A preliminary study of empathy, emotional intelligence and examination performance in MBChB students

The impact of empathy on medical students: an integrative review

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.

The integrated curriculum and student empathy: a longitudinal multi-cohort analysis

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.

Outcomes of Emotional Intelligence Training for Surgeons in a Real-World Setting: a Mixed Methods Study

OBJECTIVE

The objective was to assess, improve and re-assess Emotional Intelligence (EI) in a group of junior and senior surgeons in a real-world setting.

DESIGN

This was a mixed methods study. An EI education program was delivered through a series of webinars. The program drew from the central concepts of emotional intelligence: Motivation, empathy, social skills, self-knowledge, and self-control. There was also a component of professional development. EI assessment was performed pre- and post-intervention using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and a series of targeted questions. Qualitative assessment was performed by means of structured interviews examining uptake in techniques, understanding of EI, and its effect on personal and professional life.

SETTING

The Australia and New Zealand Training Board in Colorectal Surgery administers a 2-year bi-national training program in teaching hospitals in Australia and New Zealand and runs a series of educational webinars throughout the training program. The "EI series" was part of this educational program.

PARTICIPANTS

Webinars were attended by 35 junior surgeons and 8 senior surgeons RESULTS: Self-perceived knowledge and use of EI increased from a mean of 3.6 to 6.5 (p<0.0001). There was a significant difference between experiential (94) and strategic (101) scores (p=0.005). There was a nonsignificant improvement (98.04-100.6, p=0.16), in the pre-post MSCEIT among the junior surgeons and no change for senior surgeons. Seventy-eight percent (25/32) of surgeons interviewed reported using any new EI strategies. Seventy-five percent actively stopped and considered what other people in a clinical scenario may be thinking; 78% commenced metacognition; 81% practiced the process of self-regulation; 66% had begun to recognise and use emotions as data; and, 47% had actively practiced the process of self-distancing CONCLUSION: This study demonstrated the feasibility and utility of delivering EI training in an online format to a group of time-poor surgeons in a real-world setting.

Emotional intelligence weakly predicts academic success in medical programs: a multilevel meta-analysis and systematic review

BACKGROUND

Emotional intelligence (EI) is a predictive factor of academic success in undergraduate Doctor of Medicine (MD) programs. Although some research suggests a positive association between EI and academic success in MD programs, other research reports neither an association nor a negative correlation between the two variables. The current study aimed to resolve these contradictory findings by conducting a systematic review and a meta-analysis using research from 2005 to 2022.

METHODS

Data were analyzed using a multilevel modeling approach to (a) estimate the overall relationship between EI and academic success in MD programs and (b) determine whether the mean effect size varies according to country (United States vs. non-United States countries), age, EI test, EI task nature (ability-based vs. trait-based), EI subscales, and academic performance criteria (grade point average vs. examinations).

RESULTS

Findings from 20 studies (m = 105; N = 4,227) indicated a positive correlation between EI and academic success (r = .13, 95% CI [.08, - .27], p < .01). Moderator analyses indicated that the mean effect size significantly varied according to EI tests and EI subscales. Moreover, three-level multiple regression analyses showed that between-study variance explained 29.5% of the variability in the mean effect size, whereas within-study variance explained 33.5% of the variability in the mean effect.

CONCLUSIONS

Overall, the current findings show that EI is significantly, albeit weakly, related to academic success in MD programs. Medical researchers and practitioners can therefore focus on integrating EI-related skills into the MD curriculum or target them through professional development training and programs.

Does doctors' personality differ from those of patients, the highly educated and other caring professions? An observational study using two nationally representative Australian surveys

OBJECTIVES

Personality differences between doctors and patients can affect treatment outcomes. We examine these trait disparities, as well as differences across medical specialities.

DESIGN

Retrospective, observational statistical analysis of secondary data.

SETTING

Data from two data sets that are nationally representative of doctors and the general population in Australia.

PARTICIPANTS

We include 23 358 individuals from a representative survey of the general Australian population (with subgroups of 18 705 patients, 1261 highly educated individuals and 5814 working in caring professions) as well as 19 351 doctors from a representative survey of doctors in Australia (with subgroups of 5844 general practitioners, 1776 person-oriented specialists and 3245 technique-oriented specialists).

MAIN OUTCOME MEASURES

Big Five personality traits and locus of control. Measures are standardised by gender, age and being born overseas and weighted to be representative of their population.

RESULTS

Doctors are significantly more agreeable (a: standardised score -0.12, 95% CIs -0.18 to -0.06), conscientious (c: -0.27 to -0.33 to -0.20), extroverted (e: 0.11, 0.04 to 0.17) and neurotic (n: 0.14, CI 0.08 to 0.20) than the general population (a: -0.38 to -0.42 to -0.34, c: -0.96 to -1.00 to -0.91, e: -0.22 to -0.26 to -0.19, n: -1.01 to -1.03 to -0.98) or patients (a: -0.77 to -0.85 to -0.69, c: -1.27 to -1.36 to -1.19, e: -0.24 to -0.31 to -0.18, n: -0.71 to -0.76 to -0.66). Patients (-0.03 to -0.10 to 0.05) are more open than doctors (-0.30 to -0.36 to -0.23). Doctors have a significantly more external locus of control (0.06, 0.00 to 0.13) than the general population (-0.10 to -0.13 to -0.06) but do not differ from patients (-0.04 to -0.11 to 0.03). There are minor differences in personality traits among doctors with different specialities.

CONCLUSIONS

Several personality traits differ between doctors, the population and patients. Awareness about differences can improve doctor-patient communication and allow patients to understand and comply with treatment recommendations.

The Relationship Between Teacher-Student Relationship and Adolescent Emotional Intelligence: A Chain-Mediated Mediation Model of Openness and Empathy

BACKGROUND

As the role of emotional intelligence has been increasingly explored, researchers generally agree that emotional intelligence is a better predictor of individual success. And fortunately, emotional intelligence is somewhat easily shaped. Schools are important microsites for the shaping of an individual's emotional intelligence. Good teacher-student relationship contribute to the shaping and development of students' emotional intelligence.

OBJECTIVE

Based on the theory of developmental contextualism, the current study aims to identify the relationship between good teacher-student relationship and students' emotional intelligence, and the mediating roles of students' openness and emotional intelligence.

METHODS

In this study, a total of 352 adolescents (11-15 years old) from two schools were surveyed using the teacher-student relationship scale, big five inventory openness subscale, and emotional intelligence scale.

RESULTS

Teacher-student relationship were positively correlated with students' openness, empathy, and emotional intelligence. Teacher-student relationship positively predicted students' emotional intelligence; students' openness and empathy played a fully mediating role in teacher-student relationship and emotional intelligence.

CONCLUSION

The closeness and supportiveness of the teacher-student relationship were positively related to students' openness, empathy, and emotional intelligence were positively correlated.

Patient Safety/Quality Improvement Primer, Part IV: Psychological Safety-Drivers to Outcomes and Well-being

Psychological safety is the concept that an individual feels comfortable asking questions, voicing ideas or concerns, and taking risks without undue fear of humiliation or criticism. In health care, psychological safety is associated with improved patient safety outcomes, increased clinician engagement, and greater creativity. A culture of psychological safety is imperative for physician well-being and satisfaction, which in turn directly affect delivery of care. For health care professionals, psychological safety creates an environment conducive to trust and openness, enabling the team to focus on high-quality care. In contrast, unprofessional behavior reduces psychological safety and threatens the culture of the organization. This patient safety/quality improvement primer considers the barriers and facilitators to psychological safety in health care; outlines principles for creating a psychologically safe environment; and presents strategies for managing conflict, microaggressions, and lapses in professionalism. Individuals and organizations share the responsibility of promoting psychological safety through proactive policies, conflict management, interventions for microaggressions, and cultivation of emotional intelligence.

Perception of educational environment with an assessment of motivational learning strategies and emotional intelligence as factors affecting medical students' academic achievement

BACKGROUND

This study aimed to investigate how medical students perceive their educational environment, as well as the implications of motivation, learning strategies, and the factor of emotional intelligence on academic achievement.

MATERIALS AND METHODS

In a cross-sectional study, 3384 undergraduate students were recruited from randomly selected Egyptian medical colleges. Students from second to final year, taking fundamental and clinical courses and, at a minimum, three professional exams, were enrolled and subjected to the Dundee Ready Educational Environment Measure scale, the Motivated Strategies for Learning Questionnaire, and Emotional intelligence questionnaire.

RESULTS

The overall mean age of the studied students was 21.42 ± 1.61 years. Females represented 63.5%, rural residents were 52.2% and students with enough income represented 88.0%. The traditional system adopted 28.4% of the students versus 71.6% in the integrated system. Linear regression using path analysis was conducted to study the predictors of academic achievement, and it revealed that motivation was the highly significant predictor of academic achievement (β = 2.68, CI95%:2.35-3.05, P < 0.001), followed by learning (β = 1.09, CI95%:0.80-1.41, P < 0.001), emotional intelligence (β = 0.92, CI95%:0.87-0.97, P < 0.001), and the educational environment (β = 0.14, CI95%:0.13-0.15, P < 0.001).

CONCLUSION

The study's findings have implications for medical educators trying to understand the personal factors that influence learning and performance in medical school. Students' motivation was the highly significant predictor of academic achievement followed by learning, emotional intelligence, and educational environment. Perception of the learning environment had improved because of the integrated student-centered system, which fosters motivation and emotional intelligence. To improve learners' EI, optimal learning, and educational outcomes, the EI components can be taught and fostered.

Academic and non-academic predictors of academic performance in medical school: an exploratory cohort study

BACKGROUND

Medical schools should also evaluate applicants' non-academic characteristics in the search for successful students and future physicians, but ideal non-academic criteria have not yet been found. We followed two successive generations of medical students at the University of Split School of Medicine (USSM) to assess both academic and non-academic constructs as predictors of academic performance, defined as medical school grade point average (GPA). We also interviewed some of the participants to gain additional insight for future studies.

METHODS

We measured study GPA in first and last year, as well as attitudes towards science, motivation, emotional intelligence, self-esteem, and perceived personal incompetence in first year. We also obtained their scores on existing medical school enrollment criteria, the State Graduation Exam (SGE) and high-school GPA. Regression models were constructed for predictors of GPA in the last year of medical school. Four structured pilot interviews were conducted to explore participants' perceptions of necessary traits for medical school and later practice.

RESULTS

Regression analysis showed that only SGE predicted final academic performance in medical school (β=0.35, 95% confidence interval (CI)=0.06-0.64), while none of the non-academic constructs we assessed predicted this outcome of education. The two generations did not significantly differ in any variable except that intrinsic motivation was higher in the generation that enrolled in 2011 (OR=1.47, 95%CI=1.12-1.93, P=0.005).

DISCUSSION

None of the non-academic constructs predicted academic performance in medical school. Their use as selection criteria may not be warranted as they could impact the academic quality of enrolling medical students.

WLEIS as a Measure of Emotional Intelligence of Healthcare Professionals: A Confirmatory Factor Analysis

Emotional intelligence has been extensively studied in healthcare practices worldwide. It is requisite for a reliable and valid instrument to measure the emotional intelligence of healthcare professionals in India. The Wong and Law emotional intelligence scale (WLEIS) has been a widely used tool to measure trait emotional intelligence. This study examines the validity of this scale in the healthcare context. The original 16 items WLEIS scale has been administered to 98 doctors of the Ahmedabad region of Gujarat. Two competing models, single factor and four factors have been tested against each other. Fit indices of four-factor model ( χ2 (98) = 111.61, ( p > 0.001), CMIN/df = 1.139, CFI = 0.987, SRMR = 0.059, RMSEA = 0.038 and PClose = 0.714) has excellent goodness of fit. Results of confirmatory factor analysis support the original four-factor model. The model also has acceptable reliability, convergent and discriminant validity. Further, in order to establish EI construct underneath four factors, secondary factor analysis has been performed. Standardized regression weight of only one dimension, that is, ‘Regulation of emotion’ is acceptable. All fit indices of the second-order model have an excellent fit. WLEIS is a valid instrument to measure the emotional intelligence of health professionals.

The development of empathy in the healthcare setting: a qualitative approach

BACKGROUND

Healthcare professionals' empathetic behaviors have been known to lead to higher satisfaction levels and produce better health outcomes for patients. However, empathy could decrease over time especially during training and clinical practice. This study explored factors that contributed to the development of empathy in the healthcare setting. Findings could be used to improve the effectiveness and sustainability of empathy training.

METHOD

A qualitative approach, informed by aspects of grounded theory, was utilized to identify factors that enabled the development of empathy from the perspectives of doctors, nurses, allied healthcare workers and students. Twelve sessions of focus group discussions were conducted with 60 participants from two hospitals, a medical school, and a nursing school. Data was analyzed independently by three investigators who later corroborated to refine the codes, subthemes, and themes. Factors which influence the development of empathy were identified and categorized. This formed the basis of the creation of a tentative theory of empathy development for the healthcare setting.

RESULTS

The authors identified various personal (e.g. inherent characteristics, physiological and mental states, professional identity) and external (e.g. work environment, life experience, situational stressors) factors that affected the development of empathy. These could be further categorized into three groups based on the stability of their impact on the individuals' empathy state, contributed by high, medium, or low stability factors. Findings suggest empathy is more trait-like and stable in nature but is also susceptible to fluctuation depending on the circumstances faced by healthcare professionals. Interventions targeting medium and low stability factors could potentially promote the development of empathy in the clinical setting.

CONCLUSIONS

Understanding factors that impact the development of empathy allows us to develop measures that could be implemented during training or at the workplace leading to improve the quality of care and higher clinical work satisfaction.

The relationship between medical students' empathy and burnout levels by gender and study years

OBJECTIVE

To investigate the multifaceted factors affecting empathy in medical students.

METHODS

1293 medical students from 15 South Korean medical schools participated in an online survey. Affective empathy was measured with the 'empathy concern' and 'personal distress' dimensions from the Interpersonal Reactivity Index for Medical Students (IRI-MS). Cognitive empathy was assessed with IRI-MS' 'perspective taking' and Jefferson Scales for Physician Empathy for Student (JSPE-S). Maslach Burnout Inventory for Medical Students (MBI-MS) assessed the burnout levels of the participants.

RESULTS

A significant gender difference in affective and cognitive empathy was found using JSPE-S. Different patterns were seen in the empathy dimensions between the study years and genders. Burnout scores showed no gender differences, while exhaustion and cynicism increased, and academic efficacy decreased with seniority. Academic efficacy was a consistently influential factor for both affective and cognitive empathy in both genders, all study years and the three domains of burnout.

CONCLUSION

Academic efficacy was a significant factor influencing both affective and cognitive empathy.

PRACTICAL IMPLICATIONS

The comprehensive nature of empathy in medical students may be better investigated by applying multi-dimensional empathy measurement tools and by analyzing multiple factors such as gender, study year and burnout.

Emotional Intelligence Instruments Used in Health Care Education

BACKGROUND

This article aims to describe the content and the psychometric properties of emotional intelligence instruments used in health care education and to examine the relationship between emotional intelligence and study success.

METHOD

Six electronic databases were searched in spring 2020. Two researchers participated in the selection and quality assessment of the articles. Ultimately, 26 articles were included in the review.

RESULTS

From the included articles, 18 emotional intelligence instruments were identified. The content of the instruments focused on perception of emotions, understanding of emotions, emotional expression, managing emotions, using emotions, and social awareness and relations. In most of the studies, emotional intelligence was related to study success.

CONCLUSION

The assessment of several important components of emotional intelligence was identified. Comprehensive assessment using the emotional intelligence total score seemed to be the best predictor of study success. [J Nurs Educ. 2022;61(1):6-11.].

Study protocol for the ETMED-L project: longitudinal study of mental health and interpersonal competence of medical students in a Swiss university using a comprehensive framework of empathy

INTRODUCTION

Physician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students' interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients.

METHODS AND ANALYSIS

This project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1-6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills.

ETHICS AND DISSEMINATION

The project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.

Stability and Differences in Empathy Between Men and Women Medical Students: a Panel Design Study

PHENOMENON

Empathy is central to the physician-patient relationship, and affects clinical outcomes. There is uncertainty about the stability of empathy in medical students over the course of medical school, as well as differences in empathy between men and women.

APPROACH

A panel study design was used to follow first year through fourth year medical students (MS1-4) during the 2018-2019 school year. Empathy was measured using the interpersonal reactivity index (IRI), a self-report scale that separates empathy into a cognitive perspective taking (PT) and affective empathic concern (EC) component.

FINDINGS

A total of 631 (359 women and 272 men) from 970 students (65% response rate) responded to a baseline survey, and a total of 536 students (300 women and 236 men) from 970 students (55% response rate) responded to surveys throughout the year. At baseline, women had significantly higher EC scores than men (p < 0.0001), with no significant PT difference between men and women (p > 0.05). These differences were stable for all MS cohorts.

INSIGHTS

Women had self-reported higher affective empathy (EC component) than men, while there were no differences in cognitive empathy (PT component). We discuss these data in the context of defining gender vs. sex, socialized gender stereotypes, and implications for future research.

Confounding Factors Affecting the Emotional Intelligence Amongst Jordanian Nursing and Midwifery Undergraduate Students During the COVID-19 Pandemic's Outbreak: A Cross-Sectional Study Using USMEQ-i

Objective: This aim of this study was to determine which variables from the demographic data most affect the EI regarding the COVID-19 outbreak and the lockdown amongst the nursing and midwifery students in Jordan. Background: Emotional intelligence (EI) is the ability to recognize, express, comprehend, motivate, influence and regulate emotions proposed the first EI model, which includes three constructs: emotion assessment and expression, emotion consumption and emotion control. During the COVID-19 outbreak and lockdown, face-to-face study methods have been replaced by online teaching, which has caused many psychological effects. Method: A cross-sectional approach was used to measure EI for nursing and midwifery students. The tool was completed online by nursing and midwifery students using Google Forms. All of the findings were received online and then analyzed accordingly. In this study, USMEQ-i was used to gather data from the participants. Results: The general EI score for the student respondents falls into the average score (M = 39.6). Regarding the difference between males and females, the results showed no significant difference. Moreover, the general linear regressions analysis of independent variables on EI score showed four significant factors. Nursing students who study in Years 1 and 4 had significantly higher EI scores than those in Years 2 and 3. EI ability decreased when a student's economic status changed from luxurious to middle income. Moreover, an increase in age significantly decreased the value of EI. This study indicates that all nursing and midwifery students who enrolled in general nursing program tended to have higher EI scores than others (p = 0.006). Conclusion: Year of study, age, average lifestyle and enrollment in a nursing program were found to be the most significant factors associated with EI amongst Jordanian nursing and midwifery students. This issue needs to be researched further, such that appropriate steps can be taken to address it.

The role of emotional competencies in predicting medical students' attitudes towards communication skills training

OBJECTIVES

This study aims to investigate whether stress, depression and emotional competencies can help to predict medical students' attitudes towards communication skills training (CST). Anxiety and negative attitudes towards CST have been shown to be linked. Conversely, emotional competencies (EC) were associated with positive attitudes. Exploring these psycho(patho)logical variables therefore seems to be a promising approach to better understanding, or even modifying, attitudes towards CST.

METHODS

179 third year medical students were asked to complete the Communication Skills Attitude Scale (CSAS), the Perceived Stress Scale (PSS), the Montgomery-Asberg Depression Rating Scale Self-assessment (MADRS-S) and the Profile of Emotional Competence (PEC).

RESULTS

168 students completed the entire questionnaire. The stepwise regression model first revealed that, taken together, intrapersonal EC "Utilization" and interpersonal EC "Expression" account for 17% of the variance in positive attitudes. Secondly, taken together, intrapersonal EC "Utilization" and interpersonal EC "Expression" account for 16% of the variance in negative attitudes.

CONCLUSION

The more competent a student is in "Utilization" and "Expression", the more positive attitudes and the less negative attitudes he/she has towards CST. In addition, measuring a large set of bio-psycho-social factors might be a way of capturing more variance in attitudes towards CST.

PRACTICE IMPLICATIONS

In the study of variables influencing attitudes towards CST, emotional competencies cannot be ignored. The context of the medical consultation encourages the discussion of various emotions felt by the patient. As educationalists, we should prepare the student for this by integrating the notion of EC within the CST.

Empathy Among Orthopaedic Surgery Trainees

Background

It has been postulated that the process of-and stresses associated with-medical training may cause a loss of empathy among trainees. Because empathy is considered an important value for clinicians and may even be associated with better patient outcomes, we assessed the empathy of orthopaedic surgery trainees and identified factors associated with empathy.

Methods

Between June and September 2020, an anonymous survey was distributed electronically to trainees in 23 Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs via the Collaborative Orthopaedic Educational Research Group. The survey comprised the validated Short-Form 8-Item Empathy Quotient (EQ-8) questionnaire-scored on a scale of 0, least empathetic, to 16, most empathetic-and single-item measure of emotional exhaustion and depersonalization derived from the Maslach Burnout Index-scored using a frequency scale. In total, 438 of 605 (72%) trainees completed the survey. The scores were compared via one-way analysis of variance, with Bonferroni correction and Tukey post-hoc testing, α = 0.05.

Results

The mean (±SD) EQ-8 score among respondents was 11.3 ± 3.3. Women scored significantly higher (mean, 12.2 ± 2.8) than men (mean, 11.2 ± 3.3) (p = 0.02). Mean scores were significantly higher for trainees planning on a career in academic medicine (12.0 ± 2.9) than those intending to pursue private practice (10.9 ± 3.3) or those with a military commitment (10.4 ± 3.4) (p = 0.01). An inverse relationship was found between EQ-8 scores and single-item Maslach Burnout Index measures in depersonalization and emotional exhaustion (both, p < 0.01). No significant differences were found in EQ-8 scores across postgraduate year, program location, primary training setting, intended fellowship, relationship status, or whether they reported having children.

Conclusions

We found no association between postgraduate year and EQ-8 score. Women and those intending to pursue a career in academic medicine had significantly higher levels of empathy. A significant inverse relationship was found between burnout and empathy. Respondents with higher levels of emotional exhaustion and depersonalization had lower levels of empathy.

Compassion Fatigue: Understanding Empathy

In clinical medicine, empathy is considered a central feature of holistic caretaking and successful patient interaction. It is unclear whether characteristics of empathy are innate, learned, or a combination of both. The means to evaluate clinical empathy are ill-defined, but perception of empathy has been shown to influence patient outcomes as well as professional well-being. This article reviews what is known about empathy in a medical setting and how it relates to negative mental health outcomes, such as compassion fatigue.

Emotional Intelligence and its Association with Academic Success and Performance in Medical Students

Background

Emotional intelligence (EI) is potentially associated with higher academic performance. However, no study from the Gulf region has previously assessed if EI affects academic success and academic performance in medical students.

Objectives

To examine the relationship between EI and academic success and academic performance in a sample of Saudi Arabian medical students.

Methods

This cross-sectional, questionnaire study included all 4^th-6^th year medical students enrolled at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia, in the academic year 2017-18. Eligible students were invited to complete the self-administered Schutte Self-Report Emotional Intelligence Test and the Academic Success Inventory for College Students (ASICS) along with a questionnaire eliciting demographic information between January and April 2018. Academic achievement was assessed based on each student's self-reported grade point average in the most recent examination.

Results

Of 377 eligible students, 296 (78%) completed the questionnaires. A significant association was identified between overall EI and ASICS scores (r = 0.197; P < 0.001). EI scores were constant in males and females and the year of study. No statistically significant association was observed between EI and academic success across gender and academic years (P > 0.05 for all values). However, in terms of external motivation and career decidedness by level of study, final-year students had higher scores compared with students in the other two study years (P = 0.02 and P = 0.01, respectively).

Conclusion

This study offers primary data on the impact of EI scores on academic success in medical education, and it identified several factors associated with EI and academic success. The findings of this study suggest that EI and academic success are linked, and that both are vital for increasing academic performance.

Emotional intelligence and perceived stress among undergraduate students of arts and science colleges in Puducherry, India: A cross-sectional study

Background

The concept of emotional intelligence has gained great popularity in the last few decades. With significant rise in stress and other emotional disturbances among students, it becomes necessary to determine whether high emotional intelligence could help manage perceived stress better. This study aims to assess emotional intelligence and perceived stress among undergraduate students of Arts and Science colleges, to determine the association of emotional intelligence with perceived stress, academic performance, and selected socio-demographic factors.

Methods and Material

Using multistage sampling, 720 students aged 18 years and above were selected from four colleges in Puducherry. Emotional intelligence and perceived stress were assessed using standard self-administered questionnaires "The Schutte Self-Report Emotional Intelligence Test (SEIT)" and "Perceived Stress Scale (PSS-14)," respectively.

Results

The median (IQR) Emotional Intelligence score and Perceived Stress score were 127 (114-137) and 43 (39-47), respectively. The study was not able to establish a significant association between emotional intelligence and perceived stress. A weak significant correlation existed between emotional intelligence and academic performance. Multiple variable analysis revealed gender, year of study, volunteering with youth organizations, and mother's occupation to be significantly associated with emotional intelligence (p < 0.05).

Conclusions

Women, final year students and those who volunteered with youth organizations had higher emotional intelligence. Children of mothers who were employed in knowledge-intensive occupations were more emotionally intelligent. Academic performance had a weak positive significant correlation with emotional intelligence.

Family Survey of Understanding and Communication of Patient Prognosis in the Intensive Care Unit: Identifying Training Opportunities

OBJECTIVE

Family members making medical decisions for critically ill patients depend on surgeons' high-quality communication. We aimed to assess family experience of communication in the trauma intensive care unit (TICU), identify opportunities for improvement, and tailor resident communication training to address deficiencies.

DESIGN

We designed surveys based on our Conceptual Model of Surgeon Communication and Family Understanding, using items from previously validated tools to assess (1) family well-being, experiences of care, access to information, and assessment of patient condition and prognosis; and (2) surgeon and nursing assessment of patient condition and prognosis.

SETTING

Level I TICU in an independent academic medical center.

PARTICIPANTS

Adult family members of patients hospitalized in the TICU > 24 hours; 88 families, 22 residents, 9 attendings, 81 nurses completed surveys on 78 unique patients.

RESULTS

Family indicated: (1) they had easy access to medical information (91%); (2) the doctors (89%) and nurses (99%) listened carefully (p = 0.013); (3) they were included in morning rounds (80%); and (4) the doctors (91%) and nurses (98%) explained things well (p = 0.041). Family-surgeon agreement regarding the patient's condition and chance of cure was poor (28%) and fair (58%) respectively; families were typically more pessimistic than the surgeon regarding the patient's condition (65%), and more optimistic regarding chance of cure (26%). Residents cited mentors and skills practice with simulated patients as most influential training elements on communication style.

CONCLUSIONS

Although families reported high-quality communication with the surgical team and rated physicians well in attributes related to trust, significant discordance in surgeon-family understanding of the patient's condition and prognosis persisted. This may be related to physician difficulty communicating complex information, or a family member's distress resulting in cognitive compromise, coupled with coping through hope and optimism. We recommend ongoing communication training for residents, skills practice for mentors, and open communication between nursing and physicians to optimize family information access.

Development and Validation of a Novel Measure for the Direct Assessment of Empathy in Veterinary Students

Empathy is a requisite clinical skill for health professionals and empathy scores have been positively associated with professionalism, clinical competency, confidence, well-being, and emotional intelligence. In order to improve empathy in the veterinary field, it is critical to measure the construct of empathy accurately. Most research has relied on self-reporting measures to assess empathy, while some studies have recently implemented the use of simulated client encounters in veterinary education. Building on this research, the aim of the current study was to develop and validate a novel quantitative assessment tool-the Empathy Clinical Evaluation Exercise (ECEX)-designed to measure empathy based on directly observable behaviors, using simulated clients. To evaluate empathy, evaluators used the ECEX to assess the performance of student clinicians in a simulated client encounter, which contained a pre-determined number of opportunities designed to elicit empathic responses from student clinicians. Statistical analysis suggests the test has a high degree of inter-rater reliability. In addition, there was moderate correlation between average empathy scores using ECEX and previously validated measures of empathy, compassion satisfaction, and burnout. Using these methods, we found the majority of students we studied had increased empathy scores at the completion of their primary care rotations. These results provide preliminary support for the use of the ECEX as a direct and quantitative tool for the assessment of empathy. Health professionals could use this novel empathy assessment tool to teach students, evaluate teaching strategies, and improve communication competencies in a wide variety of clinical settings. Our broad aim was to examine the utility of a direct and quantitative assessment tool for measuring empathy-the ECEX-in order to answer the following questions: (1) Does the tool have good inter-rater reliability? (2) Does the tool correlate with previously validated empathy measures? and (3) Does the tool correlate with similar constructs of compassion fatigue and burnout? Our secondary aim was to evaluate the change in empathy scores over the course of a 4-month (16-week) primary care rotation (pre- to -post).

The Role of Emotional Intelligence in Predicting a Successful Career for Plastic Surgeons: A Systematic Review

The definition of a successful career in plastic surgery is both a highly variable and personal one. Career success is underpinned by a combination of skills and is often multifactorial in nature. Although clinical and academic factors have long been key determinants of success, modern medical practice is now underlining the previously understated non-clinical skills as a major contributory element. Emotional intelligence (EI) has shown clear benefits in a successful career in the business world, where it was originally popularized. As a successful career in surgery also requires proficient understanding of human emotions, the clear similarities drawn with corporate success have resulted in a growing interest in EI in the medical domain. Despite such interest, the role of EI as a predictor of career success in plastic surgery has been poorly defined. This systematic review aims to define EI, to explore its role in medical and nonmedical fields, and to investigate its impact on a successful career in plastic surgery.

Relationship between empathy and motivation in undergraduate medical students

Background: Undergraduate medical education is important for encouraging empathy which is a critical component of patient-physician communication. Studies show a decline in empathy once medical students enter their clinical years. Since empathy is also a "motivated phenomenon", the current study aims to explore the relationship between empathy and students' motivation types. Methods: This cross-sectional study used a total sampling approach to recruit medical students in years 1-5. The Jefferson Scale of Physician Empathy (JSPE) was used to measure empathy in medical students and the Academic Motivation Scale (AMS) was utilised to assess student motivation. Following descriptive analyses, the differences in empathy scores based on motivation type was assessed using Kruskal-Wallis test and post-hoc Mann-Whitney test. Furthermore, the Spearman's rank correlation analysis was completed to assess the relationship between students' empathy and motivation type. The analyses were completed for each of year 1-5. Results: A total of 827 completed questionnaires (71.3% response rate) were analysed, showing strong internal consistency. Most students displayed high intrinsic and high controlled motivation. Motivation type was found to be consistently associated with empathy. Conclusions: The present study highlights the association of motivation with empathy in undergraduate medical students with an increasingly low empathy score the more the motivation profile is towards being Low Intrinsic and Low Controlled.

Associations of emotional intelligence and gratitude with empathy in medical students

BACKGROUND

Empathy is an essential quality for physicians and medical trainees. This study aimed to examine the associations of emotional intelligence (EI) and gratitude with empathy in medical students.

METHODS

We conducted this cross-sectional study at three medical schools in China. A pack of self-reported questionnaires, consisting of the Interpersonal Reactivity Index (IRI), the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), the Gratitude Questionnaire-6 (GQ-6), and demographic section were distributed to the students.

RESULTS

A pool of 1392 students became the final participants. After adjustment for the demographics, trait EI and gratitude were positively related to Perspective Taking and Empathic Concern, accounting for 33.1 and 22.7% of their variance, respectively. While trait EI was strongly and negatively associated with Personal Distress, gratitude was modestly and positively associated with it, and they collectively explained 29.1% of its variance.

CONCLUSIONS

Trait EI and gratitude could be vital psychological constructs for understanding empathy in medical students. The positive roles they may play could be considered when intervention strategies and programs are designed to enhance the professional competencies in medical students.

Development in Danish medical students' empathy: study protocol of a cross-sectional and longitudinal mixed-methods study

BACKGROUND

Clinical empathy has been associated with positive outcomes for both physicians and patients such as: more accurate diagnosis and treatment, increased patient satisfaction and compliance, and lower levels of burnout and stress among physicians. International studies show mixed results regarding the development of empathy among future physicians associating medical education with decline, stability or increase in empathy levels. These mixed results are due to several study limitations. In Denmark, no investigation of Danish medical students' empathy trajectory has yet been conducted wherefore such a study is needed that optimizes the study design of earlier studies.

METHODS

The aim of the study is to examine and analyze empathy levels and empathy changes among Danish medical students from the four medical faculties in Denmark, employing a cross-sectional and longitudinal mixed-methods design including a control group of non-medical students. By supplementing cross-sectional and longitudinal questionnaire studies with a focus group interview study it is the aim to identify and analyze factors (including educational) that are perceived by medical students to influence the development of empathy and its expression in clinical care.

DISCUSSION

The results of the study will provide insight into the trajectory of medical students' empathy and in undergraduate and graduate students' experiences with and perceptions of empathy development. In addition, the study will provide evidence to support further research on how targeted educational programmes can best be designed to educate empathic and patient-centered physicians.

Review of emotional intelligence in health care: an introduction to emotional intelligence for surgeons

BACKGROUND

The aim of this review is to explain the components of emotional intelligence (EI) and explore the benefits within today's health care system with an emphasis on surgery. EI is a person's ability to understand their own emotions and those of the individuals they interact with. Higher individual EI has multiple proposed benefits, such as reducing stress, burnout and increasing work satisfaction. The business world recognizes EI as beneficial in terms of performance and outcomes. Could surgeons benefit from being more cognisant of EI and methods of assessing and improving EI to reap the aforementioned benefits?

METHODS

A search of Embase, Cochrane and Medline databases using the following search terms; emotional intelligen*, surg*, medic* yielded 95 articles. After review of all the literature 39 remaining articles and five text books were included.

RESULTS

To perform optimally, surgeons must be aware of their own emotions and others. EI differs from IQ and can be taught, learnt and improved upon. EI is measured via validated self-reporting questionnaires and 'multi-rater' assessments. High EI is positively associated with leadership skills in surgeons, non-technical skills, reduction in surgeon stress, burnout and increased job satisfaction, all of which translate to better patient relationships and care. Future implications of EI have been postulated as a measure of performance, a selection tool for training positions and a marker of burnout. EI should be an explicit part of contemporary surgical education and training.

How clinician examiners compare with simulated patients in assessing medical student empathy in a clinical exam setting

Background: Empathy is an important clinical attribute to be assessed during clinical examinations. While simulated patients (SPs) are well positioned to assess empathy in such settings, clinician-examiners are objective observers who are also experts in assessment. In this study, the assessments of student empathy from both examiners and SPs in clinical examinations were compared.Methods: The 10-item CARE measure were used for the assessment of empathy in 158 medical students in the Family Medicine specialty clerkship clinical competency test. The ratings from examiners and SPs were analyzed together with genders of students, examiners and patients, and the examination results.Results: SPs empathy ratings were higher than those from examiners across all ten items of CARE. A weak positive correlation was found between both ratings. Female SPs were more likely to give higher ratings, and examiners were more likely to give higher ratings to female students. SPs rating was moderately correlated with student examination score, while the correlation with examiners rating was strong.Conclusion: Although the inter-rater reliability was weak between the empathy rating from simulated patients and examiners, the evaluation of empathy from the patient's perspective was seen to be more authentic as they are in interaction with the students.

The Positive Association Between Empathy and Self-Esteem in Chinese Medical Students: A Multi-Institutional Study

Background

Empathy is an important element of the physician-patient relationship and is a critical personality trait for medical students. However, research has shown that it declines during undergraduate medical education. It is still unclear how empathy interrelates with the psychological elements of medical students, in particular, self-esteem. This study examined the relationship between empathy and self-esteem to explore other possible methods to improve medical students’ empathy.

Methods

A stratified sampling strategy was used to select 1690 medical students from 3 medical institutions in Shanghai as study participants. The questionnaires used to collect data included the Jefferson Scale of Physician Empathy-Student Version (JSPE-S), the Rosenberg Self-esteem Scale (RSES), and a self-made inventory on personal information. Descriptive analysis, independent t-test, One-Way ANOVA, and linear regression were used to analyze the data.

Results

The mean empathy score among medical students was 102.73 with SD = 12.64. Multiple regression analysis revealed that, “age,” “perception of the importance of empathy,” “academic pressure,” “desire to be a doctor after graduation,” and “self-esteem” were significant predictors of empathy (P < 0.05) and the adjusted R² was 0.462. The correlation matrix between empathy and self-esteem was significant (r = 0.510, P < 0.01). Self-esteem explained 15.5% of the variation of empathy in the final regression model.

Conclusion

There was a positive association between self-esteem and empathy. Self-esteem is one of many factors which contribute to medical students’ empathy. Age, academic pressure, attitude toward empathy and future career also play a critical role in medical student empathy. Enhancing medical students’ self-esteem may be an efficacious way to improve medical students’ empathy.

Is empathy change in medical school geo-socioculturally influenced?

CONTEXT

There is convincing evidence that physician empathy leads to better patient care. As a result, there has been considerable research interest in investigating how empathy changes during undergraduate medical studies. Early (generally North American) studies raised concerns that medical training causes a decline in empathy. More recent studies (conducted around the world) have begun to suggest that either a slight increase or decrease in empathy occurs during undergraduate medical training, which has led some to argue that empathy changes indiscriminately (with no discernible pattern). This paper explores whether there is evidence to suggest that empathy changes indiscriminately or with a discernible geo-sociocultural pattern during undergraduate medical training.

METHODS

Literature that investigated change in empathy during undergraduate medical training was reviewed. Cross-sectional and longitudinal studies were tabulated separately according to their respective geographical locations. The tabulated results were analysed to investigate whether empathy changed similarly or differently within different geographical locations.

RESULTS

The studies reviewed indicate similar patterns of empathy change within approximate geo-sociocultural clusters. Whereas US studies predominantly show small but significant decreases in empathy, Far Eastern studies mostly show small but significant increases in empathy as undergraduates progress through the medical course.

CONCLUSIONS

These results suggest that change in empathy during undergraduate medical education is not as indiscriminate (patternless) as once thought. Additionally, these results support the notion that empathy is a locally construed global construct.

Relations Between Dimensions of Emotional Intelligence, Specific Aspects of Empathy, and Non-verbal Sensitivity

In this work, on the one hand, we examined the relationship between emotional intelligence (EI) and empathy and, on the other, the relationship between EI and non-verbal sensitivity, through two independent studies. The first study analyzed the relationship between dimensions of EI and aspects of empathy, in a sample of 856 participants who completed two measures of EI, the trait meta-mood scale (TMMS) and the trait emotional intelligence questionnaire (TEIQue), and a measure of empathy, the interpersonal reactivity index (IRI). The results showed a similar pattern of significant positive relations in all the EI domains with empathic perspective-taking (PT), and significant negative relationships with empathic personal distress (PD), except for the EI domain of attention, which had a positive relationship. Stepwise multiple regression analyses showed that the dimension that best predicted empathic PT and empathic concern (EC) was the emotionality factor; whereas attention best predicted empathic fantasy; and the self-control factor best predicted PD, although negatively. Gender emerged as a predictor of three empathic aspects, fantasy, EC, and PD, with women obtaining higher scores than men in all of them. Age was the only predictor of fantasy, with a negative relationship. The second study involved 646 people who completed the same measures of EI as the participants of the first study and the mini-profile of non-verbal sensitivity (Mini-PONS). The results showed some significant relationships between EI dimensions and the channels and quadrants of the MiniPONS. Stepwise multiple regression analyses showed that very few EI dimensions predicted non-verbal sensitivity, with attention obtaining the best result. Both gender and age emerged as predictors, some in unique cases, of channels, quadrants, and of the total score of non-verbal sensitivity; age had a negative relationship, and women obtained higher scores than men.

Self-assessment of residents in respect of attitudes to communication

Aim

As communication skills are essential for medical practice, many medical schools have added communication skills training to their curricula in recent years. The aim of this study was to determine and compare the attitudes to communication skills of family medicine, internal medicine and general surgery residents.

Materials and methods

Family medicine, internal medicine and general surgery residents of three training and research hospitals and one university hospital in Ankara were included in this cross-sectional study. A questionnaire was used for obtaining information about age, gender, marital status, graduation date and whether receiving any training for communication skills. The Turkish version of the Communication Skills Attitude Scale was used.

Results

In all, 58 (50%) family medicine, 30 (25.9%) internal medicine, and 28 (24.1%) general surgery residents were accepted to participate in the study. Of the 116 residents, 58 (50%) were female and 58 (50%) were male, with a mean age of 29.47±4.63 years, and 68 (58.6%) of them were married; 59.5% of the participants received training about communication skills and 56.5% of them received it at medical school. The mean positive attitude scale (PAS) score was 3.85±0.58, and the mean negative attitude scale (NAS) score was 2.42±0.52. The PAS scores of female residents were higher than those of males (P=0.01). The PAS scores of residents who received communication skills training were higher than the scores of those who had not (P=0.01). The PAS scores of family medicine residents were higher and the NAS scores were lower than those of internal medicine and general surgery residents.

Conclusion

The communication skill attitudes of family medicine residents were better than those of internal medicine and general surgery residents.

Does medical students' personality have an impact on their intention to show empathic behavior?

Several studies have demonstrated a correlation between specific personal traits and empathy. However, it is not clear if persons with certain personality traits lack the intent to show empathic behavior or if other factors independent of their intent are affecting their empathic behavior. To answer this question, we asked 132 medical students to fill out questionnaires evaluating the General Intention to Show Empathic Behavior (GISEB) and the five personality traits measured by NEO Five-Factor Inventory (NEO-FFI). Additionally, we evaluated the influence of other factors, such as age, gender, curricular progress (second versus fourth year), and preferred specialization after graduation. We performed a Pearson's correlation and a regression analysis. Results indicate that the five personality traits and gender have little influence on the General Intention (GISEB), only extraversion (r = .221, 95% CI [.013-.394], p = .027), and agreeableness (r = .229, 95% CI [.021-.428], p = .022) correlated with the intention. The only predictor for General Intention (GISEB) was curricular progress (β = - .27, p < .05), showing a decrease of General Intention to Show Empathic Behavior from second to fourth year of university (U = 1203.5, p = .002). A further finding indicates that gender and personality influence the students' wish of specialization after graduation: Agreeableness (F(12, 53) = 2.376, p = .016) impacted the preferred specialization. Our study demonstrated that medical students' personality might not notably impact the intention to show empathic behavior. Further research is needed to investigate moderating effects.

Farahani M, Ameri Z, Salehi T, Hosseini F. The relationship between empathy and emotional intelligence among Iranian nursing students

OBJECTIVES

To determine the relationship between empathy and emotional intelligence among Iranian nursing students.

METHODS

This is a cross-sectional, descriptive-correlational study that was conducted on three hundred and twenty eligible students, selected using stratified random sampling. Participants were mainly nursing students at Tehran University of Medical Sciences. Data gathering was done using The Jefferson Scale of Empathy and The Schutte Self Report Emotional Intelligence Test. Data were analyzed using SPSS.

RESULTS

The results showed a strong positive correlation between empathy and emotional intelligence (r=0.499, p <.001). Students in their fourth year had the highest score for empathy (M=109.16, SD=10.16), while first-year students had the highest scores for emotional intelligence (M= 151.68, SD= 17.47). Female students got higher empathy scores than male students (t₍₃₁₈₎= 2.524, p= .012). Age had a strong inverse correlation with emotional intelligence (r= 0.143, p= .010).

CONCLUSIONS

The results of this study show a correlation between emotional intelligence and empathy among nursing students. Nurses with higher emotional intelligence tend to be better in establishing productive relationships with patients and their families, and if nurses possess empathetic skills, they manage their emotions more effectively. In addition to imparting knowledge and clinical experience, nursing curricula should provide students with opportunities to develop their communication and emotional skills.

An Epidemiological Study on Empathy and its Correlates: A Cross-sectional Assessment among Medical Students of a Government Medical College of India

BACKGROUND

Empathy is a desirable quality in every clinician. It is a crucial determinant of patient-physician communication and relation. There are very few existent Indian studies on empathy of medical students and its correlates.

AIM

The aim of the study was to assess empathy level of medical students and its correlates.

METHODOLOGY

It was a cross-sectional, hospital-based, analytical observational study conducted from July to November 2017. In total, 249 undergraduate medical students of a medical college of Kolkata were interviewed with a structured schedule. The schedule comprised of the sociodemographic questionnaire, career satisfaction, future career choice, and Jefferson Scale of Empathy.

RESULTS

The mean empathy score was 98.5 ± 12.5. Third-semester students had higher empathy scores (102.4 ± 12.4) compared to fifth (97.2 ± 12.9) and seventh semester (95.0 ± 10.9) students. The difference between the mean scores of different semesters was statistically significant. Female students were more empathic than male students. In the multivariable linear regression model, sex, semester, residence, career satisfaction, future career choice, and current place of living were significant predictors of empathy scores.

CONCLUSION

Empathy level of medical students of our study was quite low compared to other studies conducted outside India. Empathy eroded with semester, which supports earlier pieces of evidence in this regard.

Do doctors' attachment styles and emotional intelligence influence patients' emotional expressions in primary care consultations? An exploratory study using multilevel analysis

OBJECTIVE

To investigate whether and how doctors' attachment styles and emotional intelligence (EI) might influence patients' emotional expressions in general practice consultations.

METHODS

Video recordings of 26 junior doctors consulting with 173 patients were coded using the Verona Coding Definition of Emotional Sequences (VR-CoDES). Doctors' attachment style was scored across two dimensions, avoidance and anxiety, using the Experiences in Close Relationships: Short Form questionnaire. EI was assessed with the Mayer-Salovey-Caruso Emotional Intelligence Test. Multilevel Poisson regressions modelled the probability of patients' expressing emotional distress, considering doctors' attachment styles and EI and demographic and contextual factors.

RESULTS

Both attachment styles and EI were significantly associated with frequency of patients' cues, with patient- and doctor-level explanatory variables accounting for 42% of the variance in patients' cues. The relative contribution of attachment styles and EI varied depending on whether patients' presenting complaints were physical or psychosocial in nature.

CONCLUSION

Doctors' attachment styles and levels of EI are associated with patients' emotional expressions in primary care consultations. Further research is needed to investigate how these two variables interact and influence provider responses and patient outcomes.

PRACTICE IMPLICATIONS

Understanding how doctors' psychological characteristics influence PPC may help to optimise undergraduate and postgraduate medical education.

Associations between emotional intelligence, empathy and personality in Japanese medical students

BACKGROUND

It is known that empathic communication is important for physicians to achieve higher patient satisfaction and health outcomes. Emotional intelligence (EI), empathy and personality in medical students predict students' individual disposition and their emotional and empathic perceptions. This study aimed to investigate: 1) The association between empathy, EI and personality, and 2) Gender differences in the association between empathy, EI and personality.

METHOD

Participants were 357 1st year medical students from 2008 to 2011 at one medical school in Japan. Students completed self-report questionnaires comprising three validated instruments measuring EI: Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), empathy: Jefferson Scale of Physician Empathy- student version (JSPE) and personality: NEO-Five-Factor Inventory (NEO-FFI), which explores 5 dimensions of personality Neuroticism (N), Extraversion (E), Openness to experience (O), Agreeableness (A), and Conscientiousness (C).

RESULTS

Pearson Correlations showed weak association between TEIQue-SF and JSPE. TEIQue-SF and NEO-FFI showed positive correlation for E and C, and strong negative correlation for N and weak positive correlation for A and O. Weak positive correlation between JSPE and the NEO-FFI were observed for E and A. Although effect sizes were small, N, A and empathy were significantly higher in females (unpaired t-test). However, hierarchical multiple-regression analysis when controlling for gender and personality showed no association between EI, empathy and gender. A, TEIQue-SF and N were found to make small contributions in respect of predictions for JSPE. Personality contributed significantly to the prediction of TEIQue-SF. N had the largest independent negative contribution (β = - 0,38).

CONCLUSION

In our study population of 1st year medical students, females had significantly higher N, A and empathy scores than males. Medical students' N score was strongly negatively associated with EI. Empathy was weakly associated with EI and A. However, when controlling gender and personality in regression analysis, gender did not affect EI and empathy, rather personality is the most important factor. Our findings indicate that N is a major factor that negatively affects EI. It is important to mitigate N using thoughtful training, taking into account students' personalities, to reduce N. In future studies, we will assess how communication trainings for students might enhance EI.

Emotional Intelligence: An Old Issue and a New Look in Clinical Teaching

In this paper, a novel model of clinical teachers with social and emotional competency which is emphasized on the importance of clinical teacher's social and emotional competence is presented. In this model, we supposed that a teacher with social and emotional competence can manage her/his emotions and has the ability to personal development and well-being. Such teacher has the competency of empathy, communication with the patients, teamwork, and collaboration to provide successful patient-centered care and relationship-centered care. He/she will be success in clinical supervision, role modeling, and mentoring by providing appropriate relationship with students. This teacher can influence and build bonds that will be effective for clinical management and leadership. In addition, it will affect the hidden and informal curriculum with the awareness of the context. These factors establish an appropriate learning environment to achieve students’ academic, professional, social, and emotional outcomes and create an appropriate health care environment that influences the successful care of patient and patient's satisfaction. We reviewed a broad body of research to support our proposed model and finally proposed agendas for future research.

Clarifying changes in student empathy throughout medical school: a scoping review

Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.

A Quantitative Study of Empathy in Pakistani Medical Students: A Multicentered Approach

OBJECTIVE

To examine the empathy level of undergraduate medical students in Pakistan. Three hypotheses are developed based on the literature review. (1) Female medical students have a higher level of empathy than do male students. (2) Empathy scores vary during the medical school years in Pakistani students. (3) Medical students interested in people-oriented specialties would score higher than the students interested in technology-oriented specialties.

METHODS

This is a quantitative inquiry approach using a cross-sectional design of 1453 students from 8 Pakistani medical schools, both private and state. The sample consists of 41.1% (n = 597) male students and 58.9% (n = 856) female students. Empirical data are collected using the Jefferson Scale of Physician Empathy (JSPE), a well-validated self-administered questionnaire.

RESULTS

The mean empathy score among students is 4.77 with a standard deviation of 0.72. The results show that there is no statistically significant association between the empathy scores and gender, t(1342.36) = -0.053, P = .95). There is a statistically significant difference between the empathy scores and the years of medical school, F(14, 1448) = 4.95, P = .01. Concerning the specialty interests, there is no statistically significant difference between the empathy score and specialty interests.

CONCLUSION

The findings of this study showed that in Western countries, medical students performed better than Pakistani medical students on the empathy scale. This finding has important implications for Pakistani medical educators to improve the interpersonal skills of medical students in the context of patient care. Inconsistent with our expectations and experiences, our findings do not support that female medical students scored better than their male counterparts on the empathy scale. Because of the nature of a cross-sectional study, it is impossible to argue the decline of empathy during medical school training.

Emotional intelligence and academic performance of medical undergraduates: a cross-sectional study in a selected university in Sri Lanka

BACKGROUND

Emotional intelligence (EI) has been linked with academic and professional success. Such data are scarce in Sri Lanka. This study was conducted to describe the pattern of EI, to determine its predictors and to determine the effect of EI on academic performance at the final MBBS examination, in medical undergraduates of a Sri Lankan university.

METHODS

This is a cross-sectional study in a selected university, involving those who did final MBBS examination in 2016. Consecutive sampling was done. EI was assessed with self-administered Genos Emotional Intelligence Full Version (7 domains; 70 questions equally weighted; total score 350). Socio-demographic data were obtained using a self-administered questionnaire. Academic performance was assessed with final MBBS results in the first attempt.

RESULTS

Of 148 eligible students 130 responded (response rate-88%); 61.5% were females; mean age was 26.3 ± 1 years. Mean total EI score was 241.5 (females-245.5, males-235.1; p = 0.045).Among different domains, mean score was highest for Emotional Self-Awareness (36.8/50) and lowest for Emotional Expression (32.6/50). Multiple linear regression analysis indicated that having good family support (p = 0.002), socializing well in university (p = 0.024) and being satisfied with facilities available for learning (p = 0.002), were independent predictors of EI. At the final MBBS examination 51.6% obtained classes, 31.5% passed the examination without classes and 16.9% got repeated. Females had better academic performance than males (p = 0.009). Mean EI of second-class upper division, second-class lower division, pass and repeat groups were 249.4, 246.6, 240.2 and 226.9, respectively (with one-way ANOVA p = 0.015). After adjusting for gender, ordinal regression analysis indicated that, total EI score was an independent predictor of final MBBS results [β-0.018 (95% CI 0.005-0.031); p = 0.006].

CONCLUSIONS

In the study population, both EI and academic performance were higher among females. Independent of gender, academic performance was better in those who were more emotionally intelligent. Several psychosocial factors were found to be independent predictors of EI. These results suggest that emotional skills development might enhance academic performance of medical undergraduates in Sri Lanka. Further research is needed in this under-explored area.

Longitudinal predictive validity of emotional intelligence on first year medical students perceived stress

BACKGROUND

Emotional intelligence has been shown to affect academic performance and perceived stress. But conflicting reports suggest that the relationship between academic performance and emotional intelligence may not be straightforward. Hence, this study explored the relationship between emotional intelligence, perceived stress and academic performance.

METHODS

First year medical students were invited to participate in this longitudinal study. At Time 1, before mid-semester examinations, they completed the questionnaires on Schutte's Emotional Intelligence Scale (SEIS) and Perceived Stress Scale (PSS) (n = 213). At Time 2, before pre university examinations, students again completed perceived stress scale questionnaire. (n = 138). Academic performance was reported using summative assessment at both T1 and T2. The relationship between academic performance, emotional intelligence and perceived stress was explored using regression analysis.

RESULTS

Neither PSS nor SEIS were related to academic performance. However, perceived stress was significantly predicted by SEIS both at T1 (r = 0.333, β = 0.149, p < 0.001) as well as T2 (r = 0.240, β = 0.116, p = 0.028). The results were cross-validated at student level both at T1 and at T2.

CONCLUSION

Medical students with higher trait emotional intelligence perceived lesser stress. Therefore, it might be prudent to train medical students to increase their emotional intelligence to promote their well-being.

Associations of medical student empathy with clinical competence

OBJECTIVE

Empathy is a crucial skill for medical students that can be difficult to evaluate. We examined if self-reported empathy in medical students was associated with clinical competence.

METHODS

This study combined cross-sectional data from four consecutive years of medical students (N=590) from the Boston University School of Medicine. We used regression analysis to evaluate if self-reported empathy (Jefferson Scale of Physician Empathy (JSPE)) predicted scores in clinical clerkships, United States Medical Licensing Examinations, and OBJECTIVE: Structured Clinical Examinations (OSCEs). We separately analyzed overall and OSCE communication scores based on interpersonal skills reported by standardized patients. We controlled for age, gender, debt, and specialty affinity.

RESULTS

JSPE scores of medical students were positively associated with OSCE communication scores, and remained significant when controlling for demographics. We found that JSPE score was also predictive of overall OSCE scores, but this relationship was confounded by gender and age. JSPE scores were associated with performance in the Pediatrics clerkship, but not other clerkships or standardized tests.

CONCLUSION

JSPE scores were positively associated with OSCE communication scores in medical students.

PRACTICE IMPLICATIONS

This study supports that self-reported empathy may predict OSCE performance, but further research is needed to examine differences by gender and age.

Conceptual model for measuring Saudi banking managers’ job performance based on their emotional intelligence (EI)

Purpose

The purpose of this paper is to develop and present a research model on various emotional intelligence (EI) constructs which have been found to influence job performance in the prior literature.

Design/methodology/approach

In addition to leadership and EI, the constructs are clustered under different categories: self-awareness includes self-confidence, emotional self-awareness and accurate self-assessment; self-management includes self-control, adaptability, conscientiousness, trustworthiness and optimism; social awareness includes empathy, organizational awareness and service orientation; and social skills groups’ communication, change catalyst, developing others and self-monitoring.

Findings

The paper proposes 17 hypotheses concerning significant relationships between these constructs and job performance.

Originality/value

The paper proposes a new approach toward studying the impact of various constructs of EI on job performance in Saudi banking sector.

International study of medical school learning environments and their relationship with student well-being and empathy

OBJECTIVE

To assess whether favourable perceptions of the learning environment (LE) were associated with better quality of life, less burnout and more empathy across three undergraduate medical education programmes in Israel, Malaysia and China.

METHODS

Cross-sectional surveys were administered at the end of the 2013-2014 academic year at three medical schools: Technion American Medical Students Program (TAMS) in Israel, Perdana University-Royal College of Surgeons in Ireland School of Medicine (PURCSI) in Malaysia and Peking Union Medical College (PUMC) in China. LE perceptions were assessed using the Johns Hopkins Learning Environment Scale (JHLES). Well-being was assessed using validated items for quality of life and the depersonalisation and emotional exhaustion domains of burnout. The 20-item Jefferson Empathy Scale assessed empathy. Statistical analyses included bivariate regressions and multivariate regressions that adjusted for gender, school, class year and perceived academic rank.

RESULTS

Overall, 400/622 (64.3%) students responded, with the following rates by site: TAMS 92/121 (76.0%), PURCSI 160/198 (80.1%) and PUMC 148/303 (48.8%). In multivariate models, favourable overall LE perceptions were associated with higher odds of good quality of life (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.8-5.8; p < 0.001) and lower odds of emotional exhaustion (OR, 0.34; 95% CI, 0.24-0.50; p < 0.001) and depersonaliation (OR, 0.30; 95% CI, 0.24-0.37; p = 0.001). 'Community of Peers', one of seven factors in the JHLES, was the only one to be independently associated with better quality of life and less emotional exhaustion and depersonalisation. After adjusting for covariates, there was not a statistically significant association between overall LE and empathy (OR, 1.4; 95% CI, 0.91-2.2; p = 0.12).

CONCLUSIONS

Students' LE perceptions are closely associated with their well-being, and fostering peer community may hold promise for enhancing quality of life and protecting against burnout. Across these three settings, LE and empathy were not closely related, suggesting that any influence of learning environment on empathy would be modest.

Associations between empathy and big five personality traits among Chinese undergraduate medical students

Background

Empathy promotes positive physician-patient communication and is associated with improved patient satisfaction, treatment adherence and clinical outcomes. It has been suggested that personality traits should be taken into consideration in programs designed to enhance empathy in medical education due to the association found between personality and empathy among medical students. However, the associations between empathy and big five personality traits in medical education are still underrepresented in the existing literature and relevant studies have not been conducted among medical students in China, where tensions in the physician-patient relationship have been reported as outstanding problems in the context of China’s current medical reform. Thus, the main objective of this study was to examine the associations between empathy and big five personality traits among Chinese medical students.

Methods

A cross-sectional study was conducted in a medical university in Northeast China in June 2016. Self-reported questionnaires including the Interpersonal Reactivity Index (IRI) and Big Five Inventory (BFI) and demographic characteristics were distributed. A total of 530 clinical medical students became our final subjects. Hierarchical regression analysis was performed to explore the effects of big five personality traits on empathy.

Results

Results of this study showed that big five personality traits accounted for 19.4%, 18.1%, 30.2% of the variance in three dimensions of empathy, namely, perspective taking, empathic concern and personal distress, respectively. Specifically, agreeableness had a strong positive association with empathic concern (β = 0.477, P<0.01), and a moderate association with perspective taking (β = 0.349, P<0.01). Neuroticism was strongly associated with personal distress (β = 0.526, P<0.01) and modestly associated with perspective taking (β = 0.149, P<0.01). Openness to experience had modest associations with perspective taking (β = 0.150, P<0.01) and personal distress (β = -0.160, P<0.01). Conscientiousness had a modest association with perspective taking (β = 0.173, P<0.01).

Conclusion

This study revealed that big five personality traits were important predictors of self-reported measures of both cognitive and affective empathy among Chinese medical students. Therefore, individualized intervention strategies based on personality traits could be integrated into programs to enhance empathy in medical education.