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Gertz AM, Smith M, Thomas D, Ti A, Vamos C, Bohn J. A qualitative study to explore experiences of anti-racism teaching in medical residency programs across the United States and subsequent creation of the SPOC (Support - Pipeline - Outcomes - Community) Model to guide future curricula design. BMC MEDICAL EDUCATION 2024; 24:382. [PMID: 38589833 PMCID: PMC11003050 DOI: 10.1186/s12909-024-05305-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Racism contributes to health disparities and is a serious threat to public health. Teaching physicians about racism, how to address it in medical practice, and developing high quality and sustainable curricula are essential to combating racism. OBJECTIVE This study aimed to (1) describe the experience of racism and anti-racism teaching in residency programs, and elicit recommendations from key informants, and (2) use these data and formative research to develop recommendations for other residencies creating, implementing, and evaluating anti-racism curricula in their own programs. METHODS From May to July 2023, 20 faculty and residents were recruited via convenience sampling for key informant interviews conducted via Microsoft Teams. Interviews were audio recorded, transcribed, and coded. An initial list of themes was developed using theoretical frameworks, and then refined using a grounded-theory approach. A brief online optional anonymous demographic survey was sent to participants in August of 2023. RESULTS: Eighty percent (20/25) of participants approached were interviewed. Seventy-five percent (15/20) answered a brief optional demographic survey. Seven themes emerged: (1) Racism in medicine is ubiquitous; (2) Anti-racism teaching in medicine varies widely; (3) Sustainability strategies should be multifaceted and include recruitment, resource allocation, and outcome measures; (4) Resources are widely available and accessible if one knows where to look; (5) Outcomes and metrics of success should include resident- faculty-, patient- community-, and system-focused outcomes; (6) Curricular strategies should be multilayered, longitudinal, and woven into the curriculum; and (7) Self-reflection and discomfort are necessary parts of the process. CONCLUSIONS: This study is one of the first to qualitatively examine perspectives of key stakeholders invested in anti-racism teaching for residents. The Support - Pipeline - Outcomes - Community (SPOC) Model, that was developed using information collected during this study, can be used in the future as a guide for others working to design and implement sustainable and high quality anti-racism curricula for residents.
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Affiliation(s)
- Alida M Gertz
- Wellstar Douglas Family Medicine Residency Program, Douglasville, GA, USA.
- College of Public Health, University of South Florida, Tampa, USA.
| | - Michele Smith
- Wellstar Douglas Family Medicine Residency Program, Douglasville, GA, USA
| | - Davon Thomas
- Wellstar Douglas Family Medicine Residency Program, Douglasville, GA, USA
| | - Angeline Ti
- Wellstar Douglas Family Medicine Residency Program, Douglasville, GA, USA
| | - Cheryl Vamos
- College of Public Health, University of South Florida, Tampa, USA
| | - Joe Bohn
- College of Public Health, University of South Florida, Tampa, USA
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Byrne M, Campos C, Daly S, Lok B, Miles A. The current state of empathy, compassion and person-centred communication training in healthcare: An umbrella review. PATIENT EDUCATION AND COUNSELING 2024; 119:108063. [PMID: 38008647 DOI: 10.1016/j.pec.2023.108063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/18/2023] [Accepted: 11/08/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES This umbrella review consolidates evidence available on empathy training, its effectiveness and design mechanisms that contribute to effectiveness. METHODS We conducted an umbrella review (review of reviews) of empathy, compassion and person-centred communication training in healthcare published between 2018 and 2022. One reviewer screened titles, abstracts and full-text articles, with a second reviewer at full-text stage. Quality appraisal was done in duplicate. Data extraction was piloted by two reviewers and conducted by one reviewer with a quality check of all extracted data. All reviewers provided input into synthesis of results and analysis. RESULTS Twenty-five reviews were included. We provide an overview of the definitions of empathy, compassion and person-centred communication, outcome measures used, a synthesis of findings on the mechanisms and effectiveness of training and a summary of review recommendations. CONCLUSIONS For policy and practice, we advise the inclusion of empathic communication into the curriculum; longitudinal and sequenced learning; debriefing, targeted feedback, enabling self-reflection, deliberate practice, experiential learning; improving motivation by teaching the benefits of empathy and teaching sustainable empathy. Future research should involve patients in training and research and study the effect of targeting interventions at healthcare practitioners and patients.
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Affiliation(s)
- Monika Byrne
- School of Psychology, University of Auckland, New Zealand.
| | - Carlos Campos
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, New Zealand
| | - Svetlana Daly
- School of Psychology, University of Auckland, New Zealand
| | - Benjamin Lok
- Virtual Experiences Research Group, University of Florida, USA
| | - Anna Miles
- School of Psychology, University of Auckland, New Zealand
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Salazar K, Adams JL, Nies MA, Robinson R, Hedwig T, Hellem T. Our Patients Need Empathy Training across Healthcare Professions. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100011. [PMID: 37288677 DOI: 10.1016/j.ajpe.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/09/2023]
Abstract
Vulnerable populations are those who experience disparity at a disproportionate rate. For this article, specific vulnerable populations of interest include people who experience intellectual or developmental disorders, mental illness, or substance misuse. Vulnerable populations are some of the most stigmatized populations in our society. Research shows that vulnerable populations receive less empathic care than general health care populations, resulting in reduced quality of care and disparities in health outcomes. Empathy, a necessary health care competency, is associated with improved patient outcomes, enhanced job satisfaction, and increased retention and resilience across health care professions. However, there is no current standard for how empathy is taught, assessed, or sustained. Even when empathy education is implemented in healthcare professions curricula, research has demonstrated that it appears to erode with experience and time. In addition, the COVID-19 pandemic has exacerbated inequities in health care systems, with consequences for both patients and providers. There is an urgent need to develop efficacious training in empathy across health care professions to foster and sustain a robust workforce and improve health care experiences and outcomes.
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Affiliation(s)
- Krista Salazar
- University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | | | - Mary A Nies
- Idaho State University College of Health, Pocatello, ID, USA
| | - Renee Robinson
- Idaho State University College of Pharmacy, Anchorage, AK, USA
| | - Travis Hedwig
- University of Alaska Anchorage College of Health, Anchorage, AK, USA
| | - Tracy Hellem
- Montana State University Mark and Robyn Jones College of Nursing, Bozeman, MT, USA
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Innes SI, Simpson JK. Empathy levels in Australian chiropractic students. THE JOURNAL OF CHIROPRACTIC EDUCATION 2022; 36:110-116. [PMID: 35294012 PMCID: PMC9536223 DOI: 10.7899/jce-21-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/12/2021] [Accepted: 09/13/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Empathy is an important modifiable quality of health care practitioners that relates to the quality of patient care. The educative process may adversely affect the empathy levels of health care students at key phases of training. This topic remains unexplored in chiropractic students to date. METHODS A voluntary and anonymous questionnaire was distributed to all chiropractic students in an Australian university-based program in April 2021. This questionnaire recorded age, sex, year of study, and Toronto Empathy Questionnaire scores. RESULTS Chiropractic student empathy scores approximated those of other Australian health care students. No statistical differences were found when comparing the mean scores of empathy levels across the 5 student cohorts. The empathy levels of female chiropractic students' were significantly higher than those of the male chiropractic students. CONCLUSION This study provides a baseline from which further explorations on empathy may be conducted in chiropractic students. This holds the potential to improve practitioners' quality of life and patient outcomes and for educators to identify subject matter that may negatively affect empathy levels.
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McCullough LB, Coverdale J, Chervenak FA. John Gregory's medical ethics elucidates the concepts of compassion and empathy. MEDICAL TEACHER 2022; 44:45-49. [PMID: 34372747 DOI: 10.1080/0142159x.2021.1960295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This paper draws on eighteenth-century British medical ethics to elucidate compassion and empathy and explains how compassion and empathy can be taught, to rectify their frequent conflation. COMPASSION IN THE HISTORY OF MEDICAL ETHICS The professional virtue of compassion was first described in eighteenth-century British medical ethics by the Scottish physician-ethicist, John Gregory (1724-1773) who built on the moral psychology of David Hume (1711-1776) and its principle of sympathy. COMPASSION AND EMPATHY DEFINED Compassion is the habitual exercise of the affective capacity to engage, with self-discipline, in the experience of the patient and therefore become driven to provide effective care for the patient. Empathy is the habitual exercise of the cognitive capacity to imagine the experience of patient and to have reasons to care for the patient. There are rare clinical circumstances in which empathy should replace compassion, for example, in responding to abusive patients. Because the abstract concepts of medical ethics are translated into clinical practice by medical educators, we identify the pedagogical implications of these results by setting out a process for teaching compassion and empathy. THE TASK AHEAD Eighteenth-century British medical ethics provides a clinically applicable, philosophical response to conflation of the moral virtue of compassion and the intellectual virtue of empathy and applying them clinically.
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Affiliation(s)
- Laurence B McCullough
- Professor of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Ethics Scholar, Lenox Hill Hospital, New York, NY, USA
| | - John Coverdale
- Professor of Psychiatry and Behavioral Sciences and of Medical Ethics, Baylor College of Medicine, Houston, TX, USA
| | - Frank A Chervenak
- Professor and Departmental Chair of Obstetrics and Gynecology, Associate Dean for International Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Departmental Chair of Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY, USA
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Mehta A, Adams N, Fredrickson M, Kraszkiewicz W, Siy J, Hamel L, Hendel-Paterson B. Craving Empathy: Studying the Sustained Impact of Empathy Training on Clinicians. J Patient Exp 2021; 8:23743735211043383. [PMID: 34604510 PMCID: PMC8481707 DOI: 10.1177/23743735211043383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Evidence is sparse when it comes to the longitudinal impact of educational interventions on empathy among clinicians. Additionally, most available research on empathy is on medical trainee cohorts. We set out to study the impact of empathy and communication training on practicing clinicians' self-reported empathy and whether it can be sustained over six months. An immersive curriculum was designed to teach empathy and communication skills, which entailed experiential learning with simulated encounters and didactics on the foundational elements of communication. Self-reported Jefferson Scale of Empathy (JSE) was scored before and at two points (1-4 weeks and 6 months) after the training. Overall, clinicians' mean self-empathy scores increased following the workshop and were sustained at six months. Specifically, the perspective taking domain of the empathy scale, which relates to cognitive empathy, showed the most responsiveness to educational interventions. Our analysis shows that a structured and immersive training curriculum centered on building communication and empathy skills has the potential to positively impact clinician empathy and sustain self-reported empathy scores among practicing clinicians.
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Affiliation(s)
- Ankit Mehta
- HealthPartners, Bloomington, Minnesota, USA
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, HealthPartners, St. Paul, MN, USA
| | - Nell Adams
- Regions Hospital, HealthPartners, St. Paul, MN, USA
| | - Mary Fredrickson
- HealthPartners, Bloomington, Minnesota, USA
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, HealthPartners, St. Paul, MN, USA
| | - Wojciech Kraszkiewicz
- HealthPartners, Bloomington, Minnesota, USA
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, HealthPartners, St. Paul, MN, USA
| | - Jerome Siy
- HealthPartners, Bloomington, Minnesota, USA
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, HealthPartners, St. Paul, MN, USA
| | - Lydia Hamel
- Regions Hospital, HealthPartners, St. Paul, MN, USA
| | - Brett Hendel-Paterson
- HealthPartners, Bloomington, Minnesota, USA
- University of Minnesota, Minneapolis, MN, USA
- Regions Hospital, HealthPartners, St. Paul, MN, USA
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