1
|
Amjadi MF, Kociubuk J, Hollnagel F, Tsenkova VK, Zelenski AB. Zoom Improv is accessible and enhances medical student empathy. BMC MEDICAL EDUCATION 2024; 24:1049. [PMID: 39334240 PMCID: PMC11429412 DOI: 10.1186/s12909-024-06017-6] [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: 04/11/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Empathy declines during medical training, despite its importance. METHODOLOGY In this randomized controlled trial, we assessed the impact of Zoom improv on medical student empathy using a concurrent mixed-methods approach. Quantitative assessment with three survey tools and qualitative assessment by content analysis of Zoom session field notes were conducted. RESULTS Zoom improv participants had higher empathy scores in perspective-taking and fantasy and lower scores in personal distress compared with the control group. Medical students who participated in Zoom improv exercised emotional expression, active listening, and giving "gifts," which apply to healthcare settings in which affirming team members with empathic concern can advance communication, patient rapport, and teamwork. DISCUSSION This pilot study highlights promising findings for the incorporation of Zoom improv in medical education, including enhanced empathy, self-reflection, and understanding how these skills impact work in healthcare. Future studies may expand on the optimal timing to teach improv. Future studies conducted on virtual platforms may also further investigate our finding that the fantasy domain of empathy increases after Zoom improv sessions, whereas this increase in fantasy was absent from previous in-person studies. Given the increase in telehealth and virtual medical visits, exercising empathy skills through a screen during training may be an important addition to medical curricula.
Collapse
Affiliation(s)
- Maya F Amjadi
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, WI, USA
| | | | - Fauzia Hollnagel
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, WI, USA
| | - Vera K Tsenkova
- School of Medicine and Public Health, UW-Madison, 1685 Highland Ave, Madison, WI, USA
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin (UW)-Madison, Madison, WI, USA.
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
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.
Collapse
Affiliation(s)
- Hulya Yucel
- Department of Occupational Therapy, Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
4
|
Watari T, Houchens N, Nishizaki Y, Kataoka K, Otsuka T, Nakano Y, Sakaguchi K, Shiraishi Y, Katayama K, Kataoka H, Tokuda Y. Empathy competence and future specialty among medical residents in Japan: a nationwide cross-sectional study. Sci Rep 2023; 13:13742. [PMID: 37612358 PMCID: PMC10447498 DOI: 10.1038/s41598-023-41011-w] [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: 02/28/2023] [Accepted: 08/20/2023] [Indexed: 08/25/2023] Open
Abstract
Empathy is essential for physicians to provide patient-centered care. Nevertheless, the degree to which empathy varies among medical residents based on their desired future specialty remains undetermined. This nationwide cross-sectional study compared empathy levels (Jefferson Scale of Empathy, JSE) of 824 year one and two postgraduate residents in Japan by intended medical specialty, individual characteristics, and training and working environment characteristics. Empathy levels were compared with applicants for general medicine, which emphasizes patient-centeredness. The highest mean JSE and the highest percentage of women residents were observed in general medicine (M = 109.74; SD = 14.04), followed by dermatology (M = 106.64; SD = 16.90), obstetrics and gynecology (M = 106.48; SD = 14.31), and pediatrics (106.02; SD 12.18). Residents interested in procedure-centered departments (e.g. ophthalmology, orthopedics) garnered lower JSE scores. Multivariate regression revealed that future general medicine candidates achieved the highest JSE scores ([Formula: see text] = 6.68, 95% CI 2.39-10.9, p = 0.002). Women achieved significantly higher JSE scores than men ([Formula: see text] = 2.42, 95% CI 0.11-4.73, p = 0.041). The results have implications for empathy training and postgraduate education strategy in different clinical specialties.
Collapse
Affiliation(s)
- Takashi Watari
- General Medicine Center, Shimane University Hospital, Izumo, Shimane, Japan.
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Nathan Houchens
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yuji Nishizaki
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Koshi Kataoka
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Tomoe Otsuka
- Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Yasuhisa Nakano
- Faculty of Medicine, Shimane University, Izumo, Shimane, Japan
| | - Kota Sakaguchi
- General Medicine Center, Shimane University Hospital, Izumo, Shimane, Japan
| | | | - Kohta Katayama
- Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hitomi Kataoka
- Diversity and Inclusion Center, Okayama University Hospital, Okayama, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Project for Teaching Hospitals, Okinawa, Japan
| |
Collapse
|
5
|
Wenger K, Reist L, Achenbach A, Dukes K, Fravel M, Knockel L, Kuehnle F, Reist J, Suneja M, Pendleton C, Xie XJ, Marchini L. Empathy levels among health professional students at a large midwestern public university - a cross-sectional study. BMC MEDICAL EDUCATION 2023; 23:123. [PMID: 36804003 PMCID: PMC9940672 DOI: 10.1186/s12909-023-04090-x] [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: 06/07/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Empathic care is considered extremely important by patients and providers alike but there is still an ample need for assessing empathy among healthcare students and professionals and identifying appropriate educational interventions to improve it. This study aims to assess empathy levels and associated factors among students at different healthcare colleges at the University of Iowa. METHODS An online survey was delivered to healthcare students, including nursing, pharmacy, dental, and medical colleges (IRB ID #202,003,636). The cross-sectional survey included background questions, probing questions, college-specific questions, and the Jefferson Scale of Empathy-Health Professionals Student version (JSPE-HPS). To examine bivariate associations, Kruskal Wallis and Wilcoxon rank sum tests were used. A linear model with no transformation was used in the multivariable analysis. RESULTS Three hundred students responded to the survey. Overall JSPE-HPS score was 116 (± 11.7), consistent with other healthcare professional samples. There was no significant difference in JSPE-HPS score among the different colleges (P = 0.532). CONCLUSION Controlling for other variables in the linear model, healthcare students' view of their faculty's empathy toward patients and students' self-reported empathy levels were significantly associated with students' JSPE-HPS scores.
Collapse
Affiliation(s)
- Kelsey Wenger
- The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Lauren Reist
- The University of Iowa College of Pharmacy, Iowa City, IA, USA
| | | | - Kimberly Dukes
- The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Michelle Fravel
- The University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Laura Knockel
- The University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Francis Kuehnle
- The University of Iowa College of Nursing, Iowa City, IA, USA
| | - Jeffrey Reist
- The University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Manish Suneja
- The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Chandler Pendleton
- The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Xian Jin Xie
- The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Leonardo Marchini
- Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA.
- Department of Comprehensive Care, Case Western Reserve University School of Dental Medicine, 9601 Chester Ave, 44106, Cleveland, OH, USA.
| |
Collapse
|
6
|
Sharafkhani R, Nukpezah RN, Lathabhavan R, Kallmen H, Fournier A, Hosseini Marznaki Z. Factors that affect levels of alexithymia, empathy and communication skills of nursing students in northern Iran. Nurs Open 2023; 10:3936-3945. [PMID: 36808820 PMCID: PMC10170927 DOI: 10.1002/nop2.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/03/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023] Open
Abstract
AIM The inability of nurses to express their own emotions, understand others' emotions and show empathy could result in communication gaps that could affect patient care outcomes. This study investigates the factors associated with the levels of alexithymia, empathy and communication skills among nursing students. DESIGN A survey was conducted among 365 nursing students, and data were collected using an online questionnaire. METHODS Data analyses were done using SPSS software version 22. RESULTS There was a significant positive association between age and empathy and a negative association between the number of times a nurse took the entrance exam. The level of education and interest in nursing correlate with communication skills. All the predictor variables of alexithymia in this current study were not significant. Emphasis should be placed on improving nursing students' empathy and communication skills. Student nurses should be taught how to recognize and express their emotions. To assess their mental health, they must be screened regularly.
Collapse
Affiliation(s)
- Rahim Sharafkhani
- Department of Public health, Khoy University of Medical Sciences, Khoy, Iran
| | - Ruth Nimota Nukpezah
- Department of General Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | | | - Hakan Kallmen
- Department of Clinical Neuroscience, STAD, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | | | | |
Collapse
|
7
|
Kataoka HU, Tokinobu A, Fujii C, Watanabe M, Obika M. Eleven years of data on the Jefferson Scale of Empathy - medical student version: Japanese norm data and tentative cutoff scores. BMC MEDICAL EDUCATION 2023; 23:81. [PMID: 36732750 PMCID: PMC9893600 DOI: 10.1186/s12909-022-03977-5] [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: 08/30/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND More and more studies investigate medical students' empathy using the Jefferson Scale of Empathy (JSE). However, no norm data or cutoff scores of the JSE for Japanese medical students are available. This study therefore explored Japanese norm data and tentative cutoff scores for the Japanese translation of the JSE-medical student version (JSE-S) using 11 years of data obtained from matriculants from a medical school in Japan. METHODS Participants were 1,216 students (836 men and 380 women) who matriculated at a medical school in Japan from 2011 to 2021. The JSE-S questionnaire was administered to participants prior to the start of the program. Data were summarized using descriptive statistics and statistical tests were performed to show the norm data and tentative cutoff scores for male and female students separately. RESULTS The score distributions of the JSE-S were moderately skewed and leptokurtic for the entire sample, with indices -0.75 and 4.78, respectively. The mean score (standard deviation) for all participants was 110.8 (11.8). Women had a significantly higher mean score (112.6) than men (110.0; p < 0.01). The effect size estimate of gender difference was 0.22, indicating a small effect size. The low and high cutoff scores for men were ≤ 91 and ≥ 126, respectively, and the corresponding scores for women were ≤ 97 and ≥ 128, respectively. CONCLUSIONS This study provides JSE-S norm data and tentative cutoff scores for Japanese medical school matriculants, which would be helpful in identifying those who may need further training to enhance their empathy.
Collapse
Affiliation(s)
- Hitomi U Kataoka
- Center for Diversity and Inclusion, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama-Shi, Okayama, 700-8558, Japan.
| | - Akiko Tokinobu
- Center for Diversity and Inclusion, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama-Shi, Okayama, 700-8558, Japan
| | - Chikako Fujii
- Center for Diversity and Inclusion, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama-Shi, Okayama, 700-8558, Japan
| | - Mayu Watanabe
- Division of Kidney, Diabetes and Endocrine Diseases, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama-Shi, Okayama, 700-8558, Japan
| | - Mikako Obika
- Department of General Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-Cho, Kita-Ku, Okayama-Shi, Okayama, 700-8558, Japan
| |
Collapse
|
8
|
Yuen JK, See C, Cheung JTK, Lum CM, Lee JS, Wong WT. Can teaching serious illness communication skills foster multidimensional empathy? A mixed-methods study. BMC MEDICAL EDUCATION 2023; 23:20. [PMID: 36631787 PMCID: PMC9835381 DOI: 10.1186/s12909-023-04010-z] [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: 07/22/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND To investigate the impact of a serious illness communication skills training course on medical students' attitudes regarding clinical empathy, self-efficacy in empathic communication, and learning on different dimensions of empathy. METHODS A mixed-methods design was used. A blended learning Serious Illness Communication Skills Training (SI-CST) course was delivered to sixth-year medical students. Students (n=185) completed questionnaires with the 20-item Jefferson Scale of Empathy (JSE) and self-rated preparedness level for five empathic communication tasks at baseline (T1), six weeks (T2), and three-to-six months post-training (T3). Written reflections on key lessons learned were analyzed using inductive thematic analysis. RESULTS Total JSE scores significantly improved from T1 to T2 (111.4 vs 113.9, P=.01) and from T1 to T3 (111.4 vs 113.9, P=.01). There was an increase in Standing in Patient's Shoes subscale of the JSE with an effect size of 0.56 whereas the Perspective-Taking and Compassionate Care subscales showed no significant changes. Self-rated preparedness for all five empathic communication tasks significantly improved from T1 to T2 (P ≤ .001) and from T1 to T3 (P ≤ .001) with large effect sizes (1.09-1.41). Four key themes emerged from the qualitative analysis. They were appreciating the important role of empathy in clinical care (moral empathy), learning skills in detecting and understanding patient emotions (cognitive empathy), learning skills in responding to emotion with empathy (behavioral empathy), and appreciating that communication skills can be improved with continual practice and self-reflection. CONCLUSIONS Our results revealed that SI-CST improved medical students' empathic attitudes and self-efficacy in empathic communication. Qualitative results found learning on the cognitive, behavioral and moral dimensions of empathy.
Collapse
Affiliation(s)
- Jacqueline K Yuen
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
| | - Christopher See
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Johnny T K Cheung
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chor Ming Lum
- Department of Medical and Geriatrics, Shatin Hospital, Hong Kong SAR, China
| | - Jenny Sw Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Wai Tat Wong
- Department of Anaesthesia & Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
9
|
Rohrer JL, Weiss MJ. Teaching Compassion Skills to Students of Behavior Analysis: A Preliminary Investigation. Behav Anal Pract 2022; 16:1-20. [PMID: 36249892 PMCID: PMC9553076 DOI: 10.1007/s40617-022-00748-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
Socially valid practices are at the heart of applied behavior analysis and can influence how interventions are experienced by families. However, the training of practitioners of applied behavior analysis is primarily focused on the implementation of technical procedures with little focus on therapeutic approaches. Empathy and therapeutic rapport have been associated with improved outcomes in allied professions (Beach et al., Journal of the American Board of Family Practice, 15(1), 25-38, 2006; Hojat et al., Academic Medicine, 86(3), 359, 2011; Horst et al., Journal of Child & Family Nursing, 3, 5-14, 2000), but have been minimally studied within the field of behavior analysis. In the present study, several sources were utilized to identify and define empathic and compassionate care skills. These skills were divided into three skill areas (i.e., basic interviewing skills, interest in the family, joining with the family) and taught to ABA master's students using behavioral skills training via a telehealth platform. All four participants significantly improved their engagement in compassionate care skills following training and maintained these skills in follow-up probes and with a different experimenter. Several post-study measures of outcome were taken, including social validity measures from participants, ratings of compassion from consumer and professional experts, as well as comparison measures on the Jefferson Scale of Physician Empathy. Participant reports of social validity were high, as were consumer and professional ratings of compassionate behaviors. Improvements on the Jefferson Scale of Physician Empathy were also observed. Implications for training practitioners and for expanding the focus on compassionate care skill development within the field are explored.
Collapse
|
10
|
Walker PC, Marshall VD, Sweet BV, Vordenberg SE. Longitudinal Measurement of Empathy in Student Pharmacists. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8752. [PMID: 34753713 PMCID: PMC10159471 DOI: 10.5688/ajpe8752] [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: 05/26/2021] [Accepted: 10/27/2021] [Indexed: 05/06/2023]
Abstract
Objective. To assess empathy longitudinally in student pharmacists and describe how it changes during their four years of pharmacy education.Methods. The Jefferson Scale of Empathy Health Professions Student version (JSE-HPS) was completed by a cohort of student pharmacists at the beginning and end of their first year of pharmacy school (P1), then at the end of their second, third, and fourth years of pharmacy school (P2, P3, P4). Demographic data and information about students' previous pharmacy work experience and experience interacting with patients were also collected.Results. Student pharmacists' empathy scores were relatively high at the beginning of P1, comparable to scores reported for medical and other health professions students. Empathy scores declined over the first two years of the pharmacy curriculum but increased during both P3 and P4, recovering to the level observed at the beginning of P1. Factor analysis identified three factors, namely "perspective taking," "compassionate care," and "walking in a patient's shoes" that accounted for 26%, 19%, and 7% of the variance, respectively, and supported the construct validity of the JSE-HPS.Conclusion. Student pharmacists' empathy decreased during the early, primarily didactic years of the pharmacy curriculum but increased during the latter years that emphasize clinical experiences.
Collapse
Affiliation(s)
- Paul C Walker
- The University of Michigan, College of Pharmacy, Ann Arbor, Michigan
| | | | - Burgunda V Sweet
- The University of Michigan, College of Pharmacy, Ann Arbor, Michigan
| | | |
Collapse
|
11
|
Kristensen T, Ejersted C, Ahnfeldt-Mollerup P, Søndergaard J, Charles JA. Profiles of GPs with high and low self-reported physician empathy—personal, professional, and antibiotic prescribing characteristics. BMC PRIMARY CARE 2022; 23:243. [PMID: 36127665 PMCID: PMC9487092 DOI: 10.1186/s12875-022-01847-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
General Practitioners’ (GPs) professional empathy has been hypothesized to have substantial impact on their healthcare delivery and medication prescribing patterns. This study compares profiles of personal, professional, and antibiotic prescribing characteristics of GPs with high and low empathy.
Methods
We apply an extreme group approach to a unique combined set of survey and drug register data. The survey included questions about demographic, professional, and antibiotic prescribing characteristics, as well as the Jefferson Scale of Empathy for Health Professionals (JSE-HP) to assess self-reported physician empathy. It was sent to a stratified sample of 1,196 GPs comprising 30% of the Danish GP population of whom 464 (38.8%) GPs responded. GPs in the top and bottom decile of empathy levels were identified. All intra- and inter-profile descriptive statistics and differences were bootstrapped to estimate the variability and related confidence intervals.
Results
61% of GPs in the top decile of the empathy score were female. GPs in this decile reported the following person-centered factors as more important for their job satisfaction than the bottom decile: The Patient-physician relationship, interaction with colleagues, and intellectual stimulation. High-empathy scoring GPs prescribed significantly less penicillin than the low-empathy GPs. This was true for most penicillin subcategories. There were no significant differences in age, practice setting (urban vs. rural), practice type (partnership vs. single-handed), overall job satisfaction, or GP’s value of prestige and economic profit for their job satisfaction. The intra profile variation index and confidence intervals show less prescribing uncertainty among GPs with high empathy.
Conclusions
This study reveals that high empathy GPs may have different personal, professional, and antibiotic prescribing characteristics than low empathy GPs and have less variable empathy levels as a group. Furthermore, person-centered high empathy GPs on average seem to prescribe less penicillins than low empathy GPs.
Collapse
|
12
|
Assing Hvidt E, Ulsø A, Thorngreen CV, Søndergaard J, Andersen CM. Empathy as a learning objective in medical education: using phenomenology of learning theory to explore medical students' learning processes. BMC MEDICAL EDUCATION 2022; 22:628. [PMID: 35982451 PMCID: PMC9389818 DOI: 10.1186/s12909-022-03696-x] [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: 04/13/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Clinical empathy has been associated with a range of positive patient- and clinician outcomes. Educating medical students to become empathic physicians has in recent years become a clearly pronounced learning objective in medical education in many countries worldwide. Research knowledge about how medical students experience the learning processes conveyed by empathy-enhancing educational interventions is lacking. Our study aimed to explore Danish medical students' perspectives on which experiences allowed learning processes to take place in relation to empathy and empathic communication with patients. METHODS We conducted a qualitative research study, involving semi-structured interviews with twenty-three Danish medical students across years of curriculum and universities. Braun and Clarke's reflexive thematic analysis (RTA) guided the analytical process, moving on a continuum from inductive to deductive, theoretical approaches. Key concepts in regard to learning processes deriving from Amadeo Giorgi's learning theory were applied to analyse the data. RESULTS Learning processes in relation to clinical empathy occured: 1. when theoretical knowledge about empathy became embodied and contextualied within a clinical context 2. through interpersonal interactions, e.g., with peers, faculty members and clinicians, that conveyed behavior-mobilizing positive and negative affect and 3. when new learning discoveries in 2. and 3. were appropriated as a personalized and adequate behavior that transcends the situational level. CONCLUSION Rather than being an immediate product of knowledge transmission, skill acquisition or training, learning clinical empathy is experienced as a dynamic, temporal process embedded in a daily clinical lifeworld of becoming an increasingly human professional.
Collapse
Affiliation(s)
- Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark.
| | - Anne Ulsø
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | | | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - Christina Maar Andersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| |
Collapse
|
13
|
Assing Hvidt E, Søndergaard J, Wehberg S, Hvidt NC, Andersen CM. A cross-sectional study of student empathy across four medical schools in Denmark-associations between empathy level and age, sex, specialty preferences and motivation. BMC MEDICAL EDUCATION 2022; 22:489. [PMID: 35739548 PMCID: PMC9223265 DOI: 10.1186/s12909-022-03532-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Professional empathy has been associated with a range of positive patient- and clinician outcomes and is therefore considered important to develop for future physicians. Measuring changes in empathy scores among medical students by using the Jefferson Scale of Empathy (Student version) (JSE-S) has led to mixed results. So far, no investigation of Danish medical students' empathy development has been conducted. The aim of this study was therefore to examine the associations between empathy scores among Danish medical students and medical school, year of curriculum, age, sex, co-habitation, and parental status, specialty preferences and motivations for choosing medicine as a future profession. METHODS This was a cross-sectional questionnaire study. All medical students from four medical schools in Denmark in their first, third and sixth year (N = 4,178) were invited to participate in the study in October 2020. The associations between JSE-S sum score and the above explanatory factors were analysed by uni- and multivariable linear regression models. RESULTS The JSE-S was completed by 672 medical students. The overall mean score was 112.7. There were no statistically significant differences in empathy between medical schools, first, third- and sixth- year medical students, age groups or parental status. Female students and students living with a spouse or partner scored higher on JSE-S than male students or students living alone, and the sex difference remained statistically significant in the multivariable regression. In both the univariable and multivariable setting, preference for future medical specialty was statistically significant, with a decrease in scores for students choosing surgery-specialties. Motivational factors were not statistically significantly associated with empathy, although there was a slight upwards trend for one of the motivational categories, named "personal experiences". CONCLUSIONS Overall, our results showed neither decrease nor increase but instead rather stable empathy scores across years of curriculum of medical students in Denmark, adding to the mixed picture of empathy development among medical students. Our findings are consistent with positive associations found in international studies between empathy scores and higher age, female sex, specialty preferences for psychiatry and general practice and altruistic motivations for choosing to enroll. Although specialty preferences are changing during medical education, they may be used meaningfully as predictors of individual student empathy levels.
Collapse
Affiliation(s)
- Elisabeth Assing Hvidt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | | |
Collapse
|
14
|
Blanco Canseco JM, Blanco Alfonso A, Caballero Martínez F, Hawkins Solís MM, Fernández Agulló T, Lledó García L, López Román A, Piñas Mesa A, Vara Ameigeiras EM, Monge Martín D. Medical empathy in medical students in Madrid: A proposal for empathy level cut-off points for Spain. PLoS One 2022; 17:e0267172. [PMID: 35604951 PMCID: PMC9126362 DOI: 10.1371/journal.pone.0267172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/03/2022] [Indexed: 11/18/2022] Open
Abstract
This study evaluates the degree of empathy among medical students and its influencing factors at three critical moments of their degree studies (beginning of first year and end of third and sixth years) as well as establishes low-, medium-, and high-empathy cut-off points to obtain valid and reliable results that can be extrapolated to the general population. This cross-sectional study of the eight (public and private) medical schools in the province of Madrid, used an electronic questionnaire with the Jefferson Scale of Empathy (JSE), Medical Student Well-Being Index, and other independent characteristics as measuring instruments. Of the 2,264 student participants, 1,679 (74.0%) were women, with a 50.7% participation rate. No significant differences were found in empathy levels by academic year. Regarding range, percentile and cut-off point tables were established to identify students with high, medium, and low empathy levels. Women (p<0.001), volunteer workers (p<0.001), and those preferring general specialties (internal medicine, psychiatry, pediatrics, or family medicine) scored higher on the JSE (p<0.02). Moreover, 41.6% presented high level of psychological distress. Women reported a lower well-being level and a higher risk of psychological distress (p = 0.004). In sum, the empathy of medical students in Madrid did not differ among the three critical moments of their university studies. The established cut-off points could be taken into account when accessing the medical degree and identifying students with low levels of empathy to implement curricular interventions to rectify this perceived deficiency. There was a high percentage of medical students with high levels of psychological distress.
Collapse
Affiliation(s)
- José Manuel Blanco Canseco
- School of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
- Valle de la Oliva Healthcare Centre, Majadahonda, Madrid, Spain
| | - Augusto Blanco Alfonso
- Reina Victoria Healthcare Centre, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | - Lourdes Lledó García
- Dean Faculty of Medicine and Health Sciences, Universidad de Alcalá, Madrid, Spain
| | | | | | | | - Diana Monge Martín
- School of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| |
Collapse
|
15
|
Klöckner CC, Gerbase MW, Nendaz M, Baroffio A, Junod NP. Relationship between self-reported cognitive and behavioural empathy among medical students. PATIENT EDUCATION AND COUNSELING 2022; 105:895-901. [PMID: 34419328 DOI: 10.1016/j.pec.2021.07.053] [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: 12/15/2020] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to explore the relationship between cognitive and behavioural empathy in medical students. METHODS Fourteen 4th year medical students recruited on the basis of their scores on the self-reported Jefferson Scale of Empathy (JSE-S) were divided into two groups: low JSE-S scorers (n = 8) (M = 96.75, SD = 10.3) and high JSE-S scorers (n = 6) (M = 121.3, SD = 2.94). They were discreetly videotaped while taking history with an incognito standardized patient. Students' behavioural empathy was measured using the Verona Coding System (VR-CoDES-P) and rating of non-verbal behaviour. RESULTS Patients expressed the same number of concerns per encounter in both groups but gave more cues to high-scorers (p = 0.029). However, students of both groups demonstrated the same amount of verbal empathy (high: 16% vs low: 15% p = 1.00). High JSE-S scorers' non-verbal communication tended to be rated slightly higher than low JSE-S-scorers with a higher use of facial expression (p = 0.008). CONCLUSION This study did not reveal any differences of students' verbal empathy to patients' cues and concerns between low and high JSE_S scorers. PRACTICE IMPLICATIONS The VR-CoDES_P is a useful tool to assess medical students and physicians empathic behaviour, allowing to disentangle the different components of empathy.
Collapse
Affiliation(s)
| | - Margaret W Gerbase
- Unit of Development and Research in Medical Education, Geneva Faculty of Medicine, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Geneva Faculty of Medicine, Geneva, Switzerland; Division of General Intermal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Geneva Faculty of Medicine, Geneva, Switzerland
| | - Noelle Perron Junod
- Unit of Development and Research in Medical Education, Geneva Faculty of Medicine, Geneva, Switzerland; Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland.
| |
Collapse
|
16
|
Potts LC, Bakolis I, Deb T, Lempp H, Vince T, Benbow Y, Waugh W, Kim S, Raza S, Henderson C. Anti-stigma training and positive changes in mental illness stigma outcomes in medical students in ten countries: a mediation analysis on pathways via empathy development and anxiety reduction. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1861-1873. [PMID: 35451604 PMCID: PMC9375761 DOI: 10.1007/s00127-022-02284-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/31/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Studies of mental illness stigma reduction interventions have been criticised for failing to evaluate behavioural outcomes and mechanisms of action. This project evaluates training for medical students entitled 'Responding to Experienced and Anticipated Discrimination' (READ), developed to focus on skills in addition to attitudes and knowledge. We aimed to (i) evaluate the effectiveness of READ with respect to knowledge, attitudes, and clinical communication skills in responding to mental illness-related discrimination, and (ii) investigate whether its potential effectiveness was mediated via empathy or/and intergroup anxiety. METHODS This is an international multisite non-randomised pre- vs post-controlled study. Eligible medical students were currently undertaking their rotational training in psychiatry. Thirteen sites across ten countries (n = 570) were included in the final analysis. RESULTS READ was associated with positive changes in knowledge (mean difference 1.35; 95% CI 0.87 to 1.82), attitudes (mean difference - 2.50; 95% CI - 3.54 to - 1.46), skills (odds ratio 2.98; 95% CI 1.90 to 4.67), and simulated patient perceived empathy (mean difference 3.05; 95% CI 1.90 to 4.21). The associations of READ with knowledge, attitudes, and communication skills but not with simulated patient perceived empathy were partly mediated through student reported empathy and intergroup anxiety. CONCLUSION This is the first study to identify mediating effects of reduced intergroup anxiety and increased empathy in an evaluation of anti-stigma training that includes behavioural measures in the form of communication skills and perceived empathy. It shows the importance of both mediators for all of knowledge, skills, and attitudes, and hence of targeting both in future interventions.
Collapse
Affiliation(s)
- Laura C. Potts
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK ,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Tanya Deb
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | - Tushar Vince
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Yasmin Benbow
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - William Waugh
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - San Kim
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Syed Raza
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | |
Collapse
|
17
|
Suciu N, Meliț LE, Mărginean CO. A Holistic Approach of Personality Traits in Medical Students: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312822. [PMID: 34886548 PMCID: PMC8657758 DOI: 10.3390/ijerph182312822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 01/09/2023]
Abstract
Personality is one of the most crucial aspects of human life, since it influences all human behaviours in both personal and social life, and might also trigger important conflicts with a person’s surroundings in the setting of incompatible traits and characteristics. It is true that ‘one must be born’ for a certain medical specialty, but several components of personality might be educated with proper training. Increased levels of Conscientiousness, Agreeableness, and Openness associated with lower levels of Neuroticism might represent the key combination for achieving professional satisfaction in the medical profession. Medical students should receive proper interprofessional education, since effective interprofessional relationships among healthcare providers definitely improve patients’ safety. Empathy contributes to effective patient–physician communication, improving patient trust, compliance, and satisfaction, being positively correlated with Openness, Agreeableness, Conscientiousness and Extraversion. Emotional intelligence—the capacity to respond to one’s own and others’ emotions—was proven to contribute, in a synergistic way with empathy, to increasing empathic ability. Clinical communication skills represent a key component in medical students in order to achieve the best patient care, and they are certainly related and/or influenced by empathy, interprofessional collaboration skills, emotional intelligence and, especially, personality traits. Taking into account the complex interactions mentioned above, the implementation of effective courses based on these concepts in medical students, intending to promote the development of clinical communication skills, represents a real emergency, since it might result in a reduction in medical errors and subsequent related deaths. A thorough understanding of students’ personality is mandatory before designing these courses in order to provide a training tailored to their personality styles.
Collapse
Affiliation(s)
- Nicoleta Suciu
- European and Research Projects Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| | - Lorena Elena Meliț
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
- Correspondence: ; Tel.: +40-742-984744
| | - Cristina Oana Mărginean
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| |
Collapse
|
18
|
Avlogiari E, Maria Karagiannaki S, Panteris E, Konsta A, Diakogiannis I. Improvement of Medical Students' Empathy Levels After an Intensive Experiential Training on Empathy Skills. PSYCHIAT CLIN PSYCH 2021; 31:392-400. [PMID: 38765648 PMCID: PMC11079646 DOI: 10.5152/pcp.2021.21098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/28/2021] [Indexed: 05/22/2024] Open
Abstract
Background EMPATHY IN HEALTHCARE is an intensive 20-hour experiential training program based on mediation techniques and specialized healthcare role-play for clinicians and medical students. It is hypothesized that the training will improve empathy via the intensive experiential techniques implemented. Methods A total of 50 medical students (25 males/25 females) took the course voluntarily. Empathy was measured using the Jefferson Scale of Empathy-Medical Students Version (JSE-S) (Greek version), before and after the 20-hour training, along with a 6-month follow-up. Gender, age, preferred medical specialty and baseline empathy score were explored as possible moderator variables of the training effect. Results Empathy increased after training, with a mean JSE-S score improvement of 11.25 points (±8.848) (P < .001). After 6 months, the mean JSE-S score maintained a difference of 6.514 points (±12.912) (P < .005). No differences were recorded with regard to gender, age group or medical specialty for the pooled data. Women in the 22-24 year-old age group had a 5-point mean difference (P = .05), and higher post-training scores than men. Lower initial scorers were the ones that mostly improved, with a 3-fold mean score difference from the higher scorers regardless of gender (P < .001), while also showing a smaller drop in empathy levels 6 months after the training compared to the higher scorers. Conclusion Intensive experiential training can improve empathy in a clinical setting. EMPATHY IN HEALTHCARE is a successful training program in improving empathy in medical students, as measured by the JSE-S. A score of 110 and below could be used for selecting medical student candidates who will benefit most from empathy training.
Collapse
Affiliation(s)
- Efpraxia Avlogiari
- 1st Psychiatry Clinic, Aristotle University of Thessaloniki Faculty of Health Sciences, School of Medicine
| | | | - Eleftherios Panteris
- 1st Psychiatry Clinic, Aristotle University of Thessaloniki Faculty of Health Sciences, School of Medicine
| | - Anastasia Konsta
- 1st Psychiatry Clinic, Aristotle University of Thessaloniki Faculty of Health Sciences, School of Medicine
| | - Ioannis Diakogiannis
- 1st Psychiatry Clinic, Aristotle University of Thessaloniki Faculty of Health Sciences, School of Medicine
| |
Collapse
|
19
|
Praharaj SK, Salagre S, Sharma PSVN. Stigma, Empathy, and Attitude (SEA) educational module for medical students to improve the knowledge and attitude towards persons with mental illness. Asian J Psychiatr 2021; 65:102834. [PMID: 34508946 DOI: 10.1016/j.ajp.2021.102834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective was to develop an educational module on stigma, empathy, and attitude towards mental illness and evaluate its effectiveness among undergraduate medical students. METHODS In phase I, the authors developed the Stigma, Empathy, and Attitude (SEA) module consisting of interactive teaching-learning components through an experts-based consensus (two rounds of Delphi). In phase II, the effectiveness of the module was evaluated. SEA module (one-hour interactive lecture and three hours' small group teaching) was delivered to the fifth-semester undergraduate medical students (N = 240) once during their psychiatry rotation. Students were assessed with the Mental Health Knowledge Schedule (MHKS), Mental Illness: Clinician's Attitudes (MICA) scale, Jefferson Scale for Empathy (JSE), and Social Distance scale (SDS), to measure mental health knowledge, attitude, empathy, and stigma, at baseline and after delivery of the module. Feedback on the module was obtained from the participating students and faculty. RESULTS Baseline data was obtained for 157 students, and post-intervention assessment was completed for 66 students. There was a significant increase in MHKS score (p < 0.001, Cohen's d = 0.59) and a significant reduction in the MICA score (p = 0.016, Cohen's d = 0.31) after the intervention. However, there was no change in empathy and social distance, as measured by JSE (p = 0.23) and SDS (p = 0.31). A majority of the faculty and students were satisfied with the module and felt it should be part of the psychiatry curriculum. CONCLUSIONS The SEA module was found to improve medical students' knowledge and attitude towards mental illness and could be integrated as part of the psychiatry curriculum. However, it was ineffective in changing empathy and stigma in the students.
Collapse
Affiliation(s)
- Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Santosh Salagre
- Department of Medicine, Seth GS Medical College, Mumbai, Maharashtra, India
| | - Podila S V N Sharma
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
20
|
Impact of physician empathy on patient outcomes: a gender analysis. Br J Gen Pract 2021; 72:e99-e107. [PMID: 34990388 PMCID: PMC8763196 DOI: 10.3399/bjgp.2021.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/20/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and, to date, no study has concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions. AIM To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation's quality, and patients' trust in their physicians, and to determine whether this relationship is moderated by a physician's gender. DESIGN AND SETTING Analysis of the empathy of 61 primary care physicians in relation to 244 patient experience questionnaires in the French-speaking region of Switzerland. METHOD Sixty-one physicians were video-recorded with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean Fundamental Frequencies (SVMFF), measuring vocally coded emotional arousal. After the consultation, patients indicated their satisfaction with, trust in, and quality of the consultation. RESULTS Female physicians self-rated their empathic concern higher than their male counterparts did, whereas male physicians were more vocally synchronised (in terms of frequencies of speech) to their patients. SVMFF was the only significant predictor of all patient outcomes. Verbal empathy statements were linked to higher satisfaction when the physician was male. CONCLUSION Gender differences were observed more often in self-reported measures of empathy than in external measures, indicating a probable social desirability bias. SVMFF significantly predicted all patient outcomes, and could be used as a cost-effective proxy for relational quality.
Collapse
|
21
|
Suciu N, Mărginean CO, Meliț LE, Ghiga DV, Cojocaru C, Popa CO. Medical Students' Personalities: A Critical Factor for Doctor-Patient Communication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9201. [PMID: 34501788 PMCID: PMC8431279 DOI: 10.3390/ijerph18179201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 12/30/2022]
Abstract
The aim of this study was to assess the level of creativity and personality traits and their mutual influence on medical students using the DECAS and BWAS. We performed a prospective descriptive study on 119 medical students from Târgu Mureș, Romania between November 2020 and July 2021, who answered questions relating to the BWAS and DECAS scales to evaluate their creativity and personality traits. Our findings pointed out a reverse correlation between age and both the original and revised BWAS (r = -0.2037, p = 0.0263; r = -0.1931, p = 0.0354). In terms of extraversion, we found a significant positive correlation for both openness (r = 0.3032, p = 0.0008) and emotional stability (r = 0.2868, p = 0.0016) and a negative correlation between extraversion and agreeability (r = -0.2394, p = 0.0087). Regarding creativity, we found positive correlations between emotional stability and both the original and revised BWAS (r = 0.20, p = 0.0279; r = 0.20, p = 0.0245). Medical students' creativity might be positively influenced by emotional stability and seems to decrease with age. Higher extraversion scores could be related to increased openness and emotional stability as well as decreased agreeability.
Collapse
Affiliation(s)
- Nicoleta Suciu
- European and Research Projects Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| | - Cristina Oana Mărginean
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| | - Lorena Elena Meliț
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| | - Dana Valentina Ghiga
- Department of Medical Scientific Research Methodology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| | - Cristiana Cojocaru
- Doctoral School of “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| | - Cosmin O. Popa
- Department of Ethics and Social Sciences, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| |
Collapse
|
22
|
Hizomi Arani R, Naji Z, Moradi A, Shariat SV, Mirzamohamadi S, Salamati P. Comparison of empathy with patients between first-year and last-year medical students of Tehran University of Medical Sciences. BMC MEDICAL EDUCATION 2021; 21:460. [PMID: 34461865 PMCID: PMC8406781 DOI: 10.1186/s12909-021-02897-0] [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: 12/16/2020] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE This study was conducted to assess the developmental factors of empathy among medical students of Tehran University of Medical Sciences (TUMS). METHODS To assess the empathy levels, 42 first-year and an equal number of last-year medical students were randomly selected. They answered a questionnaire including the medical student version of the Jefferson Scale, demographic, and some related variables. Statistical analyses were performed using the Chi-square test, T-test, univariate, and multivariate regressions. RESULT The study population consisted of 51 (60.7 %) men and 33 (39.3 %) women with a mean (SD) age of 22.24 (4.10) years. The Jefferson score was 110.19 ± 13.61 and 103.52 ± 20.00 in first- and last-year medical students, respectively. Moreover, medical students who completely passed at least one of the considered empathy courses of the TUMS curriculum had higher empathy scores compared to their counterparts (109.83 ± 15.54 vs. 103.68 ± 19.02). There was no significant association between empathy and gender, self-experience of illness, marital status, family history of chronic disease, and parents' education (all P-values > 0.05). After adjusting for the effects of confounders, the empathy scores were significantly associated with the academic year level (p = 0.04), level of interest in medicine (p = 0.001), and passing the empathy courses (p = 0.04). CONCLUSIONS The data provided from a top Iranian medical school indicated that the academic year level, level of interest in medicine, and passing the empathy courses were significantly associated with the empathy level. Further studies are recommended.
Collapse
Affiliation(s)
- Reyhane Hizomi Arani
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, P.O. Box: 1136746911, Tehran, Iran
| | - Zohrehsadat Naji
- Young Researchers and Elites Club, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ali Moradi
- Occupational Health and Safety Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Vahid Shariat
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), University of Medical Sciences, Tehran, Iran
| | - Sara Mirzamohamadi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, P.O. Box: 1136746911, Tehran, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, P.O. Box: 1136746911, Tehran, Iran.
| |
Collapse
|
23
|
Gerbase MW, Gustin MP, Bajwa N, Abbiati M, Baroffio A. Development and Cross-National Validation of a French Version of the Jefferson Scale of Empathy for Students. Eval Health Prof 2021; 45:288-296. [PMID: 34372730 PMCID: PMC9446459 DOI: 10.1177/01632787211033330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Empathy is a multifaceted personal ability combining emotional and cognitive
features modulated by cultural specificities. It is widely recognized as a key
clinical competence that should be valued during professional training. The
Jefferson Scale of Empathy for medical students (JSE-S) has been developed for
this purpose and validated in several languages, but not in French. The aims of
this study were to gather validity evidence for a newly developed version of the
JSE-S and compare it between two French-speaking contexts. In total, 1,433
undergraduate medical students from the universities of Lyon (UL), France and
Geneva (UG), Switzerland participated in the study completing the JSE-S in
French. Total and partial scores of the three subscales (“perspective taking,”
“compassionate care” and “walking in patient’s shoes”) were calculated for each
site. Construct validity of the JSE-S was analyzed considering three sources of
evidence: content, internal structure and relations to other variables. A
first-order Confirmatory Factor Analysis using structural equation modeling
examined the three latent variables of the JSE-S subscales. Cronbach’s α
coefficients were 0.75 (UG) and 0.81 (UL). The items’ discrimination power
ranged between 0.29 and 1.60 (median effect size of 1.24). The overall
correlations between items and total or partial scores derived from the latent
JSE-S subscales were consistently similar in both study sites. Findings of this
study confirm the latent structure of the JSE-S in French and its cross-national
reproducibility. The comparable underlying structure of the questionnaire tested
in two distinct French-speaking contexts endorses the generalizability of its
measure.
Collapse
Affiliation(s)
| | | | - Nadia Bajwa
- 30577Department of Women-Children-Teenagers, University Hospitals of Geneva, Switzerland
| | - Milena Abbiati
- Faculty of Medicine, 27212University of Geneva, Switzerland
| | - Anne Baroffio
- Faculty of Medicine, 27212University of Geneva, Switzerland
| |
Collapse
|
24
|
Reed BN, Haines ST, Holmes ER. The Impact of Two Longitudinal Professionalism Courses on Student Pharmacists' Empathy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2021; 85:8083. [PMID: 34283738 PMCID: PMC7926277 DOI: 10.5688/ajpe8083] [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: 04/03/2020] [Accepted: 10/30/2020] [Indexed: 06/13/2023]
Abstract
Objective. To determine whether empathy increased in first-year student pharmacists after completing longitudinal professionalism courses at two schools of pharmacy, identify potential moderators, and assess whether students' conceptualization of empathy changed with time.Methods. Surveys to assess empathy and other variables were administered to student pharmacists at baseline and at the end of two professionalism courses. Baseline and follow-up scores were compared to detect changes over time. Multivariable analysis was used to identify predictors of empathy scores. Factor analysis was performed to ascertain changes in the dimensionality of empathy.Results. Students' demographics and baseline empathy scores differed between the two schools. Predictors of empathy at baseline included age, female gender, prior health care experience, and altruism score. A small increase in empathy was observed at one school but not in the combined cohort. Empathy was more likely to increase among female students, those with less health care experience, and those who did not work during the school year. Factor analyses suggested that students' conceptual clarity about empathy improved over time and became more consistent with existing models.Conclusion. Although an increase in empathy was not observed in the overall cohort, subgroups of students who may derive greater benefit from empathy-related interventions were identified. Factor analyses suggested that students' conceptual understanding of empathy improved, representing a potential alternative outcome assessment for affective domains. Given differences in demographics, instructional methodologies, and changes in empathy at each school, this study reinforces the importance of replication and multicenter studies to understand the generalizability of educational research.
Collapse
Affiliation(s)
- Brent N Reed
- University of Maryland, School of Pharmacy, Baltimore, Maryland
| | - Stuart T Haines
- University of Mississippi, School of Pharmacy, Jackson, Mississippi
| | - Erin R Holmes
- University of Mississippi, School of Pharmacy, Jackson, Mississippi
| |
Collapse
|
25
|
Mallory L, Floyed R, Doughty C, Thompson T, Lopreiato J, Chang TP. Validation of a Modified Jefferson Scale of Empathy for Observers to Assess Trainees. Acad Pediatr 2021; 21:165-169. [PMID: 32540426 DOI: 10.1016/j.acap.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 05/12/2020] [Accepted: 06/07/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE "Demonstrate insight and understanding into emotion" is a competency amenable to simulation-based assessment. The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) has validity evidence for patients to assess provider empathy. A version adapted for a third-party observers does not exist. Our aim was to modify the JSPPPE and use recorded standardized encounters to obtain validity evidence. METHODS This cross-sectional study used video and data collected from 2 pediatric residencies. In 2018, 4 raters reviewed 24 videos of 12 interns communicating with standardized patients (SP) in 2 encounters and completed a modified JSPPE for observers (JSEO). Reliability between raters was established using Intraclass Correlations (ICC). JSEO mean scores were correlated to Essential Elements of Communication (EEC), JSPPPE, and faculty composite interpersonal communication (IC) scores using Spearman Rank. RESULTS The mean ICC for all 4 raters was 0.573 (0.376-0.755). When ICC was calculated for pairs of raters, Rater 1 was an outlier. ICCs for mean scores for pairs among the 3 remaining raters was 0.81 to 0.84. Mean JSEO scores from the four raters correlated with the JSPPPE (rho = 0.45, P = .03) and IC (rho = 0.68, P < .001), but not the EEC (rho = 0.345, P = .1). CONCLUSIONS We found validity evidence for the use of a modified JSPPPE for an observer to assess empathy in a recorded encounter with a SP. This may be useful as medical educators shift toward competency-based tracking. The brevity of this tool and potential assessment using video are also appealing.
Collapse
Affiliation(s)
- Leah Mallory
- Tufts University School of Medicine (L Mallory), The Hannaford Simulation Center at Maine Medical Center, Maine.
| | - Rebecca Floyed
- Dell Medical School (R Floyed), University of Texas at Austin, Tex
| | - Cara Doughty
- Baylor College of Medicine (C Doughty), Texas Children's Hospital Simulation Center, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex
| | - Tonya Thompson
- University of Arkansas for Medical Sciences (T Thompson), Little Rock, Ark
| | - Joseph Lopreiato
- Uniformed Services University of the Health Sciences (J Lopreiato), The Val G. Hemming Simulation Center, Silver Spring, Md
| | - Todd P Chang
- Keck School of Medicine of USC (TP Chang), Children's Hospital Los Angeles, Los Angeles, Calif
| |
Collapse
|
26
|
Blanco JM, Caballero F, Álvarez S, Plans M, Monge D. Searching for the erosion of empathy in medical undergraduate students: a longitudinal study. BMJ Open 2020; 10:e041810. [PMID: 33384394 PMCID: PMC7780525 DOI: 10.1136/bmjopen-2020-041810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To analyse the trajectory of empathy throughout the degree programme of medicine in a Spanish school of medicine. DESIGN Longitudinal, prospective 5-year study, between October 2014 and June 2019. SETTING Students from a Spanish university of medicine. PARTICIPANTS Two voluntary cohorts of undergraduate medical students from two different school years were invited to participate (n=135 (cohort 1, C1) and 106 (cohort 2, C2) per school year). Finally, a total number of 174 students (102 (C1, 71.6% women) and 72 (C2, 70.8% women) students, respectively) were monitored for 5 years. Each cohort was divided in two subcohorts of paired and unpaired students that were analysed to check possible social desirability bias. PRIMARY OUTCOME MEASURE The Jefferson Scale of Empathy (JSE). RESULTS The cohort of 102 students (C1) monitored between their first and fifth years of study (71.6% women) showed an improvement among paired women of 2.15 points in total JSE score (p=0.01) and 2.39 points in cognitive empathy (p=0.01); in the unpaired female cohort the increase was of 2.32 points (cognitive empathy) (p=0.02). The cohort of 72 students (C2) monitored between their second and sixth years of study (70.8% women) displayed a cognitive empathy increase of 2.32 points (p=0.04) in the paired group of women. There were no significant differences between paired and unpaired results for either cohort. Empathy scores among men did not decrease. CONCLUSIONS The empathy of medical students at our school did not decline along grade years. In fact, it improved slightly, particularly cognitive empathy, among women. This paper contributes to enlarge data from Europe, where longitudinal studies are scarce. It supports the idea that there may be global geo-sociocultural differences; however, more studies comparing different school settings are needed.
Collapse
Affiliation(s)
- José Manuel Blanco
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
- Valle de la Oliva Healthcare Centre, Madrid, Spain
| | | | - Santiago Álvarez
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Diana Monge
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| |
Collapse
|
27
|
Tisdale CE, Black AC, Jain S, Lowther E, Madeline L, Troup C, Nathaniel T, Fowler LA. The Impact of Meeting Patients with Neurological Disorders on Medical Student Empathy. MEDICAL SCIENCE EDUCATOR 2020; 30:1561-1568. [PMID: 34457824 PMCID: PMC8368363 DOI: 10.1007/s40670-020-01102-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 06/13/2023]
Abstract
PURPOSE Empathy tends to decline during medical education, typically beginning in the third year of medical school and often continuing throughout residency and the physician's medical career. The purpose of this study was to determine if first year medical student empathy is affected by small group interactions with patients with neurological disorders, and to investigate if changes in empathy persisted over time. MATERIALS AND METHODS Eighty first year medical students participating in a Neuroscience Module interacted with a variety of neurological patients in a small group informational session. Prior to the experience, participants completed the Jefferson Scale of Physician Empathy-Student (JSPE-S) version. After the experience, students completed a post-test JSPE-S questionnaire, and a final post-post-test JSPE-S questionnaire was completed 5 weeks later. Empathy scores were compared with a repeated measures MANOVA. The relationship between gender and empathy, and the effect of the age of the neurological patients on empathy scores were also examined. RESULTS Empathy scores for seventy-one students who completed the JSPE-S questionnaires were analyzed. Students had significantly higher empathy immediately after the patient interaction experience, and the change in empathy was sustained over the course of 5 weeks (p = 0.015). The age of the neurological patients had a significant effect on empathy scores. There was no significant difference between empathy scores and gender. CONCLUSIONS This study supports the incorporation of a group patient interaction experience into the medical school curriculum as an inexpensive and practical method of enhancing medical student empathy in a non-clinical setting.
Collapse
Affiliation(s)
| | - Asa C. Black
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Sandip Jain
- Department of Medicine, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Ervin Lowther
- Department of Radiology, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Lee Madeline
- Department of Radiology, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Chris Troup
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Thomas Nathaniel
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - L. A. Fowler
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| |
Collapse
|
28
|
Byrd J, Knowles H, Moore S, Acker V, Bell S, Alanis N, Zhou Y, d'Etienne JP, Kline JA, Wang H. Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study. Emerg Med J 2020; 38:290-296. [PMID: 33239313 DOI: 10.1136/emermed-2019-209393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 08/30/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Physician empathy and burnout have been shown to be independently associated with patient satisfaction. However, their correlations were uncertain in previous studies. We aimed to determine correlations among empathy, burnout, and patient satisfaction, and further analyse interactions among these factors. METHOD A single centre prospective observational study was conducted from December 2018 to August 2019 at JPS Health Network, USA. Emergency physician (EP) self-assessed empathy and burnout were measured by the Jefferson Scale of Empathy (JSE) and the Copenhagen Burnout Inventory (CBI) separately. We assessed patient perception of physician empathy and patient satisfaction with their treating physician by the Jefferson Scale of Patient Perception of Physician Empathy and a patient assessed satisfaction survey. Spearman's correlation was used to determine associations among JSE, patient assessed physician empathy, CBI and patient satisfaction. Additionally, JSE, patient assessed physician empathy and CBI predictive of patient satisfaction were measured by multivariate logistic regression analysis. RESULTS A total of 28 EPs and 423 patients were enrolled. Patient satisfaction had a weak correlation with JSE (ρ=0.11) but showed a strong correlation with patient assessed physician empathy (ρ=0.60). CBI showed no correlation with patient satisfaction (ρ<0.1). However, when JSE, patient assessed physician empathy and CBI were analysed together in relation to patient satisfaction, adjusted odds ratios (AOR) was 3.85 (95% CI 1.36 to 10.88) with high patient assessed physician empathy alone; AOR was 7.17 (2.62-19.67) when high patient assessed physician empathy was combined with low CBI; and AOR was 8.37 (3.07-22.83) when high patient assessed physician empathy, low CBI and high JSE were combined. CONCLUSION Patient assessed physician empathy had a strong positive correlation with patient satisfaction. Moreover, higher patient satisfaction was achieved from EPs of high patient assessed physician empathy, low CBI and high JSE, indicating a positive synergistic effect. These findings suggest different interventions might be applied to EPs of different wellness features to maximise patient satisfaction.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jeffrey A Kline
- Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hao Wang
- Emergency Medicine, JPS Health Network, Fort Worth, Texas, USA .,JPS Health Network, Fort Worth, Texas, USA
| |
Collapse
|
29
|
Zhu Y, Yang C, Zhang J, Chen B. Developing an empathy educational model (EEM) for undergraduate nursing students: A Delphi Technique. Nurse Educ Pract 2020; 50:102922. [PMID: 33232914 DOI: 10.1016/j.nepr.2020.102922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 09/28/2020] [Accepted: 11/11/2020] [Indexed: 12/30/2022]
Abstract
Despite the growing benefits of empathy education for medical students, there is still a lack of formal empathy courses in the Chinese context. To develop an empathy educational model for undergraduate nursing students, the Delphi technique was used in this study. Experts were selected from different regions of China and invited to participate in the three rounds of consultation, via email. The final empathy educational model was comprised of nine themes and 44 subthemes. The nine themes included: a. Bring the learner to the empathic world; b. Introduce the basic knowledge of empathy; c. Master empathy skills; d. Practice empathy; e. Evaluate empathy ability; f. Follow-up support; g. Distribution of educational hours for teaching empathy; h. Forms of empathy training; and i. Student reflection on empathy education. Consensus was achieved among the experts on empathy educational content, using the Delphi Technique, which can provide a reference for the empathy training of university medical students. It is necessary to have the empathy educational model further applied and evaluated, in conjunction with intervention studies, in the future.
Collapse
Affiliation(s)
- Yali Zhu
- Wuhan University School of Health Sciences, 2nd Building Medical School, 115 Donghu Road, Wuhan, 430071, PR China
| | - Chao Yang
- Wuhan University School of Health Sciences, 2nd Building Medical School, 115 Donghu Road, Wuhan, 430071, PR China
| | - Jun Zhang
- Wuhan University School of Health Sciences, 2nd Building Medical School, 115 Donghu Road, Wuhan, 430071, PR China.
| | - Bowen Chen
- Sun Yat-sen University School of Public Health, 74 Zhongshan 2nd Road, Guangzhou, 510089, PR China
| |
Collapse
|
30
|
Fernández-Rodríguez LJ, Bardales-Zuta VH, San-Martín M, Delgado Bolton RC, Vivanco L. Empathy Enhancement Based on a Semiotics Training Program: A Longitudinal Study in Peruvian Medical Students. Front Psychol 2020; 11:567663. [PMID: 33192851 PMCID: PMC7658416 DOI: 10.3389/fpsyg.2020.567663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/08/2020] [Indexed: 12/30/2022] Open
Abstract
Background Empathy, as a core element of medical professionalism, is part of leadership in medicine. This attribute, predominantly cognitive, involves understanding and communication capacity. Empathy can be enhanced with courses on medical semiotics. It appears adequate to apply this enhancement in the early stages of professional training. Based on this, this study was performed with the purpose of demonstrating the positive effect that an academic course on medical semiotics has on the development of empathy in medical students. Methods A quasi-experimental study was conducted in one School of Medicine in Peru, where medical students had to attend a 17-week course on medical semiotics as part of their regular training. The sample, composed by 269 students, included two cohorts of third-year medical students. As main measures, the Jefferson Scales of Empathy (JSE), inter-professional collaboration (JSAPNC), and lifelong learning (JeffSPLL), were used. In addition, students’ scores evaluating theoretical and practical aspects of the course were collected once the course was finished. Pre- and post-tests were administered in week 1 and in week 17. Analyses compared measures in both moments and in time. Inter-professional collaboration and lifelong learning scores and empathy scores were used as discriminant and convergent validity measures of students’ course scores, respectively. Results Gender differences on empathy appeared, but only at the beginning. In the entire sample, empathy enhancement was confirmed in time (p < 0.001), with a large effect size (r = 0.45). This effect was also observed in both gender groups, separately. On the contrary, no changes appeared in inter-professional collaboration and in lifelong learning abilities in time. In addition, a positive correlation was observed among empathy, inter-professional collaboration and lifelong learning abilities at the beginning and at the end, confirming that the improvement observed was specific for empathy and explained by the educational intervention assessed. Conclusion These findings bring empiric evidence supporting the positive effect that training in medical semiotics has on empathy. In addition, these findings highlight some gender differences in the development of empathy in medical students.
Collapse
Affiliation(s)
| | | | | | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro, Logroño, Spain.,Platform of Bioethics and Medical Education, Centre for Biomedical Research of La Rioja (CIBIR), Logroño, Spain.,National Centre of Documentation on Bioethics, Rioja Health Foundation, Logro o, Spain
| | - Luis Vivanco
- Platform of Bioethics and Medical Education, Centre for Biomedical Research of La Rioja (CIBIR), Logroño, Spain.,National Centre of Documentation on Bioethics, Rioja Health Foundation, Logro o, Spain
| |
Collapse
|
31
|
Dávila Pontón Y, Reyes Reyes A, Calzadilla Núñez A, Díaz Narváez VP, Utsman R, Torres Martínez PA. Empathy and Personality Styles in Medical Students. REVISTA COLOMBIANA DE PSICOLOGÍA 2020. [DOI: 10.15446/rcp.v29n2.82988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study aimed to establish the relationship between empathy and personality styles in medical students, considering the differences by gender. The participants were 278 students of the medical career of the Universidad del Azuay, Ecuador. They were evaluated using the Jefferson empathy scale and the Millon Index of Personality Styles. Relationships between empathy and personality styles were examined using Pearson's correlation coefficient and hierarchical multiple linear regression analysis, for comparisons by gender and educational levels; with both Student's t test and analysis of variance used respectively. Results indicated that the factor structure of the empathy scale is invariant between men and women, noticing gender differences in care with compassion and total empathy, with women presenting a higher mean. Differences are observed by educational level, where the general empathy in the first three years grows progressively, and then slightly decrease. In conclusion, female students present a mean score of total empathy greater than men, with differences of empathy according to educational level
Collapse
|
32
|
MacLean H, Braschi E, Archibald D, Sanchez-Campos M, Jebanesan D, Koszycki D, Gonsalves C. A pilot study of a longitudinal mindfulness curriculum in undergraduate medical education. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e5-e18. [PMID: 32821298 PMCID: PMC7417827 DOI: 10.36834/cmej.56726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND To support student well-being, a mindfulness curriculum in undergraduate medical education was launched at our university in 2014. We describe the program and report 3-year results. METHODS Medical students responded to online questionnaires on mindfulness (Freiburg Mindfulness Inventory), empathy (Jefferson Scale of Physician Empathy), resilience (Connor-Davidson Resilience Scale) and perceived stress (Perceived Stress Scale) and were surveyed for demographics, home practice, and subjective experience at curriculum launch and yearly for 3 years. RESULTS In respondents, high stress (19.2 (SD=6)) and low resilience (71.2 (SD=12.5)) scores were seen throughout training. Scores for mindfulness correlated positively with those for empathy (r=.217 p < 0.01) and resilience (r = .539, p < 0.01), and negatively with stress scores (r = -.380, p < 0.01). While overall scale scores did not statistically change after curriculum implementation, statistically significant increases were seen in mindfulness (12%, p = 0.008), empathy (5%, p = 0.045), and resilience scores (12%, p = 0.002) with a trend toward lower stress scores (8%, p =0.080) in respondents who felt they applied the curriculum principles. Two hours of reported home practice per week was associated with statistically significant changes (14% increased mindfulness scores p < 0.001; 6% increased empathy scores p < 0.001, 10% increased resilience scores p = 0.003; 11% decreased stress scores p = 0.008). Despite positive program evaluations for both mandatory and elective sessions, student attendance at elective sessions was low. CONCLUSION A mindfulness curriculum integrated into formal undergraduate medical education is feasible. Benefits may be confined to those students who apply curriculum principles and practice regularly. Further study is needed.Résumé. CONTEXTE Pour soutenir le bien-être des étudiants, un cursus de méditation pleine conscience dans le cadre du programme de doctorat en médecine a été lancé à notre université en 2014. Nous décrivons le programme et communiquons les résultats après trois ans. MÉTHODES Des étudiants en médecine ont répondu à des questionnaires en ligne sur la pleine conscience (inventaire de pleine conscience de Freiburg), l'empathie (Échelle de Jefferson sur l'empathie du médecin), la résilience (échelle de résilience de Connor-Davidson) et le stress perçu (échelle du stress perçu) et ont été interrogés pour les caractéristiques démographiques, la pratique de la méditation pleine conscience à domicile et l'expérience subjective au moment du lancement du cursus et, ensuite, annuellement pendant trois ans. RÉSULTATS Chez les répondants, un degré de stress élevé (19,2 (ET=6)) et une faible résilience (71,2 (ET=12,5)) ont été observés tout au long de la formation. Il y avait une corrélation positive entre les la pleine conscience et l'empathie (r=0,17, p<0,01) et de la résilience (r=0,539, p<0,01), et négative avec le stress (r=-0,380, p<0,01). Alors que les résultats globaux ne changent pas statistiquement après la mise en œuvre du cursus, des augmentations statistiquement significatives ont été observées pour la pleine conscience (12%, p=0,008), l'empathie (5%, p=0,045) et la résilience (12%, p=0,002) avec une tendance vers des résultats inférieurs pour le stress (8%, p=0,080) chez les répondants qui estimaient avoir appliqué les principes du programme. On retrouvait des changements significatifs chez les répondants qui rapportaient avoir pratiqué deux heures par semaine à domicile (résultats accrus de 14% pour la pleine conscience (p<0,001), de 6% pour l'empathie (p<0,001) et de 10% pour la résilience (p= 0,003), et réduits de 11% pour le stress (p=0,008)). Malgré des évaluations de programme positives pour les sessions obligatoires et optionnelles, l'assiduité des étudiants aux sessions optionnelles était faible. CONCLUSION Un cursus de méditation pleine conscience intégré dans des études formelles de doctorat en médecine est faisable. Les avantages peuvent être confinés aux étudiants qui appliquent les principes du programme et qui le pratiquent sur une base régulière. D'autres études sont requises.
Collapse
Affiliation(s)
- Heather MacLean
- Division of Neurology, Department of Medicine, University of Ottawa, Ontario, Canada
- Correspondence: Heather MacLean MD, FRCPC University of Ottawa Faculty of Medicine, Ottawa Hospital, Department of Medicine, Division of Neurology, Box 603, 501 Smyth Rd, Ottawa, ON, K1H 8L6; phone: 613-798-5555 ext. 79813; fax: 613-737-8857; email
| | - Emelie Braschi
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Douglas Archibald
- Department of Family Medicine, University of Ottawa, Ontario, Canada
| | - Millaray Sanchez-Campos
- Department of Family Medicine, University of Ottawa, Ontario, Canada
- Faculty Medicine, University of Ottawa, Ontario, Canada
| | | | - Diana Koszycki
- Faculty Medicine, University of Ottawa, Ontario, Canada
- Faculty of Education, University of Ottawa, Ontario, Canada
| | - Carol Gonsalves
- Division of Hematology, Department of Medicine, University of Ottawa, Ontario, Canada
| |
Collapse
|
33
|
Buijs-Spanjers KR, Hegge HH, Cnossen F, Jaarsma DA, de Rooij SE. Reasons to Engage in and Learning Experiences From Different Play Strategies in a Web-Based Serious Game on Delirium for Medical Students: Mixed Methods Design. JMIR Serious Games 2020; 8:e18479. [PMID: 32723710 PMCID: PMC7424470 DOI: 10.2196/18479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 12/30/2022] Open
Abstract
Background Although many studies have recently been published on the value of serious games for medical education, little attention has been given to the role of dark play (choosing unacceptable actions in games). Objective This study aimed to investigate potential differences in the characteristics of medical students who have the opportunity to choose normal or dark play in a serious game. This study also aimed to compare their reasons for choosing a play strategy and their perceptions of what they learned from their game play. Methods We asked undergraduate medical students to play a serious game in which they had to take care of a patient with delirium (The Delirium Experience). After getting acquainted with the game, students could opt for normal or dark play. Student characteristics (age, gender, experience with caring for older or delirious patients, and number of completed clerkships) were collected, and the Delirium Attitude Scale and Learning Motivation and Engagement Questionnaire were administered. Reasons for choosing normal or dark play were evaluated with an open-ended question. Information on lessons they had learned from the game was collected using an open-ended question and self-reported knowledge on delirium. Results This study had 160 participants (89 normal play, 71 dark play). Male students (26/160, 56.5%) chose dark play significantly more often than female students (45/160, 39.5%; P=.049). We did not find significant differences in student characteristics or measurement outcomes between play strategies. Participants’ main reason for choosing normal play was to learn how to provide care to delirious patients, and the main reason for dark play was to gain insight into what a delirious patient has to endure during delirious episodes. All participants learned what to do when taking care of a delirious patient and gained insight into how a patient experiences delirium. We found no differences in self-reported knowledge. Conclusions When medical students have the opportunity to choose dark play in a serious game, half of them will probably choose this play strategy. Male students will more likely opt for dark play than female students. Choice of play strategy is not affected by any other student characteristic or measurement outcome. All students learned the same lessons from playing the game, irrespective of their learning strategy.
Collapse
Affiliation(s)
- Kiki R Buijs-Spanjers
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Center for Education Development and Research in Health Professions, LEARN, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Harianne Hm Hegge
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Center for Education Development and Research in Health Professions, LEARN, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Fokie Cnossen
- Bernoulli Institute of Mathematics, Computer Science and Artificial Intelligence, Department of Artificial Intelligence, University of Groningen, Groningen, Netherlands
| | - Debbie Adc Jaarsma
- Center for Education Development and Research in Health Professions, LEARN, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sophia E de Rooij
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Medical Spectrum Twente, Medical School Twente, Enschede, Netherlands
| |
Collapse
|
34
|
Ye X, Guo H, Xu Z, Xiao H. Empathy variation of undergraduate medical students after early clinical contact: a cross-sectional study in China. BMJ Open 2020; 10:e035690. [PMID: 32690511 PMCID: PMC7371130 DOI: 10.1136/bmjopen-2019-035690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Empathy education is very important for medical students. There is little research on the influence of early clinical practice on the development of empathy and other aspects of professionalism in medical students. The aim of this study was to compare the self-reported empathy levels of first-year and second-year undergraduate medical students before and after their early clinical contact curriculum. SETTING The study was conducted at the Shanghai University of Medicine & Health Sciences, Shanghai, China. PARTICIPANTS A total of 257 undergraduate medical students participated in the study. The 154 first-year students were studying in 10 community-based teaching hospitals, and the 103 second-year students were studying in 3 university-affiliated hospitals. PRIMARY AND SECONDARY OUTCOME MEASURES Primary measures: the Jefferson Scale of Empathy-Student version (JSE-S) was compared between students of different sexes and in different academic years before their early clinical contact course. Secondary measures: comparisons were made after they finished the curriculum 3 weeks later. RESULTS A total of 219 of 257 students responded (85.21% response rate), and 214 answers could be analysed (135 first-year and 79 second-year students; 120 female and 94 male individuals). No significant differences in the empathy scores before early clinical contact were observed between students of different sexes and in different academic years. After early clinical contact, the mean JSE-S score of the participants was significantly higher than the mean score at the beginning of the curriculum. CONCLUSIONS Empathy-focused training during early clinical contact can improve the empathetic capacity of undergraduate medical students. Fostering empathetic attitudes among undergraduate medical students is necessary for the early stage of their medical education. Further research is needed on the long-term effects of empathy-focused education in entry-level medical students.
Collapse
Affiliation(s)
- Xiong Ye
- School of Clinical Medicine, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Haiying Guo
- Department of Respiratory and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhou Xu
- Education Department, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Xiao
- Department of Respiratory and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
35
|
Stackhouse N, Chamberlain J, Bouwer A, Mexas AM. Development and Validation of a Novel Measure for the Direct Assessment of Empathy in Veterinary Students. JOURNAL OF VETERINARY MEDICAL EDUCATION 2020; 47:452-464. [PMID: 32412362 DOI: 10.3138/jvme.0818-096r] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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).
Collapse
Affiliation(s)
- Nancy Stackhouse
- Director of Assessment and Associate Professor, Midwestern University Arizona College of Veterinary Medicine
| | - Jared Chamberlain
- Director of Clinical Psychology Program and Associate Professor, Midwestern University College of Veterinary Medicine
| | - Annette Bouwer
- Director of Off-Campus Clinical Rotations and Assistant Clinical Professor, Midwestern University College of Veterinary Medicine
| | - Angela M Mexas
- Assistant Professor, Midwestern University College of Veterinary Medicine
| |
Collapse
|
36
|
Findyartini A, Felaza E, Setyorini D, Mustika R. Relationship between empathy and motivation in undergraduate medical students. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc43. [PMID: 32685671 PMCID: PMC7346292 DOI: 10.3205/zma001336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/22/2020] [Accepted: 04/16/2020] [Indexed: 05/26/2023]
Abstract
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.
Collapse
Affiliation(s)
- Ardi Findyartini
- University Indonesia, Faculty of Medicine, Department of Medical Education, Jakarta, Indonesia
- University Indonesia, Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Estivana Felaza
- University Indonesia, Faculty of Medicine, Department of Medical Education, Jakarta, Indonesia
- University Indonesia, Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Daniar Setyorini
- University Indonesia, Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Rita Mustika
- University Indonesia, Faculty of Medicine, Department of Medical Education, Jakarta, Indonesia
- University Indonesia, Faculty of Medicine, Medical Education Center, Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| |
Collapse
|
37
|
Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Does Empathy Decline in the Clinical Phase of Medical Education? A Nationwide, Multi-Institutional, Cross-Sectional Study of Students at DO-Granting Medical Schools. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:911-918. [PMID: 31977341 PMCID: PMC7242173 DOI: 10.1097/acm.0000000000003175] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
PURPOSE To examine differences in students' empathy in different years of medical school in a nationwide study of students of U.S. DO-granting medical schools. METHOD Participants in this cross-sectional study included 10,751 students enrolled in 41 of 48 campuses of DO-granting medical schools in the United States (3,616 first-year, 2,764 second-year, 2,413 third-year, and 1,958 fourth-year students). They completed a web-based survey at the end of the 2017-2018 academic year that included the Jefferson Scale of Empathy and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire for measuring "good impression" response bias. Comparisons were made on empathy scores among students in different years of medical school using analysis of covariance, controlling for the effect of "good impression" response bias. Also, comparisons were made with preexisting data from students of U.S. MD-granting medical schools. RESULTS A statistically significant decline in empathy scores was observed when comparing students in the preclinical (years 1 and 2) and the clinical (years 3 and 4) phases of medical school (P < .001); however, the magnitude of the decline was negligible (effect size =0.13). Comparison of findings with MD students showed that while the pattern of empathy decline was similar, the magnitude of the decline was less pronounced in DO students. CONCLUSIONS Differences in DO-granting and MD-granting medical education systems, such as emphasis on provision of holistic care, hands-on approaches to diagnosis and treatment, and patient-centered care, provide plausible explanations for disparity in the magnitude of empathy decline in DO compared with MD students. More research is needed to examine changes in empathy in longitudinal study and explore reasons for changes to avert erosion of empathy in medical school.
Collapse
Affiliation(s)
- Mohammadreza Hojat
- M. Hojat is research professor of psychiatry and human behavior, Department of Psychiatry and Human Behavior, and director, Jefferson Longitudinal Study of Medical Education, Asano-Gonnella Center for Research in Medical Education and Health Care, and Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; ORCID: https:///orcid.org/0000-0002-8841-3269
| | - Stephen C. Shannon
- S.C. Shannon is emeritus president, American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
| | - Jennifer DeSantis
- J. DeSantis is senior research study analyst, Asano-Gonnella Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mark R. Speicher
- M.R. Speicher is senior vice president for medical education and research, American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
| | - Lynn Bragan
- L. Bragan is project manager, American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland
| | - Leonard H. Calabrese
- L.H. Calabrese is professor of medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, R.J. Fasenmyer Chair of clinical immunology, Theodore F. Classen DO Chair of osteopathic research and education, and vice chair, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
38
|
Hojat M, DeSantis J, Shannon SC, Speicher MR, Bragan L, Calabrese LH. Empathy as related to gender, age, race and ethnicity, academic background and career interest: A nationwide study of osteopathic medical students in the United States. MEDICAL EDUCATION 2020; 54:571-581. [PMID: 32083747 PMCID: PMC7317910 DOI: 10.1111/medu.14138] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/27/2020] [Accepted: 02/17/2020] [Indexed: 05/09/2023]
Abstract
CONTEXT Research on associations between medical student empathy and demographics, academic background and career interest is limited, lacks representative samples and suffers from single institutional features. This study was designed to fill the gap by examining associations between empathy in patient care, and gender, age, race and ethnicity, academic background and career interest in nationwide, multi-institutional samples of medical students in the United States and to provide more definitive answers regarding the aforementioned associations, with more confidence in the internal and external validity of the findings. METHODS Four nationwide samples participated in this study (n = 10 751). Samples 1, 2, 3 and 4 included 3616 first-year, 2764 second-year, 2413 third-year and 1958 fourth-year students who completed a web-based survey at the end of the 2017-2018 academic year. The survey included questions on demographics, academic background and career interest, the Jefferson Scale of Empathy, and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire to control for the effect of 'good impression' response bias. RESULTS Statistically significant and practically important associations were found between empathy scores and gender (in favour of women), race and ethnicity (in favour of African-American and Hispanic/Latino/Spanish), academic background (in favour of 'Social and Behavioural Sciences' and 'Arts and Humanities' in Samples 1 and 2) and career interest (in favour of 'People-Oriented' and 'Psychiatry' specialties). CONCLUSIONS Special features of this study (eg, nationwide representative samples, use of a validated instrument for measuring empathy in patient care, statistical control for the effect of 'good impression' response bias, and consistency of findings in different samples from multiple institutions) provide more definitive answers to the issue of correlates of empathy in medical students and increase our confidence in the validity, reliability and generalisability of the results. Findings have implications for career counselling and targeting students who need more guidance to enhance their empathic orientation.
Collapse
Affiliation(s)
- Mohammadreza Hojat
- Asano‐Gonnella Center for Research in Medical Education and HealthcareSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Jennifer DeSantis
- Asano‐Gonnella Center for Research in Medical Education and HealthcareSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Stephen C. Shannon
- American Association of Colleges of Osteopathic MedicineBethesdaMarylandUSA
| | - Mark R. Speicher
- American Association of Colleges of Osteopathic MedicineBethesdaMarylandUSA
| | - Lynn Bragan
- American Association of Colleges of Osteopathic MedicineBethesdaMarylandUSA
| | - Leonard H. Calabrese
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandOhioUSA
| |
Collapse
|
39
|
Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Empathy in Medicine National Norms for the Jefferson Scale of Empathy: A Nationwide Project in Osteopathic Medical Education and Empathy (POMEE). J Osteopath Med 2020; 119:520-532. [PMID: 31355891 DOI: 10.7556/jaoa.2019.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Context National norms are necessary to assess individual scores from validated instruments. Before undertaking this study, no national norms were available on empathy scores. The Project in Osteopathic Medical Education and Empathy (POMEE) provided a unique opportunity to develop the first national norms for medical students. Objective To develop national norms for the assessments of osteopathic medical students' empathy scores on the broadly used and well-validated Jefferson Scale of Empathy (JSE) at all levels of osteopathic medical school education. Methods Participants were students from 41 of 48 participating campuses of osteopathic medical schools. Students were invited to complete a web-based survey, which included the JSE, in the 2017-2018 academic year. Results A total of 16,149 completed surveys were used to create national norm tables. Three national norm tables were developed for first-year matriculants and for students in preclinical (years 1 and 2) and clinical (years 3 and 4) phases of medical school. The norm tables allow any raw score on the JSE for male and female osteopathic medical students from matriculation to graduation to be converted to a percentile rank to assess an individual's score against national data. Conclusions National norms developed in this project, for men and women and at different levels of medical school education, can not only be used for the assessment of student's individual scores on the JSE, but can also serve as a supplementary measure for admissions to medical school and postgraduate medical education programs.
Collapse
|
40
|
Santiago LM, Rosendo I, Coutinho ML, Maurício KS, Neto I, Simões JA. Comparing empathy in medical students of two Portuguese medicine schools. BMC MEDICAL EDUCATION 2020; 20:153. [PMID: 32404095 PMCID: PMC7218824 DOI: 10.1186/s12909-020-02034-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/05/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND Empathy is paramount in the doctor-patient relationship being a comprehensive and multidimensional concept. Self-ratings of empathy change across the years of medical education only when the Jefferson Scale of Physicians Empathy is used, with a worrying decrease being found throughout the years in Medicine Schools. As there are only few studies on the factors influencing medical student's empathy, particularly of the curricular model, this study aimed to compare the levels of empathy of medicine students of two Schools with different curricular models in central Portugal, the Faculty of Medicine - University of Coimbra (FMUC) and the Faculty of Health Sciences - University of Beira Interior (FCS-UBI). METHODS Cross-sectional observational study with the Jefferson Scale of Physician Empathy - students' Portuguese version (JSPE - spv) to 1st, 3rd and 6th year students of the 2017/2018 academic year with descriptive and inferential statistical analysis (p < 0.05). RESULTS Size representative sample of 795 students. Higher total empathy score (TES) (p = 0.008) and "Perspective taking" (p = 0.001) in FCS-UBI were found. JSPE-TES was higher in FCS-UBI, 3rd year (p = 0.038). Higher FCS-UBI "Perspective taking" in the 1st year (p = 0.030) and 6th year (p = 0.044), for "Compassionate care" in the 3rd (p = 0.019) and for "Standing in the patient's shoes" in the 1st year (p = 0.018) and in FMUC for "Compassionate care" in the 1st year (p = 0.037) and the "Standing in the patient's shoes" in year 3 (p = 0.002) were found. Higher levels of empathy were found in FCS-UBI female students, for JSPE-TES (p = 0.045) and "Perspective taking" (p = 0.001). CONCLUSION Higher empathy levels in FCS-UBI were found, with different results in the third year suggesting influence of the medical course teaching characteristics between the two Medicine schools, student's empathy levels being higher when earlier and more intense contact with patients accompanied by skilled tutors was developed.
Collapse
Affiliation(s)
- Luiz Miguel Santiago
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal.
- General Practice/Family Medicine Clinic of the University of Coimbra, Coimbra, Portugal.
- CEISUC, Coimbra, Portugal.
| | - Inês Rosendo
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- USF Coimbra Centro, ARS Centro, Coimbra, Portugal
- CINTESIS, Porto, Portugal
| | | | | | - Isabel Neto
- Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
| | - José Augusto Simões
- CINTESIS, Porto, Portugal
- Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
- USF Caminhos do Cértoma, ARS Centro, Coimbra, Portugal
| |
Collapse
|
41
|
Williams CR, Rodgers PT, McLaughlin JE, Angelo TA, Shepherd G. Comparing Empathy Levels in Doctor of Pharmacy Students and Exemplary Pharmacist Preceptors. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:7497. [PMID: 32313275 PMCID: PMC7159009 DOI: 10.5688/ajpe7497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/04/2019] [Indexed: 05/22/2023]
Abstract
Objective. To determine how student pharmacists' empathy compares to that of exemplary pharmacist preceptors. Methods. First- through third-year Doctor of Pharmacy students and nominated preceptors demonstrating a model level of empathy in patient care were invited to take the Jefferson Scale of Empathy (JSE) and answer demographic questions. A comparison of total JSE scores was made between students and preceptors. Comparisons of total JSE scores were performed between male and female students, students with and without direct patient care experience, students with and without chronic care experience, and among students based on class year. A factor analysis was completed. Results. The response rate for students and preceptors was 70.3% (n=318) and 73.7% (n=14), respectively. No significant differences in median JSE scores were identified for any of the comparisons. Factor analysis revealed two factors as underlying constructs: "compassionate care" and "perspective taking." Seven of 20 items on the JSE had mean scores >6.0 (possible range 1-7). Conclusion. The majority of students had moderately high cognitive empathy not related to class year that was similar to that of exemplary pharmacist preceptors. A possible ceiling effect was found in several items on the JSE, potentially limiting its use for measuring changes in empathy longitudinally in students with baseline high empathy.
Collapse
Affiliation(s)
- Charlene R Williams
- University of North Carolina, UNC Eshelman School of Pharmacy, Asheville, North Carolina
| | - Philip T Rodgers
- University of North Carolina, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | | | - Thomas A Angelo
- University of North Carolina, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Greene Shepherd
- University of North Carolina, UNC Eshelman School of Pharmacy, Asheville, North Carolina
| |
Collapse
|
42
|
Sevrain-Goideau M, Gohier B, Bellanger W, Annweiler C, Campone M, Coutant R. Forum theater staging of difficult encounters with patients to increase empathy in students: evaluation of efficacy at The University of Angers Medical School. BMC MEDICAL EDUCATION 2020; 20:58. [PMID: 32093709 PMCID: PMC7041274 DOI: 10.1186/s12909-020-1965-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Physician empathy has been associated with improved clinical outcomes and lower physician burnout. We evaluated whether forum theater (FT), a form of applied drama that allows participants to enter the performance and represent the actions associated with emotions, would foster empathy in medical students, and which underlying variables would be associated to empathy scores. METHODS Three classes totaling 488 fourth-year medical students participated in the study. Forum theater was used to explore difficult encounters with patients and family members: announcement of cancer, fall at home of an elderly person requiring hospitalization, appointment with a patient suffering from depression, announcement of diabetes in an adolescent. The first scene was played by actors in front of a group of students, then audience members were asked to enter the performance and, by taking over the role of the "physician-actor," to explore alternative interactions. All the students followed two sessions as actors and observers in random order and were randomly assigned to FT sessions after 36 or 56 weeks of clinical rotations. They completed the Jefferson Scale of Physician Empathy (JFSE) anonymously. RESULTS Students were 22.1 ± 1.5 years old (43% males). Empathy scores increased after each session: 102.0 ± 9.8 before the sessions, 106.3 ± 9.8 after session 1 and 107.8 ± 11.5 after session 2 (p < 0.05). In regression models, gender (F vs. M, + 3.0 ± 1.0, p < 0.001) and position in the session (actor vs. observer, + 2.1 ± 1.0, p < 0.05) were significant determinants of JFSE scores, whereas age, session theme, and duration of clinical rotation were not. CONCLUSION Being an actor in forum theater was a valuable tool for enhancing empathy scores in medical students.
Collapse
Affiliation(s)
| | - Benedicte Gohier
- Department of Psychiatry, University Hospital, Angers, France
- Medical School, University of Angers, Angers, France
| | | | | | - Mario Campone
- Medical School, University of Angers, Angers, France
| | - Regis Coutant
- Department of Pediatrics, University Hospital, 4 rue Larrey, 49000, Angers, France.
- Medical School, University of Angers, Angers, France.
| |
Collapse
|
43
|
Assing Hvidt E, Søndergaard J, Hvidt NC, Wehberg S, Büssing A, Andersen CM. Development in Danish medical students' empathy: study protocol of a cross-sectional and longitudinal mixed-methods study. BMC MEDICAL EDUCATION 2020; 20:54. [PMID: 32075639 PMCID: PMC7031973 DOI: 10.1186/s12909-020-1967-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 05/05/2023]
Abstract
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.
Collapse
Affiliation(s)
- E Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark.
- Department for the Study of Culture, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - J Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - N C Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - S Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - A Büssing
- Institute of Integrative Medicine, Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany
| | - C M Andersen
- Department for Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| |
Collapse
|
44
|
Díaz Valentín MJ, Garrido Abejar M, Fuentes Chacón RM, Serrano Parra MD, Larrañaga Rubio ME, Yubero Jiménez S. Validation to the Spanish of the Jefferson empathy scale health professions students version and its psychometric properties in nursing students. Nurse Educ Pract 2019; 40:102629. [PMID: 31568983 DOI: 10.1016/j.nepr.2019.102629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/10/2019] [Accepted: 09/19/2019] [Indexed: 12/14/2022]
Abstract
The ability to empathize with patients has a positive effect on health outcomes and quality of care. This study aimed to evaluate the psychometric characteristics of the Spanish version of the Jefferson Scale of Empathy-Health Profession Student version (JSE-HPS) in a sample of 422 nursing students and to compare their factorial structure with that of the original scale. In this study, the Cronbach α value was 0.828. These analyses showed that the scale has a factorial structure with three dimensions and all the items loaded adequately (>0.36) except for item 18 (0.266). The main factor, ̔Perspective taking̕ grouped 10 items; the second factor, ̔Compassionate care̕, grouped 6 items, and the third factor, ̔Standing in the patient's shoes̕, grouped 3 items; 42.2% of the variance was explained. The results of the confirmatory factor analysis suggest that the Spanish version of the JSE-HPS is a valid and reliable way to evaluate the empathic capacity of nursing students.
Collapse
|
45
|
Archer E, Turner R. Measuring empathy in a group of South African undergraduate medical students using the student version of the Jefferson Scale of Empathy. Afr J Prim Health Care Fam Med 2019; 11:e1-e5. [PMID: 31170794 PMCID: PMC6556929 DOI: 10.4102/phcfm.v11i1.1956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 01/10/2023] Open
Abstract
Background Patient-centred care is a model of care that demands healthcare providers change their focus from the disease to the patient and his or her perceived physical and psycho-social needs. This model requires healthcare workers to listen actively and to have effective communication skills and well-developed levels of empathy. Aim The aim of this study was to determine the suitability of the Jefferson Scale for Empathy (JSE-S) as a valid test for empathy in third-year medical students at a South African university and also to determine the baseline level of empathy in this same group of students. Setting The study took place at a medical school in the Western Cape, South Africa. This medical degree (MB ChB) is a 6-year programme. Students are first exposed to patients within their second year of training, but it is during their third-year that they start their clinical rotations. We wanted to test whether our empathy training would give students the necessary skills and enable them to establish good empathic communication habits in order to prevent a fall in empathy during this vulnerable period. Methods This article explores the suitability of the student version of the JSE-S as a valid test for empathy, within the South African medical school context. We briefly discuss the psychometrics and the scores against what is already known in countries like ours, specifically, developing nations where cultural and language differences exist in the student populations. Furthermore, we explore whether the JSE-S is a valid scale for pre- and post-intervention measurement of medical student empathy within our context and discuss the limitations of self-assessment. We also report on baseline levels of empathy in third-year medical students. Results Two hundred and six third-year medical students (69% females) completed the JSE-S prior to the intervention. Females and students aged 25 years and older had significantly higher scores than males and those 22 years old or less. The mean JSE was 109.98 (SD = 12.54), which is lower than most internationally reported scores. The Cronbach’s alpha coefficient was 0.81, indicating scale reliability and consistency, but graded item response testing highlighted variance in three reverse-scored questions. Conclusion The JSE-S is an appropriate and valid scale for measuring levels of empathy in undergraduate medical students in South Africa. However, language may need to be clarified in the negatively phrased items.
Collapse
Affiliation(s)
- Elize Archer
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, University of Stellenbosch, Parow.
| | | |
Collapse
|
46
|
Di Lorenzo R, Venturelli G, Spiga G, Ferri P. Emotional intelligence, empathy and alexithymia: a cross-sectional survey on emotional competence in a group of nursing students. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:32-43. [PMID: 30977747 PMCID: PMC6625563 DOI: 10.23750/abm.v90i4-s.8273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 12/30/2022]
Abstract
Background: Emotional intelligence (EI) is the ability to recognize and manage one’s own and others’ emotions, empathy is the ability to understand how others feel, whereas alexithymia represents the difficulty in feeling and verbally expressing emotions. Emotional competences are important requirements for positive outcomes in nursing profession. The aim of the study: To analyze EI, empathy and alexithymia in nursing students. Methods: We conducted a cross-sectional survey in a sample of 237 students (53 males, 184 females), attending both the 1st and 3rd year of the University Nursing Course in Modena. We administered three Italian validated scales: Schutte Self-Report Emotional Intelligence Test (SSEIT), Jefferson Scale of Empathy - Health Professions Student (JSE-HPS), Toronto Alexithymia Scale (TAS-20). Data were statistically analyzed. Results: Statistically significant differences were found between the 1st and 3rd year students at SSEIT (t=-0.6, p=0.52), JSE-HPS (t=-3.2, p=0.0016) and TAS-20 scores (t=-3.54, p=0.0005). Among 3rd year students, females obtained significantly different scores from those of males at SSEIT (t=2.8, p=0.006). All three scales reported a Cronbach’s alpha >0.80. SSEIT correlated positively with JSE-HPS (Spearman’s rho=0.15, p=0.02) and negatively with TAS-20 (Spearman’s rho=-0.18, p=0.006). Conclusions: Our study highlighted a good level of emotional skills among students at the beginning of nursing training, further increased by the last year of the course, suggesting that emotional competences can be learned, and confirmed that empathy, but not alexithymia, is a dimension of EI. (www.actabiomedica.it)
Collapse
|
47
|
Palombaro KM, Black JD, Dole RL, Jones SA, Stewart AR. Civic-Mindedness Sustains Empathy in a Cohort of Physical Therapy Students: A Pilot Cohort Study. J Patient Exp 2019; 7:185-192. [PMID: 32851139 PMCID: PMC7427372 DOI: 10.1177/2374373519837246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Empathy is critical to patient-centered care and thus is a valued trait in graduate health-care students. The relationship between empathy and civic-mindedness in health professions has not previously been explored. Objectives: (a) To determine whether significant differences occurred on the Jefferson Scale for Empathy–Health Professions Student Version (JSE-HPS) and Civic-Minded Professional scale (CMP) and its subscales across the curriculum, (b) to explore a potential relationship between civic-mindedness and empathy in a cohort of graduate physical therapy (PT) students at regular intervals, and (c) to explore the predictive ability of civic-mindedness on empathy scores. Methods: This study was a convenience sample of a cohort of 48 PT students who completed both the JSE-HPS and the CMP at 4 points of a service-learning intensive curriculum. Statistical analysis included descriptive statistics, a Friedman’s analysis of variance with Wilcoxon signed-ranks post hoc testing, and Spearman correlations with stepwise linear regressions. Results: Statistically significant differences were not found for the JSE-HPS. Civic-Minded Professional scores increased across the curriculum. The JSE-HPS, the CMP, and various CMP subscales were significantly correlated. The JSE-HPS pretest scores were predictive of the year 1 and 2 posttest JSE-HPS scores. Conclusion: This study’s findings indicate that service-learning and the resulting development of civic-mindedness supports empathy. Programs could use JSE-HPS pretests to identify individual graduate students need for empathy mentorship upon program entrance or as one admission criterion.
Collapse
Affiliation(s)
- Kerstin M Palombaro
- Institute for Physical Therapy Education, Widener University, One University Place, Chester, PA, USA
| | - Jill D Black
- Institute for Physical Therapy Education, Widener University, One University Place, Chester, PA, USA
| | - Robin L Dole
- School of Human Service Professions, Widener University, Chester, PA, USA
| | - Sidney A Jones
- Institute for Physical Therapy Education, Widener University, One University Place, Chester, PA, USA
| | - Alexander R Stewart
- Institute for Physical Therapy Education, Widener University, One University Place, Chester, PA, USA
| |
Collapse
|
48
|
Nguyen VP, Newton BW. Anecdote or Reality: Are People From the South and/or Rural Areas of the USA More Empathetic? MEDICAL SCIENCE EDUCATOR 2019; 29:277-284. [PMID: 34457477 PMCID: PMC8368883 DOI: 10.1007/s40670-019-00693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although numerous studies have analyzed empathy scores of allopathic and osteopathic medical students and how these scores fluctuate throughout undergraduate medical education, little is known about whether demographics have an impact on medical students' empathy scores. Using the Balanced Emotional Empathy Scale (BEES) and Jefferson Scale of Empathy (JSE) surveys to measure affective and cognitive empathy, respectively, this present study examined the relationship between empathy scores with the following demographic data from first and second year students at a southeastern US osteopathic medical school: the classification of whether students came from a rural or urban background, the region of the US students lived in prior to matriculation to medical school, and the town/city size of where they were currently living at the time of applying to medical school. Data analyses showed only one statistically significant data point (p < 0.04) that revealed first year osteopathic medical students (OMS-I) from towns with < 10,000 occupants had higher JSE scores in comparison to students coming from towns with 50,000-99,999 occupants. However, trends could be established. For example, anecdotally, it is often presumed people from the southern United States tend to be friendlier than those from the northern states; however, contrary to this, the data revealed OMS-I students from the southern United States had a slightly lower BEES scores than OMS-I students from the northeastern states. JSE scores were nearly identical across all four US census bureau regions. Additionally, OMS-I students coming from an urban background had a higher BEES scores than those coming from a rural background. Compared to population norms, combined male and female BEES scores for OMS-I and -II students were within ± 0.5 s.d. of the norm and are considered to be "average" scores. Combined OMS-I JSE scores were below the population norm at the 37th percentile, and combined OMS-II JSE scores were also at the 37th percentile, except for students from the western region at the 44th percentile.
Collapse
Affiliation(s)
- Vanessa P. Nguyen
- Department of Anatomy, Campbell University School of Osteopathic Medicine, Lillington, NC 27546 USA
| | - Bruce W. Newton
- Department of Anatomy, Campbell University School of Osteopathic Medicine, Lillington, NC 27546 USA
| |
Collapse
|
49
|
Guilera T, Batalla I, Forné C, Soler-González J. Empathy and big five personality model in medical students and its relationship to gender and specialty preference: a cross-sectional study. BMC MEDICAL EDUCATION 2019; 19:57. [PMID: 30764878 PMCID: PMC6376790 DOI: 10.1186/s12909-019-1485-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/04/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Given the influence that personality can have on empathy, this study explores the relationship between empathy and personality, using three different measures of empathy, and taking into account gender and specialty preference. METHODS Cross-sectional study. One hundred and ten medical students completed the Jefferson Scale of Physician Empathy, the Interpersonal Reactivity Index, the Empathy Quotient, and the NEO-FFI Big Five personality model. Multivariable linear regression was performed to assess the association between personality traits and empathy. RESULTS Empathy scales showed weak and moderate correlation with personality. The strongest correlations were observed between IRI-Fantasy and Openness, and between IRI-Personal Distress and Neuroticism. Gender and specialty preference can modify this relationship. The extreme groups of Empathy Quotient had significant differences in most personality traits. CONCLUSIONS This study confirmed that empathy is related to personality. Using three empathy scales allows personalizing the evaluation of different empathy models and its relation with personality. These results can help to design programs to study if some personalized intervention strategies could improve the empathy in medical students.
Collapse
Affiliation(s)
- Teresa Guilera
- Psychiatry Service, Santa Maria University Hospital, Rovira Roure Avenue, 44, 25198 Lleida, Spain
- Institute for Biomedical research in Lleida Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
| | - Iolanda Batalla
- Psychiatry Service, Santa Maria University Hospital, Rovira Roure Avenue, 44, 25198 Lleida, Spain
- Institute for Biomedical research in Lleida Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Department of Medicine, Faculty of Medicine, University of Lleida, Lleida, Spain
| | - Carles Forné
- Department of Basic Medical Sciences, University of Lleida, Lleida, Spain
- Biostatistics Unit, Institute for Biomedical Research in Lleida Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
| | - Jorge Soler-González
- Institute for Biomedical research in Lleida Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Department of Medicine, Faculty of Medicine, University of Lleida, Lleida, Spain
| |
Collapse
|
50
|
Deb T, Lempp H, Bakolis I, Vince T, Waugh W, Henderson C. Responding to experienced and anticipated discrimination (READ): anti -stigma training for medical students towards patients with mental illness - study protocol for an international multisite non-randomised controlled study. BMC MEDICAL EDUCATION 2019; 19:41. [PMID: 30704531 PMCID: PMC6357462 DOI: 10.1186/s12909-019-1472-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/24/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND Stigma and discrimination are a significant public health concern and cause great distress to people with mental illness. Healthcare professionals have been identified as one source of this discrimination. In this article we describe the protocol of an international, multisite controlled study, evaluating the effectiveness of READ, an anti-stigma training for medical students towards patients with mental illness. READ aims to improve students' ability to minimise perceived discriminatory behaviours and increase opportunities for patients, therefore developing the ability of future doctors to address and challenge mental illness related discrimination. READ includes components that medical education research has shown to be effective at improving attitudes, beliefs and understanding. METHODS/DESIGN READ training was developed using evidence based components associated with changes in stigma related outcomes. The study will take place in multiple international medical schools across high, middle and low income countries forming part of the INDIGO group network, with 25 sites in total. Students will be invited to participate via email from the lead researcher at each site during their psychiatry placement, and will be allocated to an intervention or a control arm according to their local teaching group at each site. READ training will be delivered solely to the intervention arm. Standardised measures will be used to assess students' knowledge, attitudes and skills regarding discrimination in both the intervention and control groups, at baseline and at follow up immediately after the intervention. Statistical analyses of individual-level data will be conducted using random effects models accounting for clustering within sites to investigate changes in mean or percentages of each outcome, at baseline and immediately after the intervention. DISCUSSION This is the first international study across high, middle and low income countries, which will evaluate the effectiveness of training for medical students to respond effectively to patients' experiences and anticipation of discrimination. The results will promote implementation of manualised training that will help future doctors to reduce the impact of mental illness related discrimination on their patients. Limitations of the study are also discussed.
Collapse
Affiliation(s)
- Tanya Deb
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Heidi Lempp
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Ioannis Bakolis
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Tushar Vince
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - William Waugh
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Claire Henderson
- Health Service and Population Research Department, David Goldberg Centre, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| |
Collapse
|