardized patients, and clinical practicum, they offer a safe environment to practice skills. This article provides support for designing larger controlled clinical trials and provides insights for educators on how to design virtual patient empathic opportunities of varying complexity for students.
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Affiliation(s)
- Alan Gilbert
- From the University of Auckland (A.G., A.M.), Auckland, New Zealand; University of Florida (S.C., B.L.), Gainesville, FL; and University of Central Florida (S.C.), Orlando, FL
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14
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Howick J, Slavin D, Carr S, Miall F, Ohri C, Ennion S, Gay S. Towards an empathic hidden curriculum in medical school: A roadmap. J Eval Clin Pract 2024; 30:525-532. [PMID: 38332641 DOI: 10.1111/jep.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
The "hidden curriculum" in medical school includes a stressful work environment, un-empathic role models, and prioritisation of biomedical knowledge. It can provoke anxiety and cause medical students to adapt by becoming cynical, distanced and less empathic. Lower empathy, in turn, has been shown to harm patients as well as practitioners. Fortunately, evidence-based interventions can counteract the empathy dampening effects of the hidden curriculum. These include early exposure to real patients, providing students with real-world experiences, training role models, assessing empathy training, increasing the focus on the biopsychosocial model of disease, and enhanced wellbeing education. Here, we provide an overview of these interventions. Taken together, they can bring about an "empathic hidden curriculum" which can reverse the decline in medical student empathy.
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Affiliation(s)
- Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Daniel Slavin
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Sue Carr
- Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fiona Miall
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Chandra Ohri
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Steve Ennion
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Simon Gay
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
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Ying I, Stepita R, Whyte S, Seccareccia D, Beaune L, Karim A, Sirianni G. What About Empathy? A Qualitative Study Exploring the Role of a Podcast as an Asynchronous Empathy Teaching Tool. MEDICAL SCIENCE EDUCATOR 2024; 34:609-615. [PMID: 38887409 PMCID: PMC11180053 DOI: 10.1007/s40670-024-02020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 06/20/2024]
Abstract
Purpose Though medical education podcasts are fast gaining popularity, they are overwhelmingly focused on teaching the medical expert role of physicians. We explored how medical learners and educators engaged with and learned from an empathy and communication-focused podcast and sought their recommendations for integrating the podcast into medical curricula. Methods Six virtual, semi-structured focus groups were conducted with educators and learners within a large urban hospital and university setting. Participants were asked to listen to pre-selected episodes of the About Empathy podcast in advance. Thematic analysis was used to explore experiences and perceptions of empathy teaching and learning. Results There were 24 participants. We identified six themes related to the podcast and empathy learning: (1) forging connection through stories, (2) creating space to reflect on empathy, (3) shifting perspectives and biases, (4) feeling validated and enabling self-compassion, (5) gaining knowledge and building skills through empathetic communication, and (6) translating new knowledge and skills into practice. Participants highlighted that the podcast's portability and asynchronous nature allowed them to be more fully present, reflective, and intentional in their learning. Discussion The About Empathy podcast was experienced as a flexible, just-in-time tool that promoted self-agency over one's learning, reflective practice, and knowledge and skill acquisition, particularly with respect to empathic communication. Benefits of asynchronous e-learning tools such as podcasts support a shift to a blended learning model. Challenges finding a curricular home for this empathy-focused podcast require further consideration.
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Affiliation(s)
- Irene Ying
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON Canada
| | - Rebecca Stepita
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Royal Victoria Regional Health Centre, Barrie, ON Canada
| | - Sarah Whyte
- Department of Family & Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Dori Seccareccia
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | | | | | - Giovanna Sirianni
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Department of Family & Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON Canada
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16
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Roe S, McGahon MK, Parkinson S, Tansey E, Murphy P. A cross-disciplinary approach to learning medical physiology and behavioral skills involving drama students performing as simulated patients. ADVANCES IN PHYSIOLOGY EDUCATION 2024; 48:297-303. [PMID: 38452329 DOI: 10.1152/advan.00019.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
The early years of physiology education in medical curricula provide unique challenges. As well as inculcating concepts that are seen as difficult, modern curricula require that students learn in context in case-based learning courses. Additionally, regulating bodies stress that the soft skills of compassion, communication, and empathy are embedded throughout curricula. This has driven work in our organization involving drama and final-year medicine students during which they collaborate in realistic simulations of doctor/patient interactions. We adapted this transdisciplinary approach to second-year physiology tutorials. This emphasized the holistic importance of physiology to patient care, while also embedding "human factors" skills from the very earliest stages of the curriculum. After preparing by attending acting classes based on aspects of Konstantin Stanislavski's "System," the authors supervised tutorials in which drama students participated in a "physiology of hypofertility" session for second-year medical students, playing a 34-year-old woman with premature menopause (or their partner). Opinion (from all students) was evaluated by Likert questionnaires (which included open questions). A focus group of drama students was also interviewed, and the conversation was recorded for thematic analysis. Positive Likert scores were recorded for the authenticity of the tutorials, skills development, fostering empathy, and motivating students to improve. All participants evaluated the tutorial as highly enjoyable. These scores are reflected in positive open commentary on the questionnaires and in the focus group interviews. The results suggest that even basic science tutorials give opportunities for interdisciplinary study and enhancement of behavioral skills while gaining enthusiastic student acceptance.NEW & NOTEWORTHY This work details how physiology tutorials for early years medical students are transformed by taking the clinical case off the two-dimensional page and instead having the case scenario acted by drama students. This adds context and authenticity. The benefits are twofold: emphasizing the importance of physiology to the budding clinician and embedding empathy and compassion from the earliest points in a clinician's career.
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Affiliation(s)
- Seán Roe
- Centre for Biomedical Sciences Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Mary K McGahon
- Centre for Biomedical Sciences Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Sharon Parkinson
- Centre for Biomedical Sciences Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Etain Tansey
- Centre for Biomedical Sciences Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Paul Murphy
- Drama Department, School of Arts, English and Languages, University Square, Queen's University Belfast, Belfast, Northern Ireland
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17
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Allan R, McCann L, Johnson L, Dyson M, Ford J. A systematic review of 'equity-focused' game-based learning in the teaching of health staff. PUBLIC HEALTH IN PRACTICE 2024; 7:100462. [PMID: 38283754 PMCID: PMC10820634 DOI: 10.1016/j.puhip.2023.100462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/22/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024] Open
Abstract
Background An unequal distribution of the social determinants of health drives health inequalities. Existing training fails to communicate the impossible circumstances that disadvantaged groups face. Game-based learning is increasingly used as an innovative method with the potential to enhance health staff's ability to address health inequalities, but its effectiveness is unknown. Therefore, the aim of this systematic review was to evaluate the effectiveness of 'equity-focused' game-based learning in training health staff. Study design Systematic Review. Methods Three databases (Ovid Medline, Embase, Web of Science) and a citation search were systematically searched for articles from January 2010 to July 2023, reporting on effectiveness of 'equity-focused' game-based learning. Titles and abstracts were screened using eligibility criteria to identify relevant studies. Data was extracted and the ROBINS-I tool was used to assess quality. Results The search identified 7615 articles, of which thirteen were included involving 2412 healthcare workers. A variety of game-based learning tools were found to have an overall positive effect on motivation, knowledge, attitudes, and engagement of health staff. However, the significance of the results varied depending on specific game context. All included studies were judged to have serious to critical risk of bias. Conclusions Game-based learning has the potential to improve the effectiveness of 'equity-focused' training for health staff. Educators and researchers should further collaborate to expand the tools available and evaluate their effectiveness on long-term clinical practice.
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Affiliation(s)
- Robyn Allan
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Lucy McCann
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Lucy Johnson
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Maya Dyson
- Sandwell and West Birmingham Hospitals NHS Trust, UK
| | - John Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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18
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Neufeld-Kroszynski G, Michael K, Karnieli-Miller O. Associations between medical students' stress, academic burnout and moral courage efficacy. BMC Psychol 2024; 12:296. [PMID: 38802899 PMCID: PMC11129364 DOI: 10.1186/s40359-024-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Medical students, especially during the clinical years, are often exposed to breaches of safety and professionalism. These contradict personal and professional values exposing them to moral distress and to the dilemma of whether and how to act. Acting requires moral courage, i.e., overcoming fear to maintain one's core values and professional obligations. It includes speaking up and "doing the right thing" despite stressors and risks (e.g., humiliation). Acting morally courageously is difficult, and ways to enhance it are needed. Though moral courage efficacy, i.e., individuals' belief in their capability to act morally, might play a significant role, there is little empirical research on the factors contributing to students' moral courage efficacy. Therefore, this study examined the associations between perceived stress, academic burnout, and moral courage efficacy. METHODS A cross-sectional study among 239 medical students who completed self-reported questionnaires measuring perceived stress, academic burnout ('exhaustion,' 'cynicism,' 'reduced professional efficacy'), and moral courage efficacy (toward others' actions and toward self-actions). Data analysis via Pearson's correlations, regression-based PROCESS macro, and independent t-tests for group differences. RESULTS The burnout dimension of 'reduced professional efficacy' mediated the association between perceived stress and moral courage efficacy toward others' actions. The burnout dimensions 'exhaustion' and 'reduced professional efficacy' mediated the association between perceived stress and moral courage efficacy toward self-actions. CONCLUSIONS The results emphasize the importance of promoting medical students' well-being-in terms of stress and burnout-to enhance their moral courage efficacy. Medical education interventions should focus on improving medical students' professional efficacy since it affects both their moral courage efficacy toward others and their self-actions. This can help create a safer and more appropriate medical culture.
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Affiliation(s)
- Galit Neufeld-Kroszynski
- Department of Medical Education, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, 69778, Israel
| | - Keren Michael
- Department of Human Services, Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Orit Karnieli-Miller
- Department of Medical Education, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, 69778, Israel.
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Otsuka T, Sakaguchi K, Houchens N, Nakano Y, Endo T, Odagawa S, Yamasaki D, Miwa M, Shiraishi Y, Tokuda Y, Kataoka H, Watari T. Empathy Among Physicians and Nurses in Japan: A Nationwide Cross-sectional Study. J Gen Intern Med 2024; 39:960-968. [PMID: 38277022 DOI: 10.1007/s11606-024-08620-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Empathy with patients improves clinical outcomes. Although previous studies have shown no significant differences in empathy levels between physicians and nurses, investigations have not considered differences in cultural backgrounds and related factors of healthcare providers at the individual level. OBJECTIVE This study compares empathy between physicians and nurses in Japan and identifies relevant factors that contribute to these differences. DESIGN A cross-sectional survey design was used in the study. The online survey was conducted using the Nikkei Medical Online website. PARTICIPANTS A total of 5441 physicians and 965 nurses in Japan who were registered as members of Nikkei Medical Online were included. MAIN MEASURES Empathy was measured by the Jefferson Scale of Empathy (JSE). KEY RESULTS Cronbach's α was 0.89. The mean JSE score for Japanese physicians was significantly lower at 100.05 (SD = 15.75) than the mean score of 110.63 (SD = 12.25) for nurses (p<0.001). In related factors, higher age (increasing by one year) (+0.29; 95% CI 0.25 to 0.32; p<0.001), self-identified female gender (+5.45; 95% CI 4.40 to 6.49; p<0.001), having children (+1.20; 95% CI 0.30 to 2.10; p=0.009), and working at a hospital with 20-99 beds (+1.73; 95% CI 0.03 to 3.43; p=0.046) were significantly associated with higher scores, whereas those whose mother is a physician (-6.65; 95% CI -8.82 to -4.47; p<0.001) and father is a nurse (-9.53; 95% CI -16.54 to -2.52; p=0.008) or co-medical professional (-3.85; 95% CI -5.49 to -2.21; p<0.001) were significantly associated with lower scores. CONCLUSIONS Physicians had significantly lower scores on the JSE than nurses in Japan. Higher age, self-identified female gender, having children, working at a small hospital, having a mother who is a physician, and having a father who is a nurse or co-medical professional were factors associated with the level of empathy.
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Affiliation(s)
- Tomoe Otsuka
- Faculty of Medicine, Shimane University, Shimane, Japan
| | - Kota Sakaguchi
- General Medicine Center, Shimane University Hospital, 89-1, Enya-cho, Izumoshi, Shimane, 693-8501, Japan
| | - Nathan Houchens
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Takeshi Endo
- General Medicine Center, Shimane University Hospital, 89-1, Enya-cho, Izumoshi, Shimane, 693-8501, Japan
| | - Seiji Odagawa
- General Medicine Center, Shimane University Hospital, 89-1, Enya-cho, Izumoshi, Shimane, 693-8501, Japan
| | | | - Mamoru Miwa
- Nikkei BP Nikkei Medical Editorial Department, Tokyo, Japan
| | - Yoshihiko Shiraishi
- General Medicine Center, Shimane University Hospital, 89-1, Enya-cho, Izumoshi, Shimane, 693-8501, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Project for Teaching Hospitals, Okinawa, Japan
| | - Hitomi Kataoka
- Diversity and Inclusion Center, Okayama University, Okayama, Japan
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, 89-1, Enya-cho, Izumoshi, Shimane, 693-8501, Japan.
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
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20
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Dehkordi FG, Torabizadeh C, Rakhshan M, Vizeshfar F. Barriers to ethical treatment of patients in clinical environments: A systematic narrative review. Health Sci Rep 2024; 7:e2008. [PMID: 38698790 PMCID: PMC11063269 DOI: 10.1002/hsr2.2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/08/2024] [Accepted: 03/12/2024] [Indexed: 05/05/2024] Open
Abstract
Background and Aim It is essential that healthcare providers display ethical behavior toward their patients. Despite development of codes of ethics for clinical practice, the occurrence of unethical behaviors toward patients is alarmingly high. The present study was conducted to identify the barriers to ethical treatment of patients in clinical environments. Methods Through systematic narrative review, the present study investigated the barriers to ethical treatment of patients. This study was carried out in line with Assessment of Multiple Systematic Reviews 2 and Preferred Reporting Items of Systematic reviews and Meta-Analyses guidelines. Results Ethical challenges in clinical environments can be classified into two categories: "organizational factors" and "personal factors." Organizational factors consist of three domains: managers and regulations, organizational environment, and human resources. Personal factors consist of two domains: factors related to patients and their families and factors related to care providers. Conclusion Research shows that encouraging healthcare teams to adopt ethical behaviors through education and having them persistently observe ethics in their clinical practice will not completely bridge the gap between theory and practice: it seems that the clinical environment, the personal characteristics of healthcare team members and patients, and the organizational values of the healthcare system pose the greatest barrier to bridging this gap. Accordingly, in addition to raising healthcare providers' awareness of the existing issues in clinical ethics, measures should be taken to improve organizational culture and atmosphere.
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Affiliation(s)
- Fatemeh Ghani Dehkordi
- Student Research Committee of Nursing and Midwifery SchoolShiraz University of Medical SciencesShirazIran
| | | | - Mahnaz Rakhshan
- School of Nursing and MidwiferyShiraz University of Medical SciencesShirazIran
| | - Fatemeh Vizeshfar
- School of Nursing and MidwiferyShiraz University of Medical SciencesShirazIran
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21
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Chen H, Xuan H, Cai J, Liu M, Shi L. The impact of empathy on medical students: an integrative review. BMC MEDICAL EDUCATION 2024; 24:455. [PMID: 38664799 PMCID: PMC11047033 DOI: 10.1186/s12909-024-05448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Empathy is considered the ability to understand or feel others emotions or experiences. As an important part of medical education, empathy can affect medical students in many ways. It is still lacking a comprehensive evaluation of the existing articles on empathy's impact on medical students, despite the existence of many articles on the topic. OBJECTIVES To summarize the impact of empathy on medical students during medical education from four perspectives: mental health, academic performance, clinical competence, and specialty preference. METHODS The search terms used for retrieval were "empathy", "medical student", "mental health", "depression", "anxiety", "burnout", "examinations", "academic performance", "clinical competence", "specialty preference" on PubMed, EBSCO, and Web of Science before January 2024. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed based on inclusion/exclusion criteria. A consensus was drawn on which articles were included. RESULTS Our results indicated that high empathy was a positive factor for mental health, However, students with high affective empathy were more likely to suffer from depression, anxiety, and burnout. Empathy was found to be unrelated to academic performance, but positively correlated with clinical competence, particularly in terms of communication skills. Medical students with high levels of empathy tended to prefer people-oriented majors. CONCLUSIONS Medical students who score higher on the self-reported empathy scales often have better mental health, better communication skills, and tend to choose people-oriented specialties. But empathy is not related to academic performance. Additionally, the different dimensions of empathy have different impacts on medical students. It is necessary to design targeted courses and training for medical students to enhance their empathy.
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Affiliation(s)
- Hao Chen
- Department of Neurosurgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Hanwen Xuan
- Department of Neurosurgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Jinquan Cai
- Department of Neurosurgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
| | - Meichen Liu
- Modern Educational Technology Center, Harbin Medical University, Harbin, 150086, China.
| | - Lei Shi
- School of Health Management, Guangzhou Medical University, Guangzhou, 511436, China.
- School of Health Management, Southern Medical University, Guangzhou, 510515, China.
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22
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Clark JF. Medicine, emotience, and reason. Philos Ethics Humanit Med 2024; 19:5. [PMID: 38594714 PMCID: PMC11005265 DOI: 10.1186/s13010-024-00154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
Medicine is faced with a number of intractable modern challenges that can be understood in terms of hyper-intellectualization; a compassion crisis, burnout, dehumanization, and lost meaning. These challenges have roots in medical philosophy and indeed general Western philosophy by way of the historic exclusion of human emotion from human reason. The resolution of these medical challenges first requires a novel philosophic schema of human knowledge and reason that incorporates the balanced interaction of human intellect and human emotion. This schema of necessity requires a novel extension of dual-process theory into epistemology in terms of both intellect and emotion each generating a distinct natural kind of knowledge independent of the other as well as how these two forms of mental process together construct human reason. Such a novel philosophic schema is here proposed. This scheme is then applied to the practice of medicine with examples of practical applications with the goal of reformulating medical practice in a more knowledgable, balanced, and healthy way. This schema's expanded epistemology becomes the philosophic foundation for more fully incorporating the humanities in medicine.
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Affiliation(s)
- John F Clark
- UCSF, Natividad Medical Center Family Medicine Residency Program, 1441 Constitution Blvd., Salinas, CA, 93906, USA.
- UCSF Medical School, 533 Parnassus Ave., San Francisco, CA, 94143, USA.
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23
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Comrie CE, Coe TM, Moses J, Dageforde LA. Evaluating Medical Students' Perceptions of Patient-Led Transplant Surgery Education 1-2 Years Later. J Surg Res 2024; 296:149-154. [PMID: 38277951 DOI: 10.1016/j.jss.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/16/2023] [Accepted: 12/28/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Medical students value the opportunity to learn from patients as a supplement to traditional faculty-led education; however, long-term follow-up to understand the educational impact of these experiences is lacking. We surveyed medical students who conducted non-medical virtual encounters with transplant recipients or living donors to understand the impact on students' patient care approach after 1-2 y. METHODS Students who completed their surgery clerkship from July 2020 to September 2021 were surveyed about this nonmedical patient encounter in January 2023. Quantitative and qualitative survey data were analyzed using descriptive statistics and inductive thematic analysis, respectively. RESULTS Of the 27 respondents (46% response rate), 44.4% completed the experience 1 y ago and 55.6% completed the experience 2 y ago. Nearly all respondents (96.3%) agreed that this experience was an effective way to learn about organ donation and transplantation and that learning from patients was beneficial to their development as a doctor. Over 50% felt this experience changed how they provide care to patients. Qualitatively, students reported that this activity cultivated their empathy for patients, provided unique insight into patients' illness experiences, and enhanced their understanding of the longitudinal patient-surgeon relationship. CONCLUSIONS Utilizing patients as teachers in transplant surgery not only taught medical students more about organ donation and transplantation but also built empathy and highlighted unique, non-clinical aspects of the patient experience that persisted over time. This is one of the first studies to evaluate patient-led teaching of this type over a year later and assess its unique influence on medical student development.
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Affiliation(s)
| | - Taylor M Coe
- Harvard Medical School, Boston, Massachusetts; Surgery Department, Massachusetts General Hospital, Boston, Massachusetts
| | - Joy Moses
- Surgery Department, Massachusetts General Hospital, Boston, Massachusetts
| | - Leigh Anne Dageforde
- Harvard Medical School, Boston, Massachusetts; Surgery Department, Massachusetts General Hospital, Boston, Massachusetts.
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24
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Bankar M, Gupta S, Kumar H, Agarwal M. Impact of Multimodal Intervention on Empathy Levels in Medical Students: A Questionnaire-Based Study. Cureus 2024; 16:e59169. [PMID: 38807837 PMCID: PMC11129940 DOI: 10.7759/cureus.59169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/30/2024] Open
Abstract
Background Empathy is essential for effective doctor-patient communication. It enables doctors to understand patients' emotions and concerns, facilitating personalized care and support. Empathy can be cultivated through various methods and training programs. Objective The study aims to assess the effectiveness of a multimodal intervention involving interactive lectures, peer role-play, and guided reflection in enhancing empathy levels among second-year medical undergraduate students in India. Methods This study utilized a questionnaire-based, pre- and post-test interventional design. Seventy-nine second-year medical students were included after obtaining their informed consent. The students received the intervention through an interactive lecture on communication skills, role-play on selected case studies, and guided reflection. The empathy levels were assessed using the Toronto Empathy Questionnaire (TEQ) before and after the intervention. The Mann-Whitney U test was utilized to compare pre-test and post-test TEQ scores. A univariate analysis of variance was conducted to explore the relationship between demographic variables and post-test TEQ scores. Statistical significance was considered at p ≤ 0.05. Results The TEQ score improved significantly (p=0.009) after the intervention. The univariate analysis indicated that gender, style of education, and place of residence did not have a statistically significant impact on post-test scores. Conclusion The study demonstrates that a multimodal intervention significantly enhances the empathy level of medical students, highlighting the potential of focused interventions to reduce gender disparities in empathy levels. There were no significant differences in empathy scores based on gender, place of residence, or schooling, suggesting the intervention's benefits may apply to all medical students.
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Affiliation(s)
- Mangesh Bankar
- Pharmacology, All India Institute of Medical Sciences, Raebareli, IND
| | - Shefali Gupta
- Microbiology, All India Institute of Medical Sciences, Raebareli, IND
| | - Hansraj Kumar
- Pharmacology, All India Institute of Medical Sciences, Deoghar, IND
| | - Mayank Agarwal
- Physiology, All India Institute of Medical Sciences, Raebareli, IND
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25
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Driessen J, Hearn R. Development of hidden curriculum skills in a COVID-19 vaccination centre. CLINICAL TEACHER 2024; 21:e13642. [PMID: 37632296 DOI: 10.1111/tct.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, many medical students were deployed as vaccinators. This study set out to capture the lived experience of students at a London-based mass vaccination site, understand what they learned, how this learning compared to their experience of usual medical education and how any identified benefits might be leveraged in a post-pandemic context. METHODS Student vaccinators (n = 8) were recruited from the vaccine clinic workforce and invited to complete semi-structured interviews about their experiences. Thematic analysis was conducted on interview transcripts to identify significant concepts, which were interpreted in the context of available literature. FINDINGS Participants' experiences aligned broadly with the undergraduate curriculum. However, many also identified hidden curriculum areas developed through their work as vaccinators, including professionalism, self-regulating learning and ethical decision-making. DISCUSSION The need for adequate support, whilst promoting autonomy, was highlighted as vital in supporting professional identity formation within a community of practice, benchmarking clinical knowledge and performance, and in support of student wellbeing, in the face of challenging real-world clinical encounters. CONCLUSION Increased entrustment of clinical activity could be implemented in primary and secondary care settings to reproduce the benefits experienced by student vaccinators in front-line roles during the COVID-19 pandemic. Further work might consider how to maximise these benefits and increase inclusion and participation.
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Affiliation(s)
- Johannes Driessen
- King's Undergraduate Medical Education in the Community (KUMEC), Department of Primary Care and Public Health Sciences, London, UK
| | - Russell Hearn
- King's Undergraduate Medical Education in the Community (KUMEC), Department of Primary Care and Public Health Sciences, London, UK
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26
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Fujikawa H, Aoki T, Son D, Hayashi M, Eto M. Association between tolerance for ambiguity specific to the clinical context and empathy in medical trainees: A multicenter cross-sectional study in Japan. MEDICAL TEACHER 2024; 46:512-518. [PMID: 37734453 DOI: 10.1080/0142159x.2023.2259065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
PURPOSE Physicians' empathy and ambiguity tolerance have recently become a focus of medical education. However, the association between the two concepts remains unclear. This study examined the association between empathy and ambiguity tolerance in the clinical context among medical trainees. METHODS We conducted a multicenter cross-sectional study in 12 institutions: 2 universities for medical students and 10 hospitals for residents. We assessed ambiguity tolerance using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors scale. The outcome variable was empathy, measured using the Japanese translation of the Jefferson Scales of Empathy (JSE). RESULTS Data from 100 medical students and 135 residents were analyzed. After adjustment for possible confounders, the factor scores of 'tolerance for things that are not black or white in medicine' showed a dose-dependent association with the JSE. There was no clear trend in the association between the total scores or other factor scores and empathy. CONCLUSION This nationwide multicenter study showed that the factor scores of 'tolerance for things that are not black or white in medicine' were associated with empathy among medical trainees. Our findings may be helpful for developing interventions in the field of medical education to nurture empathy.
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Affiliation(s)
- Hirohisa Fujikawa
- Center for General Medicine Education, School of Medicine, Keio University, Tokyo, Japan
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, The Jikei University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Daisuke Son
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Mikio Hayashi
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Center for Health Professions Education, Kansai Medical University, Osaka, Japan
- Master of Medical Sciences in Medical Education, Harvard Medical School, Boston, MA, USA
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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27
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Han Z, Barton KC, Ho LC, Yap KZ, Tan DSY, Lee SS, Neo CXR, Tan AHL, Boey BMY, Soon CJY, Gallagher PJ. Applying narrative medicine to prepare empathetic healthcare providers in undergraduate pharmacy education in Singapore: a mixed methods study. BMC MEDICAL EDUCATION 2024; 24:292. [PMID: 38491363 PMCID: PMC10943898 DOI: 10.1186/s12909-024-05254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Narrative medicine demonstrated positive impact on empathy in medicine and nursing students. However, this pedagogical approach had not been evaluated in pharmacy education. This study sought to apply and evaluate the narrative medicine approach in extending empathy in Asian undergraduate pharmacy students. METHODS Narrative medicine was applied through workshops which used narratives of people with different experiences and perspectives. First-year undergraduate pharmacy students who volunteered and attended these workshops formed the intervention group (N = 31) and the remaining first-year cohort formed the control group (N = 112). A sequential explanatory mixed methods approach was adopted in which quantitative methods were first used to measure impact on pharmacy students' empathy using the Jefferson Scale of Empathy- Health Professions Student (JSE-HPS), and qualitative methods (i.e. group interviews) were then used to assess pharmacy students' emotional responses to narratives, and the perspectives of pharmacy students and faculty of this pedagogical approach. RESULTS There was no difference in JSE-HPS scores between intervention and control groups across baseline (i.e. upon matriculation), pre-intervention, and post-intervention timepoints. Pharmacy students in the intervention group had lower scores in Factor 3 ("Standing in People's Shoes") following the intervention. Five themes, guided by internal and external factors in cognition, emerged from the Group Interviews: (1) incongruence between students' motivation and faculty's perception, (2) learning context, (3) academic context, (4) cognitive system, and (5) affective system. Themes 1, 4 and 5 referred to internal factors such as students' motivation, perceived learnings, and feelings. Themes 2 and 3 referred to external factors including workshop materials, activities, content, and facilitation. CONCLUSION This study is the first to demonstrate that pharmacy students engaged with the narrative medicine approach as narratives elicited emotional responses, exposed them to diverse perspectives, and deepened their appreciation of the importance of empathy and complexities of understanding patients' perspectives. Scaffolded educational interventions using narratives and real-life patient encounters, alongside longitudinal measurements of empathy, are necessary to bring about meaningful and sustained improvements in empathy.
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Affiliation(s)
- Zhe Han
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore.
| | - Keith C Barton
- Department of Curriculum and Instruction, School of Education, Indiana University, 201 N. Rose Avenue, 47405, Bloomington, IN, USA
| | - Li-Ching Ho
- Department of Curriculum and Instruction, School of Education, University of Wisconsin- Madison, 225 N. Mills Street, 53706, Madison, WI, USA
| | - Kai Zhen Yap
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Doreen Su-Yin Tan
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Shuh Shing Lee
- Center for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, 117597, Singapore, Singapore
| | - Constance Xue Rui Neo
- Department of Pharmacy, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore, Singapore
| | - Amanda Han Lin Tan
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Brian Ming Yao Boey
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Charis Jia Yan Soon
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Paul J Gallagher
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, 117543, Singapore, Singapore
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28
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Beheshti A, Arashlow FT, Fata L, Barzkar F, Baradaran HR. The relationship between Empathy and listening styles is complex: implications for doctors in training. BMC MEDICAL EDUCATION 2024; 24:267. [PMID: 38459474 PMCID: PMC10924382 DOI: 10.1186/s12909-024-05258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Effective communication is the key to a successful relationship between doctors and their patients. Empathy facilitates effective communication, but physicians vary in their ability to empathize with patients. Listening styles are a potential source of this difference. We aimed to assess empathy and listening styles among medical students and whether students with certain listening styles are more empathetic. METHODS In this cross-sectional study, 97 medical students completed the Jefferson scale of Empathy (JSE) and the revised version of the Listening Styles Profile (LSP-R). The relationship between empathy and listening styles was assessed by comparing JSE scores across different listening styles using ANOVA in SPSS software. A p-value less than 0.05 was considered significant. RESULTS Overall, the students showed a mean empathy score of 103 ± 14 on JSE. Empathy scores were lower among clinical students compared to preclinical students. Most of the medical students preferred the analytical listening style. The proportion of students who preferred the relational listening style was lower among clinical students compared to preclinical students. There was no significant relationship between any of the listening styles with empathy. CONCLUSION Our results do not support an association between any particular listening style with medical students' empathic ability. We propose that students who have better empathetic skills might shift between listening styles flexibly rather than sticking to a specific listening style.
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Affiliation(s)
- Amir Beheshti
- Centre for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Urology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ladan Fata
- Centre for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Barzkar
- Centre for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Hamid R Baradaran
- Centre for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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29
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Ng SH, Babar MG, Ahmed SI, Hasan SS, Yang WY. Measuring empathic behaviour among undergraduate dietetics students. J Eval Clin Pract 2024; 30:153-161. [PMID: 37641432 DOI: 10.1111/jep.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
AIM Empathic behaviour has a direct link to the positive clinical outcomes. Health professionals, which include dietitians, are increasingly expected to demonstrate the impact of their care on patient outcomes. To date, there is limited research exploring the empathic behaviour of dietetics students. METHODS This cross-sectional study evaluated the psychometric properties of Jefferson Scale of Empathy-Healthcare Provider Student (JSE-HPS) and empathic behaviour of dietetics students. RESULTS Undergraduate dietetics students from one private and two public universities in Malaysia participated (n = 455). Item and scale psychometric properties were examined using principal component analysis and differences in mean empathy scores for students were assessed across years of study and types of universities. A 3-factor solution emerged in the results, accounting for 26.76%, 10.75% and 6.3% of the variance. The JSE-HPS demonstrated good internal consistency (α = 0.83). Despite students enroled at public universities scoring higher mean empathy scores than students enroled at the private university, the difference was not significant. The only significant difference was between the empathy level of first and third year students (p = 0.033). CONCLUSION As empathy underpins patient-centred management in the nutrition care process, it should be well integrated into curriculum delivery so that appropriate levels of empathy can be developed to prepare work-ready healthcare professionals.
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Affiliation(s)
- Shi Hui Ng
- School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Muneer Gohar Babar
- Clinical Oral Health Sciences Division, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Syed Imran Ahmed
- School of Pharmacy, College of Health and Science, University of Lincoln, UK
| | | | - Wai Yew Yang
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
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Ruiz J, Kaminnik P, Kibble J, Kauffman C. Relationships between medical student wellness, self-efficacy, and academic performance during the "post-COVID" period. ADVANCES IN PHYSIOLOGY EDUCATION 2024; 48:137-146. [PMID: 38153844 DOI: 10.1152/advan.00190.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Abstract
This study was a part of a longitudinal study investigating the relationships between medical student wellness, self-efficacy, and performance. Eighty-two eligible students were asked to complete online surveys during their second (M2) and third (M3) years. Performance outcomes included scores on various summative assessments during the M.D. program. Wellness survey results indicated that the sample of 38 M2 and 28 M3 students were overall well and self-efficacious, and they broadly maintained similar wellness characteristics across their medical education despite COVID-19 disruptions. Twenty-three students completed both surveys, and a paired analysis for this subgroup showed modest increases in stress and burnout in the M3 year. Notable correlations were observed between self-efficacy for academic work and a whole range of wellness variables for M2 students. M2 academic performance was modestly correlated to self-efficacy (rs = 0.38, P = 0.02, n = 38) and student burnout (rs = -0.34, P = 0.04, n = 38). In contrast, for the M3 students there was little correlation between wellness, clinical self-efficacy, and clinical performance, with the only significant relationships observed to be between overall clinical self-efficacy and the strength of social networks (rs = 0.41, P = 0.03, n = 28) and between scores for postencounter notes during Objective Structure Clinical Examinations (OSCEs) and self-efficacy in evidence-based medicine (rs = 0.44, P = 0.02, n = 28). In conclusion, 1) students remained generally well throughout the post-COVID period, and 2) self-efficacy for academic work is a good predictor of student wellness and performance during the preclerkship period but not during clinical training.NEW & NOTEWORTHY This study followed a group of medical students through the "post-COVID" period to assess their wellness as they transitioned from basic sciences to clinical training. We found that their wellness and belief in their ability to succeed (self-efficacy) remained strong, showing their resiliency. We observed correlations between self-efficacy and their level of wellness and academic performance during basic science classes but not during clinical training.
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Affiliation(s)
- Jonathan Ruiz
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, Florida, United States
| | - Phillip Kaminnik
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, Florida, United States
| | - Jonathan Kibble
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, Florida, United States
| | - Christine Kauffman
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, Florida, United States
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Paloniemi E, Hagnäs M, Mikkola I, Timonen M, Vatjus R. Reflective capacity and context of reflections: qualitative study of second-year medical students' learning diaries related to a general practice course. BMC MEDICAL EDUCATION 2024; 24:222. [PMID: 38429724 PMCID: PMC10908101 DOI: 10.1186/s12909-024-05199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Reflective capacity is a prerequisite for transformative learning. It is regarded as an essential skill in professional competence in the field of medicine. Our aim was to investigate the reflective capacity and the objects of action (themes) which revealed reflective writing of medical students during a general practice/family medicine course. METHODS Second-year medical students were requested to write learning diaries during a compulsory course in general practice/family medicine consisting of the principles of the physician-patient relationship. The course included a group session supervised by a clinical lecturer and a 3-day training period in a local health centre. We conducted data-driven content analysis of the learning diaries. In the learning diaries, student observations were most commonly directed to events during the training period and to group sessions. Occasionally, observation was directed at inner experience. RESULTS The following themes were related to reflective writing: feelings towards the end of life, demanding situations in practice, physician's attitude to patient, student's inner experiences, and physician's well-being. The entries indicated different types of reflective capacity. Three subgroups were identified: 'simple reporting,' 'reflective writing,' and 'advanced reflective writing.' CONCLUSION Professional growth requires the development of reflective capacity, as it is essential for successful patient care and better clinical outcomes. To develop and enhance the reflective capacity of medical students during their education, the curriculum should provide frequent opportunities for students to assess and reflect upon their various learning experiences.
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Affiliation(s)
- Elina Paloniemi
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Rovaniemi Health Center, The Wellbeing Services County of Lapland, Rovaniemi, Finland
| | - Maria Hagnäs
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Rovaniemi Health Center, The Wellbeing Services County of Lapland, Rovaniemi, Finland
| | - Ilona Mikkola
- Research Unit of Population Health, University of Oulu, Oulu, Finland.
- Rovaniemi Health Center, The Wellbeing Services County of Lapland, Rovaniemi, Finland.
| | - Markku Timonen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Ritva Vatjus
- Research Unit of Population Health, University of Oulu, Oulu, Finland
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Wooldridge JS, Soriano E, Filip TF, Moore RC, Eyler LT, Herbert MS. Compassion Dynamics in Medical Students: An Ecological Momentary Assessment Study. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10003-x. [PMID: 38402300 DOI: 10.1007/s10880-024-10003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/26/2024]
Abstract
Effective interventions to support compassionate patient- and self-care requires an understanding of how to best assess compassion. Micro-ecological momentary assessment (micro-EMA), a method in which participants provide brief responses in real-time within their own environments, can capture changes in compassion across time and contexts. This study examined a micro-EMA approach for measuring the temporal dynamics of compassion in medical students during the COVID-19 pandemic. Medical students (N = 47) completed demographic information and self-report questionnaires assessing empathy and compassion for self and others. Participants then completed six bursts of micro-EMA smartphone-delivered surveys. Each burst was 14 days, with 28 days between bursts. During each burst, participants received four daily micro-EMA surveys assessing compassion, stress, positive affect, and negative affect. Dynamic structural equation modeling was used to examine micro-EMA responses. The overall micro-EMA response rate was 83.75%. On average, daily compassion did not significantly change across the academic year. However, there was significant within-person variability in medical students' compassion trajectories over the training year (b = 0.027, p < .01). At concurrent timepoints, micro-EMA assessed compassion was associated with greater happiness (b = 0.142, p < .001) and lower stress (b = -0.052, p < .05) but was not associated with sadness. In lagged analyses, higher micro-EMA assessed compassion predicted higher next day happiness (b = 0.116, p < .01) and vice versa (b = 0.185, p < .01). Results suggest it is feasible to use micro-EMA to assess daily levels of compassion among medical students. Additionally, there is wide variability in day-to-day fluctuations in compassion levels among medical students, with some students showing substantial increases in daily compassion across the training year and others showing decreases. Positive affect as opposed to negative affect may have particularly strong associations with compassion. Further examination of antecedents and consequences of fluctuations in daily compassion could inform potent intervention targets.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Emily Soriano
- Scripps Whittier Diabetes Institute, San Diego, CA, USA
| | - Tess F Filip
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Desert-Pacific Mental Illness Research, Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA.
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Schrötter S, Kropp P, Müller B. Comparison of empathy profiles of medical students at the start and in the advanced clinical phase of their training. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc7. [PMID: 38504859 PMCID: PMC10946216 DOI: 10.3205/zma001662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/20/2023] [Accepted: 11/14/2023] [Indexed: 03/21/2024]
Abstract
Background The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) cites empathy as a basic competence for medical doctors. Based on a multidimensional concept of clinical empathy, empathy profiles of medical students at the start of their training and in the 9th semester were identified and compared in order to draw conclusions for the conception of effective course offers. Method Using the Saarbrücker Personality Questionnaire on Empathy (SPF-IRI), self-rated empathy was recorded in a cross-sectional study of medical students (1st semester: N=192/9th semester: N=221). Two Stage Clustering was performed for data analysis. Result Three empathy profiles which could be meaningfully delineated by content were identified: 1. reflected, functional empathy, 2. unreflected, burdensome empathy and 3. distancing and avoidance. Students in the 9th semester mostly tended toward unreflected, burdensome empathy. Only one-third appeared capable of feeling empathy with patients while at the same time adequately regulating their own emotions and thus protecting themselves from emotional overload. Conclusion An adequately reflected and functional empathy among medical students can neither be assumed at the start of their training, nor do existing course offers appear to provide sufficient training for this. Empathy should thus be implemented as a competence which needs to be promoted over the entire course of study. Emotion regulation plays a key role.
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Affiliation(s)
- Susanne Schrötter
- Universitätsmedizin Rostock, Institut für Medizinische Psychologie und Medizinische Soziologie, Rostock, Germany
| | - Peter Kropp
- Universitätsmedizin Rostock, Institut für Medizinische Psychologie und Medizinische Soziologie, Rostock, Germany
| | - Britta Müller
- Universitätsmedizin Rostock, Institut für Medizinische Psychologie und Medizinische Soziologie, Rostock, Germany
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Del Barrio LG, Rodríguez-Díez C, Gea A, Arbea L, Pereira J, Díez N. Impact of a longitudinal course on medical professionalism on the empathy of medical students. PATIENT EDUCATION AND COUNSELING 2024; 119:108042. [PMID: 37978022 DOI: 10.1016/j.pec.2023.108042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/08/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Medical education should enhance empathy. We examined, using self-assessment instruments and standardized patients (SPs), the impact on empathy, of a multi-year intervention (years 4-6 of medical training) that uses reflective learning approaches. METHODS 241 final-year medical students participated; 110 from the 2018 graduation class (non-intervention group) and 131 from the 2019 graduation class (intervention group). Participants completed two self-reported empathy questionnaires - the Jefferson Scale of Empathy-Students (JSE-S) and the Interpersonal Reactivity Index (IRI) - and a personality questionnaire, the NEO Five-Factor Inventory. Additionally, SPs in a simulated station assessed participants' empathy with two patient-reported instruments: the Consultation and Relational Empathy (CARE) scale and the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). RESULTS Empathy scores were significantly higher in the intervention group compared to the non-intervention group when assessed by the SP (p < 0.001). No differences were found in self-reported questionnaires between the two groups. CONCLUSION A longitudinal, multi-year reflection-based intervention enhanced empathy amongst medical students as assessed by SPs, but not when assessed by student self-reported measures. PRACTICE IMPLICATIONS Multi-year reflective learning interventions during clinical training nurture empathy in medical students. Assessments completed by SPs or patients may enhance the evaluation of empathy.
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Affiliation(s)
- Loreto García Del Barrio
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain; Department of Medical Education, Universidad de Navarra, Pamplona, Spain
| | | | - Alfredo Gea
- Department of Medical Education, Universidad de Navarra, Pamplona, Spain; Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
| | - Leire Arbea
- Department of Medical Education, Universidad de Navarra, Pamplona, Spain; Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José Pereira
- Department of Medical Education, Universidad de Navarra, Pamplona, Spain; Department of Family Medicine, McMaster University, Canada
| | - Nieves Díez
- Department of Medical Education, Universidad de Navarra, Pamplona, Spain; Department of Pathology, Anatomy and Physiology, Universidad de Navarra, Pamplona, Spain.
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Yucel H. Empathy levels in physiotherapy students: a four-year longitudinal study. Physiother Theory Pract 2024; 40:224-229. [PMID: 36093851 DOI: 10.1080/09593985.2022.2122916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Empathy is a key value in health-related occupations such as physiotherapy. PURPOSE This longitudinal study aimed to determine the empathy levels of students in a four-year bachelor of physiotherapy program. METHODS A total of 120 physiotherapy students at a non-governmental university in Istanbul participated in the study between 2016 and 2019. The Turkish adaptation of the student version of the Jefferson Scale of Physician Empathy was used. Empathy scores were compared according to year of study and gender. RESULTS Most participants were women (n = 101, 84.2%). Empathy scores differed by years of study (p < .001) being highest in the first year and lowest in the fourth year. There was no difference in empathy scores between women and men (p = .26). CONCLUSION This is the first longitudinal study to contribute data on empathy levels in Turkish physiotherapy students. The decline in empathy seen in fourth-year physiotherapy students is associated more with the academic program and clinical practice than with any other factor. Further studies are warranted to explore why there are variations in empathy levels in physiotherapy students during their education. Ensuring students develop awareness and skills related to empathy during their undergraduate studies could result in a higher quality of care early in their professional practice.
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Affiliation(s)
- Hulya Yucel
- Department of Occupational Therapy, Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey
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He S, Sultana R, Anantham D, Loh HP, Zhou JX, Tang JY, Sim M, Ayre TC, Fong KY, Tan KH. Empathy Levels Among Healthcare Professionals: An Asian Multi-professional Cross-Sectional Study. Cureus 2024; 16:e53750. [PMID: 38465054 PMCID: PMC10921128 DOI: 10.7759/cureus.53750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The aim of the study was to measure empathy in healthcare professionals in Singapore and to compare the scores between the different professions: doctors, nurses, and allied health professionals. METHODS An online survey questionnaire was conducted using the Jefferson Scale of Empathy (JSE) from July 2019 to January 2020. The total JSE score was calculated and compared among the different groups. Multiple linear regression was performed to assess predictors of total empathy scores for groups with statistically lower scores. RESULTS The survey was completed by 4,188 healthcare professionals (doctors (n=569, 13.6%), nurses (n=3032, 72.4%), and allied health professionals (n=587, 14.0%)) out of the 9,348-strong survey population, with a response rate of 44.8%. The study revealed a mean empathy score (SD) of 103.6 (15.6) for the cohort. The mean empathy score (SD) was 112.3 (14.7), 101.3 (15.2), and 107.0 (15.0), respectively for doctors, nurses, and allied health professionals. These were statistically significantly different among the groups (p< 0.0001), with nurses scoring significantly lower than either doctors (p< 0.0001) or allied health professionals (p< 0.0001). Multiple linear regression showed that age < 30 years old, male gender, Malay ethnicity, and working in a hospital setting were associated with significantly lower empathy scores in the nursing group. CONCLUSION Nurses in Singapore had significantly lower empathy scores compared to doctors and allied health professionals. Further research on the underlying causes should be undertaken and measures to improve empathy among Singapore nursing staff should be explored and implemented.
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Affiliation(s)
- Song He
- Department of Obstetrics and Gynaecology, KK (Kandang Kerbau) Women's and Children's Hospital, Singapore, SGP
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS (National University of Singapore) Medical School, Singapore, SGP
| | - Devanand Anantham
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, SGP
| | - Huey Peng Loh
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
| | - Jamie X Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, SGP
| | - Joo Ying Tang
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
| | - Mabel Sim
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
| | | | - Kok Yong Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, SGP
| | - Kok Hian Tan
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
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Guthrie E, Charon R. Disability and narrative medicine: Challenges and opportunities. Dev Med Child Neurol 2024; 66:149-154. [PMID: 37390126 DOI: 10.1111/dmcn.15685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 07/02/2023]
Abstract
Despite decades of international entreaties for improvement, education about and provision of healthcare for people with disabilities remains harmfully inferior to that of the non-disabled population. Many obstacles confound efforts to ameliorate this inequity, perhaps the most pernicious of which is negative bias on the part of providers. Narrative medicine offers a means to address healthcare attitudes towards people with disabilities, in particular negative attitudes based on 'ableism'. Through absorbing, writing, and sharing of diverse perspectives, narrative medicine kindles imagination and empathy, promoting self-reflection. This approach enriches the students' capacity to absorb what their patients are trying to say, and to appreciate, respect, and hopefully meet the healthcare needs of people with disability. WHAT THIS PAPER ADDS: Narrative medicine is a pedagogical tool to help providers listen and reflect on patients with disabilities.
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Affiliation(s)
- Elisabeth Guthrie
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Rita Charon
- Columbia University Irving Medical Center, New York, NY, USA
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Vieten C, Rubanovich CK, Khatib L, Sprengel M, Tanega C, Polizzi C, Vahidi P, Malaktaris A, Chu G, Lang AJ, Tai-Seale M, Eyler L, Bloss C. Measures of empathy and compassion: A scoping review. PLoS One 2024; 19:e0297099. [PMID: 38241358 PMCID: PMC10798632 DOI: 10.1371/journal.pone.0297099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024] Open
Abstract
Evidence to date indicates that compassion and empathy are health-enhancing qualities. Research points to interventions and practices involving compassion and empathy being beneficial, as well as being salient outcomes of contemplative practices such as mindfulness. Advancing the science of compassion and empathy requires that we select measures best suited to evaluating effectiveness of training and answering research questions. The objective of this scoping review was to 1) determine what instruments are currently available for measuring empathy and compassion, 2) assess how and to what extent they have been validated, and 3) provide an online tool to assist researchers and program evaluators in selecting appropriate measures for their settings and populations. A scoping review and broad evidence map were employed to systematically search and present an overview of the large and diverse body of literature pertaining to measuring compassion and empathy. A search string yielded 19,446 articles, and screening resulted in 559 measure development or validation articles reporting on 503 measures focusing on or containing subscales designed to measure empathy and/or compassion. For each measure, we identified the type of measure, construct being measured, in what context or population it was validated, response set, sample items, and how many different types of psychometrics had been assessed for that measure. We provide tables summarizing these data, as well as an open-source online interactive data visualization allowing viewers to search for measures of empathy and compassion, review their basic qualities, and access original citations containing more detail. Finally, we provide a rubric to help readers determine which measure(s) might best fit their context.
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Affiliation(s)
- Cassandra Vieten
- Centers for Integrative Health, Department of Family Medicine, University of California, San Diego, San Diego, California, United States of America
- Clarke Center for Human Imagination, School of Physical Sciences, University of California, San Diego, San Diego, California, United States of America
| | - Caryn Kseniya Rubanovich
- Department of Psychiatry, University of California, San Diego, San Diego, California, United States of America
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, San Diego, California, United States of America
- T. Denny Sanford Institute for Empathy and Compassion, University of California, San Diego, San Diego, California, United States of America
- T. Denny Sanford Center for Empathy and Technology, University of California, San Diego, San Diego, California, United States of America
| | - Lora Khatib
- Department of Psychiatry, University of California, San Diego, San Diego, California, United States of America
| | - Meredith Sprengel
- Human Factors, Netherlands Organisation for Applied Scientific Research (TNO), Soesterberg, The Netherlands
| | - Chloé Tanega
- Clarke Center for Human Imagination, School of Physical Sciences, University of California, San Diego, San Diego, California, United States of America
| | - Craig Polizzi
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
| | - Pantea Vahidi
- Compassion Clinic, San Diego, California, United States of America
| | - Anne Malaktaris
- Department of Psychiatry, University of California, San Diego, San Diego, California, United States of America
- VA San Diego Center of Excellence for Stress and Mental Health, San Diego, California, United States of America
| | - Gage Chu
- VA San Diego Center of Excellence for Stress and Mental Health, San Diego, California, United States of America
| | - Ariel J. Lang
- Department of Psychiatry, University of California, San Diego, San Diego, California, United States of America
- VA San Diego Center of Excellence for Stress and Mental Health, San Diego, California, United States of America
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, California, United States of America
| | - Ming Tai-Seale
- Departments of Family Medicine and Medicine (Bioinformatics), School of Medicine, University of California, San Diego, San Diego, California, United States of America
| | - Lisa Eyler
- Department of Psychiatry, University of California, San Diego, San Diego, California, United States of America
- T. Denny Sanford Institute for Empathy and Compassion, University of California, San Diego, San Diego, California, United States of America
- T. Denny Sanford Center for Empathy and Compassion Training in Medical Education, University of California, San Diego, San Diego, California, United States of America
| | - Cinnamon Bloss
- Department of Psychiatry, University of California, San Diego, San Diego, California, United States of America
- T. Denny Sanford Institute for Empathy and Compassion, University of California, San Diego, San Diego, California, United States of America
- T. Denny Sanford Center for Empathy and Technology, University of California, San Diego, San Diego, California, United States of America
- T. Denny Sanford Center for Empathy and Compassion Training in Medical Education, University of California, San Diego, San Diego, California, United States of America
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Liang JZ, Ng DKW, Raveendran V, Teo MYK, Quah ELY, Chua KZY, Lua JK, Owyong JLJ, Vijayan AV, Abdul Hamid NAB, Yeoh TT, Ong EK, Phua GLG, Mason S, Fong W, Lim C, Woong N, Ong SYK, Krishna LKR. The impact of online education during the Covid-19 pandemic on the professional identity formation of medical students: A systematic scoping review. PLoS One 2024; 19:e0296367. [PMID: 38181035 PMCID: PMC10769105 DOI: 10.1371/journal.pone.0296367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/09/2023] [Indexed: 01/07/2024] Open
Abstract
Evolving individual, contextual, organizational, interactional and sociocultural factors have complicated efforts to shape the professional identity formation (PIF) of medical students or how they feel, act and think as professionals. However, an almost exclusive reliance on online learning during the COVID-19 pandemic offers a unique opportunity to study the elemental structures that shape PIF and the environmental factors nurturing it. We propose two independent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA)s to map accounts of online learning environment and netiquette that structure online programs. The data accrued was analysed using the clinically evidenced Krishna-Pisupati Model of Professional Identity Formation (KPM) to study the evolving concepts of professional identity. The results of each SSR in SEBA were evaluated separately with the themes and categories identified in the Split Approach combined to create richer and deeper 'themes/categories' using the Jigsaw Perspective. The 'themes/categories' from each review were combined using the Funnelling Process to create domains that guide the discussion. The 'themes/categories' identified from the 141 included full-text articles in the SSR in SEBA of online programs were the content and effects of online programs. The themes/categories identified from the 26 included articles in the SSR in SEBA of netiquette were guidelines, contributing factors, and implications. The Funnelling Process identified online programs (encapsulating the content, approach, structures and the support mechanisms); their effects; and PIF development that framed the domains guiding the discussion. This SSR in SEBA identifies the fundamental elements behind developing PIF including a structured program within a nurturing environment confined with netiquette-guided boundaries akin to a Community of Practice and the elemental aspect of a socialisation process within online programs. These findings ought to be applicable beyond online training and guide the design, support and assessment of efforts to nurture PIF.
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Affiliation(s)
- Jonathan Zhen Liang
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Donovan Kai Wei Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Vijayprasanth Raveendran
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Mac Yu Kai Teo
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jun Kiat Lua
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Andrew Vimal Vijayan
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Ting Ting Yeoh
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Assisi Hospice, Singapore, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Singapore, Singapore
| | - Natalie Woong
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom
- PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
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Cole JD, Ruble MJ, Jacoby JL, Smith AB, Duka S, Kincaid H, Quinn JF. Longitudinal Assessment of Empathy and Burnout Across a Single Pharmacy Class Cohort. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100604. [PMID: 37832651 DOI: 10.1016/j.ajpe.2023.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/23/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE This is a final analysis of longitudinal evaluation of burnout and empathy among a cohort of Doctor of Pharmacy students throughout their 4-year enrollment. METHODS The class of 2021 received sequential Qualtrics (Qualtrics, Provo, UT) surveys containing 2 validated survey instruments, the Jefferson Scale of Empathy and the Maslach Burnout Inventory. Surveys were disseminated at the start of the program (PY1start) and the end of each academic year (PY1end, PY2, PY3, PY4). Linear mixed models accounting for repeated measures, Generalized Estimating Equation, and Cochran's Q statistic were used to evaluate longitudinal change in the Jefferson Scale of Empathy and Maslach Burnout Inventory survey scores, categorized subscales, and burnout. RESULTS Matched survey responses were included for 91 students (85.8% response rate). Across all years, a decrease in empathy and professional efficacy and an increase in exhaustion and cynicism was seen. High categorical levels of exhaustion and cynicism indicated evidence of burnout throughout the program. Year-to-year analysis indicated statistically significant increases in exhaustion and cynicism between PY1start and all subsequent assessments, a decrease in professional efficacy from PY1start to PY1end and PY2, and a decrease in empathy for PY1start to PY1end. CONCLUSION Students reported trends of decreasing empathy and professional efficacy, with a simultaneous increase in exhaustion and cynicism. Further evaluation of the impact of COVID-19 on these results, as well as additional methods to support overall student wellness, is needed.
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Affiliation(s)
- Jaclyn D Cole
- University of South Florida, Taneja College of Pharmacy, Tampa, FL, USA
| | - Melissa J Ruble
- University of South Florida, Taneja College of Pharmacy, Tampa, FL, USA.
| | - Jeanne L Jacoby
- Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine (USF-MCOM), Lehigh Valley Campus, Allentown, PA, USA
| | - Amy B Smith
- Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine (USF-MCOM), Lehigh Valley Campus, Allentown, PA, USA
| | - Shae Duka
- Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine (USF-MCOM), Lehigh Valley Campus, Allentown, PA, USA
| | - Hope Kincaid
- Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine (USF-MCOM), Lehigh Valley Campus, Allentown, PA, USA
| | - Joann Farrell Quinn
- University of South Florida Morsani College of Medicine (USF-MCOM), Tampa Campus, Tampa, FL, USA
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Newton BW, Vaskalis ZT. Cognitive empathy of osteopathic students: a longitudinal study with data comparisons to the Project in Osteopathic Medical Education and Empathy (POMEE). J Osteopath Med 2024; 124:13-20. [PMID: 37702322 DOI: 10.1515/jom-2023-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/27/2023] [Indexed: 09/14/2023]
Abstract
CONTEXT Establishing an empathic bond of trust with patients is a characteristic that physicians need, because patients feel that physicians are more caring if they sense that they are empathetic. Former cross-sectional studies have shown an erosion of cognitive empathy as medical students progress through their education. OBJECTIVES This study aims to measure the changes in student cognitive empathy as they progress through their undergraduate osteopathic medical education. Cognitive empathy scores are compared to the nationwide norms established by the Project in Osteopathic Medical Education and Empathy (POMEE) study by Mohammadreza Hojat, PhD, and colleagues. METHODS During orientation to medical school, and at the beginning of each subsequent academic year, and just before graduation, the graduating classes of 2017-2019 participated in this longitudinal study by filling out the Jefferson Scale of Empathy-Student Version (JSE-S). A total of 345/459 Osteopathic Medical Student (OMS) I-IV students (75.2 % of the graduates) filled out the forms for all five time points. Desired specialty choice and sex were also collected. Specialty choice was divided into Core and Non-Core groups. Core specialties are "people-oriented" and have a large amount of patient contact and continuity of care, while Non-Core specialties are "technical- or procedure-oriented" and have little or no patient contact and/or continuity of care. RESULTS Men selecting Non-Core specialties had significant drops in JSE-S scores (p=0.001); whereas men who selected the Core specialties did not have a significant decrease. For women, there was no significant drop in JSE-S scores for those selecting either Core or Non-Core specialties. When compared to POMEE norm data, none of the Campbell University School of Medicine students had JSE-S scores that were above the 50th percentile. CONCLUSIONS Students selecting Core specialties do a better job of maintaining their cognitive empathy, which aids their ability to establish an empathic bond of trust with patients, when compared to students who desire Non-Core specialties. JSE-S scores not above the POMEE 50th percentile is concerning and indicate either a curricular change to better enhance empathic communication skills and/or better applicant selection.
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Affiliation(s)
- Bruce W Newton
- Department of Anatomy, Campbell University, Jerry M. Wallace School of Osteopathic Medicine in North Carolina, Buies Creek, NC, USA
| | - Zachary T Vaskalis
- Department of Medical Education, Campbell University, Jerry M. Wallace School of Osteopathic Medicine, Buies Creek, NC, USA
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Bhagat PR, Trivedi KY, Prajapati KM, Chauhan AS, Shah NP, Shah RT, Kathiara RA, Asari WA, Rajput V. Nurturing Empathy through Arts, Literature, and Role Play for Postgraduate Trainees of Ophthalmology. Int J Appl Basic Med Res 2024; 14:42-47. [PMID: 38504843 PMCID: PMC10947765 DOI: 10.4103/ijabmr.ijabmr_454_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 03/21/2024] Open
Abstract
Background and Purpose Empathy is essential in patient-centered compassionate health care. Lack of formal training, workload, patient factors, and digitalization have been attributed to its regression. Empathy can be nurtured by educational interventions. A structured empathy education module for postgraduate trainees is not available in India. The aim for this research was to develop, deliver, and evaluate one for ophthalmology postgraduate trainees. Methodology This interventional study was conducted in the tertiary ophthalmology department of Western India during 2022-2023. Four workshops comprising of interactive lectures, literature, creative arts, and role plays were delivered with trained facilitators. Data from surveys for trainee self-assessment, patient perception of trainee empathy, pre-post knowledge test, and trainee and facilitator feedback were collected and analyzed. Results Seventy-nine ophthalmology postgraduate trainees participated in this intervention. Excessive workload and lack of training were shared as the barriers to empathetic care. Trainees showed improved knowledge, skills, and attitude in empathy after the workshops. The facilitators and trainees were satisfied with the learning goals, execution, utility, feasibility, and relevance of the workshops. Ninety-three percent trainees want this module to be a part of postgraduate curriculum. Conclusion This study substantiates the use of structured interactive training for cultivating empathy in postgraduate trainees. Barriers against empathy were identified and can be mitigated by restorative measures. Literature, arts, and role plays are the effective education tools for empathy.
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Affiliation(s)
- Purvi R. Bhagat
- Department of Ophthalmology, M and J Western Regional Institute of Ophthalmology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Kinjal Y. Trivedi
- Department of Ophthalmology, M and J Western Regional Institute of Ophthalmology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Kamini M. Prajapati
- Department of Ophthalmology, M and J Western Regional Institute of Ophthalmology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Abhishek S. Chauhan
- Department of Ophthalmology, M and J Western Regional Institute of Ophthalmology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Neeharika Pinakin Shah
- Department of Ophthalmology, M and J Western Regional Institute of Ophthalmology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Rupal T. Shah
- Department of Ophthalmology, M and J Western Regional Institute of Ophthalmology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Ravija A. Kathiara
- Department of Ophthalmology, M and J Western Regional Institute of Ophthalmology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Wilhemina A. Asari
- Department of Ophthalmology, M and J Western Regional Institute of Ophthalmology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Vijay Rajput
- Department of Medical Education, Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Florida, United States
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Laird-Gion JN, Garabedian LF, Conrad R, Shaffer AC, Witkowski ML, Mateo CM, Jones DS, Hundert E, Kasper J. "The Water in Which We Swim:" A Unique, Post-Clerkship Multidisciplinary Course. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241232184. [PMID: 38390256 PMCID: PMC10883117 DOI: 10.1177/23821205241232184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To improve patient outcomes and promote health equity, medical students must be taught not only biomedicine, but also the social sciences to understand the larger contexts in which patients live and health care operates. Yet, most undergraduate medical education does not explicitly cover these topics in a required, longitudinal curriculum. METHODS In January 2015 at Harvard Medical School, we created a two-part sequence (pre- and post-clerkship) of required, 4-week multidisciplinary courses-"Essentials of the Profession I and II"-to fill this gap. "Essentials of the Profession II (EOP2)" is an advanced social sciences course anchored in patient narratives and the lived experiences of students and includes clinical epidemiology and population health, healthcare delivery and leadership, health policy, medical ethics and professionalism, and social medicine that engages students to conduct structural analyses to be effective healers, advocates, and leaders. RESULTS Per student course evaluations, the overall course rating was 1.7 (SD 0.9, 1 = excellent and 5 = poor); its overall rating has improved over time; and it has scored well even when run virtually. It was rated highly in application of critical thinking, integration of the disciplines, and relevance for clinical work. Qualitative analyses of student responses revealed the following key course strengths: breadth of topics, teaching faculty and guest speakers, and small group discussions. The weaknesses included workload, lack of diversity of opinions, repetition, and time spent in lectures. CONCLUSIONS We argue that EOP2 is "essential" for post-clerkship medical education. It offers an opportunity to re-ignite and enhance humanism and activism; remind students why they chose the medical profession; equip them with frameworks and toolkits to help them to overcome challenges; and devise solutions to improve health care and patient outcomes that are applicable to their future training and ongoing practice of medicine.
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Affiliation(s)
- Jessica N Laird-Gion
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura F Garabedian
- Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Rachel Conrad
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Adam C Shaffer
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary L Witkowski
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Camila M Mateo
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - David S Jones
- Harvard Medical School, Boston, MA, USA
- Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA
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Quah ELY, Chua KZY, Lin CKR, Vijayan AV, Abdul Hamid NAB, Owyong JLJ, Satku N, Woong N, Lim C, Phua GLG, Ong EK, Fong W, Krishna LKR. The role of patients' stories in medicine: a systematic scoping review. BMC Palliat Care 2023; 22:199. [PMID: 38087237 PMCID: PMC10714554 DOI: 10.1186/s12904-023-01319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Patients' stories provide Palliative Care physicians with a glimpse into the former's lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients' stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this 'care influencing' practice in medicine. METHODS This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach's concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion. RESULTS Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns. CONCLUSION Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this 'care influencing' practice.
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Affiliation(s)
- Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Casper Keegan Ronggui Lin
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
- Division of Outpatient Pharmacy, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Andrew Vimal Vijayan
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Nur Amira Binte Abdul Hamid
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Neeta Satku
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
| | - Natalie Woong
- Department of Internal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Road, Singapore, 574627, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC C/O Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
- Health Data Science, University of Liverpool, Whelan Building The Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK.
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Baskin C, Duncan F, Adams EA, Oliver EJ, Samuel G, Gnani S. How co-locating public mental health interventions in community settings impacts mental health and health inequalities: a multi-site realist evaluation. BMC Public Health 2023; 23:2445. [PMID: 38062427 PMCID: PMC10702025 DOI: 10.1186/s12889-023-17404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Public mental health interventions are non-clinical services that aim to promote wellbeing and prevent mental ill health at the population level. In England, the health, social and community system is characterised by complex and fragmented inter-sectoral relationships. To overcome this, there has been an expansion in co-locating public mental health services within clinical settings, the focus of prior research. This study evaluates how co-location in community-based settings can support adult mental health and reduce health inequalities. METHODS A qualitative multi-site case study design using a realist evaluation approach was employed. Data collection took place in three phases: theory gleaning, parallel testing and refining of theories, and theory consolidation. We collected data from service users (n = 32), service providers (n = 32), funders, commissioners, and policy makers (n = 11), and members of the public (n = 10). We conducted in-depth interviews (n = 65) and four focus group discussions (n = 20) at six case study sites across England, UK, and two online multi-stakeholder workshops (n = 20). Interview guides followed realist-informed open-ended questions, adapted for each phase. The realist analysis used an iterative, inductive, and deductive data analysis approach to identify the underlying mechanisms for how community co-location affects public mental health outcomes, who this works best for, and understand the contexts in which co-location operates. RESULTS Five overarching co-location theories were elicited and supported. Co-located services: (1) improved provision of holistic and person-centred support; (2) reduced stigma by creating non-judgemental environments that were not associated with clinical or mental health services; (3) delivered services in psychologically safe environments by creating a culture of empathy, friendliness and trust where people felt they were being treated with dignity and respect; (4) helped to overcome barriers to accessibility by making service access less costly and more time efficient, and (5) enhance the sustainability of services through better pooling of resources. CONCLUSION Co-locating public mental health services within communities impacts multiple social determinants of poor mental health. It has a role in reducing mental health inequalities by helping those least likely to access services. Operating practices that engender inter-service trust and resource-sharing are likely to support sustainability.
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Affiliation(s)
- Cleo Baskin
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
| | - Fiona Duncan
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK.
| | - Emma A Adams
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK
| | - Emily J Oliver
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK
| | - Gillian Samuel
- The McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
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Childress A, Lou M. Illness Narratives in Popular Music: An Untapped Resource for Medical Education. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:533-552. [PMID: 37566168 DOI: 10.1007/s10912-023-09813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
Illness narratives convey a person's feelings, thoughts, beliefs, and descriptions of suffering and healing as a result of physical or mental breakdown. Recognized genres include fiction, nonfiction, poetry, plays, and films. Like poets and playwrights, musicians also use their life experiences as fodder for their art. However, illness narratives as expressed through popular music are an understudied and underutilized source of insights into the experience of suffering, healing, and coping with illness, disease, and death. Greater attention to the value of music within medical education is needed to improve students' perspective-taking and communication. Like reading a good book, songs that resonate with listeners speak to shared experiences or invite them into a universe of possibilities that they had not yet imagined. In this article, we show how uncovering these themes in popular music might be integrated into medical education, thus creating a space for reflection on the nature and meaning of illness and the fragility of the human condition. We describe three kinds of illness narratives that may be found in popular music (autobiographical, biographical, and metaphorical) and show how developing skills of close listening through exposure to these narrative forms can improve patient-physician communication and expand students' moral imaginations.
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Affiliation(s)
- Andrew Childress
- Humanities Expression and Arts Lab, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA.
| | - Monica Lou
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Tzialla N, Boka V, Menexes G, Kotsanos N, Arapostathis K. Psychometric properties of the Greek version of the Jefferson Scale of Empathy and empathy levels in Greek dental postgraduate students. Eur Arch Paediatr Dent 2023; 24:691-700. [PMID: 37531023 DOI: 10.1007/s40368-023-00826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE The aims of this study were to: (1) examine the psychometric properties of the Greek version of JSE-HP and (2) explore empathy among Greek dental postgraduate students. METHODS The JSE-HP scale was translated into Greek using the back translation method. The questionnaire was given to 111 dental postgraduate students between November 2017 and February 2018. A random sample of 25% was retested to assess test-retest reliability. The reliability of the Greek version of JSE-HP was measured with Cronbach's alpha (α) and Discrimination Indices (DIs). Exploratory Factor Analysis, with varimax rotation of the factorial axes, was used to examine the dimensionality and the factorial validity of the Greek version of the JSE-HP. Comparisons between groups of postgraduate students were performed as appropriate with the Kruskal-Wallis or the Mann-Whitney U test. RESULTS The response rate was 100%. The mean age was 28.9 years. The reliability, in the sense of internal consistency of the questionnaire was considered satisfactory (Cronbach's alpha: 0.76, average DI: 0.33.) The test-retest reliability was satisfactory (Pearson's r = 0.77, p < 0.001). Factor Analysis revealed 7 significant factors. No statistically significant differences in empathy scores were found among groups of postgraduate students. CONCLUSIONS The Greek version of the JSE-HP shows good psychometric properties. Empathy scores do not differ among Greek dental postgraduate students.
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Affiliation(s)
- N Tzialla
- Department of Paediatric Dentistry, Faculty of Dentistry, Aristotle University of Thessaloniki, 54636, Thessaloniki, Greece.
| | - V Boka
- Department of Paediatric Dentistry, Faculty of Dentistry, Aristotle University of Thessaloniki, 54636, Thessaloniki, Greece
| | - G Menexes
- Laboratory of Agronomy, School of Agriculture, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Kotsanos
- Department of Paediatric Dentistry, Faculty of Dentistry, Aristotle University of Thessaloniki, 54636, Thessaloniki, Greece
| | - K Arapostathis
- Department of Paediatric Dentistry, Faculty of Dentistry, Aristotle University of Thessaloniki, 54636, Thessaloniki, Greece
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Hardy SB, Starr E, Maagaard CA, McAuliffe S, McConnell E, Quesenberry K. "A Widely Applicable Model": Teaching Sarah Manguso's The Two Kinds of Decay Across Institutions. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:431-453. [PMID: 36749537 PMCID: PMC9902827 DOI: 10.1007/s10912-022-09780-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 06/18/2023]
Abstract
Many of those teaching at the intersection of medicine and the humanities are siloed within institutional spaces. This essay recounts the teaching of Sarah Manguso's The Two Kinds of Decay to students across different academic contexts and considers what we can learn when we put classrooms in conversation with each other. This essay argues for the value of texts like Manguso's, which explicitly hold the narrating subject and form of illness narrative up for critical examination. The authors call for more collaborative teaching, which has special resonance in the health humanities, where conversations already depend on bridging disciplines and listening to the stories others can tell.
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Affiliation(s)
| | - Elizabeth Starr
- Department of English, Westfield State University, Westfield, MA, USA
| | - Cindie Aaen Maagaard
- Department of Language and Communication, University of Southern Denmark, Odense, Denmark
| | - Shena McAuliffe
- Department of English, Union College (Formerly at Earlham College, Department of English), Schenectady, NY, USA
| | - Erin McConnell
- Internal Medicine and Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Krista Quesenberry
- Department of English, Albion College (Formerly at Penn State University, Departments of English and Women's, Gender, and Sexuality Studies), Albion, MI, USA
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Corradi‐Dell'Acqua C, Hofstetter C, Sharvit G, Hugli O, Vuilleumier P. Healthcare experience affects pain-specific responses to others' suffering in the anterior insula. Hum Brain Mapp 2023; 44:5655-5671. [PMID: 37608624 PMCID: PMC10619377 DOI: 10.1002/hbm.26468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/13/2023] [Accepted: 07/22/2023] [Indexed: 08/24/2023] Open
Abstract
Medical students and professional healthcare providers often underestimate patients' pain, together with decreased neural responses to pain information in the anterior insula (AI), a brain region implicated in self-pain processing and negative affect. However, the functional significance and specificity of these neural changes remains debated. Across two experiments, we recruited university medical students and emergency nurses to test the role of healthcare experience on the brain reactivity to other's pain, emotions, and beliefs, using both pictorial and verbal cues. Brain responses to self-pain was also assessed and compared with those to observed pain. Our results confirmed that healthcare experience decreased the activity in AI in response to others' suffering. This effect was independent from stimulus modality (pictures or texts), but specific for pain, as it did not generalize to inferences about other mental or affective states. Furthermore, representational similarity and multivariate pattern analysis revealed that healthcare experience impacted specifically a component of the neural representation of others' pain that is shared with that of first-hand nociception, and related more to AI than to other pain-responsive regions. Taken together, our study suggests a decreased propensity to appraise others' suffering as one's own, associated with a reduced recruitment of pain-specific information in AI. These findings provide new insights into neural mechanisms leading to pain underestimation by caregivers in clinical settings.
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Affiliation(s)
- Corrado Corradi‐Dell'Acqua
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE)University of GenevaGenevaSwitzerland
- Geneva Neuroscience CenterUniversity of GenevaGenevaSwitzerland
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
| | - Christoph Hofstetter
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
| | - Gil Sharvit
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
- Swiss Center for Affective Sciences, University of GenevaGenevaSwitzerland
- Balgrist University Hospital and University of ZurichZurichSwitzerland
| | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne (UHL)LausanneSwitzerland
| | - Patrik Vuilleumier
- Geneva Neuroscience CenterUniversity of GenevaGenevaSwitzerland
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
- Swiss Center for Affective Sciences, University of GenevaGenevaSwitzerland
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Sattar K, Yusoff MSB, Arifin WN, Mohd Yasin MA, Mat Nor MZ. A scoping review on the relationship between mental wellbeing and medical professionalism. MEDICAL EDUCATION ONLINE 2023; 28:2165892. [PMID: 36621960 PMCID: PMC9833410 DOI: 10.1080/10872981.2023.2165892] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/01/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Mental wellbeing issues among medical students are common, and their relationship to medical professionalism is debated. Few studies have attempted to link such issues with undergraduate medical education. This review aimed to advance the knowledge on this matter by exploring the relationship between mental wellbeing and medical professionalism in undergraduate medical education. METHODS We collected the literature about mental wellbeing and medical professionalism (published from 1 January 1986 to 31 March 2021) from the Web of Science, PubMed, Scopus and ScienceDirect databases using the search terms 'mental wellbeing' and 'medical professionalism'.We included all peer-reviewed articles in which mental wellbeing and medical professionalism in the undergraduate medical education context were the central topics regardless of the age range, nationality, race and gender of the participants. RESULTS From the 13,076 Iinitially found articles, 16 were included. These 16 articles were from nine countries in four different continents, which all together helped us find answer to our research question using extracted points relating to the main study themes (mental wellbeing and medical professionalism). Under theme 1 (mental wellbeing), six subthemes emerged: burnout, stress, depression, disappointment, depersonalisation and conscientiousness. Theme 2 (medical professionalism), on the other hand, had five subthemes: empathy, academic performance, compassion, unprofessional behaviour and professionalism. A significant inverse association was found between empathy and burnout. Academic performance was also related to burnout. At the same time, empathy was found to have a varied association with stress. Moreover, compassion was found to alleviate burnout and nurture professional gratification. CONCLUSION The medical professionalism attributes were found to deteriorate as the mental wellbeing issues grow. This can harm medical students' overall health, current learning abilities and future attitudes towards their patients. Explicit primary research is thus required to examine and intervene in the cause-effect relationship between medical professionalism and mental wellbeing.
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Affiliation(s)
- Kamran Sattar
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Muhamad Saiful Bahri Yusoff
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Wan Nor Arifin
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Azhar Mohd Yasin
- Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Zarawi Mat Nor
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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