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Howick J, de Zulueta P, Gray M. Beyond empathy training for practitioners: Cultivating empathic healthcare systems and leadership. J Eval Clin Pract 2024; 30:548-558. [PMID: 38436621 DOI: 10.1111/jep.13970] [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: 09/28/2023] [Accepted: 01/11/2024] [Indexed: 03/05/2024]
Abstract
Empathic care benefits patients and practitioners, and empathy training for practitioners can enhance empathy. However, practitioners do not operate in a vacuum. For empathy to thrive, healthcare consultations must be situated in a nurturing milieu, guided by empathic, compassionate leaders. Empathy will be suppressed, or even reversed if practitioners are burned out and working in an unpleasant, under-resourced environment with increasingly poorly served and dissatisfied patients. Efforts to enhance empathy must therefore go beyond training practitioners to address system-level factors that foster empathy. These include patient education, cultivating empathic leadership, customer service training for reception staff, valuing cleaning and all ancillary staff, creating healing spaces, and using appropriate, efficiency saving technology to reduce the administrative burden on healthcare practitioners. We divide these elements into environmental factors, organisational factors, job factors, and individual characteristics.
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Affiliation(s)
- Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
| | - Paquita de Zulueta
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Muir Gray
- Director of the Oxford Value and Stewardship Programme, Oxford, UK
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
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Lange AA, Bonvin R, Guttormsen S, Zambrano Ramos SC. Physicians' emotion awareness and emotion regulation training during medical education: a systematic scoping review protocol. BMJ Open 2024; 14:e080643. [PMID: 38754890 PMCID: PMC11097880 DOI: 10.1136/bmjopen-2023-080643] [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: 10/06/2023] [Accepted: 03/13/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION The objective of this systematic scoping review is to identify what approaches have been implemented in medical education programmes to teach medical students the skills to identify and manage emotions that may be elicited in them during physician-patient interactions and in the clinical environment. Emotions of all involved in the clinical encounter are central to the process of clinical care. However, a gap remains addressing and teaching medical students about recognising and dealing with their own emotions. METHODS AND ANALYSIS This scoping review will follow the updated JBI (The Johanna Briggs Institute) methodology guidance for the conduct and reporting of systematic scoping reviews, and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A search strategy was developed and applied to five databases. Terms used included medical education, medical curriculum, medical students, emotion (regulation), psychological well-being and mental health. Additionally, a grey literature and reference list search will be conducted. Two independent reviewers will first screen titles and abstracts followed by a second, full-text screening phase. Publications to be included will contain information and data about teaching approaches such as lectures, and other teaching material on physicians' emotion awareness and emotion regulation training in medical education. ETHICS AND DISSEMINATION This study will review existing literature on emotion awareness and emotion regulation training in medical education, and a systematic scoping review does not require ethical approval. The results of this scoping review will be submitted for publication to relevant peer-reviewed journals and will be used to inform the development and implementation of training programmes and research studies aimed at preparing medical students to identify and manage their own emotions in the clinical environment.
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Affiliation(s)
- Anna Adelheid Lange
- Institute of Social Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Raphaël Bonvin
- Department of Community Health, University of Fribourg, Fribourg, Switzerland
| | | | - Sofia Carolina Zambrano Ramos
- Institute of Social Preventive Medicine (ISPM), University of Bern Institute of Social and Preventive Medicine, Bern, Switzerland
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David JG, Dotson J, Mackner L. Is it "all in the bag?" Multidisciplinary perspectives on ostomy surgery in pediatric IBD across the ImproveCareNow network. JPGN REPORTS 2024; 5:101-109. [PMID: 38756109 PMCID: PMC11093923 DOI: 10.1002/jpr3.12044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/15/2023] [Accepted: 01/15/2024] [Indexed: 05/18/2024]
Abstract
Objectives Pediatric inflammatory bowel disease (IBD) is a chronic illness with various treatments, including ostomy surgery. Ostomy-related medical decision-making (MDM) is complex for multidisciplinary healthcare professionals (HCPs). This study sought to understand national multidisciplinary HCPs' perceptions about pediatric IBD ostomy surgery in the United States. Methods This cross-sectional REDCap survey recruited HCPs in pediatric IBD HCP roles from the ImproveCareNow (ICN) Learning Health System. The survey gathered data on, (1) demographics, (2) participants' perspectives on patients/families' ostomy perceptions, (3) participants' own perspectives on ostomies, and (4) participants' perspectives on multidisciplinary collaboration in ostomy surgery. Results Participants (n = 69, across n = 30 American ICN sites) were 84% White, 62% female, and 54% gastroenterologists. In reflecting on patients/families' perceptions, participants endorsed most (86%) view ostomies as a "failure," various psychosocial concerns (e.g., 97% endorsed body image concerns), and most (81%) have moderate to significant stigma about ostomies. In reflecting on their own perceptions, nearly half (44%) endorsed some to moderate stigma about ostomies and felt ostomy discussions were difficult when families had negative perceptions (88%). Over half (54%) endorsed currently having multidisciplinary care for pediatric IBD surgery. Most (70%) endorsed variability in the amount and/or quality of multidisciplinary collaboration. Conclusion MDM related to pediatric IBD ostomy surgery presents nuanced clinical complexities for HCPs. This work underscores interest in multidisciplinary care, notable ostomy-related psychosocial needs, and ostomy-related stigma. Future work should develop systematic approaches to multidisciplinary pediatric IBD ostomy care, bolster psychosocial support, and evaluate how systematic care may impact psychosocial, and healthcare utilization outcomes.
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Affiliation(s)
- Jennie G. David
- Department of PediatricsThe Ohio State Wexner Medical CenterColumbusOhioUSA
- Nationwide Children's HospitalColumbusOhioUSA
| | - Jennifer Dotson
- Department of PediatricsThe Ohio State Wexner Medical CenterColumbusOhioUSA
- Nationwide Children's HospitalColumbusOhioUSA
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's HospitalColumbusOhioUSA
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's HospitalColumbusOhioUSA
| | - Laura Mackner
- Department of PediatricsThe Ohio State Wexner Medical CenterColumbusOhioUSA
- Nationwide Children's HospitalColumbusOhioUSA
- Center for Biobehavioral Health, Nationwide Children's HospitalColumbusOhioUSA
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Arshad M, Sriram S, Khan S, Gollapalli PK, Albadrani M. Mediating role of physician's empathy between physician's communication and patient's satisfaction. J Family Med Prim Care 2024; 13:1530-1534. [PMID: 38827677 PMCID: PMC11142003 DOI: 10.4103/jfmpc.jfmpc_1615_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Physician communication is vital for an effective physician-patient relationship. Physician empathy is crucial to patient communication. The relationship between physician empathy, physician communication, and patient satisfaction is not very clear. This study aims to study the mediating role of physician's empathy between physician's communication, physician's empathy, and patient's satisfaction. Methods A cross-sectional study was conducted at the National Institute of Psychology, Quaid-i-Azam University, during the time period of December 2018 to February 2019. Employing the technique of purposive convenience sampling, data were collected (N = 238) from psychiatric, cardiology, and dermatology wards of public and private sector hospitals of Islamabad and Rawalpindi. The Communication Assessment Tool, specifically the Patient's Perception of Physician's Empathy and Patient Satisfaction Scale, was used to assess study variables. The measures used in the research assess the patient's perception of the physician's communication, empathy, and patient's satisfaction. Formal permission for the research was taken from the hospital administration with approval from the institutional review boards. Participants were briefed about the purpose of the research. Both verbal and written informed consent was taken from them. Results The result shows that a physician's empathy plays a mediating role between the physician's communication skills and patient satisfaction. Moreover, Pearson product-moment correlation indicated a significant positive relationship between doctors' communication skills, doctors' empathy, and patients' satisfaction. Conclusion Building a positive doctor-patient relationship would not only lead to improved patient satisfaction but also reduce the likelihood of medical malpractice. Therefore, steps should be taken to enforce trust, interaction, and empathy in doctor-patient relationships, with patient-centered services. Physician's empathy plays a mediating role between physician's communication skills and patient's satisfaction.
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Affiliation(s)
- Maham Arshad
- National Institute of Psychology, Quaid-I-Azam University, Islamabad, Pakistan
| | - Shyamkumar Sriram
- Department of Social and Public Health, Ohio University, Athens, Ohio, USA
| | - Saira Khan
- National Institute of Psychology, Quaid-I-Azam University, Islamabad, Pakistan
| | - Pavan Kumar Gollapalli
- Department of Community Medicine, Faculty of Medicine, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India
| | - Muayad Albadrani
- Department of Family and Community Medicine, Taibah University Medical School, Kingdom of Saudi Arabia
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Valestrand EA, Kvernenes M, Kinsella EA, Hunskaar S, Schei E. Transforming self-experienced vulnerability into professional strength: a dialogical narrative analysis of medical students' reflective writing. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10317-3. [PMID: 38401015 DOI: 10.1007/s10459-024-10317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/04/2024] [Indexed: 02/26/2024]
Abstract
Medical students' efforts to learn person-centered thinking and behavior can fall short due to the dissonance between person-centered clinical ideals and the prevailing epistemological stereotypes of medicine, where physicians' life events, relations, and emotions seem irrelevant to their professional competence. This paper explores how reflecting on personal life experiences and considering the relevance for one's future professional practice can inform first-year medical students' initial explorations of professional identities. In this narrative inquiry, we undertook a dialogical narrative analysis of 68 essays in which first-year medical students reflected on how personal experiences from before medical school may influence them as future doctors. Students wrote the texts at the end of a 6-month course involving 20 patient encounters, introduction to person-centered theory, peer group discussions, and reflective writing. The analysis targeted medical students' processes of interweaving and delineating personal and professional identities. The analysis yielded four categories. (1) How medical students told their stories of illness, suffering, and relational struggles in an interplay with context that provided them with new perspectives on their own experiences. Students formed identities with a person-centered orientation to medical work by: (2) recognizing and identifying with patients' vulnerability, (3) experiencing the healing function of sharing stories, and (4) transforming personal experiences into professional strength. Innovative approaches to medical education that encourage and support medical students to revisit, reflect on, and reinterpret their emotionally charged life experiences have the potential to shape professional identities in ways that support person-centered orientations to medical work.
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Affiliation(s)
- Eivind Alexander Valestrand
- Center for Medical Education, Faculty of Medicine, University of Bergen, Bergen, Norway.
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Monika Kvernenes
- Center for Medical Education, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Elizabeth Anne Kinsella
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Edvin Schei
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Schrötter S, Kropp P, Müller B. Comparison of empathy profiles of medical students at the start and in the advanced clinical phase of their training. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc7. [PMID: 38504859 PMCID: PMC10946216 DOI: 10.3205/zma001662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/20/2023] [Accepted: 11/14/2023] [Indexed: 03/21/2024]
Abstract
Background The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) cites empathy as a basic competence for medical doctors. Based on a multidimensional concept of clinical empathy, empathy profiles of medical students at the start of their training and in the 9th semester were identified and compared in order to draw conclusions for the conception of effective course offers. Method Using the Saarbrücker Personality Questionnaire on Empathy (SPF-IRI), self-rated empathy was recorded in a cross-sectional study of medical students (1st semester: N=192/9th semester: N=221). Two Stage Clustering was performed for data analysis. Result Three empathy profiles which could be meaningfully delineated by content were identified: 1. reflected, functional empathy, 2. unreflected, burdensome empathy and 3. distancing and avoidance. Students in the 9th semester mostly tended toward unreflected, burdensome empathy. Only one-third appeared capable of feeling empathy with patients while at the same time adequately regulating their own emotions and thus protecting themselves from emotional overload. Conclusion An adequately reflected and functional empathy among medical students can neither be assumed at the start of their training, nor do existing course offers appear to provide sufficient training for this. Empathy should thus be implemented as a competence which needs to be promoted over the entire course of study. Emotion regulation plays a key role.
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Affiliation(s)
- Susanne Schrötter
- Universitätsmedizin Rostock, Institut für Medizinische Psychologie und Medizinische Soziologie, Rostock, Germany
| | - Peter Kropp
- Universitätsmedizin Rostock, Institut für Medizinische Psychologie und Medizinische Soziologie, Rostock, Germany
| | - Britta Müller
- Universitätsmedizin Rostock, Institut für Medizinische Psychologie und Medizinische Soziologie, Rostock, Germany
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van Klinken M, Hafkamp E, Gualtherie van Weezel A, Hales S, Lanceley A, Rodin G, Schulz-Quach C, de Vries F. Teaching Oncology Nurses a Psychosocial Intervention for Advanced Cancer: A Mixed-Methods Feasibility Study. Semin Oncol Nurs 2023; 39:151507. [PMID: 37758582 DOI: 10.1016/j.soncn.2023.151507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Psychological interventions for advanced cancer patients are effective in decreasing distress but are not well integrated into cancer care. Oncology nurses are well positioned to deliver such interventions, and their participation may enhance professional satisfaction and wellbeing. Managing Cancer and Living Meaningfully (CALM) is an evidence-based psychotherapy supporting advanced cancer patients. A CALM-Nurses (CALM-N) training program was developed to teach oncology nurses the basics of CALM for use in daily practice. Feasibility and acceptability of CALM-N and its impact on professional wellbeing were assessed in this pilot study. DATA SOURCES Fifty-five nurses attended CALM-N in three groups. Thirty-five nurses completed the first e-learning, 29 nurses (83%) attended the first group session, and 22 (63%) attended all sessions. At baseline, 35 questionnaires were collected. Response rate at follow-up was 63% for Jefferson Scale of Empathy (n=22), 66% for self-efficacy scale (n=23), and for subscales of Professional Quality of Life Scale burnout; 51% (n=18), secondary traumatic stress; 49% (n=17), compassion satisfaction; 57% (n=20). A statistically significant increase in self-efficacy was found, but there were no significant changes in PROQOL and empathy. Focus groups suggested CALM-N helped nurses' understanding of patients and nurse-patient communication and increased reflection and perspective taking. CONCLUSION CALM-N is a feasible and acceptable intervention for oncology nurses, with the potential to improve nurse-patient communication and the nurses' reflective capacities. IMPLICATIONS FOR NURSING PRACTICE CALM-N has the potential to improve the capacity of oncology nurses to provide psychosocial care for advanced cancer patients and its application to nursing practice merits further investigation.
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Affiliation(s)
- Merel van Klinken
- Centre for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Emma Hafkamp
- Centre for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Sarah Hales
- Department of Psychiatry, University of Toronto; Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto; and Global Institute of Psychosocial Oncology and Palliative Care (GIPPEC), Princess Margaret Cancer Centre, University of Toronto
| | - Anne Lanceley
- EGA Institute for Women's Health, Dept of Women's Cancer, University College London, London
| | - Gary Rodin
- Department of Psychiatry, University of Toronto; Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto; and Global Institute of Psychosocial Oncology and Palliative Care (GIPPEC), Princess Margaret Cancer Centre, University of Toronto
| | - Christian Schulz-Quach
- Department of Psychiatry, University of Toronto; Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto; and Global Institute of Psychosocial Oncology and Palliative Care (GIPPEC), Princess Margaret Cancer Centre, University of Toronto
| | - Froukje de Vries
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Canada; and Department of Psychiatry, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Bapayeva G, Terzic M, Semenova Y, Sarria-Santamera A, Gusmanov A, Aimagambetova G, Laganà AS, Chiantera V, Kadroldinova N, Ukybassova T, Kongrtay K, Abdukassimova M, Togyzbayeva K, Terzic S. Unveiling the Role of the Work Environment in the Quality of Life of Menopausal Physicians and Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6744. [PMID: 37754604 PMCID: PMC10531365 DOI: 10.3390/ijerph20186744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND There is a lack of scientific evidence regarding the specific challenges faced by menopausal medical professionals in different work settings. This study aims to investigate the relationship between work environment and the menopausal quality of life (QoL) in physicians and nurses. METHODS This survey was conducted using the Menopausal Quality of Life Questionnaire (MENQOL) with a sample of 35 menopausal physicians and 95 nurses employed in health facilities in Astana and Kyzylorda cities, Kazakhstan. RESULTS Physicians reported a higher frequency of menopausal symptoms compared to nurses. The difference was statistically significant (p < 0.05) for symptoms such as decreased productivity (60.00% vs. 38.20%), flatulence or gas pains (71.43% vs. 48.39%), weight gain (79.41% vs. 61.80%), changes in skin appearance (79.59% vs. 50.00%), and changes in sexual desire (58.82% vs. 33.70%). Physicians with managerial duties had a significantly higher occurrence of vasomotor symptoms compared to non-managerial physicians (mean 3.35 ± 2.14 vs. 1.69 ± 0.89) and also had a higher mean psychological score (mean 3.26 ± 1.28 vs. 2.29 ± 1.19). CONCLUSIONS These findings reflect differences between the menopause effects related to work environment for doctors and nurses, and shed light on the specific challenges faced by them during menopause. In addition, it is important to consider socio-demographic and workplace-related factors in investigating their impact on the QoL.
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Affiliation(s)
- Gauri Bapayeva
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan; (G.B.); (M.T.); (T.U.); (K.T.)
| | - Milan Terzic
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan; (G.B.); (M.T.); (T.U.); (K.T.)
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan; (Y.S.); (G.A.); (N.K.); (K.K.); (M.A.)
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Yuliya Semenova
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan; (Y.S.); (G.A.); (N.K.); (K.K.); (M.A.)
| | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 020000, Kazakhstan;
| | - Arnur Gusmanov
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 020000, Kazakhstan;
| | - Gulzhanat Aimagambetova
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan; (Y.S.); (G.A.); (N.K.); (K.K.); (M.A.)
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; (A.S.L.); (V.C.)
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; (A.S.L.); (V.C.)
- Unit of Gynecologic Oncology, National Cancer Institute, IRCCS, Fondazione “G. Pascale”, 80131 Naples, Italy
| | - Nazira Kadroldinova
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan; (Y.S.); (G.A.); (N.K.); (K.K.); (M.A.)
| | - Talshyn Ukybassova
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan; (G.B.); (M.T.); (T.U.); (K.T.)
| | - Kuralay Kongrtay
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan; (Y.S.); (G.A.); (N.K.); (K.K.); (M.A.)
| | - Meruyert Abdukassimova
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan; (Y.S.); (G.A.); (N.K.); (K.K.); (M.A.)
| | - Karlygash Togyzbayeva
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan; (G.B.); (M.T.); (T.U.); (K.T.)
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan;
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Anestis E, Eccles FJR, Fletcher I, Simpson J. Neurologists' lived experiences of communicating the diagnosis of a motor neurodegenerative condition: an interpretative phenomenological analysis. BMC Neurol 2023; 23:178. [PMID: 37138217 PMCID: PMC10155430 DOI: 10.1186/s12883-023-03233-3] [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: 01/29/2023] [Accepted: 04/29/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Receiving the diagnosis of a motor neurodegenerative condition (MNDC) can be a life-changing experience. Although several studies of individuals' experiences have indicated dissatisfaction with aspects of how an MNDC diagnosis was communicated, few studies have addressed doctors' experiences of breaking bad news for these conditions, especially from a qualitative perspective. This study explored UK neurologists' lived experience of delivering an MNDC diagnosis. METHODS Interpretative phenomenological analysis was used as the overarching method. Eight consultant neurologists working with patients with MNDCs took part in individual, semi-structured interviews. RESULTS Two themes were constructed from the data: 'Meeting patients' emotional and information needs at diagnosis: a balancing act between disease, patient and organization-related factors', and 'Empathy makes the job harder: the emotional impact and uncovered vulnerabilities associated with breaking bad news'. Breaking the news of an MNDC diagnosis was challenging for participants, both in terms of achieving a patient-centred approach and in terms of dealing with their own emotions during the process. CONCLUSIONS Based on the study's findings an attempt to explain sub-optimal diagnostic experiences documented in patient studies was made and how organizational changes can support neurologists with this demanding clinical task was discussed.
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Affiliation(s)
- Eleftherios Anestis
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ian Fletcher
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Song J, Fan C, Li Q, Wang A, Wang W, Zhou L, Lv H, Ma D, Chen Z, Yin W. The status of emotional labour and its influence on job burnout among village doctors during the COVID-19 pandemic in China: a cross-sectional study. BMC PRIMARY CARE 2023; 24:19. [PMID: 36650448 PMCID: PMC9843955 DOI: 10.1186/s12875-023-01982-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Village doctors in China are not only the gatekeepers of rural residents' health but also the net bottom of the medical security system. However, emotional labour is increasingly threatening the stability of the rural primary medical system. In addition, the ongoing coronavirus disease 2019 (COVID-19) pandemic has further exposed the vulnerability of human resources in China's rural health system. This study aims to evaluate the current situation of emotional labour among village doctors and explore the impact of emotional labour on job burnout during the COVID-19 pandemic in China. METHODS A cross-sectional survey was conducted in December 2021 in Shandong Province. We used structured questionnaires to collect data, including sociodemographic characteristics, emotional labour, and job burnout. Data were analysed by t test, analysis of variance (ANOVA), Pearson correlation analysis, and hierarchical multiple linear regression. RESULTS A total of 1,093 village doctors from Shandong Province participated in the study. More than half of the participants were male (62.40%) and were between 41 and 50 years old (53.43%). The total mean score of emotional labour was 3.17 ± 0.67, of which the surface acting (SA) score was 2.28 ± 0.90, and the deep acting (DA) score was 3.91 ± 0.93. There were significant differences in SA according to gender and work content (P < 0.05) and in DA according to gender, age, education level, and work content (P < 0.05). Pearson correlation analysis showed that SA was positively correlated with job burnout (P < 0.001), and DA was negatively correlated with job burnout (P < 0.001). Hierarchical multiple linear regression analysis revealed that 29% of the variance in job burnout is attributable to SA (β = 0.530, P < 0.001) and DA (β = -0.154, P < 0.001). CONCLUSION Village doctors in Shandong Province performed moderate levels of emotional labour during the COVID-19 pandemic. SA had a significant positive effect on job burnout, while DA had a significant negative effect on job burnout among village doctors. Administrators should enhance training on emotional labour for village doctors to play a positive role in alleviating their job burnout.
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Affiliation(s)
- Jia Song
- grid.268079.20000 0004 1790 6079School of Management, Weifang Medical University, NO. 7166, Western Baotong Road, Weifang, Shandong China
| | - Chengxin Fan
- grid.268079.20000 0004 1790 6079School of Management, Weifang Medical University, NO. 7166, Western Baotong Road, Weifang, Shandong China
| | - Qiusha Li
- grid.268079.20000 0004 1790 6079School of Public Health, Weifang Medical University, NO. 7166, Western Baotong Road, Weifang, Shandong China
| | - Anqi Wang
- grid.268079.20000 0004 1790 6079School of Public Health, Weifang Medical University, NO. 7166, Western Baotong Road, Weifang, Shandong China
| | - Wanchen Wang
- grid.268079.20000 0004 1790 6079School of Public Health, Weifang Medical University, NO. 7166, Western Baotong Road, Weifang, Shandong China
| | - Lifang Zhou
- grid.268079.20000 0004 1790 6079School of Management, Weifang Medical University, NO. 7166, Western Baotong Road, Weifang, Shandong China
| | - Haiyuan Lv
- grid.268079.20000 0004 1790 6079School of Management, Weifang Medical University, NO. 7166, Western Baotong Road, Weifang, Shandong China
| | - Dongping Ma
- grid.268079.20000 0004 1790 6079School of Management, Weifang Medical University, NO. 7166, Western Baotong Road, Weifang, Shandong China
| | - Zhongming Chen
- grid.268079.20000 0004 1790 6079School of Management, Weifang Medical University, NO. 7166, Western Baotong Road, Weifang, Shandong China
| | - Wenqiang Yin
- grid.268079.20000 0004 1790 6079School of Management, Weifang Medical University, NO. 7166, Western Baotong Road, Weifang, Shandong China
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11
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von Knorring J, Lehti A, Fahlström M, Semb O. Empathy as a silent art-A doctor´s daily balancing act: A qualitative study of senior doctors' experiences of empathy. PLoS One 2022; 17:e0277474. [PMID: 36520784 PMCID: PMC9754163 DOI: 10.1371/journal.pone.0277474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
Empathy in the doctor-patient relationship is of great importance and has long been considered a true professional virtue for doctors. Despite the general agreement concerning the importance of empathy, there is no consensus regarding the definition of empathy in medical research. While several quantitative studies, measuring empathy as an individual trait, show a decline in empathy among medical students, other studies have shown that empathy is influenced by contextual factors as well as the availability of role models. Therefore, further studies about the transition from medical school to clinical work also including the perspective of senior doctors are needed. The study presented in this article aims to better understand the clinical conditions for empathy through interviews with senior doctors about their lived experience of empathy. Twelve senior doctors, from different specialities were interviewed using a semi-structured approach. The data was analysed using content analysis. The analysis resulted in the main theme: Empathy as a silent art-a doctor`s daily balancing act. This main theme comprised three categories: "A tacit, yet language-dependent process", "A daily balancing act" and "An unsupported path towards mastery". Doctors face many challenges in their daily balancing act between individual and structural conditions that may affect empathy. In order to maintain and further develop empathy, doctors need working conditions allowing for collegial reflection and conversations that promote empathy.
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Affiliation(s)
- Johanna von Knorring
- Unit of Professional Development, Department of Clinical Sciences, Umeå University, Umeå, Sweden
- * E-mail:
| | - Arja Lehti
- Unit of Professional Development, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Martin Fahlström
- Unit of Professional Development, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Olof Semb
- Unit of Professional Development, Department of Clinical Sciences, Umeå University, Umeå, Sweden
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Zdun-Ryżewska A, Sobczak K, Rudnik A. Fatigue, Pro-Social Attitude and Quality of Life as Predictors of Empathy in Medical and Social-Oriented Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15853. [PMID: 36497926 PMCID: PMC9735796 DOI: 10.3390/ijerph192315853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Empathy is significant in professions that require establishing proper contact as a condition for providing help. Identifying factors related to empathy is important for understanding how to teach empathic behavior. The main goal of this study was to find variables related to empathy in a group of students from two universities: medical and social oriented (N = 1701). The study group consisted of female (81%) and male (19%) participants, aged between 18-20 (37%), 21-23 (49%), or 24 years and above (14%). A self-designed questionnaire was used to collect socio-demographical information, with additional questions (social self-esteem, prosocial attitude, subjective quality of life). Empathy was measured with the EQ-40, fatigue with CHFQ-PL, and stress with PSS-10. The results showed a statistically significant regression model for empathy. A high quality of life and having feelings of pleasure when helping other people allows to predict a high level of empathy, especially among females. Higher levels of fatigue and social self-esteem, the latter of which is measured here by the belief that you are more important than others, predicts lower empathy. There were no differences between students from two different kinds of universities when taking into consideration stress levels, subjective quality of life, and prosocial attitude. However, students from the medical university were more exhausted and more convinced that their value was greater than others, as compared to the students studying social sciences. When teaching empathic behavior, it is beneficial to attempt to maintain or restore students' well-being and reduce fatigue and to teach how to achieve such effects in the future. Learning the balance between compassion, willingness to help, and self-compassion also seems to be important.
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Affiliation(s)
- Agata Zdun-Ryżewska
- Department of Quality of Life Research, Faculty of Health Sciences, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Krzysztof Sobczak
- Department of Sociology of Medicine and Social Pathology, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdańsk, Poland
| | - Agata Rudnik
- Institute of Psychology, University of Gdansk, 80-309 Gdańsk, Poland
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Boshra M, Lee A, Kim I, Malek-Adamian E, Yau M, LaDonna KA. When patients teach students empathy: a systematic review of interventions for promoting medical student empathy. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:46-56. [PMID: 36440084 PMCID: PMC9684039 DOI: 10.36834/cmej.73058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Despite growing emphasis on empathic care, numerous studies demonstrate diminishing empathy in medical students. Involving patient educators in medical curricula may be a solution. Therefore, we conducted a systematic review to evaluate patient-involved interventions that promote empathy among medical students. METHOD A literature search of MEDLINE, Embase, PsycINFO, and ERIC databases was performed using the keywords "empathy," "medical student," and their synonyms. Results were independently screened in duplicate. Conflicts were resolved by group consensus. All English studies describing interventions that promote empathy in medical students engaging patient educators were included. Relevant data was extracted and summarized. RESULTS 1467 studies were screened. 14 studies were included, of which 10 were pilot studies. Studies included patient involved interventions such as storytelling (5/14), shadowing patients (3/14), recorded videos (3/14), or combinations of methods (3/14). Qualitative measurements of empathy included written feedback and group discussions. Quantitative measurements included validated scales measuring empathy. All studies demonstrated increase in empathy among medical students. Participants reported satisfaction with training and patients reported being proud of giving back by training future physicians. CONCLUSION Interventions engaging patient educators were shown to have a positive impact on medical student empathy. Furthermore, patient-led education was shown to increase medical student understanding of subject and knowledge retention while empowering patients. Further implementation of patient-involved education is an important step forward in patient-partnered care and may identify additional advantages of patient engagement in medical education.
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Affiliation(s)
- M Boshra
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - A Lee
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - I Kim
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - M Yau
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - KA LaDonna
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ontario, Canada
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Chen C, Chen YH, Cheng Y. Meta-analysis of functional neuroimaging and dispositional variables for clinical empathy. Neurosci Biobehav Rev 2022; 142:104874. [PMID: 36116577 DOI: 10.1016/j.neubiorev.2022.104874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 01/10/2023]
Abstract
Clinical empathy refers to the ability of healthcare providers (HP) to recognize and understand what patients feel. While neuroimaging investigations have identified a neural network of empathy, activation consistency of brain regions and their specific functions in clinical empathy remains unclear. Herein, we conducted meta-analyses of dispositional assessments using random-effects models and functional neuroimaging using Seed-based d Mapping with Permutation of Subject Images to ascertain the shared neural processes consistently identified as relevant to clinical empathy. The dispositional meta-analysis (n = 15) revealed that HP exhibited higher scores on empathic concern and perspective taking. The HP neuroimaging meta-analysis (n = 11) identified consistent activation of the anterior mid-cingulate cortex, anterior insula, and ventrolateral prefrontal cortex (vlPFC) while HP vs. controls comparison (n = 9) did not yield robust alterations. The vlPFC mediated positive and negative functional connectivity of the insula. We revisited the framework of emotion regulation in clinical empathy. The empathetic agent flexibly shifts between affective regulatory strategies to meet contextual demands, with vlPFC figuring as the key region where this neural mechanism takes place.
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Affiliation(s)
- Chenyi Chen
- Department of Physical Medicine and Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Research Center of Brain and Consciousness, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Graduate Institute of Mind, Brain and Consciousness, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Yu-Hsin Chen
- Department of Physical Medicine and Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; Institute of Neuroscience and Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yawei Cheng
- Department of Physical Medicine and Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; Institute of Neuroscience and Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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15
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Herring J. Sharing Vulnerabilities in the Woman Patient/Doctor Encounter. New Bioeth 2022; 28:223-237. [PMID: 35679124 DOI: 10.1080/20502877.2022.2072262] [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] [Indexed: 06/15/2023]
Abstract
This article is an examination of the doctor-woman patient encounter through a vulnerability lens. This relationship has been traditionally been critiqued as a paternalistic encounter in which the remedy was to recognize the patient's rights of autonomy. In this article, it is suggested that a more helpful approach is to recognize the vulnerability of both the patient and doctor. This encourages an interaction that involves seeking a mutual and collaborative response to the issues facing the patient.
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Affiliation(s)
- Jonathan Herring
- DM Wolfe-Clarendon Fellow in Law, and Professor of Law, Faculty of Law, Exeter College, Oxford, UK
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Shiao YC, Shen RN, Chen WW, Liu YP, Shih CL, Wang CC. Programme of triple-I mediator education (TIME) to improve medical disputes in clinical settings in Taiwan: a Delphi study. BMJ Open 2022; 12:e058880. [PMID: 36028268 PMCID: PMC9422892 DOI: 10.1136/bmjopen-2021-058880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To establish a training programme to cultivate trainee mediation skills through time investment, skill incorporation and formation of in-house mediation services. DESIGN A four-round consensus conference was conducted by a number of seasoned experts selected in the manner of purposive sampling to determine core competences and relevant curricula through the modified Delphi process. SETTING Responses collected from enrolled experts through four rounds of the Delphi process from 11 November 2018 to 17 May 2019. PARTICIPANTS Onboard seasoned mediators with different specialties. OUTCOME MEASURES Items with a median rating of 4 or more on a Likert scale of 1-7 points and 70% or more in agreement were identified as core competence and curricula. RESULTS Eleven enrolled experts reached the consensus about the training syllabus based on the 4-round agreement with four pillars of core competence, including 'knowledge base of law', 'internalisation of the denotative and connotative meanings of care', 'effective, smooth and timely communication' and 'conflict resolution'. To grasp the dynamics and diversity of medical disputes on target, it is necessary to have sufficient knowledge and skills. We arrange our course in the order of teaching materials with pure didactics in the former two and with mixed contents comprising lectures and field exercises in the rest two. CONCLUSIONS The sample developed a syllabus to train apprentices to take intermediate responses to medical disputes through the skills of conflict resolution and establishment of effective communication to improve the relationship between patients/relatives and medical staff, as a result of eventually reducing the conversion rate from dispute into litigation or alternative pathway. Policy-makers in healthcare and top management in healthcare institutions can use this syllabus to guide their future education and training programme.
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Affiliation(s)
- Yi-Chih Shiao
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center; School of Medicine, National Defense Medical Center, Taipei, Taiwan
- College of Law, National Chengchi University, Taipei, Taiwan
| | | | | | - Yueh-Ping Liu
- Department of Medical Affairs, Ministry of Health and Welfare, Taipei, Taiwan
- Ministry of Health and Welfare, Taipei, Taiwan
| | | | - Chih-Chia Wang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center; School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Ben-Kimhy R, Taubman–Ben-Ari O. Perceptions of Fertility Physicians Treating Women Undergoing IVF Using an Egg Donation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127159. [PMID: 35742403 PMCID: PMC9222713 DOI: 10.3390/ijerph19127159] [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] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023]
Abstract
In the course of their work, medical teams are routinely exposed to difficult and stressful situations. The few studies in the literature that have examined physicians’ perceptions and responses to such situations have focused primarily on the fields of emergency medicine and chronic and terminal illness. However, the field of fertility medicine can also evoke complex feelings among physicians. The present qualitative study examined the perceptions of fertility physicians treating women undergoing egg donation. Semi-structured in-depth interviews were conducted with 20 fertility physicians, and a categorical analysis was performed. The main category to emerge was the physicians’ perception of egg donation and its implications. Two prominent themes were identified within this category: doctor–patient communication surrounding egg donation and how the idea was presented to the patient; and doctors’ perception of the implications of egg donation, including maternal identity, the relationship between mother and infant, and the mother’s sense of the child’s identity. This is the first study to consider the response to fertility treatments, a contemporary and sensitive topic, from the perspective of the physicians. The findings can contribute to physicians’ understanding of themselves and can help to devise ways to assist them in managing their emotional responses to their work for the benefit of both themselves and their patients.
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Affiliation(s)
- Reut Ben-Kimhy
- IVF Unit, Department of Obstetrics & Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel;
- The Gender Studies Program, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Orit Taubman–Ben-Ari
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan 5290002, Israel
- Correspondence:
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Balhara KS, Irvin N, Zink KL, Mohan S, Olson AS, Tackett S, Regan L. "A sorely neglected field": A multisite study of self-reported humanities exposure among emergency medicine residents. AEM EDUCATION AND TRAINING 2022; 6:e10772. [PMID: 35784381 PMCID: PMC9242415 DOI: 10.1002/aet2.10772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Association of American Medical Colleges has identified the humanities as fundamental to medical education across all specialties. Evidence from undergraduate medical education (UME) demonstrates the humanities' positive impacts on outcomes that could be relevant to patient care and trainee well-being in emergency medicine (EM) residency training. However, less is known about the humanities' role in graduate medical education (GME). OBJECTIVES The objectives were to describe EM residents' self-reported exposure to the humanities and its relationship with their empathy, tolerance of ambiguity, and patient-centeredness, and to assess their attitudes toward the humanities in GME. METHODS This cross-sectional survey-based study was conducted at six U.S. EM residency programs in 2018-2019. Quantitative analyses included linear regressions testing for trends between humanities exposures and outcomes, adjusted for sex, year in training, and clustering within programs; adjunct analysis of free-text responses was performed using an exploratory constructivist approach to identify themes about views on the humanities' role in medicine. RESULTS Response rate was 54.8% (153/279). A total of 65% of respondents were male and 28.1% of respondents had a preceding humanities degree. Preceding humanities degree and current self-reported humanities exposure were positively associated with performance on empathy subscales (p = 0.02). Seventy-five percent (n = 114) of respondents agreed humanities are important in GME; free-text responses revealed perceived positive impacts of humanities on generating well-rounded clinicians and enhancing patient care. CONCLUSIONS Engagement with the humanities may be associated with empathy among EM residents. Although the magnitude of associations was smaller than that seen in UME, this study demonstrates resident interest in humanities and suggests that extracurricular engagement with the humanities may be insufficient to prolong positive impacts seen in UME. Further research is needed to explore how to sustain these benefits through integration or addition of the humanities in existing GME curricula.
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Affiliation(s)
- Kamna S. Balhara
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Nathan Irvin
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Korie L. Zink
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Sanjay Mohan
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency MedicineNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Adriana S. Olson
- Section of Emergency Medicine, Department of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Sean Tackett
- Division of General Internal MedicineJohns Hopkins Bayview Medical CenterBaltimoreMarylandUSA
- Biostatistics Epidemiology and Data Management CoreJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | | | - Linda Regan
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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19
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Hofmann R, Darnton R. 'This trainee makes me feel angry': It's time to validate the reality and role of trainer emotions. MEDICAL EDUCATION 2022; 56:359-361. [PMID: 34978095 PMCID: PMC9303210 DOI: 10.1111/medu.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Discussing the 'failiure to fail' phenomenon, the authors call for a system‐wide culture shift to better articulate failures as learning opportunities in healthcare.
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Affiliation(s)
| | - Richard Darnton
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
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20
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Lappeman M, Swartz L. Stillbirth in Khayelitsha Hospital, South Africa: Women's Experiences of Care. BRITISH JOURNAL OF PSYCHOTHERAPY 2022. [DOI: 10.1111/bjp.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Marchini F, Caputo A, Langher V, Giuliani C, Convertino A, Mazzilli R, Faggiano A, Napoli A. Understanding care relationships in diabetes practice: A psychodynamic interview-based exploratory study. PLoS One 2022; 17:e0263226. [PMID: 35176064 PMCID: PMC8853562 DOI: 10.1371/journal.pone.0263226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/17/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To explore the subjective experience of physicians working in diabetic settings about their care relationships in order to find some unique clues contributing to physician professional health and capacity to manage patients’ adherence. Research design and methods An interview-based exploratory study has been carried out involving 18 physicians (77.8% female) with at least 3 years of clinical practice in diabetes care. In-depth interviews about the emotional experience with patients with diabetes were conducted and audio recorded. Interviews transcripts were analyzed through a computer-based text analysis which allowed the identification of thematic domains (Cluster Analysis) and latent factors (Correspondence Analysis) viewed through a psychodynamic and constructivist lens. Results Six thematic domains emerged respectively referring to: Concern (8.43%), Control (14.42%), Ambivalence (22.08%), Devotion (22.49%), Guilt (19.29%) and Strive for Achievement (13.30%). Moreover, three latent dimensions were taken into account, which explained 69.20% of data variance: Affect Repression (28.50%), Tendency to Repair (22.70%) and Anxiety Pattern (18.00%). Conclusions Overall, the results of the present study confirm the challenging nature of diabetes care. In particular, physicians ongoing effort to restore patients’ psychological integrity in chronic condition constitute the most novel finding above all. In this regard, the need for emotional labor in physicians’ education and training is suggested in order to both prevent burnout symptoms (e.g. depersonalization) and promote shared decision making in care relationships. However, findings should be treated as preliminary given the convenience nature of the sample and its reduced size.
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Affiliation(s)
- Francesco Marchini
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
- Italian Center of Analytical Psychology, CIPA, Roma, Italy
- * E-mail:
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | - Viviana Langher
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | - Chiara Giuliani
- Endocrinology Unit, Department of Clinical and Molecular Medicine, “Sapienza” University” of Rome, Rome, Italy
| | - Alessio Convertino
- Endocrinology Unit, Department of Clinical and Molecular Medicine, “Sapienza” University” of Rome, Rome, Italy
| | - Rossella Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, “Sapienza” University” of Rome, Rome, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, “Sapienza” University” of Rome, Rome, Italy
| | - Angela Napoli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, “Sapienza” University” of Rome, Rome, Italy
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Chhabra N, Chhabra S, Archer E. Medical Students' Perspectives on the Factors Affecting Empathy Development During Their Undergraduate Training. MEDICAL SCIENCE EDUCATOR 2022; 32:79-89. [PMID: 35186434 PMCID: PMC8814260 DOI: 10.1007/s40670-021-01487-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 05/09/2023]
Abstract
INTRODUCTION This study investigated the perspectives of medical students on the factors influencing empathy development during their undergraduate training. METHODOLOGY A descriptive phenomenological approach was used to generate illustrations of empathy development and decline that had educational significance and applicability. Individual online semi-structured interviews were conducted to elicit experiential details from twelve final-year medical students. The interview recordings were transcribed verbatim, and data were analysed employing Braun and Clarke's thematic analysis method. RESULTS The self-reported empathic behavior of medical students seemed to have improved with time in medical school. Students attributed their empathy development to real patient encounters, positive role-modelling by teachers, and attainment of confidence and personal maturity. They identified exams, academic overload, time constraints, personal stresses, negative role models, unconducive learning environments, and lack of formal empathy training as barriers to empathy development. CONCLUSION Medical institutes should identify and address the barriers to empathy development and encourage the holistic development of medical students. Furthermore, medical educators should model their behavior accurately for their increasing roles and responsibilities and support the students in their empathic expressions with patients.
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Affiliation(s)
- Namrata Chhabra
- Department of Medical Biochemistry, SSR Medical College, University of Mauritius, Belle Rive, Phoenix, Mauritius
| | - Sahil Chhabra
- Graduate Division, University of California, San Diego, USA
| | - Elize Archer
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Román-Sánchez D, Paramio-Cuevas JC, Paloma-Castro O, Palazón-Fernández JL, Lepiani-Díaz I, de la Fuente Rodríguez JM, López-Millán MR. Empathy, Burnout, and Attitudes towards Mental Illness among Spanish Mental Health Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:692. [PMID: 35055513 PMCID: PMC8776222 DOI: 10.3390/ijerph19020692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
Mental health nurses, together with psychiatrists, are the healthcare professionals who display the highest levels of empathy and the best attitudes towards patients with mental disorders. However, burnout is a common problem among these professionals. The aim of our study is to describe the association between empathy, burnout, and attitudes towards patients with mental disorders among mental health nurses in Spain. A descriptive cross-sectional design was used involving a sample of 750 specialist nurses working in mental health facilities in Spain. An intentional, non-probability, non-discriminative, exponential snowball sampling method was used. The Jefferson Scale of Empathy, the Maslach Burnout Inventory, and the Community Attitudes towards Mental Illness Inventory were used to measure the study variables. A positive correlation was observed between empathy and all the study variables, with the exception of the personal accomplishment dimension of burnout and the social restrictiveness and authoritarianism dimensions of attitudes towards mental illness, where a negative relation was observed. Our findings suggest that empathy is associated with an increase in positive attitudes towards patients with mental disorders, decreasing associated stigma, but did not act as a protective factor against burnout in the study sample.
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Affiliation(s)
- Daniel Román-Sánchez
- Nursing Faculty “Salus Infirmorum”, University of Cadiz, 11001 Cadiz, Spain; (D.R.-S.); (J.C.P.-C.); (J.L.P.-F.); (I.L.-D.); (J.M.d.l.F.R.)
| | - Juan Carlos Paramio-Cuevas
- Nursing Faculty “Salus Infirmorum”, University of Cadiz, 11001 Cadiz, Spain; (D.R.-S.); (J.C.P.-C.); (J.L.P.-F.); (I.L.-D.); (J.M.d.l.F.R.)
| | | | - José Luis Palazón-Fernández
- Nursing Faculty “Salus Infirmorum”, University of Cadiz, 11001 Cadiz, Spain; (D.R.-S.); (J.C.P.-C.); (J.L.P.-F.); (I.L.-D.); (J.M.d.l.F.R.)
| | - Isabel Lepiani-Díaz
- Nursing Faculty “Salus Infirmorum”, University of Cadiz, 11001 Cadiz, Spain; (D.R.-S.); (J.C.P.-C.); (J.L.P.-F.); (I.L.-D.); (J.M.d.l.F.R.)
| | - José Manuel de la Fuente Rodríguez
- Nursing Faculty “Salus Infirmorum”, University of Cadiz, 11001 Cadiz, Spain; (D.R.-S.); (J.C.P.-C.); (J.L.P.-F.); (I.L.-D.); (J.M.d.l.F.R.)
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Who Cares What the Doctor Feels: The Responsibility of Health Politics for Burnout in the Pandemic. Healthcare (Basel) 2021; 9:healthcare9111550. [PMID: 34828596 PMCID: PMC8620824 DOI: 10.3390/healthcare9111550] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 12/05/2022] Open
Abstract
Modern health has become a defining facet of contemporary life managed by health policy. The COVID-19 pandemic has significantly affected mental health, resulting in stress and anxiety in doctors’ professional and private life. Since the beginning of the pandemic, doctors have been facing chronic stress, which was reported to the hospital managers and health-care agencies, but nothing was done in the practice to protect them. Although doctors are trained to stay emotionally restrained, a large number of patients in intensive care, along with the personal concerns for their families, has led to burnout. This article highlights the need for health politics to take responsibility for dealing with burnout in health-care workers with a new approach that should help doctors recognize, understand, and manage work-related stress with additional support in the pandemic.
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Exploring GP work in areas of high socioeconomic deprivation: a secondary analysis. BJGP Open 2021; 5:BJGPO.2021.0117. [PMID: 34465578 PMCID: PMC9447302 DOI: 10.3399/bjgpo.2021.0117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/24/2021] [Indexed: 12/03/2022] Open
Abstract
Background There is a GP workforce crisis, particularly in areas of high socioeconomic deprivation where levels of multimorbidity and social complexity are higher than in areas of low socioeconomic deprivation. How this impacts GP work, and how GPs manage workload has not been fully explored. Aim To explore GP work in areas of high socioeconomic deprivation and the strategies GPs employ, using Corbin and Strauss’s framework on managing chronic illness as an analytical lens. Design & setting Secondary analysis of qualitative in-depth interviews with GPs working with populations experiencing high levels of socioeconomic deprivation. Method Secondary analysis of in-depth interviews with GPs working in areas of high socioeconomic deprivation (n = 10). Results All three types of work defined by Corbin and Strauss (everyday, illness, and biographical) were described, and one additional type: emotional (work managing GPs’ own emotions). The context of socioeconomic deprivation, increased multimorbidity plus social complexity (’multimorbidity plus’), influenced GP work. Healthcare systems and self-management strategies did not meet patients’ needs, which meant the resulting gap created extra everyday work, often unrecognised (which was a source of frustration). GPs also described taking on ’illness work’ for patients who were either overwhelmed or unable to do it. Some GPs described biographical work, asserting their professional role against demands from patients and other professionals. Work aligning with personal values was important in sustaining motivation; for example, being part of a strong team and having outside professional interests appeared to build resilience. Conclusion GPs working in areas of high socioeconomic deprivation experience different types of work from those working in areas of low socioeconomic deprivation; much of which is unrecognised and not resourced. Current strategies to reduce burnout could be more effective if the complexity of different types of work was addressed. In addition, personal values, practice teams, and outside professional interests all need to be supported.
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Maitra A, Kamdar MR, Zulman DM, Haverfield MC, Brown-Johnson C, Schwartz R, Israni ST, Verghese A, Musen MA. Using ethnographic methods to classify the human experience in medicine: a case study of the presence ontology. J Am Med Inform Assoc 2021; 28:1900-1909. [PMID: 34151988 PMCID: PMC8363802 DOI: 10.1093/jamia/ocab091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/26/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Although social and environmental factors are central to provider-patient interactions, the data that reflect these factors can be incomplete, vague, and subjective. We sought to create a conceptual framework to describe and classify data about presence, the domain of interpersonal connection in medicine. METHODS Our top-down approach for ontology development based on the concept of "relationality" included the following: 1) a broad survey of the social sciences literature and a systematic literature review of >20 000 articles around interpersonal connection in medicine, 2) relational ethnography of clinical encounters (n = 5 pilot, 27 full), and 3) interviews about relational work with 40 medical and nonmedical professionals. We formalized the model using the Web Ontology Language in the Protégé ontology editor. We iteratively evaluated and refined the Presence Ontology through manual expert review and automated annotation of literature. RESULTS AND DISCUSSION The Presence Ontology facilitates the naming and classification of concepts that would otherwise be vague. Our model categorizes contributors to healthcare encounters and factors such as communication, emotions, tools, and environment. Ontology evaluation indicated that cognitive models (both patients' explanatory models and providers' caregiving approaches) influenced encounters and were subsequently incorporated. We show how ethnographic methods based in relationality can aid the representation of experiential concepts (eg, empathy, trust). Our ontology could support investigative methods to improve healthcare processes for both patients and healthcare providers, including annotation of videotaped encounters, development of clinical instruments to measure presence, or implementation of electronic health record-based reminders for providers. CONCLUSION The Presence Ontology provides a model for using ethnographic approaches to classify interpersonal data.
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Affiliation(s)
- Amrapali Maitra
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Presence Center, Stanford University School of Medicine, Stanford, California, USA
| | - Maulik R Kamdar
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
| | - Donna M Zulman
- Division of Primary Care and Population Health, Stanford University, Stanford, California, USA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Marie C Haverfield
- Department of Communication Studies, San Jose State University, San Jose, California, USA
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Stanford University, Stanford, California, USA
| | - Rachel Schwartz
- WellMD Center, Stanford University School of Medicine, Stanford, California, USA
| | | | - Abraham Verghese
- Presence Center, Stanford University School of Medicine, Stanford, California, USA
| | - Mark A Musen
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California, USA
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Delgado J. Vulnerability as a key concept in relational patient- centered professionalism. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:155-172. [PMID: 33423192 DOI: 10.1007/s11019-020-09995-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 05/21/2023]
Abstract
The goal of this paper is to propose a relational turn in healthcare professionalism, to improve the responsiveness of both healthcare professionals and organizations towards care of patients, but also professionals. To this end, it is important to stress the way in which difficult situations and vulnerability faced by professionals can have an impact on their performance of work. This article pursue two objectives. First, I focus on understanding and making visible shared vulnerability that arises in clinical settings from a triple perspective: patient and family, health professionals, and institutions. Second, to address this challenge for professionalism, in this paper I articulate the term "relational centered-patient professionalism", which has two main axes. The relational approach means taking into account how the relationships among professionals, patients and institutions determine the constitution and evolution of those professional values. The focus on patient centered care is indispensable, because it is the ultimate goal pursued by the development of these professional values, and must always be at the center.
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Affiliation(s)
- Janet Delgado
- University Institute of Women's Studies, University of La Laguna, La Laguna, Spain.
- University Hospital of the Canary Islands, La Laguna, Spain.
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Weilenmann S, Schnyder U, Keller N, Corda C, Spiller TR, Brugger F, Parkinson B, von Känel R, Pfaltz MC. Self-worth and bonding emotions are related to well-being in health-care providers: a cross-sectional study. BMC MEDICAL EDUCATION 2021; 21:290. [PMID: 34020633 PMCID: PMC8139026 DOI: 10.1186/s12909-021-02731-7] [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: 08/09/2020] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Interacting with patients can elicit a myriad of emotions in health-care providers. This may result in satisfaction or put providers at risk for stress-related conditions such as burnout. The present study attempted to identify emotions that promote provider well-being. Following eudaimonic models of well-being, we tested whether certain types of emotions that reflect fulfilment of basic needs (self-worth, bonding with patients) rather than positive emotions in general (as suggested by hedonic models) are linked to well-being. Specifically, we hypothesized that well-being is associated with positive emotions directed at the self, which reflect self-worth, and positive as well as negative emotions (e.g., worry) directed at the patient, which reflect bonding. However, we expected positive emotions directed at an object/situation (e.g., curiosity for a treatment) to be unrelated to well-being, because they do not reflect fulfilment of basic needs. METHODS Fifty eight physicians, nurses, and psychotherapists participated in the study. First, in qualitative interviews, they reported their emotions directed at the self, the patient, or an object/situation during distressing interactions with patients. These emotions were categorised into positive emotions directed towards the self, the patient, and an object/situation, and negative emotions directed towards the patient that reflect bonding. Second, providers completed questionnaires to assess their hedonic and eudaimonic well-being. The well-being scores of providers who did and did not experience these emotions were compared. RESULTS Providers who experienced positive emotions directed towards the self or the patient had higher well-being than those who did not. Moreover, for the first time, we found evidence for higher well-being in providers reporting negative patient-directed emotions during distressing interactions. There was no difference between providers who did and did not experience positive object/situation-directed emotions. CONCLUSIONS These findings may point towards the importance of "eudaimonic" emotions rather than just positive emotions in interactions with patients. Emotions such as contentment with oneself, joy for the patient's improvement, and, notably, grief or worry for the patient may build a sense of self-worth and strengthen bonding with the patient. This may explain their association with provider well-being.
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Affiliation(s)
- Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
| | | | - Nina Keller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Claudio Corda
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Fabio Brugger
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Brian Parkinson
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Kaul V, Gallo de Moraes A, Khateeb D, Greenstein Y, Winter G, Chae J, Stewart NH, Qadir N, Dangayach NS. Medical Education During the COVID-19 Pandemic. Chest 2021; 159:1949-1960. [PMID: 33385380 PMCID: PMC7772576 DOI: 10.1016/j.chest.2020.12.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022] Open
Abstract
All aspects of medical education were affected by the COVID-19 pandemic. Several challenges were experienced by trainees and programs alike, including economic repercussions of the pandemic; social distancing affecting the delivery of medical education, testing, and interviewing; the surge of patients affecting redeployment of personnel and potential compromises in core training; and the overall impact on the wellness and mental health of trainees and educators. The ability of medical teams and researchers to peer review, conduct clinical research, and keep up with literature was similarly challenged by the rapid growth in peer-reviewed and preprint literature. This article reviews these challenges and shares strategies that institutions, educators, and learners adopted, adapted, and developed to provide quality education during these unprecedented times.
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Affiliation(s)
- Viren Kaul
- Crouse Health/Upstate Medical University.
| | | | | | | | | | - JuneMee Chae
- Mayo Clinic Health System-Franciscan Healthcare at La Crosse
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Velayudhan BV. Embracing uncertainty: an empathy and resilience-based approach to cardiothoracic surgery in a post-pandemic era. Indian J Thorac Cardiovasc Surg 2021; 37:247-254. [PMID: 33897124 PMCID: PMC8053561 DOI: 10.1007/s12055-021-01193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Bashi V Velayudhan
- Institute of Cardiac and Aortic Disorders, SIMS Hospitals, Chennai, India
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Elzie CA, Shaia J. A Pilot Study of the Impact of Virtually Embodying a Patient with a Terminal Illness. MEDICAL SCIENCE EDUCATOR 2021; 31:665-675. [PMID: 34457919 PMCID: PMC8368971 DOI: 10.1007/s40670-021-01243-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 05/12/2023]
Abstract
Compassionate end-of-life care matters deeply for patients and their caregivers, but studies continue to demonstrate ways in which physicians fall short. Despite specific training during medical school, many patients report lack of empathy in their providers with respect to end-of-life conversations. This is likely because empathy is simply hard to teach. Numerous activities have been tried to combat the decline in empathy during medical training with little to moderate success. However, virtual reality, which allows users to viscerally experience anything from another person's point of view, could be a game changer for building empathy within medicine. This type of perspective-taking has previously shown to improve understanding, reduce biases, facilitate empathy, and promote prosocial behaviors. In this pilot study, virtual reality was used to allow students to "become a patient" virtually embodying their daily activities, symptoms, and interactions with caregivers. Using the Embodied Labs modules, first-year medical students were able to experience first-hand having a terminal illness, being told no further treatments are available and witnessing loved ones' reactions. Data generated through surveys and reflections indicated a high level of place illusion, plausibility, and embodiment of users. This high level of immersion generated an increase in comfortability with talking about end-of-life issues, produced a better understanding of what patients and their families experience, and promoted a change in the way students would approach clinical skills. Analysis of reflections indicated a high level of empathy for the patient and his family members. Overall, the activity was highly received by students as a valuable learning activity. As such, we propose that virtual reality could be a useful pedagogical tool to facilitate empathy and clinical skills within medical education.
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Affiliation(s)
- Carrie A. Elzie
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA USA
| | - Jacqueline Shaia
- Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA USA
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Wang P, Wang J, Li Q. Cognitive mechanisms underlying interaction and contribution in online health communities: the perspectives of doctors and patients. ASLIB J INFORM MANAG 2021. [DOI: 10.1108/ajim-03-2020-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeActive interaction and knowledge contribution are vital yet challenging elements of the sustainable development of online health communities (OHCs). To investigate the cognitive mechanisms underlying these behaviours in doctors' and patients' use of OHCs, this study develops a theoretical model to examine the relationships among cognitive modes, patterns of interaction, perceived usefulness, and contribution behaviour and the impact of user identity on these relationships.Design/methodology/approachTo test the research hypotheses, structural equation modelling and multiple-group analysis were used to analyse survey data from 207 doctors and 213 patients.FindingsThe results indicate that dual processes and perceived usefulness are the key cognitive antecedents of interaction and knowledge contribution, respectively. However, the correlation of the rational mode and instrumental interaction is significantly stronger in the doctors' group than in the patients' group, while a stronger correlation between the experiential mode and instrumental interaction is observed in the patients' group.Practical implicationsThese findings support the development of information and system strategies to support the operation of dual processes underlying doctors' and patients' instrumental and affective interactions, facilitate evaluation and sense-making of interaction activities, and motivate knowledge contribution.Originality/valueThis study uncovers the invariance and variability in the relationships between salient cognitive activities and behavioural responses in doctors' and patients' use of OHCs and the impact of user identity on variability.
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Grignoli N. Potential Space in Hospitals: Insight From a Health Psychologist. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:84-95. [PMID: 33375881 DOI: 10.1177/1937586720983831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Humanization is a challenge for the future of healthcare. Architecture may play a major role in designing spaces that enhance communication and help the patient to maintain mental health during physical illness. Health psychologists struggle to find adequate space for taking care of their patients. There is an urgent need to better define how relational space, defined here as potential, can be guaranteed in everyday hospital psychological consultations. BACKGROUND The author relates to his work as a health psychologist and psychotherapist in a consultation-liaison psychiatry (CLP) service operating in a general hospital in Lugano (Switzerland). METHODS An autoethnographic method is applied through calling on childhood memories on architecture and analyzing insights regarding the healthcare space in everyday work as a psychologist. Photographs and drawings are employed as evocative material. RESULTS Autoethnographical data show that building interiors can be a metaphor for an inner dimension. Spaces can be perceived as depersonalized in hospital. Through psychoanalytical theory, it is argued that space becomes ideal for CLP if it can ensure the continuity of the patient's self during hospitalization. Proximity, confidentiality, and privacy are healthcare design requirements to be considered for favoring potential space and psychological intervention. CONCLUSION Fostering potential space represents an outstanding challenge for the hospital of tomorrow in order to humanize healthcare spaces and promote a person-centered approach.
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Affiliation(s)
- Nicola Grignoli
- Consultation-Liaison Psychiatry Service, 30767Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland.,Clinical Ethics Commission, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
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Collini A, Parker H, Oliver A. Training for difficult conversations and breaking bad news over the phone in the emergency department. Emerg Med J 2020; 38:151-154. [PMID: 33273038 DOI: 10.1136/emermed-2020-210141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/09/2020] [Accepted: 11/10/2020] [Indexed: 11/04/2022]
Abstract
Due to the COVID-19 pandemic, there have been strict limits on visitors to hospitals. This has led to clinicians having an increasing number of difficult conversations with patients and their relatives over the phone. There is a lack of published literature examining how to do this well, but it is recognised that phone communication does differ from face to face interactions, and requires specific training. What is most important to patients and their families when receiving bad news is privacy, adequate time without interruptions, clarity and honesty when delivering the information, and an empathetic and caring attitude. Much of the work done on breaking bad news has been done in oncology and focusses on face to face interaction; there has been an assumption that this is transferrable to the emergency department, and more recently that this is applicable to conversations over the phone. Multiple educational interventions to improve the delivery of bad news have been developed, with differing frameworks to help clinicians carry out this stressful task. Simulation is widely used to train clinicians to break bad news, and has solid theoretical foundations for its use. The psychological safety of participants must be considered, especially with emotive subjects such as breaking bad news. We believe there is a need for specific training in breaking bad news over the phone, and developed an innovative simulation-based session to address this. The training has been well received, and has also highlighted the need for a space where clinicians feel able to discuss the emotional impact of the difficult conversations they are having.
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Affiliation(s)
- Anna Collini
- Education Academy, Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Helen Parker
- Emergency Department, Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Amy Oliver
- Role Plays for Training (RPfT), London, UK
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Tabibzadeh N, Mullaert J, Zafrani L, Balagny P, Frija-Masson J, Marin S, Lefort A, Vidal-Petiot E, Flamant M. Knowledge self-monitoring, efficiency, and determinants of self-confidence statement in multiple choice questions in medical students. BMC MEDICAL EDUCATION 2020; 20:445. [PMID: 33213443 PMCID: PMC7678098 DOI: 10.1186/s12909-020-02352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Multiple-choice question (MCQ) tests are commonly used to evaluate medical students, but they do not assess self-confidence nor penalize lucky guess or harmful behaviors. Based on a scoring method according to the appropriateness of confidence in answers, the study aimed at assessing knowledge self-monitoring and efficiency, and the determinants of self-confidence. METHODS A cross-sectional study of 842 s- and third-year medical students who were asked to state their level of confidence (A: very confident, B: moderately confident and C: not confident) during 12 tests (106,806 events). A bonus was applied if the level of confidence matched with the correctness of the answer, and a penalty was applied in the case of inappropriate confidence. RESULTS Level A was selected more appropriately by the top 20% students whereas level C was selected more appropriately by the lower 20% students. Efficiency of higher-performing students was higher when correct (among correct answers, rate of A statement), but worse when incorrect compared to the bottom 20% students (among incorrect answers, rate of C statement). B and C statements were independently associated with female and male gender, respectively (OR for male vs female = 0.89 [0.82-0.96], p = 0.004, for level B and 1.15 [1.01-1.32], p = 0.047, for level C). CONCLUSION While both addressing the gender confidence gap, knowledge self-monitoring might improve awareness of students' knowledge whereas efficiency might evaluate appropriate behavior in clinical practice. These results suggest differential feedback during training in higher versus lower-performing students, and potentially harmful behavior in decision-making during clinical practice in higher-performing students.
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Affiliation(s)
- Nahid Tabibzadeh
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, CRI, INSERM, F-75018, Paris, France.
| | - Jimmy Mullaert
- Biostatistics, Epidemiology and Clinical Research Department, APHP Hôpital Bichat, Université de Paris, IAME, INSERM, F-75018, Paris, France
| | - Lara Zafrani
- Intensive Care Unit, APHP, Hôpital Saint-Louis, Université de Paris, UMR 976, INSERM, F-75010, Paris, France
| | - Pauline Balagny
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, CRI, INSERM, F-75018, Paris, France
| | - Justine Frija-Masson
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, Neurodiderot, INSERM, F-75018, Paris, France
| | - Stéphanie Marin
- Department of Educational Sciences in the Dean's office, Faculté de Médecine, Paris Diderot University, Paris, France
| | - Agnès Lefort
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, Université de Paris, iLumens Paris-Diderot Simulation Department, IAME, UMR 1137, INSERM, Paris, F-75018, France
| | - Emmanuelle Vidal-Petiot
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, CRI, INSERM, F-75018, Paris, France
| | - Martin Flamant
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, CRI, INSERM, F-75018, Paris, France.
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Keshet Y, Popper-Giveon A. Experiences of Jewish and Arab Healthcare Practitioners Treating Terrorists in Israel. VIOLENCE AND VICTIMS 2020; 35:674-689. [PMID: 33060250 DOI: 10.1891/vv-d-19-00098] [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] [Indexed: 06/11/2023]
Abstract
The growing number of terror attacks worldwide draws attention to the difficulties that healthcare practitioners experience when they treat terrorists or suspected terrorists. Research literature on the challenges faced by healthcare practitioners treating terrorists in conflict areas is limited. In-depth interviews were conducted during 2016-2017 with 50 Jewish and Arab healthcare practitioners (managers, physicians, and nurses) employed in 11 public hospitals in Israel, who treat Palestinian terrorists and security prisoners, in the context of a prolonged and violent national conflict. Jewish practitioners find it emotionally difficult to treat terrorists and security prisoners. They face an ethical dilemma when called upon to save the lives of those who took life and find themselves identifying with the victims. Arab practitioners identify with both sides of the conflict. Three coping strategies were described: maintaining a humanistic standpoint; adherence to a standard of detached professionalism; and refusal to treat terrorists and security prisoners.
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Affiliation(s)
- Yael Keshet
- Western Galilee Academic College, Akko, Israel
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Kerasidou A, Bærøe K, Berger Z, Caruso Brown AE. The need for empathetic healthcare systems. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105921. [PMID: 32709754 PMCID: PMC8639938 DOI: 10.1136/medethics-2019-105921] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/15/2020] [Accepted: 05/01/2020] [Indexed: 05/23/2023]
Abstract
Medicine is not merely a job that requires technical expertise, but a profession concerned with making the best decisions and recommendations with reference to, and in consultation with, the patient. This means that the skill set required for healthcare professionals in order to provide good care is a combination of scientific knowledge, technical aptitude, and affective qualities or virtues such as compassion and empathy.
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Affiliation(s)
- Angeliki Kerasidou
- The Ethox Centre and the Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kristine Bærøe
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Zackary Berger
- Berman Institute of Bioethics, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amy E Caruso Brown
- Centre for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York, USA
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Kalocsai C, des Ordons AR, Sinuff T, Koo E, Smith O, Cook D, Golan E, Hales S, Tomlinson G, Strachan D, MacKinnon CJ, Downar J. Critical care providers' support of families in bereavement: a mixed-methods study. Can J Anaesth 2020; 67:857-865. [PMID: 32240521 DOI: 10.1007/s12630-020-01645-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/13/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE When people die in intensive care units (ICUs), as many as half of their family members may experience a severe grief reaction. While families report a need for bereavement support, most ICUs do not routinely follow-up with family members. Clinicians are typically involved in supporting families during death and dying, yet little is known about how they work with families in bereavement. Our goal was to explore how clinicians support bereaved families, identify factors that facilitate and hinder support, and understand their interest and needs for follow-up. METHODS Mixed-methods study of nurses and physicians working in one of nine adult medical-surgical ICUs in academic hospitals across Canada. Qualitative interviews followed quantitative surveys to reflect, expand, and explain the quantitative results. RESULTS Both physicians and nurses perceived that they provided empathetic support to bereaved families. Emotional engagement was a crucial element of support, but clinicians were not always able to engage with families because of their roles, responsibilities, experiences, or unit resources. Another important factor that could facilitate or challenge engagement was the degree to which families accepted death. Clinicians were interested in participating in a follow-up bereavement program, but their participation was contingent on time, training, and the ability to manage their own emotions related to death and bereavement in the ICU. CONCLUSIONS Multiple opportunities were identified to enhance current bereavement support for families, including the desire of ICU clinicians for formal follow-up programs. Many psychological, sociocultural, and structural factors would need to be considered in program design.
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Affiliation(s)
- Csilla Kalocsai
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, CAMH Education, 33 Russell Street, Rm. 2054, Toronto, ON, M5S 2S1, Canada.
| | - Amanda Roze des Ordons
- Division of Palliative Medicine, Department of Critical Care Medicine, Department of Oncology, Department of Anesthesiology, University of Calgary, Calgary, AB, Canada
| | - Tasnim Sinuff
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Ellen Koo
- University Health Network, Toronto, ON, Canada
| | - Orla Smith
- St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah Cook
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Eyal Golan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - James Downar
- Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada
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Kerasidou A. Artificial intelligence and the ongoing need for empathy, compassion and trust in healthcare. Bull World Health Organ 2020; 98:245-250. [PMID: 32284647 PMCID: PMC7133472 DOI: 10.2471/blt.19.237198] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/13/2023] Open
Abstract
Empathy, compassion and trust are fundamental values of a patient-centred, relational model of health care. In recent years, the quest for greater efficiency in health care, including economic efficiency, has often resulted in the side-lining of these values, making it difficult for health-care professionals to incorporate them in practice. Artificial intelligence is increasingly being used in health care. This technology promises greater efficiency and more free time for health-care professionals to focus on the human side of care, including fostering trust relationships and engaging with patients with empathy and compassion. This article considers the vision of efficient, empathetic and trustworthy health care put forward by the proponents of artificial intelligence. The paper suggests that artificial intelligence has the potential to fundamentally alter the way in which empathy, compassion and trust are currently regarded and practised in health care. Moving forward, it is important to re-evaluate whether and how these values could be incorporated and practised within a health-care system where artificial intelligence is increasingly used. Most importantly, society needs to re-examine what kind of health care it ought to promote.
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Affiliation(s)
- Angeliki Kerasidou
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, England
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The application of psychologically informed practice: observations of experienced physiotherapists working with people with chronic pain. Physiotherapy 2020; 106:163-173. [DOI: 10.1016/j.physio.2019.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/13/2019] [Indexed: 11/17/2022]
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'Hitting Targets': a poem from a study of cardiovascular disease prevention. Br J Gen Pract 2020; 70:131. [PMID: 32107236 DOI: 10.3399/bjgp20x708629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Abstract
Efficiency is an important value for all publicly funded healthcare systems. Limited resources need to be used prudently and wisely in order to ensure best possible outcomes and waste avoidance. Since 2010, the drive for efficiency, in the UK, has acquired a new impetus, as the country embarked on an ‘age of austerity’ purportedly to balance its books and reduce national deficit. Although the NHS did not suffer any direct budget cuts, the austerity policies imposed on the welfare system, including social and mental healthcare, have had a direct and detrimental impact on the healthcare service. This paper draws from a qualitative study conducted in three A&E Departments in England to explore the effects of austerity policies on the everyday experiences of doctors and nurses working in Emergency Departments. It discusses the operationalisation of efficiency in A&E, in a climate of austerity, and its effects on the experiences and practices of healthcare professionals. It uses the empirical data as a springboard to highlight the role of structures and regulations, in this case targets and protocols, in how core healthcare ethical values, such as empathy, are exercised in practice. It provides an analysis of the normative role structures and regulations can play on the perception and practice of professional duties and obligations in healthcare.
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Affiliation(s)
- Angeliki Kerasidou
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK. .,The Wellcome Trust Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK.
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Lamiani G, Dordoni P, Vegni E, Barajon I. Caring for Critically Ill Patients: Clinicians' Empathy Promotes Job Satisfaction and Does Not Predict Moral Distress. Front Psychol 2020; 10:2902. [PMID: 31969851 PMCID: PMC6960200 DOI: 10.3389/fpsyg.2019.02902] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 12/06/2019] [Indexed: 12/30/2022] Open
Abstract
Background Several studies have highlighted the benefits of empathy in healthcare settings. A correlation between clinicians' empathy and patients' adherence and satisfaction, as well as the ability for the clinician to accurately assess family members' needs, has been found. However, empathy is often seen by clinicians as a risk factor for their wellbeing. This study aims to assess whether the level of empathy of clinicians working in critical care settings may expose them to moral distress, poor job satisfaction, and intention to quit their job. Methods Italian clinicians who attended the 2016 "Smart Meeting Anesthesia Resuscitation in Intensive Care" completed the Empathy Quotient questionnaire, the Moral Distress Scale-Revised, and two questions assessing job satisfaction and intention to quit the job. Multiple linear and logistic regressions were performed to determine if clinicians' empathy influences moral distress, job satisfaction, and intention to quit. Age, gender, and profession were used as control variables. Results Out of 927 questionnaires distributed, 216 were returned (23% response rate) and 210 were used in the analyses. Respondents were 56% physicians, 24% nurses, and 20% residents. Over half of the clinicians (58%) were female. Empathy resulted the only significant predictor of job satisfaction (β = 0.193; p < 0.05). None of the variables included in the model predicted moral distress. Conclusion Empathy determined neither moral distress nor intention to quit. Findings suggest that empathy is not a risk factor for critical care clinicians in developing moral distress and the intention to quit their job. On the contrary, empathy was found to enhance clinicians' job satisfaction.
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Affiliation(s)
- Giulia Lamiani
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Paola Dordoni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Isabella Barajon
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Brown-Johnson C, Schwartz R, Maitra A, Haverfield MC, Tierney A, Shaw JG, Zionts DL, Safaeinili N, Thadaney Israni S, Verghese A, Zulman DM. What is clinician presence? A qualitative interview study comparing physician and non-physician insights about practices of human connection. BMJ Open 2019; 9:e030831. [PMID: 31685506 PMCID: PMC6858153 DOI: 10.1136/bmjopen-2019-030831] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE We sought to investigate the concept and practices of 'clinician presence', exploring how physicians and professionals create connection, engage in interpersonal interaction, and build trust with individuals across different circumstances and contexts. DESIGN In 2017-2018, we conducted qualitative semistructured interviews with 10 physicians and 30 non-medical professionals from the fields of protective services, business, management, education, art/design/entertainment, social services, and legal/personal services. SETTING Physicians were recruited from primary care clinics in an academic medical centre, a Veterans Affairs clinic, and a federally qualified health centre. PARTICIPANTS Participants were 55% men and 45% women; 40% were non-white. RESULTS Qualitative analyses yielded a definition of presence as a purposeful practice of awareness, focus, and attention with the intent to understand and connect with individuals/patients. For both medical and non-medical professionals, creating presence requires managing and considering time and environmental factors; for physicians in particular, this includes managing and integrating technology. Listening was described as central to creating the state of being present. Within a clinic, presence might manifest as a physician listening without interrupting, focusing intentionally on the patient, taking brief re-centering breaks throughout a clinic day, and informing patients when attention must be redirected to administrative or technological demands. CONCLUSIONS Clinician presence involves learning to step back, pause, and be prepared to receive a patient's story. Building on strategies from physicians and non-medical professionals, clinician presence is best enacted through purposeful intention to connect, conscious navigation of time, and proactive management of technology and the environment to focus attention on the patient. Everyday practice or ritual supporting these strategies could support physician self-care as well as physician-patient connection.
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Affiliation(s)
- Cati Brown-Johnson
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States
| | - Rachel Schwartz
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, United States
| | - Amrapali Maitra
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Marie C Haverfield
- Department of Communication Studies, San Jose State University, San Jose, California, United States
| | - Aaron Tierney
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, United States
| | - Jonathan G Shaw
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States
| | - Dani L Zionts
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States
| | - Nadia Safaeinili
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States
| | - Sonoo Thadaney Israni
- Presence Center, Stanford University School of Medicine, Stanford, California, United States
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
| | - Abraham Verghese
- Presence Center, Stanford University School of Medicine, Stanford, California, United States
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
| | - Donna M Zulman
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, United States
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Cross-sectional study of the association between empathy and burnout and drug prescribing quality in primary care. Prim Health Care Res Dev 2019; 20:e145. [PMID: 31663492 PMCID: PMC6842647 DOI: 10.1017/s1463423619000793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: The aim of this study was to assess whether burnout and empathy levels among general practitioners (GPs) might influence prescribing performance assessed using pharmaceutical prescription quality standard indicators. Design and Setting: Cross-sectional descriptive study of 108 GPs from 22 primary care centers in Lleida, Spain, and of centralized data corresponding to 183 600 patients under their care. The study was conducted between May and July 2014. Main Outcome Measures: Burnout and empathy were measured using the Spanish versions of the Maslach Burnout Inventory and the Jefferson Scale for Physician Empathy, and prescribing quality was measured using the Catalan Pharmaceutical Prescription Quality Standard (EQPF). Normal distribution of scores was verified using the Chi-square and Kolmogorov–Smirnov–Lilliefors tests. The effect of each of the variables was evaluated using crude odds ratios. Results: Older GPs scored significantly higher in the EQPF (P < 0.05). High empathy scores were positively associated with high EQPF scores. GPs with low burnout also performed better in the EQPF. Conclusions: More empathic, less burned-out, older GPs showed better prescribing performance according to quality indicators. However, further studies are needed to evaluate other factors influencing prescribing habits. The promotion of communication skills may increase empathy and reduce burnout, thus benefiting patients.
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Ashraf F, Ahmad H, Shakeel M, Aftab S, Masood A. Mental health problems and psychological burnout in Medical Health Practitioners: A study of associations and triadic comorbidity. Pak J Med Sci 2019; 35:1558-1564. [PMID: 31777493 PMCID: PMC6861496 DOI: 10.12669/pjms.35.6.444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective Mental health problems not only affect the common person but also medical health practitioners (MHPs) dealing with health care issues of patients. The current study aimed to explore the triadic (three dimensional) comorbidity of mental health problems and its association with three forms of psychological burnout (person, client and work related). Methods This correlational study was conducted at three hospitals of Islamabad/ Rawalpindi (Holy Family Hospital=57, District Headquarter Hospital=60, and Benazir Bhutto Hospital=40) from June 2018 to September 2018. The sample comprised of 157 medical health practitioners (medical doctors) serving in general ward (n=64), emergency (n=60) and OPD (n=33) sections. The participants were administered self-report measures of DASS-21 and Copenhagen Burnout Inventory. Results Triadic comorbidity of depression, anxiety and stress ranged from 9% to 26% for excessive severe and normal levels respectively. Comorbidity of work related and personal related burnout at severe level was found 8%. Further, depression, anxiety and stress symptoms were strongly associated with psychological burnout at .0001 significance level. Conclusion MHPs demonstrated excessive severe comorbidity of depression, anxiety and stress simultaneously. Along with this triadic comorbidity, the presence of severe psychological burnout is alarming and affecting overall efficiency and mental health of doctors which need to be identified, screened out and managed timely and managed properly.
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Affiliation(s)
- Farzana Ashraf
- Dr. Farzana Ashraf, Department of Humanities, COMSATS University Islamabad, Lahore Campus, Pakistan
| | - Hassaan Ahmad
- Dr. Hassaan Ahmad, Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Muneeba Shakeel
- Dr. Muneeba Shakeel, Department of Humanities, COMSATS University Islamabad, Lahore Campus, Pakistan
| | - Sana Aftab
- Dr. Sana Aftab, Department of Pediatrics, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Afsheen Masood
- Dr. Afhseen Masood, Institute of Applied Psychology, University of the Punjab, Lahore, Pakistan
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Lappeman M, Swartz L. Care and the politics of shame: Medical practitioners and stillbirths in a South African district hospital. PSYCHODYNAMIC PRACTICE 2019. [DOI: 10.1080/14753634.2019.1670093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Maura Lappeman
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Stuart B, Mahler E, Koomson P. A Large-Scale Advanced Illness Intervention Informs Medicare's New Serious Illness Payment Model. Health Aff (Millwood) 2019; 38:950-956. [PMID: 31158017 DOI: 10.1377/hlthaff.2018.05517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with advanced illness receive fragmented, hospital-based care that is unaligned with their preferences near the end of life. We describe a team-based intervention that provides home-based, coordinated care to more than 2,000 seriously ill patients daily in nineteen urban, suburban, or rural counties in California. In the last month of life, compared to matched Medicare beneficiaries in similar counties, this program reduced hospital days by 1,361 per 1,000 beneficiaries, hospital deaths by 8.2 percent, inpatient payments by $6,127, and the total cost of care by $5,657 per beneficiary. The Centers for Medicare and Medicaid Services (CMS) has announced a new Medicare payment model for serious illness care, based in part on this program. To inform model development and implementation, we describe lessons learned about changing the focus of care for advanced illness from hospital to home, broadening care coordination to achieve system integration, and developing methods for payment and quality accountability that transform care delivery.
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Affiliation(s)
- Brad Stuart
- Brad Stuart ( ) is the chief medical officer at the Coalition to Transform Advanced Care, in Washington, D.C
| | - Elizabeth Mahler
- Elizabeth Mahler is vice president of patient health management in the Office of Patient Experience, Sutter Health, in Sacramento, California
| | - Praba Koomson
- Praba Koomson is director of advance illness management at Sutter Health in Fairfield, California
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Waltz M, Jean Cadigan R, Joyner B, Ossman P, Davis A. Perils of the Hidden Curriculum: Emotional Labor and “Bad” Pediatric Proxies. THE JOURNAL OF CLINICAL ETHICS 2019. [DOI: 10.1086/jce2019302154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Anthony is a fourth-year medical student, currently on service during an away surgery rotation. He is rounding with a first-year intern, Dr. Lovett, and the attending, Dr. Todd. They stop outside the room of Mr. Turpin, a 54-year-old male who has recently had a toe amputation due to uncontrolled diabetes mellitus. His chart lists him as a drug-seeker managed for chronic pain. As such, his analgesics are being closely monitored. Before entering the room, Dr. Lovett mentions that the patient had been irritated the night prior, complaining of uncontrolled pain, and upset at staff for refusing increased pain medication. Dr. Todd knows this, remarking that Mr. Turpin has a history of being a "difficult patient."
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