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Huang R, Zhou Z, Liu Y, Lin M, Gong M, Xian S, Yin H, Meng T, Wang X, Wang Y, Chen W, Zhang C, Du E, Liu X, Lin Q, Wu H, Huang Z, Zhang J, Zhang G, Ji S. Empathy in undergraduate medical students: a multi-center cross-sectional study in China. BMC Psychiatry 2024; 24:414. [PMID: 38834981 PMCID: PMC11151548 DOI: 10.1186/s12888-023-05350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/06/2023] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Fostering empathy has been continuously emphasized in the global medical education. Empathy is crucial to enhance patient-physician relationships, and is associated with medical students' academic and clinical performance. However, empathy level of medical students in China and related influencing factors are not clear. METHODS This was a cross-sectional study among medical students in 11 universities. We used the Jefferson Scale of Empathy Student-version of Chinese version to measure empathy level of medical students. Factors associated with empathy were identified by the univariate and multivariate logistic regression analyses. Based on the variables identified above, the nomogram was established to predict high empathy probability of medical students. Receiver operating characteristic curve, calibration plot and decision curve analysis were used to evaluate the discrimination, calibration and educational utility of the model. RESULTS We received 10,901 samples, but a total of 10,576 samples could be used for further analysis (effective response rate of 97.02%). The mean empathy score of undergraduate medical students was 67.38 (standard deviation = 9.39). Six variables including gender, university category, only child or not, self-perception doctor-patient relationship in hospitals, interest of medicine, Kolb learning style showed statistical significance with empathy of medical students (P < 0.05). Then, the nomogram was established based on six variables. The validation suggested the nomogram model was well calibrated and had good utility in education, as well as area under the curve of model prediction was 0.65. CONCLUSIONS We identify factors influencing empathy of undergraduate medical students. Moreover, increasing manifest and hidden curriculums on cultivating empathy of medical students may be needed among medical universities or schools in China.
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Affiliation(s)
- Runzhi Huang
- Department of Burns, The First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Zhitong Zhou
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Yifan Liu
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Min Lin
- Mental Health Education and Consultation Center, Chongqing Medical University, 61 Daxuecheng Middle Road, Chongqing, 401331, China
| | - Meiqiong Gong
- Office of Educational Administration, Shanghai University, Shanghai, 200444, China
| | - Shuyuan Xian
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Huabin Yin
- Department of Orthopedics, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, 100 Haining Road, Shanghai, China
| | - Tong Meng
- Department of Orthopedics, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, 100 Haining Road, Shanghai, China
| | - Xiaonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Beijing, 100069, China
| | - Yue Wang
- Department of Health Statistics, School of Public Health, Air Force Medical University, No.169,Changle West Road, Xi'an, 710032, China
| | - Wenfang Chen
- Faculty of Medicine, Jinggangshan University, 28 Xueyuan Road, Ji'An, 343009, China
| | - Chongyou Zhang
- Basic Medical College, Harbin Medical University, 157 Baojian Road, Heilongjiang, 150081, Heilongjiang, China
| | - Erbin Du
- Frist Clinical Medical College, Mudanjiang Medical University, 66 Tongxiang Street, Mudanjiang, 157011, China
| | - Xin Liu
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Qing Lin
- Department of Human Anatomy, Laboratory of Clinical Applied Anatomy, School of Basic Medical Sciences, Fujian Medical University, 1 Xuefu North Road, Fuzhou, 350122, China
| | - Hongbin Wu
- National Centre for Health Professions Education Development, Peking University, Beijing, 100191, China
- Institute of Medical Education, Peking University, 5 YiHeYuan Road, Beijing, 100871, China
| | - Zongqiang Huang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jie Zhang
- Tongji University School of Medicine, Shanghai, 200092, China
- Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 2699 Gaoke West Road, Shanghai, 201204, China
| | - Guoyang Zhang
- Maastricht University School of Health Professions Education, Maastricht, the Netherlands.
| | - Shizhao Ji
- Department of Burns, The First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, 200433, China.
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Benmaarmar S, Bourkhime H, El Harch I, El Rhazi K. The level and determinants of empathy among medical students from Arabic speaking countries: A systematic review. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc15. [PMID: 38779697 PMCID: PMC11106575 DOI: 10.3205/zma001670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/13/2023] [Accepted: 02/09/2024] [Indexed: 05/25/2024]
Abstract
Aim This systematic review aims to investigate the level of empathy among medical students in Arabic speaking countries and analyze its determinants. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2022 (PRISMA), the authors conducted a systematic research of studies investigating the level and determinants of empathy among medical students in Arabic speaking countries. The databases PubMed, Scopus, web of science and google scholar were searched. Results Ten studies from six countries were included. Nine of which had a cross-sectional study design. Level of empathy was assessed using the Jefferson scale in seven studies and using the Interpersonal Reactivity Index in two studies. The mean of empathy scale ranges between 97.65±14.10 to 106.55±19.16 in studies used the Jefferson scale of empathy. The associated factors with empathy were gender; high levels of empathy were reported in female students. Other factors are explored in relation with empathy such as specialty preference (surgery or medicine, "people-orientated" specialties or ''technology-oriented specialties''), family factors (marital status of parents, satisfactory relationship with parents, parents level of education and household income) and factors related to medical education (academic performance, year of study and type of curriculum) but the results are heterogeneous. Conclusion This is the first systematic review, which illustrated the determinants of empathy in Arabic medical students. Our results revealed varied results on empathy determinants. Further studies may guarantee a full exploration of this ability in order to improve the doctor-patient relationship and patient management in the Arab world.
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Affiliation(s)
- Soumaya Benmaarmar
- Sidi Mohamed Ben Abdellah University, Faculty of Medicine and Pharmacy of Fez, Department of Epidemiology, Clinical Research and Community Health, Fez, Morocco
| | - Hind Bourkhime
- Sidi Mohamed Ben Abdellah University, Faculty of Medicine and Pharmacy of Fez, Biostatistics and Informatics Unit, Department of Epidemiology, Clinical Research and Community Health, Fez, Morocco
| | - Ibtissam El Harch
- Sidi Mohamed Ben Abdellah University, Faculty of Medicine and Pharmacy of Fez, Department of Epidemiology, Clinical Research and Community Health, Fez, Morocco
| | - Karima El Rhazi
- Sidi Mohamed Ben Abdellah University, Faculty of Medicine and Pharmacy of Fez, Department of Epidemiology, Clinical Research and Community Health, Fez, Morocco
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Santiago LM, Rosendo I, Valente C, Ferreira AC, Simões JA. Compassion and extracurricular activities of Portuguese Health Sciences students in Portugal. BMC MEDICAL EDUCATION 2022; 22:464. [PMID: 35710486 PMCID: PMC9205127 DOI: 10.1186/s12909-022-03419-2] [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: 10/21/2021] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Compassion, one of the items of empathy, is crucial in health care professions. So, the evaluation of the levels of compassion of Medicine, Dentistry and Pharmaceutical Sciences Master Degrees' (M.D.) students of the public Colleges in Portugal according to the type of Master Degree and the participation in extracurricular activities (E.A.) was a task to be performed. METHODS Cross-sectional study in 2020, applying an on-line questionnaire including the "Compassion" items of the Jefferson Medical Empathy Scale - Students' version and questions about the participation in E.A. RESULTS A sample of 901 students was studied. Its distribution by participation in E.A. did not differ significantly between M.D. (p = 0,854), most of the students participating in E.A. Using quartile distribution of compassion, the distribution of compassion levels was different among the three I.M. (p < 0.001), between Colleges (p < 0.001), and between curricular years (p < 0.001), with not different between genders (p = 0.036). For 56.4%, 74,6% and 69,5% of the respondents there was "medium-low" and "low" compassion for I.M. in Medicine, Pharmaceutical Sciences and Dentistry. These levels were also more prevalent among students in the 1st and 5th years. Levels of compassion were not different with the participation (p = 0,865), type (p = 0,177) and frequency of E.A. (p = 0,109). CONCLUSIONS For their importance in future health care professionals, compassion and their differences found among the M.Ds. of this area deserve future studies. Levels of compassion showed differences between the M.D. studied and academic years of frequency. There was no relationship between the participation, type, and frequency of E.A. and the students' levels of compassion. The distribution of the level of compassion did not vary significantly with participation in E.A. (p = 0.865), with the type of E.A. (p = 0.177), with the frequency of E.A. (p = 0.109) or with the answer to the question "The practice of E.A. can make a person more compassionate?" (p = 0.503).
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Affiliation(s)
- Luiz Miguel Santiago
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal.
- Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
- CEISUC, University of Coimbra, Coimbra, Portugal.
| | - Inês Rosendo
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Catarina Valente
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - António Cruz Ferreira
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- CEISUC, University of Coimbra, Coimbra, Portugal
| | - José Augusto Simões
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Voultsos P, Chatzinikolaou F, Papana A, Deliligka A. Reliability of Greek version of the Toronto empathy questionnaire in medical students and associations with sociodemographic and lifestyle factors. BMC Psychol 2022; 10:113. [PMID: 35501889 PMCID: PMC9063083 DOI: 10.1186/s40359-022-00824-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/26/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Empathy is an important key driver of any therapeutic relationship. It is beneficial for both physicians and patients. Enhancing physician's empathy should be an important goal of medical education. As there was a literature gap regarding the topic of empathy among medical students in Greece, this study aimed to contribute to filling this gap. METHODS A cross-sectional study was conducted. A socio-demographic questionnaire and the 52-item Greek version of the Toronto composite empathy scale (TCES) for measuring the cognitive and emotional aspects of empathy in both personal and professional life was administered to all the medical students in the Aristotle University of Thessaloniki, in Greece. Descriptive statistics were displayed for demographics. The associations of the variables were quantified by Chi-2 independence tests and Pearson's Correlation Coefficient. The reliability and validity of the questionnaire was determined by Cronbach's α, Hotelling's T-Squared Test, and Pearson correlation. Paired and Independent Sample T-Tests and One-way ANOVAs indicated statistically significant mean differences among the variables or subgroups of the variables. RESULTS The 52-item TCES, 26 for the personal (Per) setting and another 26 for professional (Pro) life, equally divided into cognitive (Cog) and emotional (Emo) empathy in each case. The overall reliability of the TCES questionnaire was found to be high (Cronbach's α = 0.895, significant positive correlations between the subscales). The mean total score of empathy showed that students had a moderately high empathy. Further, there was a statistically significant difference in means between the Per-Cog and Per-Emo settings (p < 0.001), the Pro-Cog and Pro-Emo (p < 0.001), the Per-Cog and Pro-Cog (p = 0.004), and the Per-Emo and Pro-Emo (p < 0.001). Females had significantly higher empathy scores (mean score 208.04) than males (192.5) on the Per-Cog, Per-Emo and Pro-Emo subscales. Furthermore, a positive correlation was found between empathy and factors such as love for animals, interest in medical ethics, belief in God, having an ill person in the family, class year or carrier intention. CONCLUSIONS The TCES is applicable to medical students. For the most part our findings were consistent with previous literature. However, we identified some nuances that might draw researchers' attention. The results of this study may contribute to plan interventions in the curriculum to enhance empathy in the medical students.
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Affiliation(s)
- Polychronis Voultsos
- Laboratory of Forensic Medicine and Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece.
| | - Fotios Chatzinikolaou
- Laboratory of Forensic Medicine and Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece
| | - Angeliki Papana
- Department of Economics, School of Economics and Regional Studies, University of Macedonia, Egnatia Str 156, 546 36, Thessaloniki, Greece
| | - Aspasia Deliligka
- AHEPA University Hospital, Kiriakidi Str 1, 546 21, Thessaloniki, Greece
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Yang YS, Liu PC, Lin YK, Lin CD, Chen DY, Lin BYJ. Medical students' preclinical service-learning experience and its effects on empathy in clinical training. BMC MEDICAL EDUCATION 2021; 21:301. [PMID: 34039327 PMCID: PMC8157642 DOI: 10.1186/s12909-021-02739-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/10/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Service learning (SL) is an educational methodology presumed to help medical students be more empathetic and compassionate. We longitudinally investigated the level of empathy in medical students and how preclinical SL experience was related to their level of empathy in their clinical clerkships. METHODS Our cohort comprised fifth-year medical students engaged in clerkships as part of a 7-year medical programme at one medical school in Taiwan. Surveys were conducted at the beginning of the clerkship in September 2015 (T1) to collect data on the medical students' preclinical SL experience in curriculum-based service teams (CBSTs) and extracurricular service teams (ECSTs) and their SL self-efficacy, demographic characteristics, and empathy level. Subsequently, three follow-up surveys were conducted once every 3 months to determine the empathy level of the students during their clinical clerkships (T2-T4). Seventy students who returned the written informed consent and completed the baseline (T1) and two or more follow-up surveys (T2-T4) were included in our analysis with the response rate of 34%. In total, 247 responses across the 1-year clerkship were analysed. Descriptive statistics, paired t tests, and generalised estimating equations were employed. RESULTS Our study revealed that changes in empathy level in the dimensions of perspective taking, compassionate care, and standing in patients' shoes in their clinical clerkships. Relative to that at T1, their empathy decreased in perspective taking and compassionate care at T2-T4 but increased in standing in patients' shoes at T3. Additionally, our study verified the positive effect of medical students' preclinical SL experience in CBSTs and ECSTs on empathy in terms of compassionate care and perspective taking, respectively, but not on that of standing in patients' shoes. CONCLUSIONS Separate investigations into subconstructs of empathy, such as perspective taking, compassionate care, and standing in patients' shoes, in medical students may be necessary for exploring the various driving forces or barriers to developing empathy in medical students. Moreover, SL experience through both CBSTs and ECSTs at medical academies may have positive effects on medical students' empathy in their clinical clerkships and should be promoted at medical schools.
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Affiliation(s)
- Yi-Sheng Yang
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Pei-Chin Liu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Yung Kai Lin
- Department of Surgery, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan, Republic of China
- Division of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Der Lin
- Department of Otolaryngology-Head & Neck Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China
- School of Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan, Republic of China
- College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Blossom Yen-Ju Lin
- Department of Medical Humanities and Social Sciences, School of Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan, Republic of China.
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