Physician empathy: definition, outcome-relevance and its measurement in patient care and medical education

Simulating empathy: A qualitative experiential study of embedded resident learners in an empathy curriculum

Objectives

Physician empathy and communication skills are crucial parts of a successful emergency department (ED) interaction. This study aimed to evaluate whether these skills can be improved through a novel curriculum where interns act as patients for their senior residents during simulated ED cases.

Methods

Twenty-five residents participated in the curriculum. Prior to the cases, participants filled out the Toronto Empathy Questionnaire (TEQ). They then completed three simulated cases, with the 11 interns portraying the patients and the 14 seniors (postgraduate year [PGY]-2 and PGY-3 residents) in the physician role. Following the cases, the residents participated in a recorded, structured focus group. At the conclusion of the session participants again filled out the TEQ and answered a Likert questionnaire on their thoughts about the curriculum. Qualitative analysis was used to determine themes from the debriefs.

Results

Twenty-two residents completed all components of the study. The mean (±SD) TEQ scores pre- and postcurriculum for all residents were 46.2 (±4.64) pre and 47.9 (±6.03) post (ns). On qualitative analysis, we derived four major themes: empathy, communication, feedback, and physician experience. The most common subthemes discussed were empathy for the patient situation and the importance of communicating visit expectations. On a 5-point Likert survey related to the simulated cases, respondents rated comfort providing feedback to their peers (mean ± SD 4.41 ± 0.95) and gaining insight into the patient experience (mean ± SD 4.27 ± 0.83).

Conclusions

The embedded intern exercise was rated well by resident participants, with no observed change in empathy scores. Qualitative analysis identified empathy and communication as major themes. Residents enjoyed this style of simulation and found it realistic.

Comparison of empathy profiles of medical students at the start and in the advanced clinical phase of their training

Background

The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) cites empathy as a basic competence for medical doctors. Based on a multidimensional concept of clinical empathy, empathy profiles of medical students at the start of their training and in the 9th semester were identified and compared in order to draw conclusions for the conception of effective course offers.

Method

Using the Saarbrücker Personality Questionnaire on Empathy (SPF-IRI), self-rated empathy was recorded in a cross-sectional study of medical students (1st semester: N=192/9th semester: N=221). Two Stage Clustering was performed for data analysis.

Result

Three empathy profiles which could be meaningfully delineated by content were identified: 1. reflected, functional empathy, 2. unreflected, burdensome empathy and 3. distancing and avoidance. Students in the 9th semester mostly tended toward unreflected, burdensome empathy. Only one-third appeared capable of feeling empathy with patients while at the same time adequately regulating their own emotions and thus protecting themselves from emotional overload.

Conclusion

An adequately reflected and functional empathy among medical students can neither be assumed at the start of their training, nor do existing course offers appear to provide sufficient training for this. Empathy should thus be implemented as a competence which needs to be promoted over the entire course of study. Emotion regulation plays a key role.

Compassionate Presence in Seriously Ill Cancer Patients

Background: Compassion is a relational response to patients' suffering. Palliative care focuses not only on skills but also on compassion. Nevertheless, incorporated patient perspectives are largely missing from existing research. Aim: Our mixed-method exploratory study in a major Swiss cancer center sought to better understand compassionate presence, its benefits and challenges for patients and providers (ie, close relatives, close friends, and professionals-all referred to here as providers). It also investigated providers' motivation. Method: Twelve multidisciplinary, specially trained professionals interviewed 50 patients who had received compassionate presence. All patients had advanced cancer with risk of death. Providers were also interviewed. Data on the positive and burdensome effects of compassionate presence on patients and providers were gathered using a specific protocol. This also served to record patients' characteristics and providers' motivations to give compassion and whether providers felt sustained (eg, by nature). Results: The study suggests a high impact of compassionate presence with benefits on patients (50/50) and on providers (49/50). Enhanced connectedness was evident not only in the patient-provider relationship (38/50) but also, for instance, in an increased ability to love (8/50) or in an intensified solidarity (29/50). A considerable number of patients and providers experienced mental-spiritual change but also burdensome effects (eg, ambivalences). Providers showed a range of motivations. Conclusion: Compassion is not only necessary in existential crises and near death, but also happens and takes considerable effects precisely in such situations.

Learning Language, Un/Learning Empathy in Medical School

This article considers the ways in which empathy for patients and related solidarity with communities may be trained out of medical students during medical school. The article focuses especially on the pre-clinical years of medical school, those that begin with orientation and initiation events such as the White Coat Ceremony. The ethnographic data for the article come from field notes and recordings from my own medical training as well as hundreds of hours of observant participation and interviews with medical students over the past several years. Exploring the framework of language socialization, I argue that learning the verbal, textual and bodily language of medical practice contributes to the increasing experience of separation between physicians and patients. Further considering the ethnographic data, I argue that we also learn a form of empathy limited to performance that short circuits clinical care and the possibility for solidarity for health equity. The article concludes with implications for medical education and the medical social sciences and humanities.

A survey of clinical empathy training at UK medical schools

BACKGROUND

The benefits of enhancing practitioner empathy include better patient outcomes and improved job satisfaction for practitioners. Evidence suggests empathy can be taught and empathy is listed as an outcome for graduates in the General Medical Council requirements. Despite this, empathy training is not mandatory on medical school curricula and the extent to which medical students are given empathy-specific training is unknown.

AIM

To conduct a survey of empathy training currently offered to medical students in UK medical schools.

METHODS

An invitation to participate in an online survey was sent to all UK medical schools (n = 40). The survey was developed through a consultancy and pilot process to ensure validity and reliability. Questions explored what empathy-focused training is offered, and asked educators whether or not they believed that current provision of empathy training is sufficient. In parallel, medical school websites were searched to identify what information regarding empathy-focused training is described as being part of the degree course. Descriptive statistics were used to describe empathy training delivery from the results of the online materials survey and closed survey questions. Thematic analysis was used to explore free text comments.

RESULTS

Response rate was 70% (28/40), with 28 medical schools included in the analysis. Twenty-six schools reported that their undergraduate curriculum included some form of empathy-focused training with variation in what, when and how this is delivered. Thematic analysis revealed two overarching themes with associated sub-themes: (i) empathy-focused training and development (considering where, when and how empathy training should be integrated); (ii) challenges presented by including empathy on the curriculum (considering the system, students and faculty). All schools agreed empathy training should be on the undergraduate curriculum.

CONCLUSION

This is the first nationwide survey of empathy-focused training at UK medical schools. While some form of empathy-focused training appears to be provided on the undergraduate curriculum at most UK medical schools, empathy is rarely specifically assessed. Most medical educators do not feel their school does enough to promote empathy and the majority would like to offer more.

Empathy in health professions education: What works, gaps and areas for improvement

INTRODUCTION

Developing a physician equipped with both technical and affective skills is crucial in ensuring quality patient care. Of these skills, nurturing empathy is a key skill that has been studied in great detail, particularly among medical undergraduates. Despite numerous studies trending the changes in empathy, the results are often contradictory or confusing. Our study aims to find what interventions are effective to inculcate empathy in both undergraduate and postgraduate medical education and suggest areas for improvement.

METHODS

A narrative review was conducted on the interventions in nurturing empathy in undergraduate and postgraduate medical education. Original research articles and systematic reviews with clear interventions and outcomes were included in the study.

RESULTS

A total of 44 articles were reviewed. About 44% (n = 18) of the studies used a mixture of different approaches as their interventions. Some interventions were anchored by specific topics: Seven papers focusing on communication skills, three papers on humanities, and three on arts. A majority of the interventions (60%; n = 26) were implemented over a span of time as compared to studies which suggested a one-off intervention (30%; n = 12). Of the 26 papers in which the interventions were enforced over a period of time, 62% (n = 16) indicated an increase in student empathy whereas 16% (n = 4) indicated no changes in empathy post-intervention. On the contrary, 50% (n = 6) of the one-off interventions revealed no significant change in student empathy. Jefferson Scale of Empathy (JSE) is widely used in measuring student empathy postintervention, but approximately 41% of the studies included measuring tools other than JSE.

CONCLUSIONS

Pedagogical methods that invoke thought processes related to the affective domain of learning and experiential learning are more effective than the didactic methods of teaching and learning. Multimodal mixed-methods approach that combine different pedagogical interventions is more likely to bring about the desired results.

Empathy as a silent art-A doctor´s daily balancing act: A qualitative study of senior doctors' experiences of empathy

Empathy in the doctor-patient relationship is of great importance and has long been considered a true professional virtue for doctors. Despite the general agreement concerning the importance of empathy, there is no consensus regarding the definition of empathy in medical research. While several quantitative studies, measuring empathy as an individual trait, show a decline in empathy among medical students, other studies have shown that empathy is influenced by contextual factors as well as the availability of role models. Therefore, further studies about the transition from medical school to clinical work also including the perspective of senior doctors are needed. The study presented in this article aims to better understand the clinical conditions for empathy through interviews with senior doctors about their lived experience of empathy. Twelve senior doctors, from different specialities were interviewed using a semi-structured approach. The data was analysed using content analysis. The analysis resulted in the main theme: Empathy as a silent art-a doctor`s daily balancing act. This main theme comprised three categories: "A tacit, yet language-dependent process", "A daily balancing act" and "An unsupported path towards mastery". Doctors face many challenges in their daily balancing act between individual and structural conditions that may affect empathy. In order to maintain and further develop empathy, doctors need working conditions allowing for collegial reflection and conversations that promote empathy.

The Impact of Contemplative Practice in Dental Education: A Qualitative Study in General Dentistry

AIM

This study explored perceptions of dental postgraduates regarding the impact of contemplative practice in a patient care aspect.

MATERIALS AND METHODS

The qualitative research approach using semi-structured interview was employed. Postgraduate students from the General Dentistry Residency Training Program were selected by purposive sampling by considering sex and working experience. The retrieved data were transcribed using a verbatim technique and analyzed using framework analysis.

RESULTS

There were 12 students participating in this research. The retrieved data were analyzed and categorized into two main themes, which were mindfulness and humanized patient-centered care paradigm. Mindfulness can be categorized into four subthemes to represent its required skills, including concentration, deep listening, emotional regulation, as well as critical thinking and problem-solving skill. There were six subthemes for humanized patient-centered care paradigm, which were understanding in patients' context, development of individualized comprehensive treatment planning, treatment with humanization and compassion, management with phycological integrated care, rapport establishment with patients, and good attitudes toward special care needs patients. These skills are considered necessary for patient-centered dental practice, which could be expected from the learning process through contemplative practice.

CONCLUSION

This research supports the implementation of contemplative practice in dental education, as the data demonstrated the positive impact of contemplative practice in both personal and professional perspectives. These included the cultivation of mindfulness and other relevant skills, which were required for humanized patient-centered care in dental practice.

Empathy, personality traits, and emotional management in 2nd and 4th-year dentistry students: a single-center study

BACKGROUND

Patients fearing dental interventions are at risk of delaying or skipping much-needed treatments. Empathic communication could lead to a higher rate of compliance from patients within this group. Empathy, the big five personality traits, and emotion management abilities are all known to influence the quality of communication between dentists and patients. This study was conducted to analyze whether there is a correlation between these factors in dentistry students.

METHODS

Dentistry students in their 2nd and 4th year of study were asked to complete questionnaires assessing empathy, emotion management, and personality traits. Out of a total of 148 eligible participants, 53 students (34%) volunteered to participate. For empathy, the Jefferson Scale of Physician Empathy (students' version; JSPE-S) and the Interpersonal Reactivity Index (IRI) were used. Personality traits were assessed using the Short Big Five Inventory (BFI-s), and the Situational Test of Emotional Management (STEM) to measure emotional management ability.

RESULTS

Higher scores for emotion management were significantly correlated with the female gender (p ≤ 0.005) and with higher scores in openness (p ≤ 0.05). Students with higher scores in openness also achieved higher scores on the IRI subscales: Perspective taking (p ≤ 0.05), Fantasy (p ≤ 0.01), Empathic concern (p ≤ 0.05), and Personal distress (p ≤ 0.05). For JSPE-S, no correlation with emotion management and personality traits was found.

CONCLUSION

Empathy and emotion management might not be significantly related in dentistry students. Regarding personality traits, students who scored higher on openness also indicated higher abilities in emotion management. These findings should be taken into consideration when planning communication courses for dentistry students, as it might be possible to independently train empathy and emotion management as part of emotional intelligence.

Intensity, dynamics and deficiencies of empathy in medical and non-medical students

BACKGROUND

Empathy is an important competence in the professional development of medical students. The purpose of our study was to compare the levels and scales of empathy in people studying in different educational strategies.

METHODS

The study was conducted between April 2019 and March 2020. Medicine, nursing, midwifery, physiotherapy, psychology, pedagogy and sociology students were the participants of this study. University students preparing for medical professions (n = 1001) and students of programs unrelated to medicine (n = 700) underwent the Empathy Quotient test (EQ-40). We have compared results in both study groups with the use of the distribution of density, analysis of variance and student's t-test.

RESULTS

The average results received by students of the university preparing for medical professions were lower (M = 42.6) than those of the non-medical university students (M = 45.3) and the differences between the universities turned out to be statistically important (t = - 5.15, df = 1699, p < 0.001). As many as 14.6% of the students in the 1st EQ class were preparing for various medical professions while 9% studied social sciences. 18.2% of all medical programme students (n = 412) manifested the lowest empathy class. Our research has revealed that the students with Asperger profile (AP) and high-functioning autism (HFA) studied at universities preparing for medical professions (n = 18) more frequently than at non-medical universities (n = 5).

CONCLUSIONS

We have noticed a serious indicator of erosion in the levels of empathy in medical students and an increase in the number of people with AP and HFA. Empathy decreases in students after the third year of their studies, regardless of the kind of university. We recommend an introduction of career counselling when specialization is being chosen.

Self-worth and bonding emotions are related to well-being in health-care providers: a cross-sectional study

BACKGROUND

Interacting with patients can elicit a myriad of emotions in health-care providers. This may result in satisfaction or put providers at risk for stress-related conditions such as burnout. The present study attempted to identify emotions that promote provider well-being. Following eudaimonic models of well-being, we tested whether certain types of emotions that reflect fulfilment of basic needs (self-worth, bonding with patients) rather than positive emotions in general (as suggested by hedonic models) are linked to well-being. Specifically, we hypothesized that well-being is associated with positive emotions directed at the self, which reflect self-worth, and positive as well as negative emotions (e.g., worry) directed at the patient, which reflect bonding. However, we expected positive emotions directed at an object/situation (e.g., curiosity for a treatment) to be unrelated to well-being, because they do not reflect fulfilment of basic needs.

METHODS

Fifty eight physicians, nurses, and psychotherapists participated in the study. First, in qualitative interviews, they reported their emotions directed at the self, the patient, or an object/situation during distressing interactions with patients. These emotions were categorised into positive emotions directed towards the self, the patient, and an object/situation, and negative emotions directed towards the patient that reflect bonding. Second, providers completed questionnaires to assess their hedonic and eudaimonic well-being. The well-being scores of providers who did and did not experience these emotions were compared.

RESULTS

Providers who experienced positive emotions directed towards the self or the patient had higher well-being than those who did not. Moreover, for the first time, we found evidence for higher well-being in providers reporting negative patient-directed emotions during distressing interactions. There was no difference between providers who did and did not experience positive object/situation-directed emotions.

CONCLUSIONS

These findings may point towards the importance of "eudaimonic" emotions rather than just positive emotions in interactions with patients. Emotions such as contentment with oneself, joy for the patient's improvement, and, notably, grief or worry for the patient may build a sense of self-worth and strengthen bonding with the patient. This may explain their association with provider well-being.

The Longitudinal Communication Curriculum at Leipzig University, Medical Faculty - implementation and first experiences

Purpose: Communication skills are an essential instrument for building a sustainable patient-doctor-relationship for future doctors. They are learnable and teachable. The learning should be facilitated with the help of a longitudinal curriculum, which is planned at Leipzig University. Project: At the Medical Faculty of Leipzig University, the Longitudinal Communication Curriculum is established since 2016/17. Up to now, the curriculum consists of four parts in which students repeatedly practise their communication skills in curricular and extracurricular courses. Several formats help to teach an integrated learning of communication and physical examination skills. Assessment of communication skills is also performed. Curricular implementation is accompanied by concomitant evaluation. Results: Three parts of the curriculum already have taken place. Students report an increase in communication skills. Students rate the units as instructive and helpful. The assessment of communication skills occurs in two clinical practical examinations (OSCEs). Together with summative assessment a formative feedback was implemented. Students judge this practice as highly positive. Discussion: The curriculum is part of undergraduate medical education in Leipzig. It would be beneficial to add another simulated patient encounter, as well as interprofessional units. Student questionnaires will be evaluated and results will help to develop the curriculum. Conclusion: Consolidation of the curriculum accompanied by evaluation and adaption of content can help to assure the quality of the curriculum. Additional professions and study units shall be integrated in the Longitudinal Communication Curriculum in the future.

The Development of Empathy and Associated Factors during Medical Education: A Longitudinal Study

PURPOSE

In this longitudinal study, we investigated the development of empathy during medical education and assessed potential predictors of empathy at different time points in the course of medical studies.

METHODS

In our longitudinal study, starting in 2011, we surveyed medical students at Lübeck Medical School, Germany at the beginning of their course of study and after 2, 4, and 6 years (t0-t3) using standard instruments for empathy (Jefferson Scale of Empathy, Student Version, JSE-S), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), stress (Perceived Medical School Stress scale), and behavior and experience patterns (Arbeitsbezogene Verhaltens- und Erlebensmuster [Work-related Behavior and Experience Patterns]).

RESULTS

A total of 43 students completed all surveys. The cross-sectional samples for the different survey time points comprised between n = 220 and 658 students. We observed a slight, but statistically significant, increase of empathy scores from t0 to t3 (t(43) = -3.09, P < .01). Across all analyses, a preference for a people-oriented specialty was associated with a higher JSE-S sum score, as well as being female, whereas we saw a negative association between HADS depression and JSE-S scores.

CONCLUSION

In our study, empathy scores were shown to be relatively stable during medical education with a tendency to increase. In line with previous research, individuals preferring a people-oriented specialty and women showed higher empathy scores.

Towards Establishing Criteria for the Ethical Analysis of Artificial Intelligence

Ethical reflection on Artificial Intelligence (AI) has become a priority. In this article, we propose a methodological model for a comprehensive ethical analysis of some uses of AI, notably as a replacement of human actors in specific activities. We emphasize the need for conceptual clarification of relevant key terms (e.g., intelligence) in order to undertake such reflection. Against that background, we distinguish two levels of ethical analysis, one practical and one theoretical. Focusing on the state of AI at present, we suggest that regardless of the presence of intelligence, the lack of morally relevant features calls for caution when considering the role of AI in some specific human activities.

Development of a CanMEDS-based instrument for evaluating medical students' perceptions of the key competencies of a socially accountable healthcare practitioner

INTRODUCTION

Numerous frameworks and tools have been developed to assist medical schools striving to achieve their social accountability mandate. The purpose of this study was to design an instrument to evaluate medical students' perceptions of the key competencies of a 'socially accountable' healthcare practitioner using widely accepted frameworks which contain clear measurable outcomes.

METHODS

The instrument was designed in three phases: selection of a competency-based framework, development of items, and validation of the instrument through exploratory factor analysis. Medical students in the 6‑year medical degree program at the University of Cape Town, South Africa were invited to participate in the study. Descriptive and inferential statistical analysis was performed using Stata/SE version 13.1.

RESULTS

Of 619 students invited to participate in the study, 484 (78%) responded. The CanMEDS framework was selected for designing the instrument, which comprised 35 statements reflecting five competencies for each CanMEDS role. Exploratory factor analysis of the student responses yielded a 28-item instrument. There was a significant difference in overall Perceptions of Social Accountability Instrument (PSAI) scores between men and women (p = 0.002) but no significant difference between the overall PSAI scores for students in the respective years of study.

DISCUSSION

This study describes the design of an instrument to evaluate medical students' perceptions of the essential competencies of socially accountable healthcare practitioners. Used longitudinally, the data may provide evidence of the successes of our programs and identify areas where further improvements are required.

Care Is the Doctor's Best Prescription: The Impact of Doctor-Patient Empathy on the Physical and Mental Health of Asthmatic Patients in China

Background

To explore the impact of empathy between Chinese doctors and patients on anxiety, self-efficacy, sleep and IL-6 levels in hospitalized asthmatic patients.

Methods

This study included 195 asthmatic patients and 30 respirologists in China. The Jefferson Empathy Scale (JSE) was used to measure the empathy level of doctors, and the consultation and relational empathy (CARE) scale was used to measure patients' perception of empathy between themselves and their doctors. Doctors were divided into three groups, according to JSE scores. Data about anxiety, self-efficacy, sleep and IL-6 were collected and compared between patients in different JSE groups at admission (T1) and 3 months later (T2). The correlation between JSE scores and CARE scores was analyzed. Pearson correlation analysis along with a structural equation model was applied to explore the relevance among anxiety, self-efficacy, sleep, inflammatory factors (IL-6) and patients' perception of empathy shown by their doctors.

Results

There was no statistical difference between the indices of patients in three groups at admission. For all patients, the changes of indicators were statistically different from T1 to T2. Three months later, patients in high empathy scoring group showed lower anxiety and IL-6, and higher self-efficacy and sleep quality. There was a positive correlation between JSE and CARE scores. Patients' perception of doctor-patient empathy was negatively correlated to anxiety levels and IL-6, and positively correlated to self-efficacy and sleep quality. Anxiety, self-efficacy and sleep quality were mediators in the relationship between patients' perception of empathy and IL-6.

Conclusion

In the Chinese sample, anxiety, self-efficacy, sleep, empathy between doctors and patients and IL-6 are closely correlated. Anxiety, self-efficacy and sleep may play additional roles in the influence of patients' perception of empathy between doctors and patients on IL-6 in asthmatic patients.

Association Between Empathy and Burnout Among Emergency Medicine Physicians

Background

The association between physician self-reported empathy and burnout has been studied in the past with diverse findings. We aimed to determine the association between empathy and burnout among United States emergency medicine (EM) physicians using a novel combination of tools for validation.

Methods

This was a prospective single-center observational study. Data were collected from EM physicians. From December 1, 2018 to January 31, 2019, we used the Jefferson scale of empathy (JSE) to assess physician empathy and the Copenhagen burnout inventory (CBI) to assess burnout. We divided EM physicians into different groups (residents in each year of training, junior/senior attendings). Empathy, burnout scores and their association were analyzed and compared among these groups.

Results

A total of 33 attending physicians and 35 EM residents participated in this study. Median self-reported empathy scores were 113 (interquartile range (IQR): 105 - 117) in post-graduate year (PGY)-1, 112 (90 - 115) in PGY-2, 106 (93 - 118) in PGY-3 EM residents, 112 (105 - 116) in junior and 114 (101 - 125) in senior attending physicians. Overall burnout scores were 43 (33 - 50) in PGY-1, 51 (29 - 56) in PGY-2, 43 (42 - 53) in PGY-3 EM residents, 33 (24 - 47) in junior attending and 25 (22 - 53) in senior attending physicians separately. The Spearman correlation (ρ) was -0.11 and β-weight was -0.23 between empathy and patient-related burnout scores.

Conclusion

Self-reported empathy declines over the course of EM residency training and improves after graduation. Overall high burnout occurs among EM residents and improves after graduation. Our analysis showed a weak negative correlation between self-reported empathy and patient-related burnout among EM physicians.

Learning climate positively influences residents' work-related well-being

An optimal learning climate is crucial for the quality of residency training and may also improve residents' well-being and empathy. We investigated the associations of learning climate with residents' work-related well-being. A multicenter questionnaire study was performed among 271 surgery and gynaecology residents in 21 training programs from September 2012 to February 2013. Residents were asked to complete work-related well-being measurements: work engagement (Utrecht Work Engagement Scale), job and specialty satisfaction (measures from Physician Worklife Study), and physician empathy (Jefferson Scale of Physician Empathy). The Dutch Residency Educational Climate Test was used to evaluate learning climate. Multivariate adjusted linear regression analyses were used to estimate associations of learning climate with work-related well-being measures. Well-being measures were completed by 144 residents (53.1%). Learning climate was evaluated by 193 residents, yielding 9.2 evaluations per training program on average. Overall learning climate score was positively associated with work engagement [regression coefficient b = 0.58; 95% confidence interval (CI) 0.18-0.98; p = 0.004] and job satisfaction (b = 0.80; 95% CI 0.48-1.13; p < 0.001). No associations were found between learning climate and empathy and specialty satisfaction. Residents' work engagement and job satisfaction are positively related to the learning climate and may be further enhanced by improved learning climates of training programs.

Empathy and big five personality model in medical students and its relationship to gender and specialty preference: a cross-sectional study

BACKGROUND

Given the influence that personality can have on empathy, this study explores the relationship between empathy and personality, using three different measures of empathy, and taking into account gender and specialty preference.

METHODS

Cross-sectional study. One hundred and ten medical students completed the Jefferson Scale of Physician Empathy, the Interpersonal Reactivity Index, the Empathy Quotient, and the NEO-FFI Big Five personality model. Multivariable linear regression was performed to assess the association between personality traits and empathy.

RESULTS

Empathy scales showed weak and moderate correlation with personality. The strongest correlations were observed between IRI-Fantasy and Openness, and between IRI-Personal Distress and Neuroticism. Gender and specialty preference can modify this relationship. The extreme groups of Empathy Quotient had significant differences in most personality traits.

CONCLUSIONS

This study confirmed that empathy is related to personality. Using three empathy scales allows personalizing the evaluation of different empathy models and its relation with personality. These results can help to design programs to study if some personalized intervention strategies could improve the empathy in medical students.

Understanding compassion in family medicine: a qualitative study

BACKGROUND

Patients and physicians have traditionally valued compassion; however, there is concern that physician compassion has declined with the increasing emphasis on science and technology in medicine. Although the literature on compassion is growing, very little is known about how family physicians experience compassion in their work.

AIM

To explore family physicians' capacity for and experiences of compassion in practice.

DESIGN AND SETTING

This was a qualitative study designed using a phenomenological approach in rural and urban Ontario, Canada.

METHOD

In-depth interviews were audiotaped and transcribed verbatim, followed by independent and team coding. An iterative and interpretive analysis was conducted using immersion and crystallisation techniques. Purposive sampling recruited 22 participants (nine males and 13 females aged 26-64 years) that included family medicine residents from Western University (n = 6), and family physicians practising <5 years (n = 7) or >10 years (n = 9) in Ontario, Canada.

RESULTS

From the data, the authors derived the Compassion Trichotomy as a theoretical model to describe three interrelated areas that determine the evolution or devolution of compassion experienced by family physicians: motivation (core values), capacity (energy), and connection (relationship).

CONCLUSION

The Compassion Trichotomy highlights the importance and interdependence in physician compassion of motivation (personal reflection and values), capacity (awareness and regulation of energy, emotion, and cognition), and connection (sustained patient-physician relationship). This model may assist practising family physicians, educators, and researchers to explore how compassion development might enhance physician effectiveness and satisfaction.

Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016)

BACKGROUND

Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.

AIM

To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.

METHODS

A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I² statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis.

RESULTS

Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained.

CONCLUSION

The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales.

A Comparison of Stress Perception in International and Local First Semester Medical Students Using Psychometric, Psychophysiological, and Humoral Methods

(1) Medical doctors and medical students show increased psychological stress levels. International medical students seem to be particularly vulnerable. (2) We compared different methods of assessing stress levels in international and local first year medical students. First, study participants completed questionnaires related to stress, depression, empathy, and self-efficacy (MBI, PSQ, PHQ-9, JSPE-S, and GSE) at three separate points in time (T1 to T3). Second, their heart rate variabilities (HRVs) were recorded in an oral examination, a seminar, and in a relaxing situation. Third, hair samples were collected at the beginning and at the end of the semester to assess the cortisol concentration. (3) Included were 20 international and 20 local first semester medical students. At T1, we found considerable differences between international and local students in the JSPE-S; at T2 in the MBI factor "professional efficacy", the PHQ-9, and in the JSPE-S; and at T3 in the MBI factors "cynicism" and "professional efficacy", the PHQ-9, and in the JSPE-S. International and local students also differed concerning their HRVs during relaxation. Over the course of the semester, international students showed changes in the MBI factors "emotional exhaustion" and "professional efficacy", the PHQ-9, and the GSE. Local students showed changes in the GSE. No effects were found for students' hair cortisol concentrations. (4) All participants showed low levels of stress. However, while international students experienced their stress levels to decrease over the course of the semester, local students found their stress levels to increase.

Influences on students' empathy in medical education: an exploratory interview study with medical students in their third and last year

BACKGROUND

Empathy is beneficial for patients and physicians. It facilitates treatment and improves physical and psychosocial outcomes. The therapeutic relevance of empathy emphasizes the need to help medical students develop their empathic abilities. Our study aimed to identify factors which promote or hinder the development and expression of empathy in medical students during the course of their studies.

METHODS

We interviewed 24 medical students (six male and six female students in their 6th semester as well as six male and six female students in their final clinical year) using semi-structured interviews. The interviews were recorded, transcribed verbatim and analyzed using Braun & Clarke's thematic analysis.

RESULTS

We identified four main themes influencing the development and expression of empathy. 1) Course of studies: hands-on-experience, role models, science and theory, and emphasis on the importance of empathy; 2) students: insecurities and lack of routine, increasing professionalism, previous work experiences, professional distance, mood, maturity, and personal level of empathy; 3) patients: "easy" and "difficult" patients including their state of health; and 4) surrounding conditions: time pressure/stress, work environment, and job dissatisfaction.

CONCLUSIONS

The development and use of empathy could be promoted by increasing: hands-on-experiences, possibilities to experience the patient's point of view and offering patient contact early in the curriculum. Students need support in reflecting on their actions, behavior and experiences with patients. Instructors need time and opportunities to reflect on their own communication with and treatment of patients, on their teaching behavior, and on their function as role models for treating patients empathically and preventing stress. Practical experiences should be made less stressful for students. The current changes implemented in some medical school curriculums (e.g., in Germany) seem to go in the right direction by integrating patient contact early on in the curriculum and focusing more on teaching adequate communication and interaction behaviors.

Empathy among undergraduate medical students: A cross-sectional study in one Malaysian public medical school

Background

Empathy is one of the cardinal components for physician-patient relationships, optimal outcomes in patient care, improved patient satisfaction, greater adherence to therapy, and lower malpractice liability. It is also considered an essential quality for health-care professionals to practice medicine. The aim of the present study was to assess the empathy level of medical students of Universiti Pertahanan Nasional Malaysia (UPNM) National Defense University of Malaysia, Kuala Lumpur, Malaysia.

Methods

This was a cross-sectional study conducted in 2017 which recruited medical students of UPNM. The Empathy Quotient, a self-reported questionnaire, was utilized for data collection. The total empathy score of the questionnaire is 80.

Results

Majority of the respondents were male (60.9%), year-V students (26.6%), Malay (70.5%), and cadet officer (69.6%). The overall mean score achieved by the respondents was 36.76 ± 9.18, and 74.4% of the respondents scored more than 30. The empathy scores of the students were significantly affected by the gender (t = 2.371; df = 205; P < 0.05), year of study (F = 2.553; df = 4/202; P < 0.05), and examination grades (F = 3.488; df = 2/204; P < 0.05). The findings showed that female students are more empathetic than their male counterparts. Further, the post hoc Tukey test analysis revealed that Year-V students are more empathetic than their junior counterparts and students who got highest grade are more empathetic.

Conclusions

To improve the empathy level of the UPNM medical students, appropriate educational strategies and interventions should be designed and implemented in the curriculum to inculcate, maintain, and enhance empathy.

Emotion Transfer, Emotion Regulation, and Empathy-Related Processes in Physician-Patient Interactions and Their Association With Physician Well-Being: A Theoretical Model

Physicians experience many emotionally challenging situations in their professional lives, influencing their emotional state through emotion contagion or social appraisal processes. Successful emotion regulation is crucial to sustain health, enable well-being, foster resilience, and prevent burnout or compassion fatigue. Despite the alarmingly high rate of stress-related disorders in physicians, affecting not only physician well-being, but also outcomes such as physician performance, quality of care, or patient satisfaction, research on how to deal with emotionally challenging situations in physicians is lacking. Based on extant literature, the present article proposes a theoretical model depicting emotions, emotion regulation, and empathy-related processes and their relation to well-being in provider-client interactions. This model serves as a basis for future research and interventions aiming at improving physician well-being and professional functioning. As a first step, interviews with 21 psychiatrists were conducted. Results of qualitative and initial quantitative analyses provided detailed descriptions of the model's components confirming its usefulness for detecting mechanisms linking emotion regulation and well-being in psychiatrist-patient interactions. Additionally, results lend preliminary support for the validity of the model, suggesting that successful regulation of emotions (i.e., achieving a desired emotional state) elicited by cyclical transfer processes in provider-client interactions is associated with both short- and long-term well-being and resilience. Furthermore, empathy-related emotions and their regulation seem to be linked to well-being. Based on the results of the present study, a prospective longitudinal study is under preparation, which is intended to inform effective interventions targeting emotion transfer, empathy-related processes, and emotion regulation in physicians' professional lives. The model and results are also potentially applicable to other health care and social services providers.

Empathy score among medical students in Mashhad, Iran: study of the Jefferson Scale of Physician Empathy

Background

Empathy is one of the essential components of physician-patient relationship that has a significant effect on treatment outcomes.

Objective

The aim of this study was to assess the empathy score among medical students in Mashhad, Iran.

Methods

In this cross-sectional study in 2015, 624 medical students at Mashhad University of Medical Science (Iran) completed the Jefferson Scale of Physician Empathy (JSPE). Data were analyzed by SPSS ver. 16, using independent-samples t-test, Chi-square, MANOVA, Spearman correlation, and Confirmatory factor analysis.

Results

Of the 38.4% males and 65% females who participated in this study, the mean score of JSPE in the sample was 103.67 (±15.34) which was higher in women than in men. Also, the mean scores for each of the three factors of the scale were calculated. The total empathy score, compassionate care, and taking perspectives among different age groups were significant (p=0.000). Furthermore, students having high interest in their field were more empathic (p=0.008). Empathy of interns in relation to three areas of basic sciences (the first year, the second year and the first half of the third year), physiopathology (the second half of the third year, and the fourth year), and clinical trainings (the fifth year, and the first half of the sixth year), experienced significant reduction (p≤0.001).

Conclusions

This study showed that empathy was higher in women in their first medical year and who were of younger age. The overall rate of empathy in the basic sciences period was more than that in the clinical period. Therefore, the initial exposure to clinical education, especially patient education and empathy, has a very prominent effect on the ability of medical students.

Developing a Compassionate Culture Within Pediatric Rehabilitation: Does the Schwartz Rounds™ Support Both Clinical and Nonclinical Hospital Workers in Managing Their Work Experiences?

Schwartz Rounds™ offers an interprofessional forum for staff to openly engage in discussions about social-emotional aspects of care. We aimed to assess the perceived impact of Rounds in the health care context of pediatric rehabilitation, as well as a comparative analysis of how Rounds affected clinical versus nonclinical staff. Does effect on perceived outcomes was also investigated. Data were collected from 29 hospital staff (15 clinicians, 14 nonclinicians) who attended one, two, or three+ Rounds via semistructured interviews. Thematic analysis indicated impacts at the personal and social levels (e.g., reduced stress, increased level of approaching behaviors, normalizing and validating emotional experiences, and building bridges within the hospital). Data also revealed the novel finding of Rounds affecting professional knowledge and skills (e.g., interprofessional practice, reflective practice, clinical imagination). These findings elucidate how Schwartz Rounds™ is beneficial in a pediatric rehabilitation setting, albeit somewhat differentially for clinical and nonclinical staff.

Empathy Variation in General Practice: A Survey among General Practitioners in Denmark

Background: Previous studies have demonstrated that high levels of physician empathy may be correlated with improved patient health outcomes and high physician job satisfaction. Knowledge about variation in empathy and related general practitioner (GP) characteristics may allow for a more informed approach to improve empathy among GPs. Objective: Our objective is to measure and analyze variation in physician empathy and its association with GP demographic, professional, and job satisfaction characteristics. Methods: 464 Danish GPs responded to a survey containing the Danish version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP) and questions related to their demographic, professional and job satisfaction characteristics. Descriptive statistics and a quantile plot of the ordered empathy scores were used to describe empathy variation. In addition, random-effect logistic regression analysis was performed to explore the association between empathy levels and the included GP characteristics. Results: Empathy scores were negatively skewed with a mean score of 117.9 and a standard deviation of 10.1 within a range from 99 (p5) to 135 (p95). GPs aged 45–54 years and GPs who are not employed outside of their practice were less likely to have high empathy scores (≥120). Neither gender, nor length of time since specialization, length of time in current practice, practice type, practice location, or job satisfaction was associated with odds of having high physician empathy. However, odds of having a high empathy score were higher for GPs who stated that the physician-patient relationship and interaction with colleagues has a high contribution to job satisfaction compared to the reference groups (low and medium contribution of these factors). This was also the trend for GPs who stated a high contribution to job satisfaction from intellectual stimulation. In contrast, high contribution of economic profit and prestige did not contribute to increased odds of having a high empathy score. Conclusions: Albeit generally high, we observed substantial variation in physician empathy levels among this population of Danish GPs. This variation is positively associated with values of interpersonal relationships and interaction with colleagues, and negatively associated with middle age (45–54 years) and lack of outside employment. There is room to increase GP physician empathy via educational and organizational interventions, and consequently, to improve healthcare quality and outcomes.

More than visual literacy: art and the enhancement of tolerance for ambiguity and empathy

BACKGROUND

Comfort with ambiguity, mostly associated with the acceptance of multiple meanings, is a core characteristic of successful clinicians. Yet past studies indicate that medical students and junior physicians feel uncomfortable with ambiguity. Visual Thinking Strategies (VTS) is a pedagogic approach involving discussions of art works and deciphering the different possible meanings entailed in them. However, the contribution of art to the possible enhancement of the tolerance for ambiguity among medical students has not yet been adequately investigated. We aimed to offer a novel perspective on the effect of art, as it is experienced through VTS, on medical students' tolerance of ambiguity and its possible relation to empathy.

METHODS

Quantitative method utilizing a short survey administered after an interactive VTS session conducted within mandatory medical humanities course for first-year medical students. The intervention consisted of a 90-min session in the form of a combined lecture and interactive discussions about art images. The VTS session and survey were filled by 67 students in two consecutive rounds of first-year students.

RESULTS

67% of the respondents thought that the intervention contributed to their acceptance of multiple possible meanings, 52% thought their visual observation ability was enhanced and 34% thought that their ability to feel the sufferings of other was being enhanced. Statistically significant moderate-to-high correlations were found between the contribution to ambiguity tolerance and contribution to empathy (0.528-0.744; p ≤ 0.01).

CONCLUSIONS

Art may contribute especially to the development of medical students' tolerance of ambiguity, also related to the enhancement of empathy. The potential contribution of visual art works used in VTS to the enhancement of tolerance for ambiguity and empathy is explained based on relevant literature regarding the embeddedness of ambiguity within art works, coupled with reference to John Dewey's theory of learning. Given the situational nature of the tolerance for ambiguity in this context, VTS provides a path for enhancing ambiguity tolerance that is less conditioned by character traits. Moreover, the modest form of VTS we utilized, not requesting a significant alteration in the pre-clinical curricula, suggests that enhancing the tolerance of ambiguity and empathy among medical students may be particularly feasible.

Does the model of additive effect in placebo research still hold true? A narrative review

Personalised and contextualised care has been turned into a major demand by people involved in healthcare suggesting to move toward person-centred medicine. The assessment of person-centred medicine can be most effectively achieved if treatments are investigated using ‘with versus without’ person-centredness or integrative study designs. However, this assumes that the components of an integrative or person-centred intervention have an additive relationship to produce the total effect. Beecher’s model of additivity assumes an additive relation between placebo and drug effects and is thus presenting an arithmetic summation. So far, no review has been carried out assessing the validity of the additive model, which is to be questioned and more closely investigated in this review.

Initial searches for primary studies were undertaken in July 2016 using Pubmed and Google Scholar. In order to find matching publications of similar magnitude for the comparison part of this review, corresponding matches for all included reviews were sought.

A total of 22 reviews and 3 clinical and experimental studies fulfilled the inclusion criteria. The results pointed to the following factors actively questioning the additive model: interactions of various effects, trial design, conditioning, context effects and factors, neurobiological factors, mechanism of action, statistical factors, intervention-specific factors (alcohol, caffeine), side-effects and type of intervention.

All but one of the closely assessed publications was questioning the additive model. A closer examination of study design is necessary. An attempt in a more systematic approach geared towards solutions could be a suggestion for future research in this field.

Empathy Score among Student Residence Assistants in Iran

Introduction

Empathy, an essential component of the physician–patient relationship, may be linked to positive patient outcomes. This study aimed to determine the empathy score among student residence assistants (RAs).

Methods

In this descriptive design (cross-sectional study), 102 Iranian RAs participated in the study during 2015, completing the Jefferson Scale of Empathy (JSPE). Data collection was analyzed using SPSS version 17. MANOVA, independent-samples t-test, Spearman correlation and confirmatory factor analysis (CFA) were used for data analysis.

Results

Mean score of JSE in the sample was 87.06 (±15.14). The mean scores for perspective taking, compassionate care, and standing in the patients shoes were 38.90 (±13.11), 39.27 (±7.94), and 8.89 (±2.80) respectively. Among the three specialties, (psychiatric, internal medicine, surgery) results showed significant differences in total empathy score (p=0.001) and perspective taking score (p= 0.008).

Conclusions

this study showed significant differences in total empathy score and perspective taking in three specialties. We suggest that the curriculum in Iranian RAs include more teaching on empathy and communicational skills.

Are the results of questionnaires measuring non-cognitive characteristics during the selection procedure for medical school application biased by social desirability?

Introduction: A stronger consideration of non-cognitive characteristics in Medical School application procedures is desirable. Psychometric tests could be used as an economic supplement to face-to-face interviews which are frequently conducted during university internal procedures for Medical School applications (AdH, Auswahlverfahren der Hochschulen). This study investigates whether the results of psychometric questionnaires measuring non-cognitive characteristics such as personality traits, empathy, and resilience towards stress are vulnerable to distortions of social desirability when used in the context of selection procedures at Medical Schools. Methods: This study took place during the AdH of Lübeck University in August 2015. The following questionnaires have been included: NEO-FFI, SPF, and AVEM. In a 2x1 between-subject experiment we compared the answers from an alleged application condition and a control condition. In the alleged application condition we told applicants that these questionnaires were part of the application procedure. In the control condition applicants were informed about the study prior to completing the questionnaires. Results: All included questionnaires showed differences which can be regarded as social-desirability effects. These differences did not affect the entire scales but, rather, single subscales. Conclusion: These results challenge the informative value of these questionnaires when used for Medical School application procedures. Future studies may investigate the extent to which the differences influence the actual selection of applicants and what implications can be drawn from them for the use of psychometric questionnaires as part of study-place allocation procedures at Medical Schools.

Patient-centeredness and empathy in a bilingual interprofessional primary care teaching clinic: a pilot study

Utilizing the Consultation and Relational Empathy survey, this project examined the perceptions of care team empathy and patient-centeredness between English- and Spanish-speaking patients. From fall through spring semesters, patient surveys from a primary care, interprofessional student-led teaching clinic were collected and analyzed. Overall, mean scores for both English- and Spanish-speaking patients were above the reported normative average for general practitioners. While, overall, patients expressed satisfaction with the student-led teaching clinic in terms of empathy and patient-centeredness, English-speaking patients had higher median scores than Spanish-speaking patients. Analyzed individually, questions related to communication and provider attitudes were scored lower by Spanish-speaking patients. These results demonstrate that student-led clinics can deliver patient-centered care and highlight the continuing need to investigate and address disparities between English- and Spanish-speaking patients with regard to feelings of empathy and patient-centeredness.

Empathy among undergraduate medical students: A multi-centre cross-sectional comparison of students beginning and approaching the end of their course

BACKGROUND

Although a core element in patient care the trajectory of empathy during undergraduate medical education remains unclear. Empathy is generally regarded as comprising an affective capacity: the ability to be sensitive to and concerned for, another and a cognitive capacity: the ability to understand and appreciate the other person's perspective. The authors investigated whether final year undergraduate students recorded lower levels of empathy than their first year counterparts, and whether male and female students differed in this respect.

METHODS

Between September 2013 and June 2014 an online questionnaire survey was administered to 15 UK, and 2 international medical schools. Participating schools provided both 5-6 year standard courses and 4 year accelerated graduate entry courses. The survey incorporated the Jefferson Scale of Empathy-Student Version (JSE-S) and Davis's Interpersonal Reactivity Index (IRI), both widely used to measure medical student empathy. Participation was voluntary. Chi squared tests were used to test for differences in biographical characteristics of student groups. Multiple linear regression analyses, in which predictor variables were year of course (first/final); sex; type of course and broad socio-economic group were used to compare empathy scores.

RESULTS

Five medical schools (4 in the UK, 1 in New Zealand) achieved average response rates of 55 % (n = 652) among students starting their course and 48 % (n = 487) among final year students. These schools formed the High Response Rate Group. The remaining 12 medical schools recorded lower response rates of 24.0 % and 15.2 % among first and final year students respectively. These schools formed the Lower Response Rate Group. For both male and female students in both groups of schools no significant differences in any empathy scores were found between students starting and approaching the end of their course. Gender was found to significantly predict empathy scores, with females scoring higher than males.

CONCLUSIONS

Participant male and female medical students approaching the end of their undergraduate education, did not record lower levels of empathy, compared to those at the beginning of their course. Questions remain concerning the trajectory of empathy after qualification and how best to support it through the pressures of starting out in medical practice.

Complex and novel determinants of empathy change in medical students

PURPOSE

Physician empathy is a core attribute in medical professionals, giving better patient outcomes. Medical school is an opportune time for building empathetic foundations. This study explores empathy change and focuses on contributory factors.

METHODS

We conducted a cross-sectional study involving 881 students (63%) from Years 1 to 5 in a Singaporean medical school using the Jefferson Scale of Physician Empathy-Student version (JSPE-S) and a questionnaire investigating the relationship between reported and novel personal-social empathy determinants.

RESULTS

Empathy declined significantly between preclinical and clinical years. Female and medical specialty interest respondents had higher scores than their counterparts. Despite strong internal consistency, factor analysis suggested that the JSPE model is not a perfect fit. Year 1 students had highest Perspective Taking scores and Year 2 students had highest Compassionate Care scores. High workload and inappropriate learning environments were the most relevant stressors. Time spent with family, arts, and community service correlated with higher empathy scores, whilst time spent with significant others and individual leisure correlated with lower scores. Thematic analysis revealed that the most common self-reported determinants were exposure to activity (community service) or socialisation, personal and family-related event as well as environment (high work-load).

CONCLUSION

While the empathy construct in multicultural Singapore is congruent with a Western model, important differences remain. A more subtle understanding of the heterogeneity of the medical student experience is important. A greater breadth of determinants of empathy, such as engagement in arts-related activities should be considered.

Exploring physiotherapists' personality traits that may influence treatment outcome in patients with chronic diseases: a cohort study

Background

During treatment of patients with Chronic Diseases (CD) the therapist-patient interaction is often intense, and the strategies used during treatment require physiotherapists to assume a coaching role. Uncovering therapist factors that explain inter-therapist variation might provide tools to improve treatment outcome and to train future therapists. The purpose of this study was to explore the so-called ‘therapist-effect’, by looking at the influence of intrinsic therapist factors, specifically personality traits, on treatment outcome in patients with CD.

Methods

A cohort study was performed using data from the NIVEL Primary Care Database (NPCD) in 2011–2012 and an additional questionnaire. Patients with CD (n = 393) treated by Dutch physiotherapists working in outpatient practices (n = 39) were included. Patient and treatment outcome variables were extracted from NPCD. The course of complaint was measured using the Numeric Rating Scale. Therapist variables were measured using a questionnaire consisting of demographics and the Big Five traits: Extraversion, Neuroticism, Agreeableness, Conscientiousness and Openness to experiences. Data were analysed using multilevel linear regression.

Results

Only Neuroticism was found to be significant (Neuroticism F = 0.71, P = 0.01; therapist gender F = 0.72, P = 0.03; life events F = −0.54, P = 0.09; patient gender F = −0.43, P = 0.10; patient age F = 0.01, P = 0.27). Subgroup analyses of 180 patients with Osteoarthritis and 30 therapists showed similar results.

Conclusions

There are indications that patients with CD who are treated by therapists who tend to be calmer, more relaxed, secure and resilient have a greater reduction in severity of complaints compared to patients treated by therapists who show less of these traits. Being a male therapist and having experienced life events influence outcome positively. However, more extensive research is needed to validate the current findings.

How do national cultures influence lay people's preferences toward doctors' style of communication? A comparison of 35 focus groups from an European cross national research

Background

The evidence that inspires and fosters communication skills, teaching programmes and clinical recommendations are often based on national studies which assume, implicitly, that patients’ preferences towards doctors’ communication style are not significantly affected by their cultural background. The cross-cultural validity of national results has been recognized as a potential limitation on how generally applicable they are in a wider context. Using 35 country-specific focus group discussions from four European countries, the aim of the present study is to test whether or not national cultures influence lay people’s preferences towards doctors’ style of communication.

Methods

Lay people preferences on doctor’s communication style have been collected in Belgium, the Netherlands, the United Kingdom and Italy. Each centre organized between eight and nine focus groups, where participants (n = 259) were asked to comment on a video of a simulated medical interview. The discussions were audiotaped, transcribed and coded using a common framework (Guliver Coding System) that allowed for the identification of different themes.

Results

The frequency distribution of the topics discussed highlights lay people’s generally positive views towards most part of doctors interventions. The regression model applied to the Guliver categories highlighted slight national differences and the existence of a cross-cultural appreciation, in particular, of five types of intervention: Doctors attitudes (both Task-Oriented and Affective/Emotional), Summarizing, Structuring and Providing solution.

Conclusion

Lay panels valued doctors’ communication style in a similar manner in the countries selected. This highlights the existence of a common background, which in the process of internationalization of heath care, might foster the implementation of cross-national teaching programmes and clinical guidelines.

Residents' engagement and empathy associated with their perception of faculty's teaching performance

BACKGROUND

Faculty members rely on residents' feedback about their teaching performance. The influence of residents' characteristics on evaluations of faculty is relatively unexplored. We aimed to evaluate the levels of work engagement and empathy among residents and the association of both characteristics with their evaluation of the faculty's teaching performance.

METHODS

A multicenter questionnaire study among 271 surgery and gynecology residents was performed from September 2012 to February 2013. Residents' ratings of the faculty's teaching performance were collected using the system for evaluation of teaching quality (SETQ). Residents were also invited to fill out standardized measures of work engagement and empathy using the short Utrecht Work Engagement Scale and the Jefferson Scale of Physician Empathy, respectively. Linear regression analysis using generalized estimating equations to evaluate the association of residents' engagement and empathy with residents' evaluations of teaching performance.

RESULTS

Overall, 204 (75.3 %) residents completed 1814 SETQ evaluations of 302 faculty, and 143 (52.8 %) and 140 (51.7 %) residents, respectively, completed the engagement and empathy measurements. The median scores of residents' engagement and empathy were 4.56 (scale 0-6) and 5.55 (scale 1-7), respectively. Higher levels of residents' engagement (regression coefficient b = 0.128; 95 % confidence interval (CI) 0.072-0.184; p < 0.001) and empathy (b = 0.113; 95 % CI 0.063-0.164; p < 0.001) were associated with higher faculty teaching performance scores.

CONCLUSIONS

Residents' engagement and empathy appear to be positively associated with their evaluation of the faculty's performance. A possible explanation is that residents who are more engaged and can understand and share others' perspectives stimulate and experience faculty's teaching better than others.

Healing Relationships: A Qualitative Study of Healers and Their Clients in Germany

Background. The aim of this study was to investigate the nature of the relationships between healers and their clients in Germany. Methods. An interdisciplinary research team performed semistructured interviews with healers and clients and participatory observation of healing sessions. All interviews were digitally recorded, transcribed, and analyzed using content analysis. Results. Fifteen healers and sixteen clients were included. The healer-client relationship was described as a profound and unique experience, which brought forth interpersonal and spiritual connections. The healers were seen as role models for healing to occur and support for being connected spiritually. The clients had to be open-minded and responsible. The importance of the healers' empathy was emphasized. Discussion. The relationship between healer and client can be seen as a triangular connection between client, healer, and a transcendent source which is not the case in typical patient-doctor relationships. The spiritual connection is also said to enhance the empathetic understanding of the healer. The personality and a partner-like attitude of the healer supported the client in giving a more positive meaning to his life, in reconnecting to his spirituality, and in taking responsibility. Future studies should address the role of spirituality in health care and the development of enduring healer-client relationships.

Preaching to the choir: comparing health professionals who enroll in mind-body skills versus herbs and dietary supplements training?

BACKGROUND

Observational studies evaluating elective training programs may be biased if learners who enroll differ from nonenrollees. To assess self-selection bias, we compared participants who enrolled in 2 different online courses in complementary and alternative medical therapies.

METHODS

Participants were recruited from entering classes in medicine, nursing, social work, and dietetics, and residencies in family medicine and pediatrics. The 2 electives were (a) herbs and dietary supplements and (b) mind-body skills training. Participants completed standardized questionnaires before training.

RESULTS

The 218 participants had an average age of 28 years; 76% were trainees. There were no significant differences between enrollees in mind-body skills and herbs and dietary supplements with regard to age, gender, stress levels, mind-body training or practice, mindfulness, empathy, compassion, or resilience.

CONCLUSIONS

Those who enroll in mind-body skills are not measurably different than those who enroll in herbs and dietary supplements. There is no evidence of self-selection bias or "preaching to the choir."

[Therapeutic relationship and communication. Attitude towards patients with functional pain syndromes]

Establishing a trustful therapeutic relationship and reflecting on attitudes and behavior is essential in caring for patients with functional pain syndromes. Hope-disappointment circles are common and can be intensified by unfavorable caregiver behavior. A biopsychosocial, empathetic and coping-oriented attitude has proved to be useful. A motivating communication is recommended that carefully explores the pain and its interactions with psychosocial factors following the three typical phases of accepting complaints, establishing biopsychosocial understanding and developing coping strategies.

The difficult hair loss patient: a particular challenge

Few dermatologic complaints carry as much emotional overtones as hair loss. Adding to the patient's worry may be prior frustrating experiences with physicians, who trivialize hair loss. A detailed patient history, physical examination and few pertinent screening blood tests usually establish a specific diagnosis. Once the diagnosis is certain, treatment appropriate for that diagnosis is likely to control the problem. Treatment options are available, though limited, in terms of indications and efficacy. Success depends both on comprehensions of the underlying pathology and on unpatronizing sympathy from the part of the physician. Ultimately, patients need to be educated about the basics of the hair cycle and why considerable patience is required for effective cosmetic recovery. Communication is an important component of patient care. For a successful encounter at an office visit, one needs to be sure that the patient's key concerns have been addressed. Physicians should recognize that alopecia goes well beyond the simple physical aspects of hair loss. Patients' psychological reactions to hair loss are less related to physicians' ratings than to patients' own perceptions. Some of the patients have difficulties adjusting to hair loss. The best way to alleviate the emotional distress is to eliminate the hair disease that is causing it. Treatment success relies on patient compliance. Rather than being the patient's failure, patient non-compliance results from failure of the physician to ensure confidence and motivation. Finally, patients with hypochondriacal, body dysmorphic, somatoform, or personality disorders remain difficult to manage. The physician should be careful not to be judgmental or scolding because this may rapidly close down communication. The influence of the prescribing physician should be kept in mind, since inspiring confidence versus scepticism and fear clearly impacts the outcome of treatment. Sometimes the patient gains therapeutic benefit just from venting concerns in a safe environment with a caring physician.

[Therapeutic relationship and communication. Attitude towards patients with functional pain syndromes]

Establishing a trustful therapeutic relationship and reflecting on attitudes and behavior is essential in caring for patients with functional pain syndromes. Hope-disappointment circles are common and can be intensified by unfavorable caregiver behavior. A biopsychosocial, empathetic and coping-oriented attitude has proved to be useful. A motivating communication is recommended that carefully explores the pain and its interactions with psychosocial factors following the three typical phases of accepting complaints, establishing biopsychosocial understanding and developing coping strategies.