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Canino S, Torchia V, Gaita M, Raimo S, Palermo L. Linking the inner and outer mental representations of the body to social cognition skills: A systematic review and meta-analysis. Neuropsychologia 2024; 204:108989. [PMID: 39233220 DOI: 10.1016/j.neuropsychologia.2024.108989] [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: 04/23/2024] [Revised: 07/17/2024] [Accepted: 08/30/2024] [Indexed: 09/06/2024]
Abstract
An interesting interpretation of embodiment highlights the critical role of mental body representations (BR), including motor, somatosensory, and interoceptive formats, for social cognition. However, the nature of this relationship is still debated at the empirical level, with various studies arriving at different conclusions. Here, we present a systematic review and meta-analysis aimed to summarize data from 3466 participants in 21 studies to provide a more comprehensive understanding of the relationship between inner and outer BR and social cognition. We focused on two core social cognition aspects: empathy and Theory of Mind (ToM). Concerning the inner BR, our meta-analytic findings reveal a significant correlation between specific interoceptive dimensions (i.e., interoceptive sensibility and accuracy) and social cognition, which was stronger for empathy than ToM. Conversely, although further research is needed, functional BR that mainly involve the outer body processing (i.e., nonaction-oriented BR) may show positive links with ToM. These findings point to specific interactions between BR and social cognition skills, supporting multi-faceted and embodied social cognition models. However, we also identified critical knowledge gaps and highlighted the need for further investigation to deepen our theoretical understanding of these relationships and their implications for clinical practice.
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Affiliation(s)
- Silvia Canino
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Valentina Torchia
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Mariachiara Gaita
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Simona Raimo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Liana Palermo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
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2
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Bani M, Russo S, Ardenghi S, Rampoldi G, Wickline V, Nowicki S, Strepparava MG. Behind the mask: What the eyes can't tell: Facial emotion recognition in a sample of Italian health care students. Q J Exp Psychol (Hove) 2024; 77:1430-1442. [PMID: 37599379 DOI: 10.1177/17470218231198145] [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: 08/22/2023]
Abstract
Wearing a facemask remains a pivotal strategy to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection even after vaccination, but one of the possible costs of this protection is that it may interfere with the ability to read emotion in facial expressions. We explored the extent to which it may be more difficult for participants to read emotions in faces when faces are covered with masks than when they are not, and whether participants' empathy, attachment style, and patient-centred orientation would affect their performance. Medical and nursing students (N = 429) were administered either a masked or unmasked set of 24 adult faces depicting anger, sadness, fear, or happiness. Participants also completed self-report measures of empathy, patient-centredness, and attachment style. As predicted, participants made more errors to the masked than the unmasked faces with the exception of the identification of fear. Of note, when participants missed happiness, they were most likely to see it as sadness, and when they missed anger, they were most likely to see it as happiness. A multiple linear regression analysis showed that more errors identifying emotions in faces was associated with faces being masked as opposed to unmasked, lower scores on the empathy fantasy scale, and higher scores on the fearful attachment style. The findings suggest that wearing facemasks is associated with a variety of negative outcomes that might interfere with the building of positive relationships between health care workers and patients. Those who teach student health care workers would benefit from bringing this finding into their curriculum and training.
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Affiliation(s)
- Marco Bani
- School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Selena Russo
- School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Stefano Ardenghi
- School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giulia Rampoldi
- School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Virginia Wickline
- Department of Psychology, Georgia Southern University, Savannah, GA, USA
| | - Stephen Nowicki
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Corradi‐Dell'Acqua C, Hofstetter C, Sharvit G, Hugli O, Vuilleumier P. Healthcare experience affects pain-specific responses to others' suffering in the anterior insula. Hum Brain Mapp 2023; 44:5655-5671. [PMID: 37608624 PMCID: PMC10619377 DOI: 10.1002/hbm.26468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/13/2023] [Accepted: 07/22/2023] [Indexed: 08/24/2023] Open
Abstract
Medical students and professional healthcare providers often underestimate patients' pain, together with decreased neural responses to pain information in the anterior insula (AI), a brain region implicated in self-pain processing and negative affect. However, the functional significance and specificity of these neural changes remains debated. Across two experiments, we recruited university medical students and emergency nurses to test the role of healthcare experience on the brain reactivity to other's pain, emotions, and beliefs, using both pictorial and verbal cues. Brain responses to self-pain was also assessed and compared with those to observed pain. Our results confirmed that healthcare experience decreased the activity in AI in response to others' suffering. This effect was independent from stimulus modality (pictures or texts), but specific for pain, as it did not generalize to inferences about other mental or affective states. Furthermore, representational similarity and multivariate pattern analysis revealed that healthcare experience impacted specifically a component of the neural representation of others' pain that is shared with that of first-hand nociception, and related more to AI than to other pain-responsive regions. Taken together, our study suggests a decreased propensity to appraise others' suffering as one's own, associated with a reduced recruitment of pain-specific information in AI. These findings provide new insights into neural mechanisms leading to pain underestimation by caregivers in clinical settings.
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Affiliation(s)
- Corrado Corradi‐Dell'Acqua
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE)University of GenevaGenevaSwitzerland
- Geneva Neuroscience CenterUniversity of GenevaGenevaSwitzerland
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
| | - Christoph Hofstetter
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
| | - Gil Sharvit
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
- Swiss Center for Affective Sciences, University of GenevaGenevaSwitzerland
- Balgrist University Hospital and University of ZurichZurichSwitzerland
| | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne (UHL)LausanneSwitzerland
| | - Patrik Vuilleumier
- Geneva Neuroscience CenterUniversity of GenevaGenevaSwitzerland
- Laboratory of Behavioural Neurology and Imaging of Cognition, Department of NeuroscienceUniversity Medical Center, University of GenevaGenevaSwitzerland
- Swiss Center for Affective Sciences, University of GenevaGenevaSwitzerland
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Campos C, Rocha NB, Barbosa F. Dissociating cognitive and affective empathy across psychopathy dimensions: The role of interoception and alexithymia. Front Psychol 2023; 14:1082965. [PMID: 37457066 PMCID: PMC10345207 DOI: 10.3389/fpsyg.2023.1082965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/15/2023] [Indexed: 07/18/2023] Open
Abstract
This study examined the associations between psychopathy dimensions (triarchic phenotypes and classical factors), empathy domains (cognitive and affective), and interoception (interoceptive attention and accuracy) while accounting for the putative role of alexithymia. A community sample (n = 515) completed an online survey encompassing: Triarchic Psychopathy Measure (boldness, meanness, disinhibition); Levenson Self-Report Psychopathy Scale (primary and secondary psychopathy); Body Perception Questionnaire (interoceptive attention); Interoceptive Accuracy Scale; Toronto Alexithymia Scale. Hierarchical linear regression models were implemented for hypothesis-driven analyses examining the associations between psychopathy, empathy, and interoception while controlling for sex, age, and alexithymia. Exploratory path models were employed to investigate alexithymia and/or cognitive empathy as mediators between interoception and psychopathy. Our results largely confirmed the postulated empathy profiles across psychopathy dimensions, as meanness and primary psychopathy displayed a broad empathy impairment, while disinhibition and secondary psychopathy were only associated with diminished cognitive empathy. Importantly, boldness displayed a unique pattern (enhanced cognitive empathy and reduced affective empathy), further reinforcing its importance within the constellation of psychopathy traits. Contrary to our hypotheses, self-perceived interoceptive attention and accuracy were not associated with either psychopathy dimension after controlling for alexithymia. However, interoceptive accuracy and alexithymia were associated with cognitive empathy, while alexithymia was also positively related to all psychopathy dimensions (as expected), despite the unexpected strong and negative association with boldness. Exploratory analyses suggested significant indirect effects (mediation) between interoceptive accuracy and psychopathy via alexithymia and/or cognitive empathy. These mediating effects must be interpreted with caution and future studies should be designed to formally test this model.
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Affiliation(s)
- Carlos Campos
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Neurocognition Group|LabRP, School of Health, Center for Rehabilitation Research, Polytechnic University of Porto, Porto, Portugal
| | - Nuno Barbosa Rocha
- School of Health, Center for Translational Health and Medical Biotechnology Research, Polytechnic University of Porto, Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Zorani S, Peles E. Intact and Impaired Mentalization and Its Relation to Empathy and Pain — a Cross-sectional Study of Patients with Opioid Use Disorder Receiving Methadone Maintenance Treatment. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00927-6] [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: 10/10/2022] Open
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Voultsos P, Chatzinikolaou F, Papana A, Deliligka A. Reliability of Greek version of the Toronto empathy questionnaire in medical students and associations with sociodemographic and lifestyle factors. BMC Psychol 2022; 10:113. [PMID: 35501889 PMCID: PMC9063083 DOI: 10.1186/s40359-022-00824-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/26/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Empathy is an important key driver of any therapeutic relationship. It is beneficial for both physicians and patients. Enhancing physician's empathy should be an important goal of medical education. As there was a literature gap regarding the topic of empathy among medical students in Greece, this study aimed to contribute to filling this gap. METHODS A cross-sectional study was conducted. A socio-demographic questionnaire and the 52-item Greek version of the Toronto composite empathy scale (TCES) for measuring the cognitive and emotional aspects of empathy in both personal and professional life was administered to all the medical students in the Aristotle University of Thessaloniki, in Greece. Descriptive statistics were displayed for demographics. The associations of the variables were quantified by Chi-2 independence tests and Pearson's Correlation Coefficient. The reliability and validity of the questionnaire was determined by Cronbach's α, Hotelling's T-Squared Test, and Pearson correlation. Paired and Independent Sample T-Tests and One-way ANOVAs indicated statistically significant mean differences among the variables or subgroups of the variables. RESULTS The 52-item TCES, 26 for the personal (Per) setting and another 26 for professional (Pro) life, equally divided into cognitive (Cog) and emotional (Emo) empathy in each case. The overall reliability of the TCES questionnaire was found to be high (Cronbach's α = 0.895, significant positive correlations between the subscales). The mean total score of empathy showed that students had a moderately high empathy. Further, there was a statistically significant difference in means between the Per-Cog and Per-Emo settings (p < 0.001), the Pro-Cog and Pro-Emo (p < 0.001), the Per-Cog and Pro-Cog (p = 0.004), and the Per-Emo and Pro-Emo (p < 0.001). Females had significantly higher empathy scores (mean score 208.04) than males (192.5) on the Per-Cog, Per-Emo and Pro-Emo subscales. Furthermore, a positive correlation was found between empathy and factors such as love for animals, interest in medical ethics, belief in God, having an ill person in the family, class year or carrier intention. CONCLUSIONS The TCES is applicable to medical students. For the most part our findings were consistent with previous literature. However, we identified some nuances that might draw researchers' attention. The results of this study may contribute to plan interventions in the curriculum to enhance empathy in the medical students.
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Affiliation(s)
- Polychronis Voultsos
- Laboratory of Forensic Medicine and Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece.
| | - Fotios Chatzinikolaou
- Laboratory of Forensic Medicine and Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece
| | - Angeliki Papana
- Department of Economics, School of Economics and Regional Studies, University of Macedonia, Egnatia Str 156, 546 36, Thessaloniki, Greece
| | - Aspasia Deliligka
- AHEPA University Hospital, Kiriakidi Str 1, 546 21, Thessaloniki, Greece
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7
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Pavlova A, Wang CXY, Boggiss AL, O'Callaghan A, Consedine NS. Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review. J Gen Intern Med 2022; 37:900-911. [PMID: 34545471 PMCID: PMC8452146 DOI: 10.1007/s11606-021-07055-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Compassion in healthcare provides measurable benefits to patients, physicians, and healthcare systems. However, data regarding the factors that predict care (and a lack of care) are scattered. This study systematically reviews biomedical literature within the Transactional Model of Physician Compassion and synthesizes evidence regarding the predictors of physician empathy, compassion, and related constructs (ECRC). METHODS A systematic literature search was conducted in CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, OvidJournals, ProQuest, Web of Science, and Scopus using search terms relating to ECRC and its predictors. Eligible studies included physicians as participants. Methodological quality was assessed based on the Cochrane Handbook, using ROBINS-I risk of bias tool for quantitative and CASP for qualitative studies. Confidence in findings was evaluated according to GRADE-CERQual approach. RESULTS One hundred fifty-two included studies (74,866 physicians) highlighted the diversity of influences on compassion in healthcare (54 unique predictors). Physician-related predictors (88%) were gender, experience, values, emotions and coping strategies, quality of life, and burnout. Environmental predictors (38%) were organizational structure, resources, culture, and clinical environment and processes. Patient-related predictors (24%) were communication ease, and physicians' perceptions of patients' motives; compassion was also less forthcoming with lower SES and minority patients. Evidence related to clinical predictors (15%) was scarce; high acuity presentations predicted greater ECRC. DISCUSSION The growth of evidence in the recent years reflects ECRC's ongoing importance. However, evidence remains scattered, concentrates on physicians' factors that may not be amenable to interventions, lacks designs permitting causal commentary, and is limited by self-reported outcomes. Inconsistent findings in the direction of the predictors' effects indicate the need to study the relationships among predictors to better understand the mechanisms of ECRCs. The current review can guide future research and interventions.
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Affiliation(s)
- Alina Pavlova
- Faculty of Medical and Health Sciences, Department of Psychological Medicine, The University of Auckland, Building 507, 3, Auckland, New Zealand.
| | - Clair X Y Wang
- Faculty of Medical and Health Sciences, Department of Psychological Medicine, The University of Auckland, Building 507, 3, Auckland, New Zealand
| | - Anna L Boggiss
- Faculty of Medical and Health Sciences, Department of Psychological Medicine, The University of Auckland, Building 507, 3, Auckland, New Zealand
| | - Anne O'Callaghan
- Faculty of Medical and Health Sciences, Department of Psychological Medicine, The University of Auckland, Building 507, 3, Auckland, New Zealand
| | - Nathan S Consedine
- Faculty of Medical and Health Sciences, Department of Psychological Medicine, The University of Auckland, Building 507, 3, Auckland, New Zealand
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8
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Dirupo G, Totaro S, Richard J, Corradi-Dell'Acqua C. Medical education and distrust modulate the response of insular-cingulate network and ventral striatum in pain diagnosis. eLife 2021; 10:63272. [PMID: 33904406 PMCID: PMC8104963 DOI: 10.7554/elife.63272] [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: 09/19/2020] [Accepted: 04/23/2021] [Indexed: 12/18/2022] Open
Abstract
Healthcare providers often underestimate patients’ pain, sometimes even when aware of their reports. This could be the effect of experience reducing sensitivity to others pain, or distrust toward patients’ self-evaluations. Across multiple experiments (375 participants), we tested whether senior medical students differed from younger colleagues and lay controls in the way they assess people’s pain and take into consideration their feedback. We found that medical training affected the sensitivity to pain faces, an effect shown by the lower ratings and highlighted by a decrease in neural response of the insula and cingulate cortex. Instead, distrust toward the expressions’ authenticity affected the processing of feedbacks, by decreasing activity in the ventral striatum whenever patients’ self-reports matched participants’ evaluations, and by promoting strong reliance on the opinion of other doctors. Overall, our study underscores the multiple processes which might influence the evaluation of others’ pain at the early stages of medical career.
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Affiliation(s)
- Giada Dirupo
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland.,Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland.,Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Sabrina Totaro
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland
| | - Jeanne Richard
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Department of Psychology, Swiss Distance University Institute, Brig, Switzerland
| | - Corrado Corradi-Dell'Acqua
- Theory of Pain Laboratory, Department of Psychology, Faculty of Psychology and Educational Sciences (FPSE), University of Geneva, Geneva, Switzerland.,Geneva Neuroscience Center, University of Geneva, Geneva, Switzerland
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Givron H, Desseilles M. Decline of Empathy after the First Internship: Towards a More Functional Empathy? SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1070246ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Research has shown a decline in empathy as medical studies progress. Among various hypotheses, an explanation track evoked is the first contact with the internship.
Objectives This quasi-experimental study was designed to examine the impact of the first internship in medical students. Our research question was: “to what extent the first internship may decreased the empathy’s scores of our 3d year medical students?”
Methods We measured the empathy of 220 third year medical students before and after their first internship (3 weeks) in family medicine. Using online surveys methodology, we collected data about empathy (“Interpersonal Reactivity Index”: IRI), epidemiology, professional orientation choices.
Results Statistical analyses revealed a small but significant decrease in IRI’s “fantasy,” “empathic concern” and “personal distress” subscales.
Conclusion These results suggest a potential impact of the first internship on empathic skills. The fact that the students’ score for the “personal distress” subscale (which characterizes a difficulty in managing their emotions) decreases is actually a rather good thing. These data raise the question of the “function” of this loss of empathy. The fact that this score decreases after first internship, may indicate a positive change for these medical students: towards better emotional regulation and more functional affective empathy.
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Affiliation(s)
- Hélène Givron
- Département de Psychologie, Faculté de médecine, Université de Namur, Belgique
- Institut Transitions, Université de Namur, Belgique
| | - Martin Desseilles
- Institut Transitions, Université de Namur, Belgique
- Clinique Psychiatrique des Frères Alexiens, Henri-Chapelle, Belgique – Département de Psychologie, Faculté de médecine, Université de Namur, Belgique
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Isernia S, Cabinio M, Pirastru A, Mendozzi L, Di Dio C, Marchetti A, Massaro D, Baglio F. Theory of mind network in multiple Sclerosis: A double disconnection mechanism. Soc Neurosci 2020; 15:544-557. [DOI: 10.1080/17470919.2020.1766562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Sara Isernia
- Center of Advanced Diagnostic and Rehabilitation Therapy (CADiTeR), IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica Del Sacro Cuore, Milano, Italy
| | - Monia Cabinio
- Center of Advanced Diagnostic and Rehabilitation Therapy (CADiTeR), IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Alice Pirastru
- Center of Advanced Diagnostic and Rehabilitation Therapy (CADiTeR), IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Laura Mendozzi
- Center of Advanced Diagnostic and Rehabilitation Therapy (CADiTeR), IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Cinzia Di Dio
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica Del Sacro Cuore, Milano, Italy
| | - Antonella Marchetti
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica Del Sacro Cuore, Milano, Italy
| | - Davide Massaro
- Research Unit on Theory of Mind, Department of Psychology, Università Cattolica Del Sacro Cuore, Milano, Italy
| | - Francesca Baglio
- Center of Advanced Diagnostic and Rehabilitation Therapy (CADiTeR), IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
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Shi M, Du T. Associations of emotional intelligence and gratitude with empathy in medical students. BMC MEDICAL EDUCATION 2020; 20:116. [PMID: 32303212 PMCID: PMC7164156 DOI: 10.1186/s12909-020-02041-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Empathy is an essential quality for physicians and medical trainees. This study aimed to examine the associations of emotional intelligence (EI) and gratitude with empathy in medical students. METHODS We conducted this cross-sectional study at three medical schools in China. A pack of self-reported questionnaires, consisting of the Interpersonal Reactivity Index (IRI), the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), the Gratitude Questionnaire-6 (GQ-6), and demographic section were distributed to the students. RESULTS A pool of 1392 students became the final participants. After adjustment for the demographics, trait EI and gratitude were positively related to Perspective Taking and Empathic Concern, accounting for 33.1 and 22.7% of their variance, respectively. While trait EI was strongly and negatively associated with Personal Distress, gratitude was modestly and positively associated with it, and they collectively explained 29.1% of its variance. CONCLUSIONS Trait EI and gratitude could be vital psychological constructs for understanding empathy in medical students. The positive roles they may play could be considered when intervention strategies and programs are designed to enhance the professional competencies in medical students.
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Affiliation(s)
- Meng Shi
- Department of English, School of Fundamental Sciences, China Medical University, 77 Puhe Road, Shenyang North Development Zone, Shenyang, People’s Republic of China
- Department of Psychology, School of Humanities and Social Sciences, China Medical University, 77 Puhe Road, Shenyang North Development Zone, Shenyang, People’s Republic of China
| | - Tianjiao Du
- Department of Psychology, School of Humanities and Social Sciences, China Medical University, 77 Puhe Road, Shenyang North Development Zone, Shenyang, People’s Republic of China
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Cameron CD, Inzlicht M. Empathy choice in physicians and non-physicians. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2019; 59:715-732. [PMID: 31562659 DOI: 10.1111/bjso.12342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/14/2019] [Accepted: 09/10/2019] [Indexed: 01/09/2023]
Abstract
Empathy in medical care has been one of the focal points in the debate over the bright and dark sides of empathy. Whereas physician empathy is sometimes considered necessary for better physician-patient interactions, and is often desired by patients, it also has been described as a potential risk for exhaustion among physicians who must cope with their professional demands of confronting acute and chronic suffering. The present study compared physicians against demographically matched non-physicians on a novel behavioural assessment of empathy, in which they choose between empathizing or remaining detached from suffering targets over a series of trials. Results revealed no statistical differences between physicians and non-physicians in their empathy avoidance, though physicians were descriptively more likely to choose empathy. Additionally, both groups were likely to perceive empathy as cognitively challenging, and perceived cognitive costs of empathy associated with empathy avoidance. Across groups, there were also no statistically significant differences in self-reported trait empathy measures and empathy-related motivations and beliefs. Overall, these results suggest that physicians and non-physicians were more similar than different in terms of their empathic choices and in their assessments of the costs and benefits of empathy for others.
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Affiliation(s)
- C Daryl Cameron
- The Pennsylvania State University, University Park, Pennsylvania, USA
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13
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Smith KE, Norman GJ, Decety J. Medical students' empathy positively predicts charitable donation behavior. JOURNAL OF POSITIVE PSYCHOLOGY 2019; 15:734-742. [PMID: 33042206 DOI: 10.1080/17439760.2019.1651889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Empathy is known to motivate prosocial behavior. This relationship, however is complex and influenced by the social context and the type of prosocial behavior. Additionally, empathy is a complex psychological capacity, making it important to examine how different components of empathy influence different prosocial behaviors. The current study uses a unique longitudinal sample to assess how changes in cognitive and affective components of empathy relate to charitable giving. Measures of empathy were collected from medical students in the fall and spring of students' first three years of medical school. After this time, students had the opportunity to donate to charity. Positive changes in students' cognitive empathy predicted their charitable giving, with students who demonstrated greater increases in cognitive empathy giving more money. This study points to an important role for cognitive empathy in certain prosocial behaviors, and suggests that long term changes in empathy influence individual differences in prosocial behavior.
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Affiliation(s)
- Karen E Smith
- Department of Psychology, University of Chicago, 5848 S University Ave, Chicago IL 60615
| | - Greg J Norman
- Department of Psychology, University of Chicago, 5848 S University Ave, Chicago IL 60615
| | - Jean Decety
- Department of Psychology, University of Chicago, 5848 S University Ave, Chicago IL 60615
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Pace-Schott EF, Amole MC, Aue T, Balconi M, Bylsma LM, Critchley H, Demaree HA, Friedman BH, Gooding AEK, Gosseries O, Jovanovic T, Kirby LA, Kozlowska K, Laureys S, Lowe L, Magee K, Marin MF, Merner AR, Robinson JL, Smith RC, Spangler DP, Van Overveld M, VanElzakker MB. Physiological feelings. Neurosci Biobehav Rev 2019; 103:267-304. [DOI: 10.1016/j.neubiorev.2019.05.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/27/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
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15
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Rizkalla MN, Henderson KK. Empathy and Osteopathic Manipulative Medicine: Is It All in the Hands? J Osteopath Med 2019; 118:573-585. [PMID: 30178047 DOI: 10.7556/jaoa.2018.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Context The osteopathic medical school curriculum is unique because of the inclusion of training in osteopathic manipulative medicine (OMM). Interest in and use of OMM promotes cognitive training in diagnosing conditions, emotional training in the alleviation of pain, and physical training in the application of OMM. Osteopathic manipulative medicine may mitigate a reduction in empathy levels of medical students and explain why osteopathic medical students do not follow the declining pattern of empathy previously reported in allopathic medical students. Objective To examine whether favorable opinions of OMM are positively correlated with overall student empathy as well as the cognitive, emotional, and behavioral subcomponents of empathy. Methods Institutional review board approval was obtained to measure empathy in medical students attending the Midwestern University/Chicago College of Osteopathic Medicine for this cross-sectional study. The 20-item Jefferson Scale of Empathy medical student version (JSE-S) was distributed via email to first-year students at the beginning of the 2016-2017 academic year and at the end of the academic year to all students. Items were divided into cognitive, emotional, and behavioral categories. Items related to demographics, interest and use of OMM and the osteopathic philosophy, frequency of touch, and personality were also included in the survey. Data were analyzed using SPSS software and presented as mean (SEM). Statistical significance was set at P<.05. Results Of the 801 students the survey was sent to at the end of the 2016-2017 academic year, 598 students completed the survey, for a response rate of 75%. When accounting for the effect of gender with a multivariate analysis of covariance, there were no differences in empathy scores across school years. When empathy scores from first- and second-year students were combined and compared with combined third- and fourth-year students' scores to examine the difference between empathy in students during academic and clinical training, a difference in the mean (SEM) JSE-S empathy score was noted (114.6 [0.7] and 112.0 [0.7], respectively; P=.01); however, the effect size was small (partial η2=0.01). Interest in OMM and the osteopathic philosophy were significantly associated with higher empathy scores (P<.05; medium effect; partial η2=0.08). Conclusion Interest in and use of OMM are associated with higher empathy scores and empathy subcomponents. Training and use of OMM should be examined as a mechanism contributing to the durability of empathy in the osteopathic medical profession.
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Ponnamperuma G, Yeo SP, Samarasekera DD. Is empathy change in medical school geo-socioculturally influenced? MEDICAL EDUCATION 2019; 53:655-665. [PMID: 30891799 DOI: 10.1111/medu.13819] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/08/2018] [Accepted: 01/09/2019] [Indexed: 05/24/2023]
Abstract
CONTEXT There is convincing evidence that physician empathy leads to better patient care. As a result, there has been considerable research interest in investigating how empathy changes during undergraduate medical studies. Early (generally North American) studies raised concerns that medical training causes a decline in empathy. More recent studies (conducted around the world) have begun to suggest that either a slight increase or decrease in empathy occurs during undergraduate medical training, which has led some to argue that empathy changes indiscriminately (with no discernible pattern). This paper explores whether there is evidence to suggest that empathy changes indiscriminately or with a discernible geo-sociocultural pattern during undergraduate medical training. METHODS Literature that investigated change in empathy during undergraduate medical training was reviewed. Cross-sectional and longitudinal studies were tabulated separately according to their respective geographical locations. The tabulated results were analysed to investigate whether empathy changed similarly or differently within different geographical locations. RESULTS The studies reviewed indicate similar patterns of empathy change within approximate geo-sociocultural clusters. Whereas US studies predominantly show small but significant decreases in empathy, Far Eastern studies mostly show small but significant increases in empathy as undergraduates progress through the medical course. CONCLUSIONS These results suggest that change in empathy during undergraduate medical education is not as indiscriminate (patternless) as once thought. Additionally, these results support the notion that empathy is a locally construed global construct.
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Affiliation(s)
- Gominda Ponnamperuma
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Su Ping Yeo
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dujeepa D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Weilenmann S, Schnyder U, Parkinson B, Corda C, von Känel R, Pfaltz MC. Emotion Transfer, Emotion Regulation, and Empathy-Related Processes in Physician-Patient Interactions and Their Association With Physician Well-Being: A Theoretical Model. Front Psychiatry 2018; 9:389. [PMID: 30210371 PMCID: PMC6121172 DOI: 10.3389/fpsyt.2018.00389] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/02/2018] [Indexed: 01/10/2023] Open
Abstract
Physicians experience many emotionally challenging situations in their professional lives, influencing their emotional state through emotion contagion or social appraisal processes. Successful emotion regulation is crucial to sustain health, enable well-being, foster resilience, and prevent burnout or compassion fatigue. Despite the alarmingly high rate of stress-related disorders in physicians, affecting not only physician well-being, but also outcomes such as physician performance, quality of care, or patient satisfaction, research on how to deal with emotionally challenging situations in physicians is lacking. Based on extant literature, the present article proposes a theoretical model depicting emotions, emotion regulation, and empathy-related processes and their relation to well-being in provider-client interactions. This model serves as a basis for future research and interventions aiming at improving physician well-being and professional functioning. As a first step, interviews with 21 psychiatrists were conducted. Results of qualitative and initial quantitative analyses provided detailed descriptions of the model's components confirming its usefulness for detecting mechanisms linking emotion regulation and well-being in psychiatrist-patient interactions. Additionally, results lend preliminary support for the validity of the model, suggesting that successful regulation of emotions (i.e., achieving a desired emotional state) elicited by cyclical transfer processes in provider-client interactions is associated with both short- and long-term well-being and resilience. Furthermore, empathy-related emotions and their regulation seem to be linked to well-being. Based on the results of the present study, a prospective longitudinal study is under preparation, which is intended to inform effective interventions targeting emotion transfer, empathy-related processes, and emotion regulation in physicians' professional lives. The model and results are also potentially applicable to other health care and social services providers.
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Affiliation(s)
- Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Brian Parkinson
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Claudio Corda
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Monique C. Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
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Spring VL, Cameron CD, McKee S, Todd AR. Intentional and Unintentional Empathy for Pain Among Physicians and Nonphysicians. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2018. [DOI: 10.1177/1948550618771890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Empathy can be both beneficial and costly. This trade-off is pertinent for physicians who must care for patients while maintaining emotional distance to avoid burnout. Prior work using self-report and neurophysiological measures has found mixed evidence for differences in empathy between physicians and nonphysicians. We used implicit measurement and multinomial modeling to examine intentional empathy (IE) and unintentional empathy (UE) for pain among physicians and demographically matched nonphysicians. Relative to nonphysicians, physicians displayed greater ability to judge the painfulness of target experiences (i.e., IE). Contrary to some prior work, however, physicians and nonphysicians displayed comparable spontaneous resonance with distracter experiences (i.e., UE). These findings suggest that physicians may be more likely than nonphysicians to empathize with others’ pain when empathy aligns with their overt goals.
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Affiliation(s)
- Victoria L. Spring
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - C. Daryl Cameron
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Stephanie McKee
- Psychology Department, University of Kentucky, Lexington, KY, USA
| | - Andrew R. Todd
- Psychology Department, University of California, Davis, CA, USA
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Romosan RS, Dehelean L, Enatescu VR, Bredicean AC, Papava I, Giurgi-Oncu C, Romosan AM. Profiling undergraduate students from a Romanian medical university. Neuropsychiatr Dis Treat 2018; 14:1891-1899. [PMID: 30100724 PMCID: PMC6063451 DOI: 10.2147/ndt.s165797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Medical students' personality traits, emotion regulation strategies, and empathic behavior are considered powerful predictors for their future achievements, professional adjustment, and mental strength. Coping strategies such as "self-blame," "rumination," "catastrophizing," "blaming others," lack of empathy, decreased emotion recognition abilities, and neuroticism are maladaptive and, thus, less desirable traits in medical professionals. The purpose of the study was to comparatively assess and find potential correlations between personality traits, empathy levels, emotion recognition abilities, and cognitive emotion regulation strategies of three medical student samples: general medicine (GM), dental medicine (DM), and general nursing (GN) students. PATIENTS AND METHODS This cross-sectional comparative study was conducted throughout the second semester of 2017, during Psychiatry class, on 306 medical undergraduates of the "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania. Personality was assessed by using Neuroticism-Extraversion-Openness to Experience Five-Factor Inventory (NEO-FFI). Cognitive emotion regulation strategies were identified using the Cognitive Emotion Regulation Questionnaire (CERQ). Empathy quotient (EQ) was used to measure empathy levels. Emotion recognition abilities were evaluated with the Reading the Mind in the Eyes test (RMET). RESULTS GM students scored significantly higher than both DM and GN students in blaming others (CERQ) and significantly higher than GN students in "neuroticism" (NEO-FFI). GM and DM students obtained significantly lower scores than their GN colleagues in "agreeableness" (NEO-FFI) and empathy (EQ). Compared to DM students, GN students gave significantly more correct answers in RMET. Neuroticism was associated with less efficient coping mechanisms (self-blame, rumination, catastrophizing, blaming others) and lower empathy scores. Empathy correlated negatively with blaming others and was positively associated with agreeableness and emotion recognition abilities. CONCLUSION The differences found between the student samples can be consequences of several overlapping factors. Certain personality traits may predispose individuals to maladaptive coping responses, increased vulnerability to stress, and lower empathy levels. The results of this study can be viewed as baseline data for future, more comprehensive, longitudinal analyses.
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Affiliation(s)
- Radu-Stefan Romosan
- Department of Neurosciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania,
| | - Liana Dehelean
- Department of Neurosciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania,
| | - Virgil-Radu Enatescu
- Department of Neurosciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania,
| | - Ana Cristina Bredicean
- Department of Neurosciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania,
| | - Ion Papava
- Department of Neurosciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania,
| | - Catalina Giurgi-Oncu
- Department of Neurosciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania,
| | - Ana-Maria Romosan
- Department of Neurosciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania,
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Ferreira-Valente A, Monteiro JS, Barbosa RM, Salgueira A, Costa P, Costa MJ. Clarifying changes in student empathy throughout medical school: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1293-1313. [PMID: 27465064 DOI: 10.1007/s10459-016-9704-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/21/2016] [Indexed: 05/07/2023]
Abstract
Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.
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Affiliation(s)
- Alexandra Ferreira-Valente
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, Gualtar, 4710-057, Braga, Portugal
- 3B PT Government Associate Laboratory, Braga, Guimarães, Portugal
- University Lusíada of Lisbon, Lisbon, Portugal
| | - Joana S Monteiro
- USF Odisseia, Maia, Portugal
- Faculty of Medicine, Oporto University, Porto, Portugal
| | | | - Ana Salgueira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, Gualtar, 4710-057, Braga, Portugal
- 3B PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, Gualtar, 4710-057, Braga, Portugal
- 3B PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Manuel J Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, Gualtar, 4710-057, Braga, Portugal.
- 3B PT Government Associate Laboratory, Braga, Guimarães, Portugal.
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21
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Smith KE, Norman GJ, Decety J. The complexity of empathy during medical school training: evidence for positive changes. MEDICAL EDUCATION 2017; 51:1146-1159. [PMID: 28884471 PMCID: PMC5657391 DOI: 10.1111/medu.13398] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/16/2017] [Accepted: 06/12/2017] [Indexed: 05/13/2023]
Abstract
CONTEXT Empathy is an essential aspect of clinical care, associated with improved patient satisfaction, increased adherence to treatment, and fewer malpractice complaints. Previous studies suggest that empathy declines during medical training. However, past research relied on a single narrowly operationalised, self-report measure of empathy. As empathy is a complex socio-emotional construct, it is critical to assess changes across its distinct components using multiple measures in order to better understand how it is influenced by medical training. METHODS In a longitudinal study, medical students completed a series of self-report and behavioural measures twice per year during the first 3 years of their study (2012-2015). These included the previously used Jefferson Scale of Physician Empathy (JSPE), designed to assess empathy in the clinical context, the Questionnaire of Cognitive and Affective Empathy (QCAE), designed to assess overall empathy and its main components, and behavioural measures of sensitivity to others' pain and understanding of others' emotions, both of which are important aspects of empathy. The employment of multiple measures allowed for a more complete assessment of medical students' empathy and related processes. RESULTS In reflection of findings in previous work, students' empathy assessed by the JSPE decreased over training. However, on the QCAE, aspects of students' empathy, specifically overall cognitive empathy and its subcomponent perspective taking, and the emotion contagion subcomponent of affective empathy improved, whereas the remaining subcomponents remained stable. During medical school, students also exhibited comparable growth in their understanding of others' emotions and increased sensitivity to others' pain. CONCLUSIONS Changes in empathy during medical school cannot be simply characterised as representing an overall decline. Indeed, aspects of empathy thought to be valuable in positive physician-patient interactions improve during training. Overall, this study points to the importance of assessing the distinct components of empathy using multiple forms of measurement in order to better understand the mechanisms involved in empathy changes in medical practice.
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Affiliation(s)
- Karen E Smith
- Department of Psychology, University of Chicago, Chicago, Illinois, USA
| | - Greg J Norman
- Grossman Institute for Neuroscience, University of Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Behavioural Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Jean Decety
- Department of Psychology, University of Chicago, Chicago, Illinois, USA
- Grossman Institute for Neuroscience, University of Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Behavioural Neuroscience, University of Chicago, Chicago, Illinois, USA
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22
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Martingano AJ, Martingano D. Measuring Multidimensional Empathy: Theoretical and Practical Considerations for Osteopathic Medical Researchers. J Osteopath Med 2017; 117:697-704. [DOI: 10.7556/jaoa.2017.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
Osteopathic physicians are increasingly recognizing the importance of empathy for improving patient satisfaction and clinical outcomes. This review advocates for a multidimensional perspective of empathy, encompassing both affective and cognitive empathy, and highlights situational and dispositional factors relevant to the curtailment of empathy. A review of the utility of self-report, behavioral, and physiological measures that researchers may use to quantify empathy in further research is also provided. The authors encourage members of the osteopathic medical profession to embrace a fuller understanding of empathy.
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Santamaría-García H, Baez S, García AM, Flichtentrei D, Prats M, Mastandueno R, Sigman M, Matallana D, Cetkovich M, Ibáñez A. Empathy for others' suffering and its mediators in mental health professionals. Sci Rep 2017; 7:6391. [PMID: 28743987 PMCID: PMC5527046 DOI: 10.1038/s41598-017-06775-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/16/2017] [Indexed: 12/30/2022] Open
Abstract
Empathy is a complex cognitive and affective process that allows humans to experience concern for others, comprehend their emotions, and eventually help them. In addition to studies with healthy subjects and various neuropsychiatric populations, a few reports have examined this domain focusing on mental health workers, whose daily work requires the development of a saliently empathic character. Building on this research line, the present population-based study aimed to (a) assess different dimensions of empathy for pain in mental health workers relative to general-physicians and non-medical workers; and (b) evaluate their relationship with relevant factors, such as moral profile, age, gender, years of experience, and workplace type. Relative to both control groups, mental health workers exhibited higher empathic concern and discomfort for others' suffering, and they favored harsher punishment to harmful actions. Furthermore, this was the only group in which empathy variability was explained by moral judgments, years of experience, and workplace type. Taken together, these results indicate that empathy is continuously at stake in mental health care scenarios, as it can be affected by contextual factors and social contingencies. More generally, they highlight the importance of studying this domain in populations characterized by extreme empathic demands.
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Affiliation(s)
- Hernando Santamaría-García
- Centro de Memoria y Cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
- Pontificia Universidad Javeriana, Psychiatry and Physiology Department, Bogotá, Colombia
- Grupo de Investigación Cerebro y Cognición Social, Bogotá, Colombia
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Sandra Baez
- Grupo de Investigación Cerebro y Cognición Social, Bogotá, Colombia
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Adolfo M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Faculty of Education, National University of Cuyo (UNCuyo), Mendoza, Argentina
| | | | - María Prats
- IntramedPortal www.intramed.net, Buenos Aires, CABA, Argentina
| | | | - Mariano Sigman
- Universidad Torcuato di Tella, Laboratorio de Neurociencias, Buenos, Aires, Argentina
| | - Diana Matallana
- Centro de Memoria y Cognición Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
- Pontificia Universidad Javeriana, Aging Institute Bogotá, Bogotá, Colombia
| | - Marcelo Cetkovich
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
- Universidad Autónoma del Caribe, Barranquilla, Colombia.
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile.
- Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, Australia.
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Foster A, Trieu M, Azutillo E, Halan S, Lok B. Teaching Empathy in Healthcare: from Mirror Neurons to Education Technology. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s41347-017-0019-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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25
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Colombo ES, Crippa F, Calderari T, Prato-Previde E. Empathy toward animals and people: The role of gender and length of service in a sample of Italian veterinarians. J Vet Behav 2017. [DOI: 10.1016/j.jveb.2016.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Schoenfeld-Tacher RM, Shaw JR, Meyer-Parsons B, Kogan LR. Changes in Affective and Cognitive Empathy among Veterinary Practitioners. JOURNAL OF VETERINARY MEDICAL EDUCATION 2017; 44:63-71. [PMID: 28206845 DOI: 10.3138/jvme.0116-009r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Clinical empathy is a multi-dimensional concept characterized by four dimensions: (1) affective-the ability to experience patients' or clients' emotions and perspectives, (2) moral-the internal motivation to empathize, (3) cognitive-the intellectual ability to identify and comprehend others' perspective and emotions, and (4) behavioral-the ability to convey understanding of those emotions and perspectives back to the patient or client. The Davis Interpersonal Reactivity Index (IRI) was used to examine the affective and cognitive facets of empathy in veterinary practitioners. The IRI consists of four subscales that measure cognitive (perspective taking and fantasy) and affective (emphatic concern and personal distress) components of empathy. Data from a cross-sectional sample of practicing veterinarians (n=434) were collected. Veterinarians' fantasy scores were lowest for those with the most clinical experience. Personal distress scores were highest among new veterinarians and lowest for those with 26 or more years in practice. High levels of personal distress in the early years of practice are concerning for the professional wellness of veterinarians. To combat this trend, the implementation of resilience-building interventions should be considered to support veterinary practitioners.
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Grossi D, Longarzo M, Quarantelli M, Salvatore E, Cavaliere C, De Luca P, Trojano L, Aiello M. Altered functional connectivity of interoception in illness anxiety disorder. Cortex 2016; 86:22-32. [PMID: 27871020 DOI: 10.1016/j.cortex.2016.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/22/2016] [Accepted: 10/28/2016] [Indexed: 11/24/2022]
Abstract
Interoception collects all information coming from the body and is sustained by several brain areas such as insula and cingulate cortex. Here, we used resting-state functional magnetic resonance imaging to investigate functional connectivity (FC) of networks implied in interoception in patients with Illness anxiety disorders (IADs). We observed significantly reduced FC between the left extrastriate body area (EBA) and the paracentral lobule compared to healthy controls. Moreover, the correlation analysis between behavioural questionnaires and ROI to ROI FC showed that higher levels of illness anxiety were related to hyper-connectivity between EBA and amygdala and hippocampus. Scores on a questionnaire for interoceptive awareness were significantly correlated with higher FC between right hippocampus and nucleus accumbens bilaterally, and with higher connectivity between left anterior cingulate cortex (ACC) and left orbitofrontal cortex (OFC). Last, patients showed increased interoceptive awareness, measured by Self-Awareness Questionnaire (SAQ), and reduced capability in recognizing emotions, indicating inverse correlation between interoception and emotional awareness. Taken together our results suggested that, in absence of structural and micro-structural changes, patients with IADs show functional alteration in the neural network involved in the self-body representation; such functional alteration might be the target of possible treatments.
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Affiliation(s)
- Dario Grossi
- Department of Psychology, Second University of Naples, Italy
| | | | - Mario Quarantelli
- Institute of Biostructure and Bioimaging, National Research Council, Naples, Italy
| | - Elena Salvatore
- Department of Neuroscience Reproductive Sciences and Odontostomatology, University Federico II, Naples, Italy
| | | | | | - Luigi Trojano
- Department of Psychology, Second University of Naples, Italy
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Thirioux B, Birault F, Jaafari N. Empathy Is a Protective Factor of Burnout in Physicians: New Neuro-Phenomenological Hypotheses Regarding Empathy and Sympathy in Care Relationship. Front Psychol 2016; 7:763. [PMID: 27303328 PMCID: PMC4880744 DOI: 10.3389/fpsyg.2016.00763] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/06/2016] [Indexed: 11/14/2022] Open
Abstract
Burnout is a multidimensional work-related syndrome that is characterized by emotional exhaustion, depersonalization-or cynicism-and diminution of personal accomplishment. Burnout particularly affects physicians. In medicine as well as other professions, burnout occurrence depends on personal, developmental-psychodynamic, professional, and environmental factors. Recently, it has been proposed to specifically define burnout in physicians as "pathology of care relationship." That is, burnout would arise, among the above-mentioned factors, from the specificity of the care relationship as it develops between the physician and the patient. Accordingly, experimental studies and theoretical approaches have suggested that burnout and empathy, which is one of the most important skills in physicians, are closely linked. However, the nature of the relation between burnout and empathy remains not yet understood, as reflected in the variety of theoretical and contradictory hypotheses attempting to causally relate these two phenomena. Firstly, we here question the epistemological problem concerning the modality of the burnout-empathy link. Secondly, we hypothesize that considering the multidimensional features of both burnout and empathy, on one hand, and on the other hand, the distinction between empathy and sympathy enables to overcome these contradictions and, consequently, gives a better understanding of the relationship between burnout and empathy in physicians. Thirdly, we propose that clarifying the link between burnout, empathy and sympathy would enable developing specific training in medical students and continuous professional formation in senior physicians and would potentially contribute to the prevention of burnout in medical care.
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Affiliation(s)
- Bérangère Thirioux
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à Vocation Régionale Pierre Deniker, Centre Hospitalier Henri LaboritPoitiers, France
| | - François Birault
- Faculté de Médecine et de Pharmacie, Département de Médecine Générale, Université de PoitiersPoitiers, France
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à Vocation Régionale Pierre Deniker, Centre Hospitalier Henri LaboritPoitiers, France
- Institut National de la Santé et de la Recherche Médicale CIC-P 1402 du Centre Hospitalo-Universitaire de Poitiers, Institut National de la Santé et de la Recherche Médicale U 1084, Experimental and Clinical Neuroscience Laboratory, Groupement de Recherche Centre National de la Recherche Scientifique 3557, Université de PoitiersPoitiers, France
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Park C, Lee YJ, Hong M, Jung CH, Synn Y, Kwack YS, Ryu JS, Park TW, Lee SA, Bahn GH. A Multicenter Study Investigating Empathy and Burnout Characteristics in Medical Residents with Various Specialties. J Korean Med Sci 2016; 31:590-7. [PMID: 27051244 PMCID: PMC4810343 DOI: 10.3346/jkms.2016.31.4.590] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/22/2015] [Indexed: 12/30/2022] Open
Abstract
We assessed empathy in medical residents, including factors modifying empathy and the relationship between empathy and burnout. Participants (n = 317 residents, response rate = 42%) from 4 university hospitals completed a socio-demographic questionnaire, the Jefferson Scale of Empathy (Health Professional version, Korean edition), and the Maslach Burnout Inventory (MBI). Participants were classified by medical specialty: "people-oriented specialty" (POS group) or "technology-oriented specialty" (TOS group), with more women in the POS than in the TOS group, χ(2) = 14.12, P < 0.001. Being female, married, and having children were factors related to higher empathy (gender, t = -2.129, P = 0.034; marriage, t = -2.078, P = 0.038; children, t = 2.86, P = 0.005). Within specialty group, POS residents showed higher empathy scores in the fourth as compared to the first year, F = 3.166, P = 0.026. Comparing POS and TOS groups by year, fourth year POS residents had significantly higher scores than did fourth year TOS residents, t = 3.349, P = 0.002. There were negative correlations between empathy scores and 2 MBI subscales, emotional exhaustion (EE) and depersonalization (DP). Additionally, first year POS residents had higher DP scores than did first year TOS residents, t = 2.183, P = 0.031. We suggest that factors important for empathy are type of medical specialty, marriage, siblings, and children. Burnout state may be related to decreasing empathy.
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Affiliation(s)
- Chanmin Park
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea
| | - Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Hospital, Seoul, Korea
| | - Minha Hong
- Department of Psychiatry, Myongji Hospital, Goyang, Korea
| | - Chul-Ho Jung
- Department of Psychiatry, Keimyung University College of Medicine, Daegu, Korea
| | - Yeni Synn
- Department of Psychiatry, Keimyung University College of Medicine, Daegu, Korea
| | - Young-Sook Kwack
- Department of Psychiatry, Jeju National University College of Medicine, Jeju, Korea
| | - Jae-Sung Ryu
- Department of Psychiatry, Jeju National University College of Medicine, Jeju, Korea
| | - Tae Won Park
- Department of Psychiatry, Chonbuk National University College of Medicine, Jeonju, Korea
| | - Seong Ae Lee
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea
| | - Geon Ho Bahn
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Korea
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Buck E, Holden M, Szauter K. A Methodological Review of the Assessment of Humanism in Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:S14-S23. [PMID: 26505097 DOI: 10.1097/acm.0000000000000910] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Humanism is a complex construct that defies simplistic measurement. How educators measure humanism shapes understanding and implications for learners. This systematic review sought to address the following questions: How do medical educators assess humanism in medical students, and how does the measurement impact the understanding of humanism in undergraduate medical education (UME)? METHOD Using the IECARES (integrity, excellence, compassion, altruism, respect, empathy, and service) Gold Foundation framework, a search of English literature databases from 2000 to 2013 on assessment of humanism in medical students revealed more than 900 articles, of which 155 met criteria for analysis. Using descriptive statistics, articles and assessments were analyzed for construct measured, study design, assessment method, instrument type, perspective/source of assessment, student level, validity evidence, and national context. RESULTS Of 202 assessments reported in 155 articles, 162 (80%) used surveys; 164 (81%) used student self-reports. One hundred nine articles (70%) included only one humanism construct. Empathy was the most prevalent construct present in 96 (62%); 49 (51%) of those used a single instrument. One hundred fifteen (74%) used exclusively quantitative data; only 48 (31%) used a longitudinal design. Construct underrepresentation was identified as a threat to validity in half of the assessments. Articles included 34 countries; 87 (56%) were from North America. CONCLUSIONS Assessment of humanism in UME incorporates a limited scope of a complex construct, often relying on single quantitative measures from self-reported survey instruments. This highlights the need for multiple methods, perspectives, and longitudinal designs to strengthen the validity of humanism assessments.
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Schoenfeld-Tacher RM, Kogan LR, Meyer-Parsons B, Royal KD, Shaw JR. Educational Research Report: Changes in Students' Levels of Empathy during the Didactic Portion of a Veterinary Program. JOURNAL OF VETERINARY MEDICAL EDUCATION 2015; 42:194-205. [PMID: 26075622 DOI: 10.3138/jvme.0115-007r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Empathy can be defined as the ability to understand and connect with the emotional state and frame of mind of another. Establishing connections with others is a crucial skill for veterinarians who must earn the trust and compliance of their clients to provide quality care for their patients. This is a longitudinal study using the Davis Interpersonal Reactivity Index (IRI) to assess changes in veterinary students' self-reported empathy as they progressed through the didactic portion of the DVM program at Colorado State University. The IRI consists of four subscales that measure cognitive and affective components of empathy: Perspective Taking, Fantasy, Emphatic Concern, and Personal Distress. Data were collected at three time points, corresponding to the start of the first year, the fourth semester (second year), and the fifth semester (third year). Results showed an overall decline in Perspective Taking scores, with a significant decrease between first and second year. There was an overall increase in students' levels of Personal Distress as they progressed through the program. The significant difference was found between years 1 and 3. This is especially concerning because the enhanced unease in interpersonal interactions coincides with students entering clinical rotations in the third year-the very time when these traits are necessary for quality client and patient care. Veterinary educators are urged to use this information as a basis for investigating novel curricular and programmatic interventions to counteract these changes in student empathy.
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Ainley V, Maister L, Tsakiris M. Heartfelt empathy? No association between interoceptive awareness, questionnaire measures of empathy, reading the mind in the eyes task or the director task. Front Psychol 2015; 6:554. [PMID: 25983715 PMCID: PMC4416382 DOI: 10.3389/fpsyg.2015.00554] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/16/2015] [Indexed: 12/30/2022] Open
Abstract
Interoception, defined as afferent information arising from within the body, is the basis of all emotional experience and underpins the 'self.' However, people vary in the extent to which interoceptive signals reach awareness. This trait modulates both their experience of emotion and their ability to distinguish 'self' from 'other' in multisensory contexts. The experience of emotion and the degree of self/other distinction or overlap are similarly fundamental to empathy, which is an umbrella term comprising affect sharing, empathic concern and perspective-taking (PT). A link has therefore often been assumed between interoceptive awareness (IA) and empathy despite a lack of clear evidence. To test the hypothesis that individual differences in both traits should correlate, we measured IA in four experiments, using a well-validated heartbeat perception task, and compared this with scores on several tests that relate to various aspects of empathy. We firstly measured scores on the Index of Interpersonal Reactivity and secondly on the Questionnaire of Cognitive and Affective Empathy. Thirdly, because the 'simulationist' account assumes that affect sharing is involved in recognizing emotion, we employed the 'Reading the Mind in the Eyes Task' for the recognition of facial expressions. Contrary to expectation, we found no significant relationships between IA and any aspect of these measures. This striking lack of direct links has important consequences for hypotheses about the extent to which empathy is necessarily embodied. Finally, to assess cognitive PT ability, which specifically requires self/other distinction, we used the 'Director Task' but found no relationship. We conclude that the abilities that make up empathy are potentially related to IA in a variety of conflicting ways, such that a direct association between IA and various components of empathy has yet to be established.
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Affiliation(s)
- Vivien Ainley
- Lab of Action and Body, Department of Psychology, Royal Holloway University of London, Egham UK
| | - Lara Maister
- Lab of Action and Body, Department of Psychology, Royal Holloway University of London, Egham UK
| | - Manos Tsakiris
- Lab of Action and Body, Department of Psychology, Royal Holloway University of London, Egham UK
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Grynberg D, Pollatos O. Perceiving one's body shapes empathy. Physiol Behav 2015; 140:54-60. [DOI: 10.1016/j.physbeh.2014.12.026] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 12/19/2022]
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Decety J, Smith KE, Norman GJ, Halpern J. A social neuroscience perspective on clinical empathy. World Psychiatry 2014; 13:233-7. [PMID: 25273287 PMCID: PMC4219055 DOI: 10.1002/wps.20146] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jean Decety
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago5848 S University Avenue, Chicago, IL, 60637, USA,Department of Psychology, University of ChicagoChicago, IL, USA
| | - Karen E Smith
- Department of Psychology, University of ChicagoChicago, IL, USA
| | - Greg J Norman
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago5848 S University Avenue, Chicago, IL, 60637, USA,Department of Psychology, University of ChicagoChicago, IL, USA
| | - Jodi Halpern
- School of Public Health and UCB-UCSF Joint Medical Program, University of CaliforniaBerkeley, CA, USA
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Youssef FF, Nunes P, Sa B, Williams S. An exploration of changes in cognitive and emotional empathy among medical students in the Caribbean. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2014; 5:185-92. [PMID: 25341229 PMCID: PMC4216728 DOI: 10.5116/ijme.5412.e641] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/24/2014] [Indexed: 05/06/2023]
Abstract
OBJECTIVE This study explored the empathy profile of students across five years of medical training. In addition the study examined whether the Jefferson Scale for Physician Empathy correlated with a measure of cognitive empathy, the Reading the Mind in the Eyes Test and a measure of affective empathy, the Toronto Empathy Questionnaire. METHODS The study was a comparative cross-sectional design at one Caribbean medical school. Students were contacted in class, participation was voluntary and empathy was assessed using all three instruments Descriptive statistics were calculated and differences between groups evaluated using non-parametric tests. RESULTS Overall 669 students participated (response rate, 67%). There was a significant correlation between the Jefferson Scale of Physician Empathy and the Toronto Empathy Questionnaire (ρ = 0.48), both scales indicating a decline in medical student empathy scores over time. There was, however, little correlation between scores from the Reading the Mind in the Eyes Test and the Jefferson Scale of Physician Empathy. Female students demonstrated significantly higher scores on all three measures. CONCLUSIONS Medical students' lower empathy scores during their final years of training appear to be due to a change in the affective component of empathy. These findings may reflect an adaptive neurobiological response to the stressors associated with encountering new clinical situations. Attention should be paid not only to providing empathy training for students but also to teaching strategies for improved cognitive processing capacity when they are encountering new and challenging circumstances.
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Affiliation(s)
- Farid F. Youssef
- />Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
- Correspondence: Farid F Youssef, Department of Preclinical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Paula Nunes
- />Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
| | - Bidyadhar Sa
- />Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
| | - Stella Williams
- />Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
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Gleichgerrcht E, Decety J. The relationship between different facets of empathy, pain perception and compassion fatigue among physicians. Front Behav Neurosci 2014; 8:243. [PMID: 25071495 DOI: 10.3389/fnbeh.2014.00243/abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/25/2014] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Medical practitioners such as physicians are continuously exposed to the suffering and the distress of patients. Understanding the way pain perception relates to empathetic dispositions and professional quality of life can contribute to the development of strategies aimed at protecting health professionals from burnout and compassion fatigue. In the present study we investigate the way individual dispositions relate to behavioral measures of pain sensitivity, empathy, and professional quality of life. METHODS A secure Web-based series of self-report measures and a behavioral task were administered to 1,199 board-certified physicians. Additionally, surveys were used to obtain measures of demographic and professional background; dispositional empathy (empathic concern, personal distress, and perspective taking); positive (compassion satisfaction) and negative (burnout and secondary traumatic stress) aspects of their professional life. In the behavioral task, participants were asked to watch a series of video clips of patients experiencing different levels of pain and provide ratings of pain intensity and induced personal distress. RESULTS Perceived pain intensity was significantly lower among more experienced physicians but similar across specialty fields with varying demands of emotional stress. Watching videos of patients in pain, however, elicited more personal distress among physicians in highly demanding medical fields, despite comparable empathy dispositions with other fields. The pain of male patients was perceived as less intense than the pain of female patients, and this effect was more marked for female physicians. The effect of dispositional empathy on pain perception and induced personal distress was different for each sub-component, with perspective taking and empathic concern (EC) being predictive of the behavioral outcomes. Physicians who experience both compassion satisfaction and fatigue perceive more pain and suffer more personal distress from it than those who only suffer the negative aspects of professional quality of life. CONCLUSIONS Professional experience seems to desensitize physicians to the pain of others without necessarily helping them down-regulate their own personal distress. Pain perception is also related with specific aspects of empathy and varies depending on context, as is the case with the gender of their patients. Minimum levels of empathy appear necessary to benefit from the positive aspects of professional quality of life in medicine.
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Affiliation(s)
- Ezequiel Gleichgerrcht
- Department of Medicine and Department of Psychology, Favaloro University Buenos Aires, Argentina ; UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University Santiago, Chile
| | - Jean Decety
- Department of Psychology and Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Chicago, IL, USA
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Gleichgerrcht E, Decety J. The relationship between different facets of empathy, pain perception and compassion fatigue among physicians. Front Behav Neurosci 2014; 8:243. [PMID: 25071495 PMCID: PMC4093939 DOI: 10.3389/fnbeh.2014.00243] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/25/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Medical practitioners such as physicians are continuously exposed to the suffering and the distress of patients. Understanding the way pain perception relates to empathetic dispositions and professional quality of life can contribute to the development of strategies aimed at protecting health professionals from burnout and compassion fatigue. In the present study we investigate the way individual dispositions relate to behavioral measures of pain sensitivity, empathy, and professional quality of life. METHODS A secure Web-based series of self-report measures and a behavioral task were administered to 1,199 board-certified physicians. Additionally, surveys were used to obtain measures of demographic and professional background; dispositional empathy (empathic concern, personal distress, and perspective taking); positive (compassion satisfaction) and negative (burnout and secondary traumatic stress) aspects of their professional life. In the behavioral task, participants were asked to watch a series of video clips of patients experiencing different levels of pain and provide ratings of pain intensity and induced personal distress. RESULTS Perceived pain intensity was significantly lower among more experienced physicians but similar across specialty fields with varying demands of emotional stress. Watching videos of patients in pain, however, elicited more personal distress among physicians in highly demanding medical fields, despite comparable empathy dispositions with other fields. The pain of male patients was perceived as less intense than the pain of female patients, and this effect was more marked for female physicians. The effect of dispositional empathy on pain perception and induced personal distress was different for each sub-component, with perspective taking and empathic concern (EC) being predictive of the behavioral outcomes. Physicians who experience both compassion satisfaction and fatigue perceive more pain and suffer more personal distress from it than those who only suffer the negative aspects of professional quality of life. CONCLUSIONS Professional experience seems to desensitize physicians to the pain of others without necessarily helping them down-regulate their own personal distress. Pain perception is also related with specific aspects of empathy and varies depending on context, as is the case with the gender of their patients. Minimum levels of empathy appear necessary to benefit from the positive aspects of professional quality of life in medicine.
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Affiliation(s)
- Ezequiel Gleichgerrcht
- Department of Medicine and Department of Psychology, Favaloro University Buenos Aires, Argentina ; UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University Santiago, Chile
| | - Jean Decety
- Department of Psychology and Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Chicago, IL, USA
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Caruso HM, Bernstein B. Evidence of declining empathy in third year osteopathic medical students. INT J OSTEOPATH MED 2014. [DOI: 10.1016/j.ijosm.2013.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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