Empathy Is a Protective Factor of Burnout in Physicians: New Neuro-Phenomenological Hypotheses Regarding Empathy and Sympathy in Care Relationship

Teaching cognitive and affective empathy in medicine: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

Empathy can be divided into cognitive empathy (CE) and affective empathy (AE). CE is defined as the accurate understanding and appropriate response to others' thoughts whereas AE is defined as the accurate understanding and appropriate response to others' emotions. The overall purpose of this systematic review and meta-analysis is to assess the effectiveness of empathy interventions in physicians and physicians-in-training in increasing CE and AE. Specifically, we are interested in examining whether specific teaching methods and intervention designs may contribute to greater empathy intervention effectiveness for CE and AE outcomes.

METHOD

Studies searched included randomized controlled trials conducted between 1971 to 2022 examining empathy interventions for medical students and physicians. Thirty-six studies, consisting of 3,833 participants, met the inclusion criteria. Data were analysed using random-effects pairwise meta-analysis.

RESULTS

Empathy interventions have moderate effect sizes on both CE [d = .50 (95% CI = .30, .70)] and AE [d = .46 (95% CI = .30, .62)]. Heterogeneity of effects was evident for both analyses. The effectiveness of interventions on AE was moderated by measurement type. Intervention effectiveness was not significantly moderated by other intervention and study characteristics for either type of empathy.

CONCLUSIONS

There is evidence of key differences, and similarities, in how CE and AE is taught to medical students and professionals; however, the small number and high level of heterogeneity in studies makes this difficult to confirm. Research in this field will benefit from investigators standardizing teaching and research methods across studies.

Physician burnout, associated factors, and their effects on work performance throughout first-year internships during the COVID-19 pandemic in Thailand: a cross-sectional study

BACKGROUND

Burnout has become a significant occupational concern for physicians who have recently graduated, attributed to their prolonged exposure to workplace stressors, poor work-life balance, and limited patient care experience. These challenges posed during the COVID-19 pandemic, placed unprecedented stress on healthcare systems and first-year interns navigating their careers. This study aimed to assess the prevalence of burnout among first-year intern physicians (1st IPs), investigate the factors contributing to burnout, and explore potential correlations between burnout and work performance.

METHODS

This cross-sectional study was carried out between June and July 2022, enrolling 412 1st IPs in Thailand. These participants completed a questionnaire through an online web-based platform. The questionnaire included the Maslach Burnout Inventory-Human Services Survey for Medical Personnel to assess burnout, as well as items addressing factors related to working conditions. These factors included colleague support, academic counselling, professional satisfaction, income and workload balance, medical errors, work performance, resignation thoughts, and suicidal ideation. Data were analysed using multivariable logistic regression.

RESULTS

Among the participants, 58.5% were female, with an average age of 25.59 years (SD 2.18). A significant proportion (81.2%) worked more than 80 h per week. Nearly half, 48.1% experienced burnout, characterized by high levels of emotional exhaustion (83.5%), depersonalization (74.8%), and low personal accomplishment (66.5%). In the adjusted model, physicians lacking support from their colleagues had higher levels of burnout (adjusted odds ratio [aOR] 2.56, 95% CI 1.18 to 5.58). Those dissatisfied with their professional life were more likely to experience burnout compared to those who were satisfied (aOR 4.52, 95% CI 2.31 to 8.84). Burnout was also significantly associated with poor work performance (aOR 2.14, 95% CI 1.08 to 4.21), while no association was found between burnout and suicidal ideation.

CONCLUSIONS

Our findings revealed a significantly high prevalence of burnout among 1st IPs in Thailand. This burnout was associated with inadequate colleague support and professional dissatisfaction, ultimately resulting in poor work performance. To address these issues, mentorship programs and buddy support systems, along with adherence to recommended work-hour guidelines, are crucial to mitigate burnout and improve work performance.

From disconnection to compassion: a phenomenological exploration of embodied empathy in a face-to-face interaction

Background

Research has advanced in revealing psychological and brain mechanisms in empathy-compassion experience. However, much of this research has been constrained by using non-ecologically valid, non-interactive experimental paradigms, as well as a lack of in-depth investigation into participants' subjective experiences.

Objective

This study aims to bridge these gaps by examining subjective experiences within an interactive setting.

Methods

Forty-two participants engaged in a 90-s, face-to-face interaction with an actor simulating a person with (Alzheimer's) dementia. The actor's performance in the interaction followed a validated emotion-inducing narrative about his fear of forgetting their family memories. Subsequently, micro-phenomenological interviews explored participants' embodied experiences. Data underwent iterative inter-coder processing, and both qualitative and quantitative analyses were conducted. Qualitative analysis focused on temporal dynamics and multilayered dimensions (bodily, affective, attentional, motivational, and relational), while quantitative analysis assessed Bayes's correlation between phenomenological dimensions and structures of experience, alongside exploratory correlations with empathy-compassion trait questionnaires.

Results

The participants initially connect with the actor's suffering in their own bodies, leading to an intensified sensation of anguish as the actor vividly describes the fear of forgetting his wife. After, four main experiential ways of navigating the anguish were identified: (1) Relational Disengagement, characterized by detachment from others' suffering, reduced anguish intensity, and a cold interaffective space; (2) Persistent Angst, characterized by ongoing distress; (3) Anguish Anchoring, characterized by a reactive willingness to alleviate suffering, intense bodily sensations, fluctuating presence, and a less warm, more distant interaffective space; and (4) Compassionate Balanced Support, characterized by a felt presence within a warm interaffective space, motivating balanced support for others. These graded experiences were positively correlated with the 'empathic concern' trait assessed by the Interpersonal Reactivity Index scale.

Conclusion

This study suggests a shift in empathy research by proposing moving from a traditional binary view (distress and compassion) to a nuanced framework identifying four distinct and holistic embodied experiences.

Compassionate care in the emergency department: A narrative review and blueprint for future inquiry

While compassion has long been accepted conceptually as a vital part of patient care, few rigorous studies have focused on its provenance or impact until quite recently. A growing body of literature gives early evidence that compassion can substantially impact health outcomes, and critically, that compassionate behaviors may be fostered by didactics or clinical environment. Only a few studies have yet addressed compassion in the emergency department (ED) setting, but there are already indications that the perception of compassionate care during medical emergencies can have a meaningful and enduring impact on health. This review aims to assess the current research on compassion as it relates to ED care and proposes a framework for future inquiry. In particular, we assess the current evidence surrounding 1) measurement of compassion, 2) the impact of compassion on patient outcomes, and 3) the efficacy of compassion education for providers. We also highlight several understudied areas in the compassion literature, including potential effect on overall cost of care, how delivery of compassionate care might influence provider burnout, and how social determinants of health, race, gender, and other factors mediate either the provision of or the perception of compassionate care. In an era of competing demands on emergency providers' time, it is vitally important to better understand both the teaching of compassion and its myriad potential impacts if we are to make informed decisions about how to prioritize this aspect of medical care.

Using virtual patients to enhance empathy in medical students: a scoping review protocol

INTRODUCTION

Empathy is a crucial skill that enhances the quality of patient care, reduces burnout among healthcare professionals, and fosters professionalism in medical students. Clinical practice and standardized patient-based education provide opportunities to enhance empathy, but a lack of consistency and reproducibility as well as significant dependency on resources are impediments. The COVID-19 pandemic has further restricted these opportunities, highlighting the need for alternative approaches. Virtual patients through standardized scenarios ensure consistency and reproducibility while offering safe, flexible, and repetitive learning opportunities unconstrained by time or location. Empathy education using virtual patients could serve as a temporary alternative during the COVID-19 pandemic and address the limitations of traditional face-to-face learning methods. This review aims to comprehensively map existing literature on the use of virtual patients in empathy education and identify research gaps.

METHODS

This scoping review will follow the Joanna Briggs Institute's guidelines and be reported according to PRISMA-P. The search strategy includes a comprehensive search across databases such as PubMed (MEDLINE), CINAHL, Web of Science, Scopus, ERIC, Google, Google Scholar, and Semantic Scholar, covering both published and gray literature without language restrictions. Both quantitative and qualitative studies will be included. Two independent researchers will screen all titles/abstracts and full texts for eligibility. Data will be extracted to summarize definitions of empathy, characteristics of virtual patient scenarios, and methods for measuring their impact on empathy development. Results will be presented in narrative and tabular formats to highlight key findings and research gaps.

DISCUSSION

As this review analyzes existing literature, ethical approval is not required. Findings will be actively disseminated through academic conferences and peer-reviewed publications, providing educators and researchers with valuable insights into the potential of virtual patients to enhance empathy in medical education. This study goes beyond the mere synthesis of academic knowledge by contributing to the advancement of medical education and clinical practice by clarifying virtual patient scenario design and evaluation methods in empathy education. The findings provide a critical foundation for our ongoing development of a medical education platform aimed at enhancing empathy through the use of virtual patients.

Does Learner Communication Behavior Change Based on Context? Observations of Surgical Residents Across Clinical Rotations

OBJECTIVE

As surgical residency programs begin developing communication skills-specific training curricula, it is important to understand those skills required of surgeons in the many settings in which they work. It is also useful to observe the skills that residents already demonstrate, as well as those skills that need further development. This study evaluated surgical residents' communication behaviors across different services to understand how the clinical learning environment influences their approach to surgeon-patient interactions.

DESIGN AND SETTING

Our communication coaching program used standardized observation and coding to evaluate residents' communication on pediatric surgery, community general surgery, and trauma/acute care surgery services.

PARTICIPANTS

Twenty-four senior residents were observed interacting with patients and families on morning rounds in each of 3 settings.

RESULTS

A total of 373 patient-resident interactions were observed. Behaviors like introducing the team, showing courtesy and respect, and sharing next steps were consistent across settings. However, different patterns emerged when evaluating 15 skills: effective communication behaviors occurred at the highest rates in pediatrics, followed by community surgery, and lowest in trauma. Most communication behaviors varied significantly between settings, underscoring the need to understand effective communication in each context to support learner development accordingly.

CONCLUSIONS

Communication skills varied significantly among the same surgical residents across different settings. The findings highlight the importance of supporting learners in adapting fundamental aspects of effective communication in various clinical environments. Modern surgical training can benefit from increased focus on communication skills across learning environments, using 1:1 communication coaching that emphasizes existing strengths, and tailoring communication skills to particular settings.

Uncovering the components of therapeutic empathy through thematic analysis of existing definitions

OBJECTIVES

To identify the components of therapeutic empathy based on a review of existing definitions.

METHODS

A search for therapeutic empathy definitions was conducted in two stages. First, a list of empathy definitions from within healthcare contexts was compiled using existing systematic reviews and a database of empathy definitions. The components of those definitions were identified through thematic analysis. Then, forward and backward citation searching (snowballing) of the papers from which those definitions were retrieved was conducted. These papers were randomly sampled and integrated into the analysis until saturation was reached.

RESULTS

The searches yielded 3948 definitions of therapeutic empathy. Saturation was reached after analysing 39 individual definitions. Six interrelated components of therapeutic empathy were identified: exploring, understanding, shared understanding, feeling, therapeutic action, and maintaining boundaries.

CONCLUSIONS

This study identified six prevailing components of therapeutic empathy that distinguish it from empathy in general. The findings provide a conceptual starting point that can help the field better focus its understanding and use of activities that relate to empathy in practice.

PRACTICE IMPLICATIONS

Future practice, research, and education can use the components generated in this study to more consistently define therapeutic empathy, thereby offering potential to improve patient and practitioner outcomes.

Exploring the bidirectional relationship between job burnout and empathy in nurses: A longitudinal study

OBJECTIVES

This study explored the bidirectional relationship between job burnout and empathy among Chinese nurses.

METHODS

A nurse cohort was assessed longitudinally in 2020 (T1) and 2022 (T2). Participants completed the Maslach Burnout Inventory (MBI)-Human Services Survey and the Jefferson Scale of Empathy-Health Professionals.

RESULTS

Out of the 1090 nurses who participated in both assessments, 551 (50.6 %) exhibited job burnout. Nurses with no burnout, discontinued burnout, and newly developed burnout groups had higher levels of empathy than the persistent burnout group. There is a bidirectional negative association between empathy and job burnout, particularly in the depersonalization and low personal accomplishment. Notably, empathy did not predict the emotional exhaustion from burnout, but heightened emotional exhaustion predicted diminished empathy.

CONCLUSION

The findings suggest a significant bidirectional negative association between empathy and job burnout, especially in depersonalization and low personal accomplishment. Notably, nurses without burnout, discontinued burnout, and newly developed burnout exhibited higher levels of empathy, emphasizing the potential impact of addressing and mitigating burnout on fostering empathetic behavior.

PRACTICE IMPLICATIONS

Interventions targeting both burnout and empathy are vital for nurses. Recognizing and addressing burnout can positively impact fostering empathetic behavior in nursing practice.

Medical students' understanding of clinical empathy - a qualitative exploratory interview study

BACKGROUND

Empathy plays an important role in the interaction and communication with patients. Physicians' empathy has various positive patients' and physicians' outcomes. Despite the inclusion of empathy in medical curricula and the relevance of empathy in general and physicians' concept of it to medical care, there is no common definition of empathy in the clinical context: definitions tend to be abstract and we do not know enough about medical students' conceptualization of clinical empathy. A clear and consensual definition of empathy is needed to be able to teach and measure empathy adequately. We aimed to explore German medical students' views and understanding of (clinical) empathy.

METHODS

We interviewed 24 students from the second half of the 3rd year and in their final clinical year (six female and male students in each subgroup) using a semi-structured interview guide. Interviews were digitally recorded and transcribed verbatim. We analysed the transcripts using thematic synthesis (Braun & Clarke).

RESULTS

We found three overarching themes: (1) empathy means perceiving and understanding patients' needs and acting accordingly, (2) empathy as an interpersonal, intangible construct and (3) taking time for patients. Showing interests, impartiality and openness towards the patients as well as the need to take patients seriously, treating them with respect, having a holistic view on patients and generate some kind of closeness with patients are subthemes of the first overarching theme.

CONCLUSIONS

Although it is often stated that the various existing definitions of empathy are abstract or far from practice, German medical students seem to have a good idea how to define empathy. Their definition resembles definitions known from the literature and used in education. Further research is needed to compare concepts of empathy of medical students from different countries and cultural backgrounds to inform research and teaching. It would also be interesting to investigate how concepts of empathy change over the course of study and affect perceptions of empathy in third party assessments.

Changing behavior and promoting clinical empathy through a patient experience curriculum for health profession students

Objectives

The authors sought to explore how a curriculum that uses a patient experience simulation followed by reflection can lead to clinical empathy in learners and whether this experience leads to behavioral change. Further, in response to critiques of common pragmatic approaches to clinical empathy teaching in which empathy is operationalized and taught through formal trainings and checklists, the study aimed to contribute insights regarding how clinical empathy may best be taught to health profession students.

Methods

Twenty-six senior medical students participated in an in situ patient experience simulation during a 4-month period in 2021-2022 in an academic emergency department. The simulation was followed by a written reflection and a structured debrief. A thematic analysis was performed on transcripts of the group debriefs.

Results

In the group debriefs, learners described several empathetic behavioral changes they made after this intervention. First, learners discussed performing more small acts of kindness to improve patient care and humanize the patient experience. Second, learners discussed seeking to improve their communication through acknowledgment and validation of the patient experience. Finally, learners described actions to keep patients informed through frequent check-ins and setting expectations on time.

Conclusions

The findings suggest that empathy may not be simply transactional for health profession students and that an understanding of the patient experience leads to actions that improve the patient experience and alleviate suffering.

Protective Effects of Authenticity Against Depression, Suicide, and Burnout among Surgeons

BACKGROUND

Physician burnout and poor mental health are highly prevalent issues within the surgical community. Authenticity, defined as the degree to which individuals align their actions with their true selves, has been identified as a potential factor facilitating positive mental health. This study explores the impact of authenticity on burnout, depression, and suicide among surgeons.

STUDY DESIGN

Members of the department of surgery at a large academic medical center were sent an anonymous survey between April and May 2023. The survey evaluated authenticity using Authenticity Scale, depression using Patient Health Questionnaire, burnout using Copenhagen Burnout Inventory, and suicidality using Ask-Suicide Screening Questions (ASQ) tool.

RESULTS

Of the 170 surgeons, 94 (55.3%) completed the survey. Higher Authentic Living Scores correlated with reduced burnout (r = -0.21, p = 0.047) and depression (r = -0.37, p = 0.0002). Conversely, higher Accepting External Influence (AEI) scores were associated with increased depression (r = 0.23, p = 0.023), and higher Authenticity Self-Alienation (ASA) scores were associated with increased burnout (r = 0.43, p < 0.0001) and depression (r = 0.48, p < 0.0001). Although authenticity domain scores were not significantly associated with ASQ, specific AEI and ASA questions indicated an elevated odds ratio (p = 0.029 and p = 0.010, respectively) of a positive ASQ. Authentic Living Score increased with advancement in professional rank (p = 0.007), whereas AEI (p = 0.0001), ASA (p = 0.003), depression (p = 0.014), and ASQ (p = 0.02) decreased.

CONCLUSIONS

In this study, higher authenticity was associated with a lower likelihood of burnout and depression among surgeons. This study contributes valuable insights into the development of targeted intervention and support mechanisms aimed at promoting authenticity and mental health within the surgical profession.

The associations between resilience, self-care, and burnout among medical students

Burnout is a work-related stress syndrome with substantial consequences for patients, physicians, and medical students. Personal resilience, i.e., the ability to bounce back and thrive despite challenging circumstances, and certain practices, such as self-care, may protect individuals from burnout. However, limited information exists on the complex relationships between resilience, different self-care practices, and burnout. Understanding these associations is important for designing efficient interventions within medical schools. Therefore, the present study examined the direct and indirect associations through a cross-sectional study among 95 fourth-year medical students. Self-reported questionnaires measured resilience, self-care dimensions (stress management, spiritual growth, interpersonal relations, health responsibility), and burnout dimensions (emotional exhaustion, depersonalization, personal accomplishment). Data were analyzed via IBM-SPSS and PROCESS-macro. The main results demonstrated that self-care mediated the associations between resilience and burnout: stress management and interpersonal relations mediated the associations with emotional exhaustion, while spiritual growth mediated the association with personal accomplishment. These results highlight that medical students' resilience may encourage self-care behaviors, thus decreasing levels of the burnout dimensions of emotional exhaustion and personal accomplishment. Developing curricula that enhance students' resilience through applying self-care techniques in stressful situations may reduce the negative impact of burnout in healthcare.

Integrating humanities in healthcare: a mixed-methods study for development and testing of a humanities curriculum for front-line health workers in Karachi, Pakistan

Lady health workers (LHWs) provide lifesaving maternal and child health services to >60% of Pakistan's population but are poorly compensated and overburdened. Moreover, LHWs' training does not incorporate efforts to nurture attributes necessary for equitable and holistic healthcare delivery. We developed an interdisciplinary humanities curriculum, deriving its strengths from local art and literature, to enhance character virtues such as empathy and connection, interpersonal communication skills, compassion and purpose among LHWs. We tested the curriculum's feasibility and impact to enhance character strengths among LHWs.We conducted a multiphase mixed-methods pilot study in two towns of Karachi, Pakistan. We delivered the humanities curriculum to 48 LHWs via 12 weekly sessions, from 15 June to 2 September 2021. We developed a multiconstruct character strength survey that was administered preintervention and postintervention to assess the impact of the training. In-depth interviews were conducted with a subset of randomly selected participating LHWs.Of 48 participants, 47 (98%) completed the training, and 34 (71%) attended all 12 sessions. Scores for all outcomes increased between baseline and endline, with highest increase (10.0 points, 95% CI 2.91 to 17.02; p=0.006) observed for empathy/connection. LHWs provided positive feedback on the training and its impact in terms of improving their confidence, empathy/connection and ability to communicate with clients. Participants also rated the sessions highly in terms of the content's usefulness (mean: 9.7/10; SD: 0.16), the success of the sessions (mean: 9.7/10; SD: 0.17) and overall satisfaction (mean: 8.2/10; SD: 3.3).A humanities-based training for front-line health workers is a feasible intervention with demonstrated impact of nurturing key character strengths, notably empathy/connection and interpersonal communication. Evidence from this study highlights the value of a humanities-based training, grounded in local literature and cultural values, that can ultimately translate to improved well-being of LHWs thus contributing to better health outcomes among the populations they serve.

Does Medical Curriculum Impact on Empathy? A Longitudinal Study in a Sample of Undergraduate Medical Students

Empathy in medical students is receiving increasing attention as it is fundamental to build and develop a functional patient-physician relationship. When looking at its determinants, demographic and academic factors seem to concur in shaping empathy in this population. Although data show strong gender differences and changes in empathy throughout medical school, it is not clear the direction of these changes and whether gender and curriculum features modulate them. This longitudinal study examined changes in empathy and explored gender differences throughout the medical school. Four consecutive cohorts of Italian medical students (N = 336) completed the Jefferson Scale of Empathy - Student (JSE-S) and the Interpersonal Reactivity Index (IRI) in their second year of study (before any clinical clerkship and communication skills courses) and fifth year of study (after a 2-year clinical clerkship and communication skills courses). Analysis of variance for repeated-measures revealed that, beyond the effect of gender, JSE-S total score and IRI Perspective Taking increased, whereas IRI Personal Distress and IRI Fantasy significantly decreased throughout medical school. No significant change in IRI Empathic Concern emerged over time. Student's t-tests showed that female students displayed significantly higher mean scores than their male counterparts for all empathy measures in both their second and fifth years of medical training. The findings suggest that the medical curriculum affects self-reported empathy dimensions among undergraduate medical students. Further research is needed to deepen the understanding of the educational factors that promote the changes in empathy levels during medical training.

Empathetic Communication in Telemedicine: A Pilot Study

Background and Objectives

In health care, empathy is a clinician's ability to understand a patient's emotional state and convey that understanding in their care; and being culturally sensitive is communicating and respecting cultural differences. Providing health care on digital platforms introduces a new challenge of conveying empathy and cultural sensitivity. This study aimed to evaluate whether patients who were seen in-person had different perceptions of clinicians' empathy and cultural sensitivity compared to those who were seen via telemedicine.

Methods

In this cross-sectional pilot study, we recruited primary care clinicians (N=8) and their telemedicine (N=14) and in-person patients (N=20) from two clinics at Emory University in Atlanta, Georgia. We evaluated clinicians' empathy and cultural sensitivity by self-report and from patients' standpoints.

Results

Patient perception of clinician empathy scores were similar (P value=.31) for in-person appointments (mean=33.8) and telemedicine appointments (mean=31.3). Patient perception of culturally sensitive communication varied in the sensitivity domain and was consistently low for the domain of discrimination (suggesting low discrimination among the clinicians) regardless of the modality of the visit.

Conclusions

This novel pilot study demonstrated comparable empathy and culturally sensitive communication scores in telemedicine and in-person visits, highlighting the potential for continued use of telemedicine in outpatient primary care. Delivery of care via telemedicine can enable an expansion of high-quality care to underserved communities. Future studies are needed to confirm our findings to enhance the experience of telemedicine visits for patients and clinicians.

Towards an empathic hidden curriculum in medical school: A roadmap

The "hidden curriculum" in medical school includes a stressful work environment, un-empathic role models, and prioritisation of biomedical knowledge. It can provoke anxiety and cause medical students to adapt by becoming cynical, distanced and less empathic. Lower empathy, in turn, has been shown to harm patients as well as practitioners. Fortunately, evidence-based interventions can counteract the empathy dampening effects of the hidden curriculum. These include early exposure to real patients, providing students with real-world experiences, training role models, assessing empathy training, increasing the focus on the biopsychosocial model of disease, and enhanced wellbeing education. Here, we provide an overview of these interventions. Taken together, they can bring about an "empathic hidden curriculum" which can reverse the decline in medical student empathy.

When Bad News Comes Through the Portal: Strengthening Trust and Guiding Patients When They Receive Bad Results Before Their Clinicians

Communication in oncology was challenging long before the emergence of the US 21st Century Cures Act. Before 2021, a growing body of evidence had demonstrated the benefits of patients' access to and review of the clinical notes in their charts (open notes); however, studies examining the benefits of immediate access to test results were scarce until the implementation of the Cures Act's Information Blocking Rule. Individuals grappling with cancer today now possess immediate access to their laboratory results, imaging scans, diagnostic tests, and progress notes as mandated by law. To many clinicians, the implementation of the Cures Act felt sudden and presented new challenges and concerns for oncologists surrounding patients' potential emotional reactions to medical notes or lack of control over the careful delivery of potentially life-changing information. Despite data that show most patients want immediate access to information in their records before it is communicated directly by a health care professional, surveys of oncologists showed trepidation. In this chapter, perspectives from a patient with cancer, an oncologist, and a cancer psychiatrist (in that order) are shared to illuminate the adjustments made in clinician-patient communication amid the era of nearly instantaneous results within the electronic health record.

Lay Perspectives on Empathy in Patient-Physician Communication: An Online Experimental Study

Research indicates that patients consider empathy as a key factor contributing to the quality-of-care. However, ambiguities in the definition of this multidimensional construct complicate definite conclusions to-date. Addressing the challenges in the literature, and using a hypothetical physician-patient interaction which explored patient-perceived differences between expressions of affective empathy, cognitive empathy, compassion and no empathy, this study aimed to test whether lay participants' evaluations of the quality-of-care depend on the type of empathic physician behavior, and on the physician's gender. We conducted a randomized web-based experiment using a 4 (type of empathy) by 2 (physician gender) between-subjects design. Empathy was subdivided into three concepts: first, affective empathy (i.e. feeling with someone); second, cognitive empathy (i.e. understanding); and third, compassion (i.e. feeling for someone and offering support). Perceived quality-of-care was the primary outcome. Compared with non-empathic interactions, quality-of-care was rated higher when physicians reacted cognitively empathic or compassionate (d = 0.71; 0.43 to 1.00 and d = 0.68; 0.38 to 0.98). No significant difference was found between affective empathy and no empathy (d = 0.13; -0.14 to 0.42). The physician's gender was not related with quality-of-care. Aspects of participants' personality but not their age, gender or the number of physician visits were associated with quality-of-care. No interactions were observed. In showing that patients rated quality-of-care higher when physician reactions were described as cognitively empathic and compassionate, as compared with affectively empathic or non-empathic, our findings refine views about the kinds of empathy that are important in patient care with implications for clinical practice, education and communication trainings.

The impact of empathy on medical students: an integrative review

INTRODUCTION

Empathy is considered the ability to understand or feel others emotions or experiences. As an important part of medical education, empathy can affect medical students in many ways. It is still lacking a comprehensive evaluation of the existing articles on empathy's impact on medical students, despite the existence of many articles on the topic.

OBJECTIVES

To summarize the impact of empathy on medical students during medical education from four perspectives: mental health, academic performance, clinical competence, and specialty preference.

METHODS

The search terms used for retrieval were "empathy", "medical student", "mental health", "depression", "anxiety", "burnout", "examinations", "academic performance", "clinical competence", "specialty preference" on PubMed, EBSCO, and Web of Science before January 2024. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed based on inclusion/exclusion criteria. A consensus was drawn on which articles were included.

RESULTS

Our results indicated that high empathy was a positive factor for mental health, However, students with high affective empathy were more likely to suffer from depression, anxiety, and burnout. Empathy was found to be unrelated to academic performance, but positively correlated with clinical competence, particularly in terms of communication skills. Medical students with high levels of empathy tended to prefer people-oriented majors.

CONCLUSIONS

Medical students who score higher on the self-reported empathy scales often have better mental health, better communication skills, and tend to choose people-oriented specialties. But empathy is not related to academic performance. Additionally, the different dimensions of empathy have different impacts on medical students. It is necessary to design targeted courses and training for medical students to enhance their empathy.

Personalized Machine Learning-Based Prediction of Wellbeing and Empathy in Healthcare Professionals

Healthcare professionals are known to suffer from workplace stress and burnout, which can negatively affect their empathy for patients and quality of care. While existing research has identified factors associated with wellbeing and empathy in healthcare professionals, these efforts are typically focused on the group level, ignoring potentially important individual differences and implications for individualized intervention approaches. In the current study, we implemented N-of-1 personalized machine learning (PML) to predict wellbeing and empathy in healthcare professionals at the individual level, leveraging ecological momentary assessments (EMAs) and smartwatch wearable data. A total of 47 mood and lifestyle feature variables (relating to sleep, diet, exercise, and social connections) were collected daily for up to three months followed by applying eight supervised machine learning (ML) models in a PML pipeline to predict wellbeing and empathy separately. Predictive insight into the model architecture was obtained using Shapley statistics for each of the best-fit personalized models, ranking the importance of each feature for each participant. The best-fit model and top features varied across participants, with anxious mood (13/19) and depressed mood (10/19) being the top predictors in most models. Social connection was a top predictor for wellbeing in 9/12 participants but not for empathy models (1/7). Additionally, empathy and wellbeing were the top predictors of each other in 64% of cases. These findings highlight shared and individual features of wellbeing and empathy in healthcare professionals and suggest that a one-size-fits-all approach to addressing modifiable factors to improve wellbeing and empathy will likely be suboptimal. In the future, such personalized models may serve as actionable insights for healthcare professionals that lead to increased wellness and quality of patient care.

Association between burnout and empathy in medical residents

BACKGROUND

Burnout is a work-related syndrome that can affect physicians' performance. Empathy is one of the clinical competencies in whose formation many factors play a role. Empathy and burnout are important topics of research in medical sciences, and both are related to the communication between the patient and the physician. This study investigated the relationship between occupational burnout and empathy among medical residents.

METHOD

This cross-sectional study was conducted on 297 medical residents in Ahvaz Jundishapur University of Medical Sciences from January to March 2021. The data collection tools were the Jefferson Scale of Empathy (JSE) and the Maslach Burnout Inventory (MBI). The reliability of the instruments was measured by calculating Cronbach's alpha. Data were analyzed by SPSS-18, using the Pearson correlation test and linear regression models.

RESULTS

The average age of the study population was 33.06 ±4.7 years, with more than half being females (57.6%) and married (51.9%). The residents' mean scores of empathy and overall burnout were 102.87 out of 140 and 55.90 out of 132, respectively. The burnout scores showed an inverse correlation with the overall empathy scores (r = -0.123, P = 0.035), and the score of standing in the patient's shoes (r = -0.165, P = 0.004). Linear regression test was used to detect which dimension of empathy was a better predictor for the reduction of burnout scores. Results showed that the best predictor was standing in the patient's shoes (P = 0.014).

CONCLUSION

The findings showed a negative association between empathy and burnout among medical residents, which suggests the need for adjustment of the existing burnout management at the institutional level. Therefore, residents should be supported by managers to reduce burnout and improve their empathic behavior.

Association between tolerance for ambiguity specific to the clinical context and empathy in medical trainees: A multicenter cross-sectional study in Japan

PURPOSE

Physicians' empathy and ambiguity tolerance have recently become a focus of medical education. However, the association between the two concepts remains unclear. This study examined the association between empathy and ambiguity tolerance in the clinical context among medical trainees.

METHODS

We conducted a multicenter cross-sectional study in 12 institutions: 2 universities for medical students and 10 hospitals for residents. We assessed ambiguity tolerance using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors scale. The outcome variable was empathy, measured using the Japanese translation of the Jefferson Scales of Empathy (JSE).

RESULTS

Data from 100 medical students and 135 residents were analyzed. After adjustment for possible confounders, the factor scores of 'tolerance for things that are not black or white in medicine' showed a dose-dependent association with the JSE. There was no clear trend in the association between the total scores or other factor scores and empathy.

CONCLUSION

This nationwide multicenter study showed that the factor scores of 'tolerance for things that are not black or white in medicine' were associated with empathy among medical trainees. Our findings may be helpful for developing interventions in the field of medical education to nurture empathy.

The relationship between Empathy and listening styles is complex: implications for doctors in training

BACKGROUND

Effective communication is the key to a successful relationship between doctors and their patients. Empathy facilitates effective communication, but physicians vary in their ability to empathize with patients. Listening styles are a potential source of this difference. We aimed to assess empathy and listening styles among medical students and whether students with certain listening styles are more empathetic.

METHODS

In this cross-sectional study, 97 medical students completed the Jefferson scale of Empathy (JSE) and the revised version of the Listening Styles Profile (LSP-R). The relationship between empathy and listening styles was assessed by comparing JSE scores across different listening styles using ANOVA in SPSS software. A p-value less than 0.05 was considered significant.

RESULTS

Overall, the students showed a mean empathy score of 103 ± 14 on JSE. Empathy scores were lower among clinical students compared to preclinical students. Most of the medical students preferred the analytical listening style. The proportion of students who preferred the relational listening style was lower among clinical students compared to preclinical students. There was no significant relationship between any of the listening styles with empathy.

CONCLUSION

Our results do not support an association between any particular listening style with medical students' empathic ability. We propose that students who have better empathetic skills might shift between listening styles flexibly rather than sticking to a specific listening style.

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.

Relationship between competency for evidence-based practice and level of burnout of physical therapists with the establishment of the therapeutic relationship

BACKGROUND

Evidence-based practice (EBP) interventions and effective therapeutic alliance (TA) are associated with greater treatment success. Furthermore, burnout syndrome could be detrimental to the development of such TA.

OBJECTIVE

To examine the association between EBP competencies and burnout level with the quality of TA among Spanish physiotherapists.

METHODS

Cross-sectional research with an electronic survey including the EBP Questionnaire-19, Maslach Burnout Inventory and Working Alliance Inventory-Short (WAI-S) and administered to 471 physiotherapists.

RESULTS

Regarding the EBP Questionnaire-19, physiotherapists scored highest on attitude and lowest on knowledge. For WAIS which achieved appropriate results of internal consistency and validity in the sample analyzed, bond scored the highest and goals the lowest. Years of experience was significantly associated with the task (r = 0.5; p = .003) and bond (r = 0.7; p = .002) and the WAIS total score (r = 0.8; p < .001), and all burnout subscales (-0.7 < r > 0.7; p < .001 for all).

CONCLUSION

Lower levels of burnout and improved EBP competencies are associated with a TA of greater quality. The association between attitudes toward EBP, a higher level of self-confidence and a lower perception of depersonalization appear to be determinant factors for improving TA.

The mediating role of work-related perceptions in the relationship between empathy and self-perceived clinical performance of residents in China: A multi-center cross-sectional study

OBJECTIVE

This study aimed to describe the association between empathy and residents' clinical performance and investigate whether work-related perception mediates this relationship.

METHODS

A multi-center cross-sectional study was conducted, including 1160 residents from 10 cities in Liaoning Province between March and October 2020. The participants completed various self-reported questionnaires regarding demographic characteristics, work-related perceptions, self-perceived clinical performance, and empathy. The relationships among empathy, work-related perception, and self-perceived clinical performance were examined using a structural equation model (SEM).

RESULTS

Of the 1160 residents, 961 (82.8 %) completed the questionnaires. The SEM path analysis showed that the direct effect of empathy on self-perceived clinical performance was significant and positive (β = 0.34, P < 0.001). There existed significant effects of empathy on work-related perception (β = 0.26, P < 0.001) and work-related perception on performance (β = 0.31, P < 0.001). The path coefficients of empathy concerning self-perceived clinical performance decreased significantly (β = 0.26, P < 0.001) when work-related perception was modeled as a mediator. The bias-corrected and accelerated bootstrap test revealed that work-related perception significantly mediated the relationship between empathy and self-perceived clinical performance (a*b = 0.08, BCa 95 % CI: 0.05-0.13). However, the correlation between the sub-scales of empathy and the items of self-perceived clinical performance was not substantial, even if most of them were statistically significant. The final SEM produced a good fit to the sample data, with CMIN/DF = 2.07 (P < 0.001), CFI = 0.99, GFI = 0.99, AGFI = 0.98, TLI = 0.98, NFI = 0.97, RMSEA (90 % CI) = 0.033 (0.017, 0.049), and SRMR = 0.024.

CONCLUSION

Empathy might significantly affect self-perceived clinical performance both directly and indirectly through the mediating role of work-related perception.

PRACTICE IMPLICATIONS

Efforts to improve clinical performance among residents might benefit from interventions for cultivating empathy and practices for improving work-related perceptions of residents.

Emergency units and COVID-19: Burnout, and empathy reported by nursing professionals and perceived by patients

OBJECTIVE

To investigate Burnout Syndrome and empathy self-reported by the nursing staff and empathy perceived by the patient.

METHOD

Cross-sectional study in a public emergency unit in São Paulo (from October/2020 to March/2021). The nursing staff answered the Maslach Burnout Inventory and the Consultation and Relational Empathy Measure-Nurses (Brazilian version), whereas adult patients answered the Consultation and Relational Empathy Measure (Brazilian version). Descriptive and inferential analysis, with a 5% significance level.

RESULTS

A total of 92 professionals and 271 patients participated. Most professionals reported impact of COVID-19 (80; 86.96%) and, among them, increased Burnout Syndrome (93; 75%), but with low emotional exhaustion (71; 74%), low depersonalization (59; 78%) and high level of professional accomplishment (72; 83%). Most reported impact and increased empathy, and the results reported by professionals and patients (mean and standard deviation) were: 39.89 (6.44) and 38.25 (9.45), respectively.

CONCLUSION

The professionals reported a low level of Burnout Syndrome and a high level of empathy in pandemic.

FIRECARE: An Evidence-Based Prevention Program to Reduce Burnout among Prehospital Caregivers: Benefits of a Combined Mindfulness, Heart Coherence Training, and Positive Psychology Intervention

BACKGROUND

Burnout among emergency health care professionals is well-described, especially during the COVID-19 pandemic. Prevention interventions, such as mindfulness, focus on the management of stress.

OBJECTIVE

To evaluate the effects of the FIRECARE program (a mindfulness intervention, supplemented by heart coherence training and positive psychology workshops) on burnout, secondary stress, compassion fatigue, and mindfulness among advanced life support ambulance staff of the Paris Fire Brigade.

MATERIALS AND METHODS

We used a non-randomized, two-group quasi-experimental study design with a waitlist control and before-and-after measurements in each group. The intervention consisted of six, once-weekly, 2.5-h sessions that included individual daily meditation and cardiac coherence practice. The study compared intervention and waitlist control groups, and investigated baseline, post-program, and 3-month follow-up change on burnout (measuring using the ProQOL-5 scale) and mindfulness (measuring using the FMI scores). Baseline burnout (measured using the ProQOL-5) was evaluated and used in the analysis.

RESULTS

Seventy-four 74 participants volunteered to participate; 66 were included in the final analysis. Of these, 60% were classified as suffering from moderate burnout, the 'burnout cluster'. A comparison of intervention and waitlist control groups found a decrease in the burnout score in the burnout cluster (p = 0.0003; partial eta squared = 0.18). However, while secondary stress fell among the burnout cluster, it was only for participants in the intervention group; scores increased for those in the waitlist group (p = 0.003; partial eta squared = 0.12). The pre-post-intervention analysis of both groups also showed that burnout fell in the burnout cluster (p = 0.006; partial eta squared = 0.11). At 3-month follow-up, the burnout score was significantly reduced in the intervention group (p = 0.02; partial eta squared = 0.07), and both the acceptance (p = 0.007) and mindfulness scores (p = 0.05; partial eta squared = 0.05) were increased in the baseline burnout cluster.

CONCLUSION

FIRECARE may be a useful approach to preventing and reducing burnout among prehospital caregivers.

Moving beyond the lab: investigating empathy through the Empirical 5E approach

Empathy is a complex and multifaceted phenomenon that plays a crucial role in human social interactions. Recent developments in social neuroscience have provided valuable insights into the neural underpinnings and bodily mechanisms underlying empathy. This methodology often prioritizes precision, replicability, internal validity, and confound control. However, fully understanding the complexity of empathy seems unattainable by solely relying on artificial and controlled laboratory settings, while overlooking a comprehensive view of empathy through an ecological experimental approach. In this article, we propose articulating an integrative theoretical and methodological framework based on the 5E approach (the "E"s stand for embodied, embedded, enacted, emotional, and extended perspectives of empathy), highlighting the relevance of studying empathy as an active interaction between embodied agents, embedded in a shared real-world environment. In addition, we illustrate how a novel multimodal approach including mobile brain and body imaging (MoBi) combined with phenomenological methods, and the implementation of interactive paradigms in a natural context, are adequate procedures to study empathy from the 5E approach. In doing so, we present the Empirical 5E approach (E5E) as an integrative scientific framework to bridge brain/body and phenomenological attributes in an interbody interactive setting. Progressing toward an E5E approach can be crucial to understanding empathy in accordance with the complexity of how it is experienced in the real world.

Clinician-associated traumatization from difficult medical encounters: Results from a qualitative interview study on the Ehlers-Danlos Syndromes

Patients with hypermobile Ehlers Danlos Syndrome often experience psychological distress resulting from the perceived hostility and disinterest of their clinicians. We conducted 26 in-depth interviews with patients to understand the origins of this trauma and how it could be addressed in practice. We found that the cumulative effects of numerous negative encounters lead patients to lose trust in their healthcare providers and the healthcare system, and to develop acute anxiety about returning to clinic to seek further care. We describe this as clinician-associated traumatization. Ultimately, our interviewees described the result of this traumatization as worse - but preventable - health outcomes.

Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies

BACKGROUND

Several studies suggest that medical student empathy declines throughout medical school. However, no studies have synthesised the evidence regarding why empathy declines.

OBJECTIVE

To conduct a systematic review and thematic synthesis of qualitative studies investigating why student empathy may change throughout medical school.

METHODS

We included any qualitative study that investigated why empathy might change during medical school. We searched the Medline, Scopus, CINAHL, ERIC, and APA PsycInfo databases for relevant studies. All databases were searched from their inception to 18 July 2022. We also searched the reference lists of the included studies and contacted experts to identify additional studies. We used the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. Overall confidence in our results was assessed using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. We used thematic methods to synthesise our findings.

RESULTS

Our searches yielded 2523 records, and 16 studies involving a total of 771 students were eligible for analysis. Most studies (n = 11) were from Europe or North America. The descriptive themes and sub-themes were identified for each study. Increased complexity in patients and their diseases, together with the 'hidden curriculum' (including a stressful workload, prioritisation of biomedical knowledge, and (sometimes) poor role models), led to student adaptations, such as cynicism and desensitisation. Students' prior lives and professional experiences appeared to exacerbate the decline in empathy. However, there were bias concerns for most of the included studies.

DISCUSSION

Many of the included studies included were small, and some did not include demographic participant data. Given the likely benefits of providing empathic care for patients and practitioners, medical education interventions should focus on developing an 'empathic hidden curriculum' that mitigates the decline in medical student empathy.

TRIAL REGISTRATION

A protocol for this systematic review was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on 28 July 2022 (registration number CRD42022347856).

Empathy and Occupational Health and Well-Being in Ecuadorian Physicians Working with COVID-19 Patients: A Mixed-Method Study

Approximately one out of ten COVID-19 cases in Ecuador was a physician. It has been reported that this situation has led to a serious detriment of physicians' health and well-being. This study aimed to (i) identify predictors of emotional exhaustion, somatization, and work alienation in Ecuadorian physicians working with COVID-19 patients and (ii) explore the pandemic impact on doctor-patient relationships and on empathy. In 79 Ecuadorian physicians (45 women) who worked with COVID-19 patients, two separate multiple regression models explained the following: 73% of the variability of emotional exhaustion was based on somatization, work alienation, working sector, and passing through a symptomatic infection (p < 0.001), and 56% of the variability of somatization was based on gender and emotional exhaustion (p < 0.001), respectively. Furthermore, intention to leave the profession was more frequent among physicians with greater work alienation (p = 0.003). On the contrary, more empathic physicians never considered leaving their profession during the COVID-19 pandemic (p = 0.03). In physicians' verbatim, cognitive empathy appeared associated to a positive change in doctor-patient relationships. On the contrary, having an overwhelming emotional empathy appeared associated to a negative change in doctor-patient relationships. These findings characterize differences in how physicians cope while working in the frontline of the pandemic.

Working in value-discrepant environments inhibits clinicians' ability to provide compassion and reduces well-being: A cross-sectional study

BACKGROUND

The practice of compassion in healthcare leads to better patient and clinician outcomes. However, compassion in healthcare is increasingly lacking, and the rates of professional burnout are high. Most research to date has focused on individual-level predictors of compassion and burnout. Little is known regarding how organizational factors might impact clinicians' ability to express compassion and well-being. The main study objective was to describe the association between personal and organizational value discrepancies and compassion ability, burnout, job satisfaction, absenteeism and consideration of early retirement among healthcare professionals.

METHODS

More than 1000 practising healthcare professionals (doctors, nurses and allied health professionals) were recruited in Aotearoa/New Zealand. The study was conducted via an online cross-sectional survey and was preregistered on AsPredicted (75407). The main outcome measures were compassionate ability and competence, burnout, job satisfaction and measures of absenteeism and consideration of early retirement.

RESULTS

Perceived discrepancies between personal and organizational values predicted lower compassion ability (B = -0.006, 95% CI [-0.01, -0.00], p < 0.001 and f ²  = 0.05) but not competence (p = 0.24), lower job satisfaction (B = -0.20, 95% CI [-0.23, -0.17], p < 0.001 and f ²  = 0.14), higher burnout (B = 0.02, 95% CI [0.01, 0.03], p < 0.001 and f ²  = 0.06), absenteeism (B = 0.004, 95% CI [0.00, 0.01], p = 0.01 and f ²  = 0.01) and greater consideration of early retirement (B = 0.02, 95% CI [0.00, 0.03], p = 0.04 and f ²  = 0.004).

CONCLUSIONS

Working in value-discrepant environments predicts a range of poorer outcomes among healthcare professionals, including hindering the ability to be compassionate. Scalable organizational and systems-level interventions that address operational processes and practices that lead to the experience of value discrepancies are recommended to improve clinician performance and well-being outcomes.

What is the Link Between Different Components of Empathy and Burnout in Healthcare Professionals? A Systematic Review and Meta-Analysis

Research on healthcare shows that the relationship between empathy and burnout is complex. The aim of this systematic review and meta-analysis is to clarify the link between different empathic components and burnout components in healthcare professionals. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. The search strategy was applied in PubMed, PsycINFO, CINAHL, Scopus, and Medline, from January 1990 to January 2021. Population included nurses and doctors. Key inclusion criteria were articles addressing the relationship between different components of empathy and professional performance and wellbeing or burn out, or studies using burnout and empathy measures with validity support from commonly accepted sources of evidence. Risk of bias was assessed using the Mixed Methods Appraisal Tool. From 1159 references identified, 22 studies were included in the systematic review, and 5 studies in the meta-analysis. Empathic Concern was significantly correlated with Depersonalization and Personal Accomplishment. Moreover, the links between Perspective Taking, Depersonalization and Personal Accomplishment were statistically significant. In conclusion, exploring and understanding the complex links between empathy and burnout could help healthcare professionals as well as institutions to reduce the risk of suffering burnout.

How well do we understand our patients' perioperative experience? A qualitative analysis of themes derived from patient-centric resident conferences

BACKGROUND

Patient-centric resident conferences (PCRCs) provide meaningful time to connect with and learn from patients. This qualitative study explores themes of patients' perioperative experiences from PCRCs through patient and resident perspectives.

METHODS

General Surgery residents participated in six PCRCs, which include condensed standard didactics to accommodate a patient panel regarding their perioperative experience. Panel transcripts and resident survey responses describing what they learned were coded using grounded theory methodology. Themes were evaluated and compared.

RESULTS

76 identified codes were grouped into major categories: "Medical/Surgical Knowledge," "Patient Perspective," "Patient-Physician Relationship," and "Communication." Themes from resident responses predominantly paralleled patient discussion, with common themes including "impact of disease and surgery on patient" and "compassion/empathy." "Medical/surgical knowledge" was only present in resident responses while themes regarding quality of life were more frequent in patient transcripts.

CONCLUSIONS

PCRCs are a valuable tool in resident education to understand patients' perioperative experiences. Themes from patient panels complement, but do not replace, information covered in didactic lectures.

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.

Appraisal of empathy among dental interns and postgraduate students at King Abdulaziz University: A cross-sectional study

PURPOSE/OBJECTIVES

Empathetic communication of dentists with their patients is a primary characteristic of their health care. This study aims to evaluate dental students' empathy levels during the transitional period of internship and postgraduate studies of different specialties at one of the oldest dental schools in Saudi Arabia and explore how this empathy was affected by gender, age, and study duration.

METHODS

In this study, the self-reported empathy level among the participants was assessed using the Jefferson scale of empathy-student version (JSE-HPS). This survey includes a 20-question Likert scale formulated to measure clinical empathy in health care professionals. The JSE-HPS was distributed to all registered dental interns and postgraduate students during the academic year 2019-20 in King Abdulaziz University Faculty of Dentistry (KAUFD), Jeddah, Saudi Arabia.

RESULTS

Mean total score of empathy of the participants was (101.07 ± 14.8) with a response rate of 89%. A statistically significant higher empathy score appeared among dental postgraduate students in general (p = 0.04) and specifically among the females (p = 0.04) and those with postgraduate programs for more than four years, (p = 0.02). Dental postgraduate students scored significantly higher in the parameters of standing in patients' shoes (p = 0.02).

CONCLUSION

Gender, academic level, and duration of postgraduates' studies influenced empathy more than the age of the dental graduates in KAUFD. Our recommendation is to integrate empathy into the dental curriculum emphasizing interactive communication skills and early patient contact.

The relationship between teacher professional identity and burnout amid the pandemic: A moderated mediation model

Background

Teacher burnout is affected by personal and social factors. COVID-19 has greatly impacted teachers' physical and mental health, which could aggravate teacher burnout.

Purpose

Based on the JD-R model, this study aims to investigate the relationship between teacher professional identity (TPI) and job burnout during the COVID-19 pandemic, and examine the moderating roles of perceived organizational support (POS) and psychological resilience (PR) in these relationships among primary and secondary school teachers in China.

Methods

A total of 3,147 primary and secondary school teachers participated in this study.

Findings

Work engagement played a mediating role in the relationship between professional identity and burnout; when the POS and PR scores were high, the predictive coefficient of TPI on burnout was the largest.

Originality

This study tested the mechanism underlying the relationship between TPI and burnout, and explored the protective factors of burnout.

Implications

This study supports the applicability of the JD-R model during COVID-19 and provides ideas for teachers to reduce burnout.

Development and Assessment of the Scale of Personal Trust and Connections (PerTC): Preliminary Data from a Hospital Employee Group

Trust and empathy constitute basic elements of healthcare delivery. In recent years, the quest for greater efficiency in healthcare has also indicated the necessity of these values. The study aims to develop and assess a 10-item tool, namely, the Personal Trust and Connections (PerTC) scale. The study was conducted at a general hospital in eastern Crete, Greece. A total of 218 healthcare professionals participated over a six-week period in 2021. The 10-item PerTC scale encompasses emotional, social, and cognitive reliance variables. The scale was tested for reliability, and scale scores were assessed for convergent validity. PerTC scale was found with high internal consistency (Cronbach's α = 0.863). At a multivariate level, younger age (p = 0.016), more work experience years (p = 0.001), the experience of a recent family crisis event (p = 0.028), and use of the internet in free time (p = 0.028) were significantly related to increased total scores of the PerTC scale. The new scale is an easy-to-use metric tool with good overall reliability. PerTC may be a suitable instrument to indirectly identify determinants and drivers in order to explore pathways to collectively build on trustful interaction and altruistic connection within a healthcare environment.

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 relationship between medical students' empathy, mental health, and burnout: A cross-sectional study

OBJECTIVE

To investigate how medical students' empathy is related to their mental health and burnout.

METHODS

This cross-sectional study included 886 medical students from curriculum years 1-6. The cognitive, affective, and behavioural dimensions of empathy were measured with self-report questionnaires and an emotion recognition test. Regressions were used to test the relationship between the empathy dimensions, depressive symptoms, anxiety, and burnout as well as the influence of curriculum year and gender.

RESULTS

Cognitive and behavioural empathy were significantly related to less mental health issues and burnout, whereas affective empathy was related to more mental health issues and burnout. Students in later curriculum years reported less mental health issues and burnout than students in earlier years, whereas no systematic difference could be observed for empathy. Female students reported more mental health issues and burnout as well as higher empathy, except for behavioural empathy for which male students scored higher.

CONCLUSIONS

The cognitive, affective, and behavioural dimensions of empathy were differently related to the mental health and burnout of medical students. Students presenting mental health issues or burnout might have more difficulty to adapt their behaviour in social situations and keep a certain distance when taking others' perspective.

What Matters Most? The Power of Kafka's Metamorphosis to Advance Understandings of HIV Stigma and Inform Empathy in Medical Health Education

HIV stigma, a social-medical problem, continues to confound researchers and health professionals, while undermining outcomes. Empathy may reduce stigma; its absence may predict stigma. This research investigates: How does Kafka's Metamorphosis advance understandings of HIV stigma in medical health education? Metamorphosis amplifies the sociological-relational mechanisms fostering HIV stigma. It offers a multi-disciplinary, responsive space for ethical, humanistic and clinical inquiry to meet: enabling students to consider how social structures shape health inequities, moral, social experience, and their professional identity within. Metamorphosis may ultimately promote medical health humanities' social mission-allowing literature to unfold such revelations towards greater equity in health.

The relationship between burnout and empathy in physiotherapists: a cross-sectional study

BACKGROUND

There have been few studies carried out into empathy in physiotherapists. Burnout can debilitate the quality of care and the efficacy of treatment as the empathetic capacity of the professional diminishes.

OBJECTIVE

The objective of the study was to examine the association between the construct burnout, empathy and sociodemographic aspects in Spanish physiotherapists.

METHODS

A cross-sectional electronic survey including the Maslach Burnout Inventory (for burnout assessment), the Interpersonal Reactivity Index (for empathy assessment) and sociodemographic data was answered by 461 Spanish physical therapists. A descriptive, bivariate and lineal regression analysis was performed.

RESULTS

There was an association between burnout and empathy. Specifically, higher levels of burnout are associated with lower levels of empathy, whilst years of work experience is associated with lower levels of burnout.

CONCLUSIONS

The results of this study contribute to a greater understanding of the relationship between the level of burnout and the dimensions of empathy in physiotherapists. The influence of burnout, which causes difficulties in the mobilization of the professional towards the establishment of a quality therapeutic relationship, is highlighted.KEY MESSAGESEmotional exhaustion is associated to greater personal discomfort and less empathy.The depersonalization is associated to personal discomfort and less empathy.Depersonalization is negatively associated to the lack of perspective.

The effect of stress coping styles on empathy level in students of medicine: A cross-sectional study

We aimed to investigate the change in the ability of clinical empathy, which has a special importance in physician-patient relationship, during medical school years, and its relationship between stress coping styles. After the preliminary interview with 292 volunteer medical school students, the students were asked to answer the Hospital Anxiety Depression Scale, the Stress Coping Scale, and the student version of the Jefferson Doctor Empathy Scale. This study shows that the lowest median of the empathy level among medical school students was in the sixth year, and the decrease in empathy in the sixth year was mostly in the perspective taking component. When the relationship between empathy and coping styles with stress was examined, it was seen that self-confident approach was positively correlated with perspective taking (R = 0.182, P = .002) and standing in the patient's shoes (R = 0.172, P = .003). It was observed that the helpless approach, which is one of the negative coping styles, was inversely correlated with standing in the patient's shoes. As a result of the study, it was determined that the styles of coping with stress were related to the components of empathy, except for compassionate care. The self-confidence approach has an impact on the ability of standing in the patient's shoes and perspective-taking. During medical education, focusing on the approaches that increase the student's self-confidence against the stress will encounter throughout their professional life will undoubtedly increase the level of empathy.

Why might medical student empathy change throughout medical school? Protocol for a systematic review and thematic synthesis of qualitative studies

INTRODUCTION

Several studies suggest that medical student empathy declines throughout medical school. However, no studies have systematically investigated why. The objective of our proposed review is to conduct a systematic review and thematic synthesis of qualitative studies investigating the reasons empathy may change throughout medical school.

METHODS AND ANALYSIS

This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We have searched MEDLINE, Scopus, CINAHL, ERIC and APA PsycINFO for relevant studies. We will also search reference lists of included studies and contact experts to identify additional studies. We will include any qualitative study investigating the reasons why empathy changes throughout medical school. We will use the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. We will use thematic analysis to synthesise our results. For all included studies, we will summarise the main characteristics including the number of participants, medical school year, country and gender. In our discussion, we will summarise the limitations of the evidence (including the risk of bias and inconsistency), and provide a general interpretation of the results and important implications.

ETHICS AND DISSEMINATION

This study will not require ethical approval since no original data will be collected. The results of this review will be published through peer-reviewed publications and conference presentations. Additionally, this review will inform changes to the enhanced empathy curriculum at the Leicester Medical School.

The Effects of an Empathic Communication Workshop on Internal Medicine Residents' Self-Perceived Empathy and Their Patients' Perception of Physician's Empathy: A Single-Group Experimental Study

Background: Empathetic communication improves the physician-patient relationship and enhances patient and physician satisfaction. This study aims to evaluate the impact of empathic communication skills training on physicians' self-perceived performance and patient satisfaction regarding the empathetic quality of their relationship with their physicians. Methods: In this single-group before-after experimental study, we recruited 50 internal medicine residents at a large teaching hospital. We assessed the residents' empathy using the Jefferson Scale of Empathy before and 3 weeks after an 8-hour workshop on empathic communication skills. We also recruited 50 of their patients before and another 50 patients 3 weeks after the training to assess the patient's perceptions of their physician's empathy using the Consultation and Relational Empathy scale. Physicians' and patients' mean scores on empathetic care at the beginning of the study were then compared using paired t-tests with their scores after the workshop. Results: The residents' mean score on Jefferson Empathy Scale increased from 81.1(95%CI:78.8-83.3) at baseline to 96.8(95%CI:93.6-100) following the workshop (p < 0.001). Before the empathetic communication skills training, patients assessed their doctors' empathy at 68.3(95%CI:63.5-73.2). After the intervention, this improved to 84.9(95%CI:82.2-87.5) (p < 0.001). Conclusion: In this study, both the residents and their patients stated that the residents' empathy skills had significantly improved after an empathetic communication workshop for internal medicine residents.

A Quasi-experimental Study Measuring the Effectiveness of Two Empathy Enhancement Programs on Caregivers Working with Older Adults Living Alone

Objectives: This quasi-experimental study assessed the effectiveness of two empathy enhancement programs on direct care workers of older adults living alone in South Korea.Methods: A total of 104 direct care workers participated in either a simulation-based program or a lecture-based program. Data were collected prior to and 2 weeks after the program implementation using self-reported questionnaires.Results: The lecture-based group had significantly higher levels of empathy compared to the simulation-based group. Pretest-posttest differences were found in the lecture-based group only, including higher levels of empathy and caring efficacy and lower levels of secondary traumatic stress and burnout.Conclusions: More studies are needed to identify helpful components of empathy enhancement programs to direct care workers working with older adults living alone. Also, a further randomized controlled trial study is needed to assess programs' effectiveness on older adults living alone and direct care workers.Clinical implications: A lecture-based empathy enhancement program can increase levels of empathy and caring efficacy of direct care workers working with older adults and decrease care workers' levels of burnout and stress. Training for direct care workers of older adults is needed to improve the empathy of direct care workers while reducing their stress and burnout.

From distress to detachment: exploring how providing care for stigmatized patients influences the moral development of medical trainees

In acute hospital settings, medical trainees are often confronted with moral challenges and negative emotions when caring for complex and structurally vulnerable patients. These challenges may influence the long term moral development of medical trainees and have significant implications for future clinical practice. Despite the importance of moral development to medical education, the topic is still relatively under-explored. To gain a deeper understanding of moral development in trainees, we conducted a qualitative exploration of how caring for a stigmatized population influences their moral development. Data were collected from 48 medical trainees, including observational field notes, supplemental interviews, and medical documentation from inpatient units of two urban teaching hospitals in a Canadian context. Utilizing a practice-based approach which draws on constructivist grounded theory, we conducted constant comparative coding and analysis. We found that caring for stigmatized populations appeared to trigger frustration in medical trainees, which often perpetuated feelings of futility as well as avoidance behaviours. Additionally, hospital policies, the physical learning environment, variability in supervisory practices, and perceptions of judgment and mistrust all negatively influenced moral development and contributed to apathy and moral detachment which has implications for the future. Recognizing the dynamic and uncertain nature of care for stigmatized patients, and addressing the influence of structural and material factors provide an opportunity to support moral experiences within clinical training, and to improve inequities.