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Steinhauser S, Haroz R, Jones I, Skelton W, Fuller BM, Roberts MB, Jones CW, Trzeciak S, Roberts BW. Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. Acad Emerg Med 2024. [PMID: 38881343 DOI: 10.1111/acem.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVES Fear of enacted stigma (fear of discrimination or being treated unfairly) is associated with decreased health care-seeking behaviors among patients with opioid use disorder (OUD). We sought to describe the prevalence of fear of enacted stigma among patients presenting to the emergency department (ED) with OUD and to test whether experiencing greater compassion from ED staff is associated with lower fear of enacted stigma. METHODS We conducted a cross-sectional study in the ED of an academic medical center between February and August 2023. We included adult patients with OUD presenting to the ED and assessed patient experience of compassion from ED staff using a previously validated 5-item compassion measure (score range 5-20). The primary outcome measure was fear of enacted stigma in the ED, measured using the validated 9-item subscale of the Substance Abuse Self-Stigma Scale (score range 9-45). RESULTS Of the 116 subjects enrolled, 97% (95% confidence interval [CI] 91%-99%) reported some degree of stigma, with a median (interquartile range) score of 23 (16-31). In a multivariable model adjusting for potential confounders, patient experience of greater ED compassion was independently associated with lower fear of enacted stigma, β = -0.66 (95% CI -1.03 to -0.29), suggesting that every 1-point increase in the 5-item compassion measure score is associated with a 0.66-point decrease in the fear of enacted stigma score. CONCLUSIONS Among ED patients with OUD, fear of enacted stigma is common. Patient experience of compassion from ED staff is associated with lower fear of enacted stigma. Future research is warranted to test if interventions aimed at increasing compassion from ED staff reduce patient fear of enacted stigma among patients with OUD.
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Affiliation(s)
- Savannah Steinhauser
- The Department of Emergency Medicine, Cooper University Health Care (CUHC), Cooper Medical School of Rowan University (CMSRU), Camden, New Jersey, USA
| | - Rachel Haroz
- The Department of Emergency Medicine, Cooper University Health Care (CUHC), Cooper Medical School of Rowan University (CMSRU), Camden, New Jersey, USA
- The Department of Emergency Medicine, Division of Toxicology and Addiction Medicine, CUHC/CMSRU, Camden, New Jersey, USA
- Cooper Center for Healing, CUHC/CMSRU, Camden, New Jersey, USA
| | - Iris Jones
- Cooper Center for Healing, CUHC/CMSRU, Camden, New Jersey, USA
| | - William Skelton
- The Department of Emergency Medicine, Cooper University Health Care (CUHC), Cooper Medical School of Rowan University (CMSRU), Camden, New Jersey, USA
- Department of Behavioral Medicine, CUHC/CMSRU, Camden, New Jersey, USA
| | - Brian M Fuller
- Division of Critical Care Medicine, Departments of Emergency Medicine and Anesthesia, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael B Roberts
- Institutional Research and Outcomes Assessment, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher W Jones
- The Department of Emergency Medicine, Cooper University Health Care (CUHC), Cooper Medical School of Rowan University (CMSRU), Camden, New Jersey, USA
| | | | - Brian W Roberts
- The Department of Emergency Medicine, Cooper University Health Care (CUHC), Cooper Medical School of Rowan University (CMSRU), Camden, New Jersey, USA
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Paloniemi E, Hagnäs M, Mikkola I, Timonen M, Vatjus R. Reflective capacity and context of reflections: qualitative study of second-year medical students' learning diaries related to a general practice course. BMC MEDICAL EDUCATION 2024; 24:222. [PMID: 38429724 PMCID: PMC10908101 DOI: 10.1186/s12909-024-05199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Reflective capacity is a prerequisite for transformative learning. It is regarded as an essential skill in professional competence in the field of medicine. Our aim was to investigate the reflective capacity and the objects of action (themes) which revealed reflective writing of medical students during a general practice/family medicine course. METHODS Second-year medical students were requested to write learning diaries during a compulsory course in general practice/family medicine consisting of the principles of the physician-patient relationship. The course included a group session supervised by a clinical lecturer and a 3-day training period in a local health centre. We conducted data-driven content analysis of the learning diaries. In the learning diaries, student observations were most commonly directed to events during the training period and to group sessions. Occasionally, observation was directed at inner experience. RESULTS The following themes were related to reflective writing: feelings towards the end of life, demanding situations in practice, physician's attitude to patient, student's inner experiences, and physician's well-being. The entries indicated different types of reflective capacity. Three subgroups were identified: 'simple reporting,' 'reflective writing,' and 'advanced reflective writing.' CONCLUSION Professional growth requires the development of reflective capacity, as it is essential for successful patient care and better clinical outcomes. To develop and enhance the reflective capacity of medical students during their education, the curriculum should provide frequent opportunities for students to assess and reflect upon their various learning experiences.
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Affiliation(s)
- Elina Paloniemi
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Rovaniemi Health Center, The Wellbeing Services County of Lapland, Rovaniemi, Finland
| | - Maria Hagnäs
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Rovaniemi Health Center, The Wellbeing Services County of Lapland, Rovaniemi, Finland
| | - Ilona Mikkola
- Research Unit of Population Health, University of Oulu, Oulu, Finland.
- Rovaniemi Health Center, The Wellbeing Services County of Lapland, Rovaniemi, Finland.
| | - Markku Timonen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Ritva Vatjus
- Research Unit of Population Health, University of Oulu, Oulu, Finland
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Nijim S, Hamdi I, Cohen S, Katz JT, Ganske IM. Prevalence of visual art education in medical school curricula: a national survey of US medical schools. MEDICAL EDUCATION ONLINE 2023; 28:2277500. [PMID: 37919950 PMCID: PMC10627040 DOI: 10.1080/10872981.2023.2277500] [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: 08/12/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
Background: The Association of American Medical Colleges (AAMC) has recommended integrating medically-relevant arts and humanities curricula into medical student education in order promote physician skills development. An analysis of the state of existing visual arts-based medical school pedagogies was conducted to inform future implementation strategies.Methodology: An electronic survey was distributed to representatives of US medical schools to describe the prevalence and characteristics of visual arts-based medical school curricula. Official courses, informal events, cross-registration opportunities, and established art museum partnerships were assessed.Results: Survey response rates were 65% for US allopathic medical schools and 56% for osteopathic medical schools. A majority (79%) of responding institutions incorporate or support medical student art experiences in some format. Thirty-one percent (n = 36) of schools offer stand-alone humanities courses using visual arts. These were primarily allopathic programs (n = 35; 37% of allopathic programs) and only one responding osteopathic program (n = 1; 5% of osteopathic programs). Schools without dedicated courses are less likely to report other curricular and extracurricular visual arts engagement. Most visual art medical courses are offered at medical schools located in the Northeastern United States.Conclusions: Many but not all medical schools are incorporating the visual arts into their medical education curriculum. Opportunities to promote increased uptake, more effective implementation, and collaboration strategies for the AAMC recommendations are proposed.
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Affiliation(s)
- Sally Nijim
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Isra Hamdi
- Department of Biology, Harvard University, Cambridge, MA, USA
| | - Stephanie Cohen
- Department of General Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Joel T. Katz
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Ingrid M. Ganske
- Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, USA
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Gill GK, Ng SL, Kangasjarvi E, Crukley J, Kumagai A, Simpson JS. From skillful to empathic: evaluating shifts in medical students' perceptions of surgeons through a combined patient as teacher and arts-based reflection program. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:14-21. [PMID: 38045079 PMCID: PMC10690007 DOI: 10.36834/cmej.76536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Introduction The purpose of this study was to identify whether the incorporation of a combined Patient as teacher (PAT) and arts-based reflection (ABR) program during a surgical clerkship rotation could influence more humanistic perceptions of surgeons, using an innovative evaluation approach. Methods A novel, single question evaluation tool was created. Third year medical-students were asked to "list the top 5 attributes of a surgeon, in order of perceived importance" both before and after their surgical clerkship rotations and participation in the PAT/ABR program. Attributes identified by students were coded as either "humanistic" or "non-humanistic," which were then analyzed using generalized linear regression models under a Bayesian framework. Results After participation in the PAT/ABR program, the predicted probability of students ranking a humanistic characteristic as the most important attribute of a surgeon had increased by 17%, and the predicted probability of students ranking a humanistic characteristic amongst their top three attributes for a surgeon had increased by 21%. Conclusion This innovative evaluative method suggested the success of a combined PAT/ABR program in encouraging a humanistic perspective of surgery and this approach could potentially be explored to evaluate other humanistic education initiatives.
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Affiliation(s)
- Gurjot K Gill
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Stella L Ng
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Emilia Kangasjarvi
- Centre for Faculty Development, University of Toronto at St. Michael’s Hospital, Unity Health Toronto, Ontario, Canada
| | - Jeff Crukley
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Arno Kumagai
- Faculty of Medicine, University of Toronto, Ontario, Canada
- Women’s College Hospital, University of Toronto, Ontario, Canada
| | - Jory S Simpson
- Department of Surgery, University of Toronto Faculty of Medicine, Ontario, Canada
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Wang CXY, Pavlova A, Boggiss AL, O'Callaghan A, Consedine NS. Predictors of Medical Students' Compassion and Related Constructs: A Systematic Review. TEACHING AND LEARNING IN MEDICINE 2023; 35:502-513. [PMID: 35930256 DOI: 10.1080/10401334.2022.2103816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Phenomenon: Compassion, and related constructs such as empathy, are core values in healthcare, with known benefits for both patients and staff. Yet research on the factors that affect compassion and compassion-related constructs remains scattered. This review systematizes and synthesizes studies investigating the predictors of compassion and related constructs among medical students, allowing for a better understanding of the factors that both positively and negatively contribute to the development of compassionate future physicians. Approach: A systematic review of 12 databases for studies from database inception up until April 2020 was conducted. Non-peer-reviewed literature and studies in which >50% of the sample were non-medical students were excluded. Intervention studies were also out of the scope of this review. We assessed risk of bias and confidence in the findings using standardized tools. Data were categorized within the Transactional Model of Physician Compassion, a framework in which compassion is influenced by personal (student), environmental, patient/family, and clinical factors. Findings: Of 14,060 retrieved articles, 222 studies were included. Of these, 95% studied student factors, but only 25% studied environmental, 9% studied patient, and 6% studied clinical factors. Predictors of greater compassion included maturity; work and life experiences; personality traits of openness to experience and agreeableness; skills such as perspective taking, reflection, and mindfulness; and positive role modeling. Conversely, negative attitudes/emotions, burnout, stress, detachment, operating in cultures prioritizing knowledge and efficiency over humanistic care, negative role models, time constraints, and heavy workloads predicted lower compassion. Patient-related factors included "difficult" and "noncompliant" patients or those perceived as responsible for their illness. Overall, 60% of studies had a serious risk of bias, particularly confounding and participant selection biases. Insights: Medical student compassion is predicted by a wide range of factors relating to the student, their training environment, their patients, and the clinical situation. However, existing research has largely focused on student factors (e.g., sociodemographic and dispositional traits), many of which are not amenable to intervention. Skills such as perspective taking, reflection, and mindfulness are associated with higher compassion and may present opportunities for intervention. There is also strong evidence that environmental factors shape students' compassion. Researchers and educators should continue to explore the impact of patient and clinical factors on students' compassion. Studies remain at high risk of bias.
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Affiliation(s)
- Clair X Y Wang
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Alina Pavlova
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Anna L Boggiss
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Anne O'Callaghan
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Johannink J, Axt S, Königsrainer A, Festl-Wietek T, Zipfel S, Herrmann-Werner A. Evaluation of the feasibility of a video-transmitted surgical ward round: a proof of concept study. BMC MEDICAL EDUCATION 2023; 23:685. [PMID: 37735381 PMCID: PMC10515251 DOI: 10.1186/s12909-023-04656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Surgical ward rounds are key element to point-of-care interprofessional postoperative treatment and technical and communicational aspects are relevant for the patient's safety and satisfaction. Due to COVID-19 restrictions, the training opportunity of experiencing a face-to-face surgical ward round was massively hampered and thus, we developed a digital concept. This study aims to investigate the feasibility of video-transmitted ward rounds integrating surgical and communicational aspects with live streaming from wards. Further, medical students were asked for their satisfaction and their subjective learning success. METHODS The proof-of-concept study consisted of self-reported subjective evaluation of competences in ward round skills. Qualitative feedback was collected to gain deeper insight and students' empathy was rated by using the student version of the Jefferson Empathy Scale (JES). RESULTS One hundred three medical students participated. The students were satisfied with the video-transmitted ward round (M = 3.54; SD = 1.22). In the subjective evaluation students' ward round competencies rose significantly (p < .001, Mpre = 3.00, SD = 0.77; Mpost = 3.76, SD = 0.75). The surgeon was rated as empathic (M = 119.05; SD = 10.09). In the qualitative feedback they named helpful aspects like including an expert for communication. However, they preferred the face-to-face setting in comparison to the digital concept. CONCLUSIONS It was feasible to implement a video-transmitted ward round within a pandemic. The format worked technically, was well-accepted and also led to a subjective rise in the students' competencies. Video-transmitted ward rounds may be integrated to support the medical education, though, they cannot replace the face-to-face setting.
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Affiliation(s)
- Jonas Johannink
- Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Steffen Axt
- Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Teresa Festl-Wietek
- Tübingen Institute for Medical Education (TIME), Medical Faculty of Tübingen, University of Tübingen, Tübingen, Elfriede-Aulhorn-Straße 10, Tübingen, 72076, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Tübingen University Hospital, Osianderstraße 5, 72076, Tübingen, Germany
| | - Anne Herrmann-Werner
- Tübingen Institute for Medical Education (TIME), Medical Faculty of Tübingen, University of Tübingen, Tübingen, Elfriede-Aulhorn-Straße 10, Tübingen, 72076, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Tübingen University Hospital, Osianderstraße 5, 72076, Tübingen, Germany
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Ataya J, Jamous I, Dashash M. Measurement of Humanity Among Health Professionals: Development and Validation of the Medical Humanity Scale Using the Delphi Method. JMIR Form Res 2023; 7:e44241. [PMID: 37129940 DOI: 10.2196/44241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Despite the importance of humanism in providing health care, there is a lack of valid and reliable tool for assessing humanity among health professionals. OBJECTIVE The aim of this study was to design a new humanism scale and to assess the validity of this scale in measuring humanism among Syrian health professional students. METHODS The Medical Humanity Scale (MHS) was designed. It consists of 27 items categorized into 7 human values including patient-oriented care, respect, empathy, ethics, altruism, and compassion. The scale was tested for internal consistency and reliability using Cronbach α and test-retest methods. The construct validity of the scale was also tested to assess the ability of the scale in differentiating between groups of health professional students with different levels of medical humanity. A 7-point Likert scale was adopted. The study included 300 participants including 97 medical, 78 dental, 82 pharmacy, and 43 preparatory-year students from Syrian universities. The Delphi method was used and factors analysis was performed. Bartlett test of sphericity and the Kaiser-Meyer-Olkin measure of sample adequacy were used. The number of components was extracted using principal component analysis. RESULTS The mean score of the MHS was 158.7 (SD 11.4). The MHS mean score of female participants was significantly higher than the mean score of male participants (159.59, SD 10.21 vs 155.48, SD 14.35; P=.008). The MHS mean score was significantly lower in dental students (154.12, SD 1.45; P=.005) than the mean scores of medical students (159.77, SD 1.02), pharmacy students (161.40, SD 1.05), and preparatory-year students (159.05, SD 1.94). However, no significant relationship was found between humanism and academic year (P=.32), university type (P=.34), marital status (P=.64), or financial situation (P=.16). The Kaiser-Meyer-Olkin test (0.730) and Bartlett test of sphericity (1201.611, df=351; P=.01) were performed. Factor analysis indicated that the proportion of variables between the first and second factors was greater than 10%, confirming that the scale was a single group. The Cronbach α for the overall scale was 0.735, indicating that the scale had acceptable reliability and validity. CONCLUSIONS The results of this study suggest that the MHS is a reliable and valid tool for measuring humanity among health professional students and the development of patient-centered care.
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Affiliation(s)
- Jawdat Ataya
- Medical Education Programme, Syrian Virtual University, Damascus, Syrian Arab Republic
- Faculty of Dental Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Issam Jamous
- Medical Education Programme, Syrian Virtual University, Damascus, Syrian Arab Republic
- Faculty of Dental Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Mayssoon Dashash
- Medical Education Programme, Syrian Virtual University, Damascus, Syrian Arab Republic
- Faculty of Dental Medicine, Damascus University, Damascus, Syrian Arab Republic
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Haribhai-Thompson J, McBride-Henry K, Hales C, Rook H. Understanding of empathetic communication in acute hospital settings: a scoping review. BMJ Open 2022; 12:e063375. [PMID: 36171029 PMCID: PMC9528576 DOI: 10.1136/bmjopen-2022-063375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Empathy and empathy education have been reviewed a number of times through systematic reviews and meta-analyses; however, the topic of 'empathetic communication' remains poorly understood when considering engaging in hospital-based research. Therefore, this scoping review aimed to explore the existing literature concerning empathetic communication in hospital settings and to evaluate the definitions presented. DESIGN Scoping review. DATA SOURCES Systematic searches of the PubMed, CINAHL, Cochrane, PsycINFO, and PsycArticles databases were conducted. STUDY SELECTION All English studies in which empathetic communication in hospital settings were explored. The search terms used included empathy, communication, hospital settings, providers, and consumers. DATA EXTRACTION Data were assessed through the use of a pre-set analysis tool. RESULTS After conducting the searches, 419 articles were identified, of which 26 were included in this review. No single article specifically defined the term 'empathetic communication'; however, 33 unique definitions of 'empathy' were identified, of which 23 considered communication to be a component of empathy. There was a considerable lack of consistency between the empathy definitions, with some classifying communication in empathy as an ability and others classifying it as a dynamic process. CONCLUSION Future and contextually focused research is needed to develop a consistent and clear definition of empathetic communication and empathy within a hospital setting to better build positive healthcare cultures. PRACTICE IMPLICATIONS Inconsistencies between definitions of empathy in empathetic communication research could reduce the efficacy of future research gains and impact the translation of research findings into clinical practice.
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Affiliation(s)
| | - Karen McBride-Henry
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Caz Hales
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Helen Rook
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
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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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Roberts BW, Roberts MB, Mazzarelli A, Trzeciak S. Validation of a 5-Item Tool to Measure Patient Assessment of Clinician Compassion in Hospitals. J Gen Intern Med 2022; 37:1697-1703. [PMID: 33835313 PMCID: PMC8034051 DOI: 10.1007/s11606-021-06733-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND We previously validated a 5-item compassion measure to assess patient experience of clinician compassion in the outpatient setting. However, currently, there is no validated and feasible method for health care systems to measure patient experience of clinician compassion in the inpatient setting across multiple hospitals. OBJECTIVE To test if the 5-item compassion measure can validly and distinctly measure patient assessment of physician and nurse compassion in the inpatient setting. DESIGN Cross-sectional study between July 1 and July 31, 2020, in a US health care network of 91 community hospitals across 16 states consisting of approximately 15,000 beds. PATIENTS Adult patients who had an inpatient hospital stay and completed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. MEASUREMENTS We adapted the original 5-item compassion measure to be specific for physicians, as well as for nurses. We disseminated both measures with the HCAHPS survey and used confirmatory factor analysis for validity testing. We tested reliability using Cronbach's alpha, as well as convergent validity with patient assessment of physician and nursing communication and overall hospital rating questions from HCAHPS. RESULTS We analyzed 4756 patient responses. Confirmatory factor analysis found good fit for two distinct constructs (i.e., physician and nurse compassion). Both measures demonstrated good internal consistency (alpha > 0.90) and good convergent validity but reflected a construct (compassionate care) distinct from what is currently captured in HCAHPS. CONCLUSION We validated two 5-item tools that can distinctly measure patient experience of physician and nurse compassion for use in the inpatient hospital setting in conjunction with HCAHPS.
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Affiliation(s)
- Brian W Roberts
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA. .,Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA. .,Cooper University Hospital, Camden, NJ, USA.
| | - Michael B Roberts
- Institutional Research and Outcomes Assessment, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Anthony Mazzarelli
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA.,Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA.,Cooper University Hospital, Camden, NJ, USA
| | - Stephen Trzeciak
- Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA.,Cooper University Hospital, Camden, NJ, USA.,Department of Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA
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11
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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] [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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Schairer CE, Tutjer J, Cannavino C, Mobley WC, Eyler L, Bloss CS. Learning to Practice Compassionate Care: Medical Students Discuss Their Most Memorable Lessons. J Patient Exp 2022; 9:23743735221117383. [PMID: 35957650 PMCID: PMC9358344 DOI: 10.1177/23743735221117383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Compassion in interactions between physicians and patients can have a therapeutic
effect independent of the technical medical treatment provided. However,
training physicians to effectively communicate compassion is challenging. This
study explores how medical students experienced training focused on interacting
with patients by examining students’ reports of particularly memorable lessons.
Six focus groups were conducted with medical students (total n = 48) in their
fourth year of training. We report on responses from students to the question,
“What was the most memorable lesson you have learned about interacting with
patients?” Students discussed lessons aimed at patient-centered physical
navigation, interpersonal navigation, and perspective taking. Concerns were
raised that navigation techniques felt inauthentic and that perspective taking
was too time consuming to be sustainable in actual practice. While
perspective-taking exercises should motivate medical students to treat every
patient with dignity by demonstrating the complexity of others’ lives, if
students assume that full understanding is a prerequisite to delivery of
compassionate care, they may dismiss explicit techniques of patient-centered
care as inauthentic and perceive compassion and efficiency as mutually
exclusive.
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Affiliation(s)
- Cynthia E. Schairer
- T. Denny Sanford Institute for Empathy and Compassion, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Jenna Tutjer
- T. Denny Sanford Institute for Empathy and Compassion, University of California San Diego, La Jolla, CA, USA
| | - Christopher Cannavino
- T. Denny Sanford Institute for Empathy and Compassion, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - William C. Mobley
- T. Denny Sanford Institute for Empathy and Compassion, University of California San Diego, La Jolla, CA, USA
- Department of Neuroscience, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lisa Eyler
- T. Denny Sanford Institute for Empathy and Compassion, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Cinnamon S. Bloss
- T. Denny Sanford Institute for Empathy and Compassion, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA
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13
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Scott J. Does compassion matter in the fast-paced environment of emergency medicine? Emerg Med Australas 2021; 33:1110-1112. [PMID: 34725932 DOI: 10.1111/1742-6723.13896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- John Scott
- Emergency Department, Central Coast Local Health District, Central Coast, New South Wales, Australia
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14
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Roberts BW, Puri NK, Trzeciak CJ, Mazzarelli AJ, Trzeciak S. Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis. PLoS One 2021; 16:e0247259. [PMID: 33657153 PMCID: PMC7928470 DOI: 10.1371/journal.pone.0247259] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy. METHODS Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity. RESULTS Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance. CONCLUSION These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity. TRIAL REGISTRATION Registration (PROSPERO): CRD42019142809.
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Affiliation(s)
- Brian W. Roberts
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Nitin K. Puri
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | | | - Anthony J. Mazzarelli
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Stephen Trzeciak
- Cooper University Health Care, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
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15
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Heinze K, Suwanabol PA, Vitous CA, Abrahamse P, Gibson K, Lansing B, Mody L. A Survey of Patient Perspectives on Approach to Health Care: Focus on Physician Competency and Compassion. J Patient Exp 2020; 7:1044-1053. [PMID: 33457544 PMCID: PMC7786646 DOI: 10.1177/2374373520968447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We conducted a cross-sectional, survey study of 764 volunteers to gain insight into patients’ perceptions of physician qualities of compassion and competence. Among 651 (85% response rate) survey participants, mean age was 52.4 (SD 21.4) years, 70.8% (n = 458) were female, and 84% (n = 539) identified as white. Predictors of compassion over competence included female gender (adjusted odds ratio [aOR] = 1.4, 95% CI: 1.04-1.89) and whether the respondent had a personal connection to the vignette (aOR = 1.24, 95% CI: 1.0-1.53). Thematic analysis demonstrated that preferences were influenced by: (a) explicit beliefs regarding the value of physician compassion and physician competence; (b) impact of emotional and mental health on medical experiences; (c) the type and frequency of health care exposure; and (d) perceived role of the physician in various clinical vignettes. Patients had wide-ranging, complex opinions on the qualities they valued in their physicians. These findings suggest that patients are engaged and can provide critical thoughtful feedback on the practice and delivery of health care.
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Affiliation(s)
- Kevin Heinze
- Department of Ophthalmology & Visual Sciences, University of Illinois, Chicago, IL, USA
| | - Pasithorn A Suwanabol
- Department of Surgery, University of Michigan, MI, USA.,Center for Healthcare Outcomes and Policy, University of Michigan, MI, USA
| | - C Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, MI, USA
| | - Paul Abrahamse
- Department of Biostatistics, University of Michigan, MI, USA
| | - Kristen Gibson
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, MI, USA
| | - Bonnie Lansing
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, MI, USA
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, MI, USA.,Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, MI, USA
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16
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Dobransky J, Gartke K, Pacheco-Brousseau L, Spilg E, Perreault A, Ameen M, Finless A, Beaulé PE, Poitras S. Relationship Between Orthopedic Surgeon's Empathy and Inpatient Hospital Experience Scores in a Tertiary Care Academic Institution. J Patient Exp 2020; 7:1549-1555. [PMID: 33457613 PMCID: PMC7786763 DOI: 10.1177/2374373520968972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Studies have examined the relationship between physician empathy and patient experience, but few have explored it in surgeons. The purpose of this study was to report on orthopedic surgeon empathy in a mutlispecialty practice and explore its association with orthopedic patient experience. Patients completed the consultation and relational empathy (CARE) measure (March 2017-August 2018) and Canadian Patient Experience Survey-Inpatient Care (CPES-IC; March 2017-February 2019) to assess empathy and patient experience, respectively. Consultation and relational empathy measures were correlated to CPES-IC for 3 surgeon-related questions pertaining to respect, listening, and explaining. Surgeon CARE scores (n = 1134) ranged from 42.0 ± 9.1 to 48.6 ± 2.4 with 50.4% of patients rating their surgeon as perfectly empathic. There were no significant differences between surgeons for CPES-IC continuous and topbox scores (n = 834) for respect and correlations between CPES-IC questions. The CARE measure for both continuous and topbox scores were weak to moderate, but none were significant. Empathy was associated with surgeon respect and careful listening, despite lack of significant correlation. Possible future work could use an empathy tool more appropriate for this surgeon population.
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Affiliation(s)
- Johanna Dobransky
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kathleen Gartke
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lissa Pacheco-Brousseau
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Physiotherapy, School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Spilg
- Division of Geriatrics, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ashley Perreault
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mohammad Ameen
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexandra Finless
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- Department of Physiotherapy, School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
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17
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Park J, Saha S, Han D, Jindal M, Korthuis PT, Moore R, Beach MC. Are clinicians' self-reported empathic concern and perspective-taking traits associated with their response to patient emotions?: Communication Studies. PATIENT EDUCATION AND COUNSELING 2020; 103:1745-1751. [PMID: 32362523 PMCID: PMC7423637 DOI: 10.1016/j.pec.2020.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To understand whether clinicians' empathic concern and perspective-taking traits are associated with their response to patient emotions. METHODS We audio-recorded 41 HIV clinician interactions with 342 patients at two academic medical centers. We assessed clinicians' self-reported empathic concern and perspective-taking traits using the Interpersonal Reactivity Index and coded emotional communication using the Verona Coding Definitions of Emotional Sequences. We used random effects models to assess associations between clinician traits and clinician responses to patients' negative emotions, accounting for clustering of emotions within encounters and patients within clinicians. RESULTS Clinicians with more self-reported empathic concern received fewer emotional expressions from their patients (β -0.06; 95% CI -0.10, -0.01) and had greater odds of responding to emotions by giving information/advice (OR 1.10; 95% CI 1.01, 1.20). There were no associations between empathic concern or perspective-taking and any other clinician responses. CONCLUSION Clinicians with higher levels of empathic concern respond to patient emotions by giving information and advice, a response traditionally thought of as a missed empathic opportunity, not by exploring emotions or providing empathy. Whether this is helpful to patients is unknown. PRACTICE IMPLICATIONS Clinicians should be aware of their tendency to give information to patients with emotional distress, and consider whether this response is helpful to patients.
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Affiliation(s)
- Jenny Park
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Somnath Saha
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Dingfen Han
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Monique Jindal
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Todd Korthuis
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA
| | - Richard Moore
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Catherine Beach
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
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18
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England JA, Howell M, White BAA. Creating a culture of communication in undergraduate medical education. Proc AMIA Symp 2020; 33:485-491. [PMID: 32676001 PMCID: PMC7340425 DOI: 10.1080/08998280.2020.1746156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022] Open
Abstract
Quality communication improves outcomes across a wide variety of health care metrics. However, communication training in undergraduate medical education remains heterogeneous, with real-life clinical settings notably underutilized. In this perspective, the authors review the current landscape in communication training and propose the development of communication-intensive rotations (CIRs) as a method of integrating communication training into the everyday clinical environment. Despite its importance, communication training is often relegated to a "parallel curriculum." Through integration, CIRs can provide opportunities for real-life skills training, decrease parallel curriculum burden, and provide specialty-specific training in preparation for residency. Clear, efficient communication and human connection remain central in a physician's practice. CIRs reinforce these crucial principles. Potential benefits of a CIR model include role modeling of expert communication techniques; real-time, specific feedback on communication behaviors; development of relationship-centered communication skills and human connection, thereby decreasing burnout; and the opportunity for quality communication practices to become habits in a medical student's daily routine.
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Affiliation(s)
- Julie A. England
- College of Medicine, Texas A&M Health Sciences CenterTempleTexas
| | - Martha Howell
- Office of Patient Experience, Baylor Scott & White HealthTempleTexas
| | - Bobbie Ann Adair White
- Department of Humanities in Medicine, Texas A&M College of MedicineTempleTexas
- MGH Health Professions InstituteBostonMassachusetts
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19
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Roberts BW, Trzeciak CJ, Puri NK, Mazzarelli AJ, Trzeciak S. Racial and socioeconomic disparities in patient experience of clinician empathy: a protocol for systematic review and meta-analysis. BMJ Open 2020; 10:e034247. [PMID: 32595149 PMCID: PMC7322320 DOI: 10.1136/bmjopen-2019-034247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/23/2020] [Accepted: 05/21/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Clinician empathy is a vital component of high-quality healthcare. Healthcare disparities may reflect a societal lack of empathy for disadvantaged persons in general, and recent research suggests that socioeconomic disparities exist in patient satisfaction with clinicians. However, it is currently unclear if there are disparities in patient experience of empathy from clinicians. Our objective is to systematically analyse the scientific literature to test the hypothesis that racial and socioeconomic status (SES) disparities exist in patient-reported experience of clinician empathy. METHODS AND ANALYSIS In accordance with published methodological guidelines for conducting a systematic review, we will analyse studies reporting patient assessment of clinician empathy using the Consultation and Relational Empathy (CARE) measure, which to date is the most commonly used and well-validated methodology in clinical research for measuring clinician empathy from the patient's perspective. We will use a standardised data collection template and assess study quality (risk of bias) using the Newcastle-Ottawa Scale. We will abstract data for the CARE measure stratified by race and SES, and we will contact the corresponding authors to obtain stratified data by race/SES if not reported in the original manuscript. Where appropriate, we will pool the data and perform quantitative meta-analysis to test if non-white (compared to white) patients and low SES (compared to high SES) patients report lower scores for clinician empathy. ETHICS AND DISSEMINATION No individual patient-level data will be collected and thus the proposed systematic review does not require ethical approval. This systematic review will test if racial and SES differences exist in patient experience of clinician empathy, and will inform future research to help promote healthcare equity. PROSPERO REGISTRATION NUMBER CRD42019142809.
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Affiliation(s)
- Brian W Roberts
- Departments of Medicine and Emergency Medicine, Cooper University Health Care, Camden, New Jersey, USA
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Christian J Trzeciak
- Departments of Medicine and Emergency Medicine, Cooper University Health Care, Camden, New Jersey, USA
| | - Nitin K Puri
- Departments of Medicine and Emergency Medicine, Cooper University Health Care, Camden, New Jersey, USA
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Anthony J Mazzarelli
- Departments of Medicine and Emergency Medicine, Cooper University Health Care, Camden, New Jersey, USA
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Stephen Trzeciak
- Departments of Medicine and Emergency Medicine, Cooper University Health Care, Camden, New Jersey, USA
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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20
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Sabapathi P, Roberts MB, Fuller BM, Puskarich MA, Jones CW, Kilgannon JH, Braz V, Creel-Bulos C, Scott N, Tester KL, Mazzarelli A, Trzeciak S, Roberts BW. Validation of a 5-item tool to measure patient assessment of clinician compassion in the emergency department. BMC Emerg Med 2019; 19:63. [PMID: 31684885 PMCID: PMC6827199 DOI: 10.1186/s12873-019-0279-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/14/2019] [Indexed: 12/30/2022] Open
Abstract
Background To test if the 5-item compassion measure (a tool previously validated in the outpatient setting to measure patient assessment of clinician compassion) is a valid and reliable tool to quantify a distinct construct (i.e. clinical compassion) among patients evaluated in the emergency department (ED). Methods Cross-sectional study conducted in three academic emergency departments in the U.S. between November 2018 and April 2019. We enrolled adult patients who were evaluated in the EDs of the participating institutions and administered the 5-item compassion measure after completion of care in the ED. Validity testing was performed using confirmatory factor analysis. Cronbach’s alpha was used to test reliability. Convergent validity with patient assessment of overall satisfaction questions was tested using Spearman correlation coefficients and we tested if the 5-item compassion measure assessed a construct distinct from overall patient satisfaction using confirmatory factor analysis. Results We analyzed 866 patient responses. Confirmatory factor analysis found all five items loaded well on a single construct and our model was found to have good fit. Reliability was excellent (Cronbach’s alpha = 0.93) among the entire cohort. These results remained consistent on sub-analyses stratified by individual institutions. The 5-item compassion measure had moderate correlation with overall patient satisfaction (r = 0.66) and patient recommendation of the ED to friends and family (r = 0.57), but reflected a patient experience domain (i.e. compassionate care) distinctly different from patient satisfaction. Conclusions The 5-item compassion measure is a valid and reliable tool to measure patient assessment of clinical compassion in the ED.
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Affiliation(s)
- Praveen Sabapathi
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, New Jersey, 08103, USA
| | - Michael B Roberts
- Institutional Research and Outcomes Assessment, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Brian M Fuller
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael A Puskarich
- Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, New Jersey, 08103, USA
| | - J Hope Kilgannon
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, New Jersey, 08103, USA.,Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Valerie Braz
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, New Jersey, 08103, USA
| | - Christina Creel-Bulos
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Nathaniel Scott
- Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Kristina L Tester
- Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA.,School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Anthony Mazzarelli
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, New Jersey, 08103, USA.,Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Stephen Trzeciak
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, New Jersey, 08103, USA.,Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brian W Roberts
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, New Jersey, 08103, USA. .,Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA.
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21
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Fischer J, Alpert A, Rao P. Promoting Intern Resilience: Individual Chief Wellness Check-ins. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10848. [PMID: 31921994 PMCID: PMC6946579 DOI: 10.15766/mep_2374-8265.10848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 07/05/2019] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Promoting resilience is key during intern year as residents transition to becoming clinical providers. Residents consistently demonstrate a decline in empathy and an increase in burnout throughout training. Interventions involving mindfulness, stress management, and small-group discussions can reduce burnout. We created a curriculum to normalize the intern experience and provide debriefing opportunities to further improve resilience and decrease burnout. METHODS Thirty-two interns met monthly, one-on-one, with a pediatric chief resident to discuss personal, professional, and emotional well-being and complete just-in-time resilience exercises. After 6 and 12 months, we conducted follow-up surveys containing 5-point Likert questions and open-ended questions to determine interns' perceptions of the initiative. RESULTS We obtained response rates of 44% (14 interns) and 38% (12 interns) for the 6- and 12-month surveys, respectively. Interns found the sessions helpful for normalizing the intern experience (6 months: 4.6 ± 0.7, 12 months: 4.8 ± 0.5), stress management (6 months: 4.0 ± 1.0, 12 months: 4.3 ± 0.7), and feeling connected to program leadership (6 months: 4.6 ± 0.9, 12 months: 5.0 ± 0.0). Thematic analysis identified normalizing the intern experience, ability to express concerns, and mentorship as benefits. DISCUSSION Normalization of the intern experience and targeted wellness and resilience exercises can have a positive impact on interns' satisfaction with program support for their well-being. Through a time-limited intervention, chief residents can be utilized in a mentorship role that is well received by interns and rewarding for the chief residents.
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Affiliation(s)
- Jason Fischer
- Pediatric Emergency Medicine Fellow, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Aviva Alpert
- General Pediatrician, Children's Community Pediatrics Allegheny, University of Pittsburgh Medical Center
| | - Priyanka Rao
- Clinical Lecturer, Department of Pediatrics, Michigan Medicine
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22
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Curricula for empathy and compassion training in medical education: A systematic review. PLoS One 2019; 14:e0221412. [PMID: 31437225 PMCID: PMC6705835 DOI: 10.1371/journal.pone.0221412] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022] Open
Abstract
Background Empathy and compassion are vital components of health care quality; however, physicians frequently miss opportunities for empathy and compassion in patient care. Despite evidence that empathy and compassion training can be effective, the specific behaviors that should be taught remain unclear. We synthesized the biomedical literature on empathy and compassion training in medical education to find the specific curricula components (skills and behaviors) demonstrated to be effective. Methods We searched CENTRAL, MEDLINE, EMBASE, and CINAHL using a previously published comprehensive search strategy. We screened reference lists of the articles meeting inclusion criteria to identify additional studies for potential inclusion. Study inclusion criteria were: (1) intervention arm in which subjects underwent an educational curriculum aimed at enhancing empathy and/or compassion; (2) clearly defined control arm in which subjects did not receive the curriculum; (3) curriculum was tested on physicians (or physicians-in-training); and (4) outcome measure assessing the effect of the curriculum on physician empathy and/or compassion. We performed a qualitative analysis to collate and tabulate effects of tested curricula according to recommended methodology from the Cochrane Handbook. We used the Cochrane Collaboration’s tool for assessing risk of bias. Results Fifty-two studies (total n = 5,316) met inclusion criteria. Most (75%) studies found that the tested curricula improved physician empathy and/or compassion on at least one outcome measure. We identified the following key behaviors to be effective: (1) sitting (versus standing) during the interview; (2) detecting patients’ non-verbal cues of emotion; (3) recognizing and responding to opportunities for compassion; (4) non-verbal communication of caring (e.g. eye contact); and (5) verbal statements of acknowledgement, validation, and support. These behaviors were found to improve patient perception of physician empathy and/or compassion. Conclusion Evidence suggests that training can enhance physician empathy and compassion. Training curricula should incorporate the specific behaviors identified in this report.
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Hannan J, Sanchez G, Musser ED, Ward-Peterson M, Azutillo E, Goldin D, Lara EG, Luna AM, Galynker I, Foster A. Role of empathy in the perception of medical errors in patient encounters: a preliminary study. BMC Res Notes 2019; 12:327. [PMID: 31182161 PMCID: PMC6558753 DOI: 10.1186/s13104-019-4365-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Healthcare professionals’ empathy have been empirically demonstrated to decrease the risk of medical errors. Medical errors affect patient’s outcomes and healthcare providers’ well-being. Therefore, the purpose of this study was to determine the relationship between patients’ perception of healthcare providers’ empathy, their intention to adhere to treatment, and their perception of medical errors made. An anonymous survey was emailed to staff at a health center and an urban university in Miami, Florida, USA. Results A total of 181 participants were enrolled. Participants rating their healthcare provider as high in empathy had 80% lower odds of reporting errors (CI 0.04–0.6). The intention to follow-up with recommendations or return to the provider were not significantly associated with provider’s empathy. Patients of high empathy providers were no more treatment adherent that those who rated their provider with low empathy but were less likely to perceive medical error. Providers’ empathy significantly affected patients’ perception of medical errors. Our results underscore that healthcare curricula need to address the link between empathy and perception of medical errors, including its potential legal implications.
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Affiliation(s)
- Jean Hannan
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 SW 8th Street, Academic Health Center 3 Office 324A, Miami, FL, 33199, USA.
| | - Gabriel Sanchez
- Citrus Health Network/Florida International University, 4175 West 20th Ave, Hialeah, FL, 33012, USA
| | - Erica D Musser
- Center for Children and Families, 11200 SW 8th Street, AHC 4, Room 455, Miami, FL, 33199, USA
| | - Melissa Ward-Peterson
- Department of Epidemiology, Florida International University, Robert Stempel College of Public Health & Social Work, 11200 SW 8th Street, AHC5-483, Miami, FL, 33199, USA
| | - Elizabeth Azutillo
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 SW 8th Street, Academic Health Center 3 Office 324A, Miami, FL, 33199, USA
| | - Deana Goldin
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 SW 8th Street, AHC 3 Office 228, Miami, FL, 33199, USA
| | - Edgar Garcia Lara
- Miami Dade College Benjamin Leon School of Nursing, 950 NW 20th Street, Miami, FL, 33127, USA
| | - Aniuska M Luna
- Department of Psychiatry & Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC4 280, Miami, FL, 33199, USA
| | - Igor Galynker
- Icahn School of Medicine, Beth Israel-Fierman, 317 E 17th St, New York, NY, 10003, USA
| | - Adriana Foster
- Department of Psychiatry & Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC1 335A, Miami, FL, 33199, USA
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Vietz E, März E, Lottspeich C, Wölfel T, Fischer MR, Schmidmaier R. Ward round competences in surgery and psychiatry - a comparative multidisciplinary interview study. BMC MEDICAL EDUCATION 2019; 19:137. [PMID: 31068159 PMCID: PMC6506958 DOI: 10.1186/s12909-019-1554-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 04/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The ward round is a key element in everyday hospital inpatient care irrespective of the medical speciality. The underperformance in conducting ward rounds of junior clinicians has already been described. Therefore, necessary skills and competences of clinicians need to be defined, taught and delivered for curricular instruction. In addition to published data on ward round competences in internal medicine this study aims to determine the common competences for surgical and psychiatric ward rounds in order to find differences depending on the speciality. METHODS Semi-structured interviews with surgical (N = 30) and psychiatric ward staff (N = 30) of a university hospital and five community hospitals were conducted. Competences necessary for performing ward rounds as well as structural aspects were identified by systematic content analysis and frequency analysis, supported by adequate statistics. RESULTS Relevant competences for both fields are: collaborative clinical reasoning, communication with the patient and the team, organization, teamwork, management of difficult situations, self-management, error-management, teaching, empathy, nonverbal communication, patient-management and professionalism. Clinical skills were mentioned more often in surgical interviews, while nonverbal communication was described more often in psychiatric interviews. Empathy and communication with the team were more frequently attributed to psychiatric residents. CONCLUSION The competences which were identified as necessary for conducting a ward round in surgery and psychiatry are similar and correspond to previously reported competences in internal medicine. Clinical skills are of greater importance in surgery than in psychiatry. Concerning empathy and nonverbal communication, further research is needed to determine whether they are of minor importance in surgery or whether there is a lack of awareness of these competences.
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Affiliation(s)
- Elisa Vietz
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336 Munich, Germany
| | - Esther März
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336 Munich, Germany
| | - Christian Lottspeich
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Ziemssenstrasse 1, 80336 Munich, Germany
| | - Teresa Wölfel
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336 Munich, Germany
| | - Martin R. Fischer
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336 Munich, Germany
| | - Ralf Schmidmaier
- Institut für Didaktik und Ausbildungsforschung in der Medizin, Klinikum der LMU München, Ziemssenstrasse 1, 80336 Munich, Germany
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Ziemssenstrasse 1, 80336 Munich, Germany
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Roberts BW, Roberts MB, Yao J, Bosire J, Mazzarelli A, Trzeciak S. Development and Validation of a Tool to Measure Patient Assessment of Clinical Compassion. JAMA Netw Open 2019; 2:e193976. [PMID: 31099870 PMCID: PMC6537812 DOI: 10.1001/jamanetworkopen.2019.3976] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Clinician compassion is a vital element of health care quality. Currently, there appears to be no validated and feasible method for health care organizations to measure patient assessment of clinician compassion on a large scale. OBJECTIVE To develop and validate a tool for measuring patient assessment of clinician compassion that can be used in conjunction with the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study took place from June 1 to August 30, 2018, at a US academic health care system among a pilot cohort consisting of 3325 adult patients and a validation cohort consisting of 3483 adult patients, both of whom had an outpatient clinic visit and completed the CG-CAHPS survey. MAIN OUTCOMES AND MEASUREMENTS After a comprehensive literature review, 12 candidate survey items were developed. Face and construct validity were performed. Candidate items were disseminated to patients in conjunction with the CG-CAHPS survey in a series of 2 studies: (1) exploratory factor analysis in one cohort to determine the factor structure and the most parsimonious set of items; and (2) validity testing in a second cohort using confirmatory factor analysis. Reliability was tested using Cronbach α. Convergent validity was tested with patient assessment of clinician communication and overall satisfaction questions from CG-CAHPS survey. RESULTS Overall, 6493 patient responses were analyzed. The mean (SD) age was 60 (15) years, 4239 patients (65.3%) were women, and 5079 (78.2%) were white. Exploratory factor analyses identified a 5-item compassion measure to be the most parsimonious. Confirmatory factor analyses found good fit. The compassion measure demonstrated good internal consistency (α = 0.94) and convergent validity (clinician communication: ρ = 0.44; overall satisfaction: ρ = 0.52) but reflected a patient experience domain (compassionate care) distinct from what is currently captured in the CG-CAHPS survey. CONCLUSIONS AND RELEVANCE A simple 5-item tool to measure patient assessment of clinician compassion was developed and validated for use in conjunction with CG-CAHPS survey.
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Affiliation(s)
- Brian W. Roberts
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Michael B. Roberts
- Institutional Research and Outcomes Assessment, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Jady Yao
- Department of Patient Family Centered Care, Cooper University Health Care, Camden, New Jersey
| | - Joshua Bosire
- Department of Patient Family Centered Care, Cooper University Health Care, Camden, New Jersey
| | - Anthony Mazzarelli
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Stephen Trzeciak
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey
- Department of Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
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Orthopaedic Surgeon Communication Skills: Perception of Empathy and Patient Satisfaction Through the Use of Anatomic Models. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e071. [PMID: 30656261 PMCID: PMC6324897 DOI: 10.5435/jaaosglobal-d-18-00071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Patient satisfaction is an increasingly emphasized measure of patient-centered care and important component of reimbursement programs. Orthopaedic surgeons are regarded as low-empathy surgeons. Our goals were to understand the role of anatomic models during the orthopaedic appointment and how their use can affect patient satisfaction and perceived empathy. Methods: New patients at an outpatient clinic were asked to participate in a postencounter questionnaire to asses empathy perception (n = 304). Clinic days were randomly assigned to use anatomic models during the encounter to assist with clinical information transmission. The instrument provided contained Consultation and Relational Empathy questionnaire (ie, a person-centered process that was developed to measure empathy in the context of the therapeutic relationship during a one-on-one consultation between a clinician and a patient). Results: A total of 304 participants were included in the study. Analyses of the sociodemographic characteristics did not reveal any significant difference between the control and experimental groups. Consultation and Relational Empathy scores for the nonanatomic group (46.0 ± 9.0) and anatomic group (48.0 ± 7.7) were not statistically different (P = 0.482). The encounter time was significantly increased with the use of anatomic models (P < 0.005). Discussion: The use of anatomic models during initial orthopaedic encounter did not improve perceived empathy and satisfaction scores in our study. Longer encounter time in the orthopaedic appointment does not mean higher empathy perception. Conclusion: Orthopaedic surgeons have the duty to find new strategies to improve communication with the patient. Better communication has been associated with better patient satisfaction. Further investigation should be considered to use other strategies to provide better care for our patients.
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Sampson S, Shapiro J, Boker J, Shallit J, Youm J, Billimek J. Medical Student Interpretation of Visual Art: Who's Got Empathy? MEDEDPUBLISH 2018; 7:206. [PMID: 38074590 PMCID: PMC10701853 DOI: 10.15694/mep.2018.0000206.2] [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] [Indexed: 02/28/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Introduction: Physician empathy is a highly desired characteristic in clinical practice with benefits for both patients and doctors. Increasingly, medical educators have acknowledged the importance of empathy and sought effective ways of inculcating and strengthening this quality in medical students. However, empathy remains difficult to measure because of differing definitions and theoretical dimensions. Our goal was to develop a de novo visual Art scale, devised to evaluate empathetic response in medical students as well as a de novo Biosocial scale to measure medical student socioeconomic and experiential stress during childhood and adolescence; and to compare these exploratory measures to the reliable and well-validated Jefferson Scale of Empathy JSE). Methods: We constructed a survey incorporating a visual Art empathy measure, a Biosocial scale, and the JSE, which we sent to approximately 200 allopathic preclinical medical students at our home institution. We received 71 complete responses. Results: Cronbach's alpha testing found that the items in both new scales had adequate reliability. Multivariate regression analysis found a significant, positive association between both the visual art and biosocial scores and the JSE. Discussion: These results support the idea that response to visual stimuli, as well as life stressors, may be factors in medical students' capacity to formulate an empathetic response to patients.
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Affiliation(s)
| | | | - John Boker
- University of California Irvine School of Medicine
| | - Joel Shallit
- University of California Irvine School of Medicine
| | - Julie Youm
- University of California Irvine School of Medicine
| | - John Billimek
- Kaiser Permanente Los Angeles Medical Center
- University of California Irvine School of Medicine
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Vitinius F, Tieden S, Hellmich M, Pfaff H, Albus C, Ommen O. Perceived Psychotherapist's Empathy and Therapy Motivation as Determinants of Long-Term Therapy Success-Results of a Cohort Study of Short Term Psychodynamic Inpatient Psychotherapy. Front Psychiatry 2018; 9:660. [PMID: 30564157 PMCID: PMC6288472 DOI: 10.3389/fpsyt.2018.00660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 11/19/2018] [Indexed: 11/23/2022] Open
Abstract
Objective: Outcome predictors and determinants for treatment outcome of inpatient psychotherapy will be assessed in a follow-up-study. Sociodemographic factors and the level of depressiveness at admission, the perceived psychotherapist's empathy rated by patients and the therapy motivation as possible moderators of treatment outcome (reduction of depressive symptoms) are analyzed. Methods: In a cohort study, the outcome of inpatient multimodal psychotherapy was examined with Beck-Depression-Inventory (BDI) at admission (T1), discharge (T2) and at follow-up (1-3 years after treatment) (T3). Inclusion criteria were: Inpatient psychotherapy between 2007 and 2010 with a duration of at least 1 week and complete data set. The influence on therapy success of (1) sociodemographic factors, (2) the perceived psychotherapist's empathy rated by patients using the Consultation and Relational Empathy Measure (CARE), and (3) the therapy motivation of the patients rated by therapists are examined by means of correlation analysis, distribution comparisons and subsequently logistic regression. Results: Ninety-two (64 females, average age 39 yrs.) of 182 eligible patients participated in the follow-up survey. Duration of inpatient psychotherapy lasted 8.7 weeks ± 3.6 [min. 1, max. 33 weeks]. The perceived psychotherapist's empathy, therapy motivation, education level and depression at baseline had a significant impact on therapy success. Gender, age, and partnership were not significant. The length between discharge and follow-up had no influence on the results. Based on these variables a multiple logistic regression explained 42% of the variation (goodness-of-fit). Conclusion: Due to the shown relevance of the psychotherapist's empathy perceived by patients and the therapy motivation of patients for therapy success, both factors should be considered already at the beginning of the therapy. Consequently, they should be recognized in the context of postgraduate training and education.
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Affiliation(s)
- Frank Vitinius
- Department of Psychosomatics and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | - Stephanie Tieden
- Department of Psychosomatics and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | - Oliver Ommen
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, Germany
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Yang N, Xiao H, Wang W, Li S, Yan H, Wang Y. Effects of doctors' empathy abilities on the cellular immunity of patients with advanced prostate cancer treated by orchiectomy: the mediating role of patients' stigma, self-efficacy, and anxiety. Patient Prefer Adherence 2018; 12:1305-1314. [PMID: 30087556 PMCID: PMC6063254 DOI: 10.2147/ppa.s166460] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The empathy of doctors is closely related to patients' outcomes. This research aimed to examine whether patients' stigma, self-efficacy, and anxiety mediate the relationship between doctors' empathy and cellular immunity in patients with advanced prostate cancer treated by orchiectomy. PARTICIPANTS AND METHODS Data on the empathy of doctors and the demographics, disease condition, stigma, self-efficacy, and anxiety of patients were collected. Patients' psychological indicators and cellular immunity were measured at admission, after 14 days, and after 3 months. The variance analysis test was used to compare the immune indices at the three time points. At T3, a multivariate linear regression model was used to analyze the factors that influenced the immune index. Pearson correlation analysis and structural equation modeling were used to examine the relationships among patients' stigma, self-efficacy, anxiety, and cellular immunity and doctors' empathy. RESULTS At the three time points, all three psychological indicators of the patients were statistically significant. Among the immune indices, only the change in the percentage of NK cells (NK subset) was statistically significant, while the changes in the percentages of CD3+, CD4+, CD8+, and B cells were not statistically significant. The doctors' empathy showed negative relationships with patients' stigma and anxiety and a positive relationship with patients' self-efficacy. Patients' stigma and anxiety were negatively associated with NK subset, while patients' self-efficacy showed a positive relationship with NK subset. Anxiety was positively related to stigma and negatively related to self-efficacy. Therefore, the effect of the doctors' empathy on the patients' NK subset was mediated by the patients' stigma, self-efficacy, and anxiety. CONCLUSION Doctors' empathy affected the NK subset in advanced prostate cancer patients and was related to the patients' stigma, self-efficacy, and anxiety. In addition, anxiety directly affected stigma and self-efficacy. Thus, medical staff should focus on improving their empathy toward patients. Interventions that focus on patients' anxiety, stigma, and self-efficacy may be helpful to improve immunity.
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Affiliation(s)
- Ningxi Yang
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, Hubei, People's Republic of China,
- Department of Medical Humanities, Institute of Medical Humanities, Peking University, Beijing, People's Republic of China,
| | - Han Xiao
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, Hubei, People's Republic of China,
| | - Wei Wang
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, Hubei, People's Republic of China,
| | - Shiyue Li
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, Hubei, People's Republic of China,
| | - Hong Yan
- Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, Hubei, People's Republic of China,
| | - Yifang Wang
- Department of Medical Humanities, Institute of Medical Humanities, Peking University, Beijing, People's Republic of China,
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Modi A, Fascelli M, Daitch Z, Hojat M. Evaluating the Relationship Between Participation in Student-Run Free Clinics and Changes in Empathy in Medical Students. J Prim Care Community Health 2016; 8:122-126. [PMID: 28033737 PMCID: PMC5932688 DOI: 10.1177/2150131916685199] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: We explored differences in changes in medical student empathy in the third year of medical school between volunteers at JeffHOPE, a multisite medical student–run free clinic of Sidney Kimmel Medical College (SKMC), and nonvolunteers. Method: Volunteerism and leadership experience at JeffHOPE were documented for medical students in the Class of 2015 (n = 272) across their medical educations. Students completed the Jefferson Scale of Empathy at the beginning of medical school and at the end of the third year. Students who reported participation in other Jefferson-affiliated clinics (n = 44) were excluded from this study. Complete data were available for 188 SKMC students. Results: Forty-five percent of students (n = 85) volunteered at JeffHOPE at least once during their medical educations. Fifteen percent of students (n = 48) were selected for leadership positions involving weekly clinic participation. Nonvolunteers demonstrated significant decline in empathy in medical school (P = 0.009), while those who volunteered at JeffHOPE at least once over the course of their medical educations did not show any significant decline (P = 0.07). Conclusions: These findings suggest that medical students may benefit from volunteering at student-run free clinics to care for underserved populations throughout medical school.
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Affiliation(s)
- Anita Modi
- 1 Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michele Fascelli
- 2 Glickman Urological and Kidney Institute at the Cleveland Clinic, Cleveland, OH, USA
| | - Zachary Daitch
- 3 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mohammadreza Hojat
- 3 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Chiapponi C, Witt M, Dlugosch GE, Gülberg V, Siebeck M. The Perception of Physician Empathy by Patients with Inflammatory Bowel Disease. PLoS One 2016; 11:e0167113. [PMID: 27875561 PMCID: PMC5119824 DOI: 10.1371/journal.pone.0167113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/08/2016] [Indexed: 12/30/2022] Open
Abstract
Background and Aims This study focused on the difference between perceived and desired physician empathy (pPE and dPE) in the eye of patients with inflammatory bowel disease (IBD). It was investigated if a discrepancy (ΔPE) correlates with trust and satisfaction of patients. At the same time the aim was to gain detailed information about the subjective burden of disease and the resources of IBD patients, in order to better understand them. Methods A modified version of the German Version of the Consultation and Relational Empathy (CARE) measure was completed as a paper-and-pencil questionnaire by IBD patients attending our facility (n = 32) and as an online survey by IBD patients at other locations throughout Germany (n = 89). Patients were in average 36.3±12 years old. Results The mean (SD) rating of pPE was 3.93 (0.96) on a scale of 1 to 5 (“poor” to “excellent”); however, the mean (SD) dPE was 4.38 (0.48) on the same scale. ΔPE correlated with perceived empathy and with patients’ satisfaction with treatment and trust in their health care providers. Patients reported quite a high subjective burden (mean [SD]: 2.93 [.63]) and named family, friends, and support groups as resources. Conclusions Rather than assessing patient satisfaction with treatment and trust in their physician only with perceived PE, we suggest ΔPE as a useful additional parameter.
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Affiliation(s)
- Costanza Chiapponi
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the University of Munich (LMU), Munich, Germany
- * E-mail:
| | - Maxie Witt
- Center of Empirical Educational Research (zepf), University of Koblenz-Landau, Campus Landau, Landau in der Pfalz, Germany
| | - Gabriele E. Dlugosch
- Center of Empirical Educational Research (zepf), University of Koblenz-Landau, Campus Landau, Landau in der Pfalz, Germany
| | - Veit Gülberg
- Medizinische Klinik IV, Division of Gastroenterology, Hospital of the University of Munich (LMU), Munich, Germany
| | - Matthias Siebeck
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the University of Munich (LMU), Munich, Germany
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Ferrante JM, Seaman K, Bator A, Ohman-Strickland P, Gundersen D, Clemow L, Puhl R. Impact of Perceived Weight Stigma among Underserved Women on Doctor-Patient Relationships. Obes Sci Pract 2016; 2:128-135. [PMID: 27293804 PMCID: PMC4902272 DOI: 10.1002/osp4.40] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective The aim of this study was to evaluate how perception of weight stigma among underserved women with obesity impacts doctor–patient relationships. Methods This study consisted of an interviewer‐administered survey of 149 women with obesity (body mass index (BMI) > 30 kg m−2) immediately after their physician visit at four Federally Qualified Health Centers. Perceptions of weight stigma and physician empathy were measured using the Stigma Situations in Health Care instrument and Consultation and Relational Empathy (CARE) measure, respectively. Associations of CARE and Stigma scores with BMI and patient characteristics were analysed using Mantel–Haenszel chi‐squared test and ordinal logistic regression. Results The mean CARE score was 42.1 (standard deviation 8.4; range 11.0–50.0), and mean stigma score was 4.6 (standard deviation 7.6; range 0–43.0). Each increase in BMI category was associated with almost twofold increased odds of higher perception of stigma (odds ratio, 1.90, 95% confidence interval 1.30–2.78, P = 0.001). BMI was not associated with CARE. However, for each increase in stigma category, the odds of lower CARE score doubled (odds ratio, 0.52, 95% confidence interval 0.36–0.75, P = 0.0005). Conclusions While BMI was not associated with perception of physician empathy, higher frequency of weight stigmatizing situations was negatively associated with perception of physician empathy. Reducing weight stigma in primary care could improve doctor–patient relationships and quality of care in patients with obesity.
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Affiliation(s)
- Jeanne M Ferrante
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - KelliAnn Seaman
- Preliminary Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alicja Bator
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pamela Ohman-Strickland
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA; Department of Biostatistics, Rutgers-School of Public Health, Piscataway, New Jersey, USA
| | - Daniel Gundersen
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Lynn Clemow
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rebecca Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
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Plant J, Barone MA, Serwint JR, Butani L. Taking Humanism Back to the Bedside. Pediatrics 2015; 136:828-30. [PMID: 26438713 DOI: 10.1542/peds.2015-3042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jennifer Plant
- Department of Pediatrics, University of California, Davis, Sacramento, California; and
| | - Michael A Barone
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janet R Serwint
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lavjay Butani
- Department of Pediatrics, University of California, Davis, Sacramento, California; and
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