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Habib H, Niinuma SA, Alrefaie K, Khalaf HAA, Hani MJ, Al-Rawi ZYM, Hussain Z, Menezes P, Roy SR, Mathew B, Guraya SY, Nicholson A, Guraya SS. Unfolding the empathic insights and tendencies among medical students of two gulf institutions using interpersonal reactivity index. BMC MEDICAL EDUCATION 2024; 24:976. [PMID: 39252067 PMCID: PMC11385142 DOI: 10.1186/s12909-024-05921-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 08/16/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Empathy is an essential core competency for future doctors. Unfortunately, the medical curriculum is infamously known to burn out aspiring doctors, which may potentially lead to a decline in empathy among medical students. This research was planned to understand the evolution of empathic approaches among students across the curriculum using the Interpersonal reactivity index (IRI) as a benchmark at the Royal College of Surgeons in Ireland - Medical University of Bahrain (RCSI-MUB) and University of Sharjah (UoS). METHODS We adopted a cross-sectional design and administered an online survey to the medical students of RCSI-MUB and UoS using a modified version of the IRI along with its three subscales of empathic concern (EC), perspective taking (PT), and personal distress (PD). To identify intra- and inter-institutional variations in empathy scores, the Analysis of Variance (ANOVA) was performed separately for each institution and with both institutions combined. A two-way ANOVA was conducted for the comparison between years and institutions. For the subscale analysis of EC, PT, and PD, we used one-way ANOVA for significant differences between years at both institutions. For the gender-effect analysis, t-test was performed to examine the differences in total IRI scores at both institutions combined and at each institution separately. Additionally, an Analysis of Covariance (ANCOVA) was done to identify the influence of gender on empathy scores. RESULTS A total of 140 students from both institutions participated in this study. We found a fluctuating pattern of empathy scores without a clear trend across the years. The sub-scales of EC, PD, and PT across academic years at both institutions showed significant differences within the EC at RCSI-MUB (p = 0.003). No significant differences were identified across other years from both institutions. There were significant differences between empathy scores from RCSI-MUB and UoS for EC (p = 0.011). Additionally, a pronounced interaction effect between year and institution was observed for PT (p = 0.032). The gender-wise analysis showed that female students had higher empathy scores than males (p = 0.004). The ANCOVA for IRI score results revealed a p-value of 0.023, indicating that gender plays a crucial role in empathy levels among medical students. The ANCOVA results revealed a p-value of 0.022 in the EC subscale. CONCLUSION Our study unveiled intricate patterns in empathy development among medical students across years and genders at RCSI-MUB and UoS. These congruences and dissimilarities in empathy scores signal a subjective understanding of empathy by medical students. The disparities in understanding may encourage medical educators to embed empathy in standard medical curricula for better healthcare outcomes.
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Affiliation(s)
- Haniya Habib
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen, 15503, Bahrain
| | - Sara Anjum Niinuma
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen, 15503, Bahrain
| | - Khadeja Alrefaie
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen, 15503, Bahrain
| | - Heba Awad Al Khalaf
- College of Medicine, University of Sharjah, Sharjah, 27272, United Arab Emirates
| | - Mohammad Jasem Hani
- College of Medicine, University of Sharjah, Sharjah, 27272, United Arab Emirates
| | | | - Zarish Hussain
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen, 15503, Bahrain
| | - Prianna Menezes
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen, 15503, Bahrain
| | - Sornali Rani Roy
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
| | - Bincy Mathew
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen, 15503, Bahrain
| | - Salman Yousuf Guraya
- College of Medicine, University of Sharjah, Sharjah, 27272, United Arab Emirates.
| | - Alfred Nicholson
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen, 15503, Bahrain
| | - Shaista Salman Guraya
- College of Medicine, Mohammed Bin Rashid University of Medical and Health Sciences, Dubai, 505055, United Arab Emirates
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Badawy YA, Almakrami AH, Alata AJ, Abujamea EZ, Khaliifa LM. Predictability of Insulin Resistance Based on the Clinical Manifestations Among Male Medical Students of a Private College in Saudi Arabia. Cureus 2024; 16:e60327. [PMID: 38883100 PMCID: PMC11177330 DOI: 10.7759/cureus.60327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Background Numerous clinical signs and symptoms are thought to be associated with insulin resistance. The purpose of this study was to examine the prevalence of insulin resistance among male medical students attending a private Saudi Arabian institution, based on clinical indications. Methods A convenient non-probability sample consisting of 241 male medical students was used to conduct cross-sectional research. Each participant had an in-person interview as well as anthropometric measurements. The interview consisted of a questionnaire that was used to assess demographic data and clinical manifestations related to insulin resistance. Results The study demonstrated the connection between a few dermatological symptoms and waist circumference as an indicator of insulin resistance. In both the high and normal waist circumference groups, acne was the most common symptom. There was no correlation found between waist circumference and psoriasis, hidradenitis suppurativa, androgenic alopecia, alopecia areata, or vitiligo. Nevertheless, as an indicator of insulin resistance, waist circumference was statistically significantly correlated with both skin tags and acanthosis nigricans. Most students had excessive day sleep, foggy brains, struggled with planning and solving problems, and had a memory that became worse in the past few years. In addition, many students feel hungry even after eating some sweets and usually have extreme thirst. Conclusion Among medical students, skin tags, acanthosis nigricans, and acne were the most prevalent dermatological manifestations. Clinicians need to be aware that skin conditions, sleep difficulties throughout the day, changes in cognition, and food cravings might all be indicators of internal changes and/or illnesses such as diabetes and prediabetes.
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Affiliation(s)
- Yousria A Badawy
- Family Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Ahmed H Almakrami
- Medicine and Surgery, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Abdullah J Alata
- Medicine and Surgery, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Emad Z Abujamea
- Medicine and Surgery, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Louai M Khaliifa
- Pharmacy, Ibn Sina National College for Medical Studies, Jeddah, SAU
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Chen H, Xuan H, Cai J, Liu M, Shi L. The impact of empathy on medical students: an integrative review. BMC MEDICAL EDUCATION 2024; 24:455. [PMID: 38664799 PMCID: PMC11047033 DOI: 10.1186/s12909-024-05448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
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.
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Affiliation(s)
- Hao Chen
- Department of Neurosurgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Hanwen Xuan
- Department of Neurosurgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Jinquan Cai
- Department of Neurosurgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
| | - Meichen Liu
- Modern Educational Technology Center, Harbin Medical University, Harbin, 150086, China.
| | - Lei Shi
- School of Health Management, Guangzhou Medical University, Guangzhou, 511436, China.
- School of Health Management, Southern Medical University, Guangzhou, 510515, China.
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Bankar M, Gupta S, Kumar H, Agarwal M. Impact of Multimodal Intervention on Empathy Levels in Medical Students: A Questionnaire-Based Study. Cureus 2024; 16:e59169. [PMID: 38807837 PMCID: PMC11129940 DOI: 10.7759/cureus.59169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/30/2024] Open
Abstract
Background Empathy is essential for effective doctor-patient communication. It enables doctors to understand patients' emotions and concerns, facilitating personalized care and support. Empathy can be cultivated through various methods and training programs. Objective The study aims to assess the effectiveness of a multimodal intervention involving interactive lectures, peer role-play, and guided reflection in enhancing empathy levels among second-year medical undergraduate students in India. Methods This study utilized a questionnaire-based, pre- and post-test interventional design. Seventy-nine second-year medical students were included after obtaining their informed consent. The students received the intervention through an interactive lecture on communication skills, role-play on selected case studies, and guided reflection. The empathy levels were assessed using the Toronto Empathy Questionnaire (TEQ) before and after the intervention. The Mann-Whitney U test was utilized to compare pre-test and post-test TEQ scores. A univariate analysis of variance was conducted to explore the relationship between demographic variables and post-test TEQ scores. Statistical significance was considered at p ≤ 0.05. Results The TEQ score improved significantly (p=0.009) after the intervention. The univariate analysis indicated that gender, style of education, and place of residence did not have a statistically significant impact on post-test scores. Conclusion The study demonstrates that a multimodal intervention significantly enhances the empathy level of medical students, highlighting the potential of focused interventions to reduce gender disparities in empathy levels. There were no significant differences in empathy scores based on gender, place of residence, or schooling, suggesting the intervention's benefits may apply to all medical students.
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Affiliation(s)
- Mangesh Bankar
- Pharmacology, All India Institute of Medical Sciences, Raebareli, IND
| | - Shefali Gupta
- Microbiology, All India Institute of Medical Sciences, Raebareli, IND
| | - Hansraj Kumar
- Pharmacology, All India Institute of Medical Sciences, Deoghar, IND
| | - Mayank Agarwal
- Physiology, All India Institute of Medical Sciences, Raebareli, IND
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Deng F, Bueber MA, Cao Y, Tang J, Bai X, Cho Y, Lee J, Lin Z, Yang Q, Keshavan MS, Stone WS, Qian M, Yang LH, Phillips MR. Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): a systematic review and meta-regression. Psychol Med 2024; 54:847-873. [PMID: 38173096 DOI: 10.1017/s0033291723003501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The reading the mind in the eyes test (RMET) - which assesses the theory of mind component of social cognition - is often used to compare social cognition between patients with schizophrenia and healthy controls. There is, however, no systematic review integrating the results of these studies. We identified 198 studies published before July 2020 that administered RMET to patients with schizophrenia or healthy controls from three English-language and two Chinese-language databases. These studies included 41 separate samples of patients with schizophrenia (total n = 1836) and 197 separate samples of healthy controls (total n = 23 675). The pooled RMET score was 19.76 (95% CI 18.91-20.60) in patients and 25.53 (95% CI 25.19-25.87) in controls (z = 12.41, p < 0.001). After excluding small-sample outlier studies, this difference in RMET performance was greater in studies using non-English v. English versions of RMET (Chi [Q] = 8.54, p < 0.001). Meta-regression analyses found a negative association of age with RMET score and a positive association of years of schooling with RMET score in both patients and controls. A secondary meta-analysis using a spline construction of 180 healthy control samples identified a non-monotonic relationship between age and RMET score - RMET scores increased with age before 31 and decreased with age after 31. These results indicate that patients with schizophrenia have substantial deficits in theory of mind compared with healthy controls, supporting the construct validity of RMET as a measure of social cognition. The different results for English versus non-English versions of RMET and the non-monotonic relationship between age and RMET score highlight the importance of the language of administration of RMET and the possibility that the relationship of aging with theory of mind is different from the relationship of aging with other types of cognitive functioning.
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Affiliation(s)
- Fei Deng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- University of Nottingham School of Economics (Ningbo China), Zhejiang, China
| | - Marlys A Bueber
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yourong Cao
- Guangxi Medical University School of Public Health, Guangxi, China
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Jeff Tang
- New York University, New York, NY, USA
| | - Xinyu Bai
- Guangxi Medical University School of Public Health, Guangxi, China
- Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Young Cho
- New York State Psychiatric Institute, New York, NY, USA
| | - Jiwon Lee
- Teachers College, Columbia University, New York, NY, USA
| | - Zhuozhi Lin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Qi Yang
- Ningxia Medical University School of Public Health, Ningxia, China
| | - Matcheri S Keshavan
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - William S Stone
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lawrence H Yang
- New York University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Michael R Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
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Wang CXY, Pavlova A, Boggiss AL, O'Callaghan A, Consedine NS. Predictors of Medical Students' Compassion and Related Constructs: A Systematic Review. TEACHING AND LEARNING IN MEDICINE 2023; 35:502-513. [PMID: 35930256 DOI: 10.1080/10401334.2022.2103816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Phenomenon: Compassion, and related constructs such as empathy, are core values in healthcare, with known benefits for both patients and staff. Yet research on the factors that affect compassion and compassion-related constructs remains scattered. This review systematizes and synthesizes studies investigating the predictors of compassion and related constructs among medical students, allowing for a better understanding of the factors that both positively and negatively contribute to the development of compassionate future physicians. Approach: A systematic review of 12 databases for studies from database inception up until April 2020 was conducted. Non-peer-reviewed literature and studies in which >50% of the sample were non-medical students were excluded. Intervention studies were also out of the scope of this review. We assessed risk of bias and confidence in the findings using standardized tools. Data were categorized within the Transactional Model of Physician Compassion, a framework in which compassion is influenced by personal (student), environmental, patient/family, and clinical factors. Findings: Of 14,060 retrieved articles, 222 studies were included. Of these, 95% studied student factors, but only 25% studied environmental, 9% studied patient, and 6% studied clinical factors. Predictors of greater compassion included maturity; work and life experiences; personality traits of openness to experience and agreeableness; skills such as perspective taking, reflection, and mindfulness; and positive role modeling. Conversely, negative attitudes/emotions, burnout, stress, detachment, operating in cultures prioritizing knowledge and efficiency over humanistic care, negative role models, time constraints, and heavy workloads predicted lower compassion. Patient-related factors included "difficult" and "noncompliant" patients or those perceived as responsible for their illness. Overall, 60% of studies had a serious risk of bias, particularly confounding and participant selection biases. Insights: Medical student compassion is predicted by a wide range of factors relating to the student, their training environment, their patients, and the clinical situation. However, existing research has largely focused on student factors (e.g., sociodemographic and dispositional traits), many of which are not amenable to intervention. Skills such as perspective taking, reflection, and mindfulness are associated with higher compassion and may present opportunities for intervention. There is also strong evidence that environmental factors shape students' compassion. Researchers and educators should continue to explore the impact of patient and clinical factors on students' compassion. Studies remain at high risk of bias.
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Affiliation(s)
- Clair X Y Wang
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Alina Pavlova
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Anna L Boggiss
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Anne O'Callaghan
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Baig KS, Hayat MK, Khan MAA, Humayun U, Ahmad Z, Khan MA. Empathy Levels in Medical Students: A Single Center Study. Cureus 2023; 15:e38487. [PMID: 37273396 PMCID: PMC10237306 DOI: 10.7759/cureus.38487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Objectives To determine the level of empathy in medical students and to determine the difference in empathy levels between the two genders in a single center. Materials & methods This qualitative study was conducted at a medical college in Peshawar from March 2021 to July 2021. Institutional ethical committee approval was taken (RMI/RMI-REC/Approval/83) before commencing the study. All students admitted into the medical college in the current academic year 2020 to 2021 were included in the study. Any students that did not fill out the questionnaire completely were excluded. The Toronto Empathy Questionnaire (TEQ) was used in this study. The questionnaire was uploaded on google forms for data collection. All the resulting scores were entered into IBM SPSS version 23.0. The mean TEQ score was calculated. Box and whisker plots were made for respective years. An Independent sample t-test was used to determine the association between mean TEQ scores and gender. Results Of 367 students, 347 (94.6%) participated in this study, with a slight female predominance (53%). The mean age of the students was 21.44 (SD = 1.751) years. The participation rate was ≥70% from each class. Most participants across the years have an above-average empathy score (49.9%). Among the participants, the year I (67.6%) showed most participants with high empathy. Year IV (40.6%) has the highest proportion of below-average empathy scores. The mean empathy score of female students was 49.08 (S.D = 7.588), while the empathy score for male students was 44.59 (S.D = 7.58). Conclusion Empathy levels decline as medical education is progressed through the years. Females show a greater sense of empathy than their male counterparts. A slight increase in empathy levels is seen in the final year of medical school after a decline over the initial years.
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Affiliation(s)
| | | | | | - Umer Humayun
- Anesthesia, Burns and Plastic Surgery Center, Peshawar, PAK
| | - Zunnoor Ahmad
- General Surgery, Khyber Teaching Hospital, Peshawar, PAK
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Jia L, Zheng Z, Sung B, Compton BJ, Wang J. Resisting repeated exposure: Characteristics of pain empathy for experienced physicians. Behav Brain Res 2023; 436:114099. [DOI: 10.1016/j.bbr.2022.114099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
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Hu Z, Wen Y, Wang Y, Lin Y, Shi J, Yu Z, Lin Y, Wang Y. Effectiveness of mindfulness-based interventions on empathy: A meta-analysis. Front Psychol 2022; 13:992575. [PMID: 36337535 PMCID: PMC9632989 DOI: 10.3389/fpsyg.2022.992575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/29/2022] [Indexed: 10/13/2023] Open
Abstract
Empathy is essential for human survival and social interaction. Although mindfulness-based interventions (MBIs) have been used to improve empathy in healthy populations, its therapeutic efficacy remains unknown. This study aims to investigate the therapeutic effects of MBIs on empathy in a healthy population and the potential factors affecting the efficacy of MBIs. The literature search focused on PubMed, Embase, Web of Science, Cochrane Library, and CNKI from inception to September 2022. Randomized controlled trials and quasi-experimental studies reporting the effects of using MBIs on empathy in healthy populations were included. A total of 13 studies were included in this review. Results of the meta-analysis showed that MBIs improved empathy (SMD, 0.372, 95% CI, 0.164-0.579, p = 0.001) in the healthy population compared with that in the control group. Moreover, results of the subgroup analysis showed that intervention dose (over 24 h vs. under 24 h), format (online vs. offline), and types (different types) were important factors affecting treatment outcomes. This comprehensive review suggests that MBIs are effective treatment for empathy in healthy population. Future research should markedly focus on large-sample, rigorously designed experiments to explore the long-term effects of MBIs on empathy and to elucidate the underlying mechanisms of MBIs. This study provides a reference for the daily application of MBIs.
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Affiliation(s)
- Zhengyu Hu
- Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
- Rehabilitation Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yurong Wen
- Rehabilitation Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yafei Wang
- Rehabilitation Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yangyang Lin
- Rehabilitation Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Shi
- Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
- Rehabilitation Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zihan Yu
- Department of Sport Rehabilitation, Shenyang Sport University, Shenyang, China
| | - Youtian Lin
- Rehabilitation Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Postgraduate Research Institute, Guangzhou Sport University, Guangzhou, China
| | - Yuling Wang
- Rehabilitation Medicine Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Innes SI, Simpson JK. Empathy levels in Australian chiropractic students. THE JOURNAL OF CHIROPRACTIC EDUCATION 2022; 36:110-116. [PMID: 35294012 PMCID: PMC9536223 DOI: 10.7899/jce-21-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/12/2021] [Accepted: 09/13/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Empathy is an important modifiable quality of health care practitioners that relates to the quality of patient care. The educative process may adversely affect the empathy levels of health care students at key phases of training. This topic remains unexplored in chiropractic students to date. METHODS A voluntary and anonymous questionnaire was distributed to all chiropractic students in an Australian university-based program in April 2021. This questionnaire recorded age, sex, year of study, and Toronto Empathy Questionnaire scores. RESULTS Chiropractic student empathy scores approximated those of other Australian health care students. No statistical differences were found when comparing the mean scores of empathy levels across the 5 student cohorts. The empathy levels of female chiropractic students' were significantly higher than those of the male chiropractic students. CONCLUSION This study provides a baseline from which further explorations on empathy may be conducted in chiropractic students. This holds the potential to improve practitioners' quality of life and patient outcomes and for educators to identify subject matter that may negatively affect empathy levels.
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Shek DTL. Engagement in Behavior to Prevent COVID-19 Infection for the Sake of Oneself or Others? J Adolesc Health 2022; 70:697-698. [PMID: 35461650 PMCID: PMC9019279 DOI: 10.1016/j.jadohealth.2022.01.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Daniel T L Shek
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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12
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Pieris D, Jafine H, Neilson S, Amster E, Zazulak J, Lam C, Grierson L. Understanding moral empathy: A verbatim-theatre supported phenomenological exploration of the empathy imperative. MEDICAL EDUCATION 2022; 56:186-194. [PMID: 34612521 DOI: 10.1111/medu.14676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/05/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Several studies have measured a decline in empathy during medical training, speculating that factors within the formal, informal and hidden curricula are responsible for this phenomenon. Although the medical education literature describes the moral domain of empathy as most fundamental to the empathic response, most research into the decline has examined the cognitive, affective and behavioural domains. This study distinguishes itself by focusing on how moral empathy is affected through training. METHODS Ten medical residents from core education specialties at McMaster University participated in lightly structured interviews concerning their training experiences. Interview transcripts were analysed by way of a descriptive phenomenological approach. Analyses afforded descriptions of the way medical training influences moral empathy. These descriptions were then used to generate a verbatim theatre play that was performed for an audience of residents, educators, learners, researchers and scholars. Following the play, audience participants completed a survey to member-check the descriptions and to glean other reflective experiences in resident training that impact moral empathy. The survey results informed revisions to the codebook that was subsequently used to re-analyse the interview transcripts. This resulted in a final, refined version of the influence of training on learner moral empathy. RESULTS The findings suggest that a resident's sense of moral empathy relies upon the notion of an innate capacity for empathy, and is influenced by their clinical and classroom education, and specific experiences with patients during training. Importantly, these factors are rarely experienced as having a direct deleterious impact on residents' moral empathy but rather are experienced as challenges to their ability to act on their moral empathy. CONCLUSIONS The study promotes reflection of what it means to experience empathy in the moral domain. The description offers a new perspective from which to view empathic declines that have been previously reported, while also highlighting a moral-behavioural tension that has implications for competency-based assessment and the way empathy is conceptualised in medical education.
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Affiliation(s)
- Dilshan Pieris
- Health Sciences Education Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Hartley Jafine
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Shane Neilson
- Department of English and Cultural Studies, Faculty of Humanities, McMaster University, Hamilton, Canada
| | - Ellen Amster
- Department of Family Medicine, Faculty of Health Sciences, Department of Religious Studies, McMaster University, Hamilton, Canada
| | - Joyce Zazulak
- Department of Family Medicine, Faculty of Health Sciences, Department of Religious Studies, McMaster University, Hamilton, Canada
| | - Connie Lam
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lawrence Grierson
- Health Sciences Education Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Family Medicine, Faculty of Health Sciences, Department of Religious Studies, McMaster University, Hamilton, Canada
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Shin HS, Park H, Lee YM. The relationship between medical students' empathy and burnout levels by gender and study years. PATIENT EDUCATION AND COUNSELING 2022; 105:432-439. [PMID: 34127334 DOI: 10.1016/j.pec.2021.05.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the multifaceted factors affecting empathy in medical students. METHODS 1293 medical students from 15 South Korean medical schools participated in an online survey. Affective empathy was measured with the 'empathy concern' and 'personal distress' dimensions from the Interpersonal Reactivity Index for Medical Students (IRI-MS). Cognitive empathy was assessed with IRI-MS' 'perspective taking' and Jefferson Scales for Physician Empathy for Student (JSPE-S). Maslach Burnout Inventory for Medical Students (MBI-MS) assessed the burnout levels of the participants. RESULTS A significant gender difference in affective and cognitive empathy was found using JSPE-S. Different patterns were seen in the empathy dimensions between the study years and genders. Burnout scores showed no gender differences, while exhaustion and cynicism increased, and academic efficacy decreased with seniority. Academic efficacy was a consistently influential factor for both affective and cognitive empathy in both genders, all study years and the three domains of burnout. CONCLUSION Academic efficacy was a significant factor influencing both affective and cognitive empathy. PRACTICAL IMPLICATIONS The comprehensive nature of empathy in medical students may be better investigated by applying multi-dimensional empathy measurement tools and by analyzing multiple factors such as gender, study year and burnout.
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Affiliation(s)
- Hyoung Seok Shin
- Department of Medical Education, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyunmi Park
- Department of Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Mee Lee
- Department of Medical Education, Korea University College of Medicine, Seoul, Republic of Korea.
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Suciu N, Meliț LE, Mărginean CO. A Holistic Approach of Personality Traits in Medical Students: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312822. [PMID: 34886548 PMCID: PMC8657758 DOI: 10.3390/ijerph182312822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 01/09/2023]
Abstract
Personality is one of the most crucial aspects of human life, since it influences all human behaviours in both personal and social life, and might also trigger important conflicts with a person’s surroundings in the setting of incompatible traits and characteristics. It is true that ‘one must be born’ for a certain medical specialty, but several components of personality might be educated with proper training. Increased levels of Conscientiousness, Agreeableness, and Openness associated with lower levels of Neuroticism might represent the key combination for achieving professional satisfaction in the medical profession. Medical students should receive proper interprofessional education, since effective interprofessional relationships among healthcare providers definitely improve patients’ safety. Empathy contributes to effective patient–physician communication, improving patient trust, compliance, and satisfaction, being positively correlated with Openness, Agreeableness, Conscientiousness and Extraversion. Emotional intelligence—the capacity to respond to one’s own and others’ emotions—was proven to contribute, in a synergistic way with empathy, to increasing empathic ability. Clinical communication skills represent a key component in medical students in order to achieve the best patient care, and they are certainly related and/or influenced by empathy, interprofessional collaboration skills, emotional intelligence and, especially, personality traits. Taking into account the complex interactions mentioned above, the implementation of effective courses based on these concepts in medical students, intending to promote the development of clinical communication skills, represents a real emergency, since it might result in a reduction in medical errors and subsequent related deaths. A thorough understanding of students’ personality is mandatory before designing these courses in order to provide a training tailored to their personality styles.
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Affiliation(s)
- Nicoleta Suciu
- European and Research Projects Department, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| | - Lorena Elena Meliț
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
- Correspondence: ; Tel.: +40-742-984744
| | - Cristina Oana Mărginean
- Department of Pediatrics I, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
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Berney A, Carrard V, Berney S, Schlegel K, Gaume J, Gholam M, Bart PA, Preisig M, Wac K, Schmid Mast M, Bourquin C. Study protocol for the ETMED-L project: longitudinal study of mental health and interpersonal competence of medical students in a Swiss university using a comprehensive framework of empathy. BMJ Open 2021; 11:e053070. [PMID: 34862292 PMCID: PMC8647527 DOI: 10.1136/bmjopen-2021-053070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/22/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Physician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students' interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients. METHODS AND ANALYSIS This project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1-6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills. ETHICS AND DISSEMINATION The project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.
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Affiliation(s)
- Alexandre Berney
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Valerie Carrard
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sylvie Berney
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Katja Schlegel
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Jacques Gaume
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Alcohol Treatment Centre, Lausanne University Hospital, Lausanne, Switzerland
| | - Mehdi Gholam
- Institute of Mathematics, EPFL, Lausanne, Switzerland
| | - Pierre-Alexandre Bart
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin Preisig
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Centre for Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Katarzyna Wac
- Department of Computer Science, University of Geneva, Geneva, Switzerland
| | - Marianne Schmid Mast
- Department of Organizational Behavior, University of Lausanne, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Sobczak K, Zdun-Ryżewska A, Rudnik A. Intensity, dynamics and deficiencies of empathy in medical and non-medical students. BMC MEDICAL EDUCATION 2021; 21:487. [PMID: 34507587 PMCID: PMC8429476 DOI: 10.1186/s12909-021-02927-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Krzysztof Sobczak
- Department of Sociology of Medicine and Social Pathology, Faculty of Health Sciences, Medical University of Gdansk, Tuwima 15 Str., 80-210, Gdansk, Poland.
| | - Agata Zdun-Ryżewska
- Department of Quality of Life Research, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Agata Rudnik
- Institute of Psychology, University of Gdansk, Gdansk, Poland
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MacArthur KR, Stacey CL, Harvey S, Markle J. The direct and indirect effects of clinical empathy on well-being among pre-medical students: a structural equation model approach. BMC MEDICAL EDUCATION 2021; 21:412. [PMID: 34340661 PMCID: PMC8327048 DOI: 10.1186/s12909-021-02838-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Empathy is a well-established facet of clinical competency that research suggests is associated with enhanced medical student well-being. Since little is known about empathy and well-being before students enter medical school-during pre-medical education-the main goal of this study is to test a conceptual model of how clinical empathy is related to two indicators of well-being, depression, and burnout among pre-medical students. The theoretical model hypothesizes that three dimensions of clinical empathy-Perspective-Taking, Compassionate Care, and Standing in Patients' Shoes- will be directly and negatively related to depression, as well as indirectly through its inverse relationship with three facets of burnout, Emotional Exhaustion, Poor Academic Efficacy, and Cynicism. METHODS Using survey data from a sample of 132 pre-medical students at an American Midwestern university, this study employs structural equation modeling (SEM) to test the theoretical model of the relationships between empathy, burnout, and depression among pre-medical students. We identify the direct effects of the three dimensions of the Jefferson Scale of Physician Empathy (JSE-S) on depression (CES-D), as well as the indirect effects of clinical empathy on depression through the three dimensions of the Maslach Burnout Inventory (MBI-S). RESULTS SEM analyses show that while none of the three dimensions of the JSE-S are directly related to depression, clinical empathy does significantly affect depression indirectly through burnout. Specifically, as predicted, we find that Perspective-Taking decreases Emotional Exhaustion, but, contrary to expectations, Compassionate Care increases it. And, the positive relationship between Compassionate Care and Emotional Exhaustion is particularly strong. In turn, Perspective-Taking and Compassionate Care are associated with depression in opposite directions and to different degrees. CONCLUSIONS Findings suggest that clinical empathy as measured by the JSE-S produces both positive and negative effects on personal well-being. We conclude that further conceptual clarity of clinical empathy is needed to better discern how the different dimensions impact different indicators of well-being. Given that pre-medical education is a crucial time for emotional socialization, the challenge for medical education will be fostering the positive, cognitive aspects of clinical empathy while simultaneously mitigating the adverse effects of affective empathy on medical student well-being.
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Affiliation(s)
- Kelly Rhea MacArthur
- Department of Sociology and Anthropology, University of Nebraska Omaha, 6001 Dodge St., Omaha, NE, 68182, USA.
| | - Clare L Stacey
- Department of Sociology, Kent State University, 800 E. Summit St., Kent, OH, 44242, USA
| | - Sarah Harvey
- Department of Sociology, Kent State University, 800 E. Summit St., Kent, OH, 44242, USA
| | - Jonathan Markle
- Northeast Ohio Medical University, College of Medicine, 4209 St, OH-44, Rootstown, OH, 44272, USA
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Yang YS, Liu PC, Lin YK, Lin CD, Chen DY, Lin BYJ. Medical students' preclinical service-learning experience and its effects on empathy in clinical training. BMC MEDICAL EDUCATION 2021; 21:301. [PMID: 34039327 PMCID: PMC8157642 DOI: 10.1186/s12909-021-02739-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/10/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Service learning (SL) is an educational methodology presumed to help medical students be more empathetic and compassionate. We longitudinally investigated the level of empathy in medical students and how preclinical SL experience was related to their level of empathy in their clinical clerkships. METHODS Our cohort comprised fifth-year medical students engaged in clerkships as part of a 7-year medical programme at one medical school in Taiwan. Surveys were conducted at the beginning of the clerkship in September 2015 (T1) to collect data on the medical students' preclinical SL experience in curriculum-based service teams (CBSTs) and extracurricular service teams (ECSTs) and their SL self-efficacy, demographic characteristics, and empathy level. Subsequently, three follow-up surveys were conducted once every 3 months to determine the empathy level of the students during their clinical clerkships (T2-T4). Seventy students who returned the written informed consent and completed the baseline (T1) and two or more follow-up surveys (T2-T4) were included in our analysis with the response rate of 34%. In total, 247 responses across the 1-year clerkship were analysed. Descriptive statistics, paired t tests, and generalised estimating equations were employed. RESULTS Our study revealed that changes in empathy level in the dimensions of perspective taking, compassionate care, and standing in patients' shoes in their clinical clerkships. Relative to that at T1, their empathy decreased in perspective taking and compassionate care at T2-T4 but increased in standing in patients' shoes at T3. Additionally, our study verified the positive effect of medical students' preclinical SL experience in CBSTs and ECSTs on empathy in terms of compassionate care and perspective taking, respectively, but not on that of standing in patients' shoes. CONCLUSIONS Separate investigations into subconstructs of empathy, such as perspective taking, compassionate care, and standing in patients' shoes, in medical students may be necessary for exploring the various driving forces or barriers to developing empathy in medical students. Moreover, SL experience through both CBSTs and ECSTs at medical academies may have positive effects on medical students' empathy in their clinical clerkships and should be promoted at medical schools.
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Affiliation(s)
- Yi-Sheng Yang
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Pei-Chin Liu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Yung Kai Lin
- Department of Surgery, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan, Republic of China
- Division of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Chia-Der Lin
- Department of Otolaryngology-Head & Neck Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China
- School of Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan, Republic of China
- College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Blossom Yen-Ju Lin
- Department of Medical Humanities and Social Sciences, School of Medicine, College of Medicine, Chang Gung University, No.259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan, Republic of China.
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Yeo S, Kim KJ. A validation study of the Korean version of the Toronto empathy questionnaire for the measurement of medical students' empathy. BMC MEDICAL EDUCATION 2021; 21:119. [PMID: 33607995 PMCID: PMC7893770 DOI: 10.1186/s12909-021-02561-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/10/2021] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study aimed to validate the Korean version of the Toronto Empathy Questionnaire (TEQ) and to determine its suitability for the measurement of empathy in medical students. METHODS The study sample was Year 1 and 2 medical students at two medical schools on six-year undergraduate medical programs in South Korea. The study participants completed the Korean TEQ, which has a single factor structure and consists of 16 items; responses are scored using a 5-point Likert scale, giving a maximum possible score of 64. Psychometric validation of the questionnaire was performed by exploratory and confirmatory factor analyses and the goodness of fit test. Average variance extracted was calculated to establish convergent validity, and associations between factors and construct reliability were analyzed to establish discriminant validity. Cronbach's alpha values were utilized for reliability analysis. RESULTS A total of 279 students completed and returned the questionnaire (a 96.2% response rate). Participant empathy scores ranged from 20 to 60 (M = 44.6, SD = 7.36). Empathy scores were higher for females than males (p < .05). The cumulative variance of the Korean TEQ was 32%, indicating that its explanatory power was rather weak. Consequently, goodness-of-fit testing was performed on four hypothetical models, among which a three-factorial structure consisting of 14 items demonstrated satisfactory fit indices and explained 55% of the variance. Reliability estimates of the three subscales were also satisfactory (Cronbach's α = .71-.81). This three-factorial model was validated by confirmatory factor analysis and demonstrated adequate convergent and discriminant validity. CONCLUSIONS This study demonstrated psychometric validation of the Korean TEQ for measuring medical students' empathy. We suggest a modified 14-item model with a three-factorial structure, which demonstrated better psychometric properties than the original scale.
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Affiliation(s)
- Sanghee Yeo
- Department of Medical Education, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kyong-Jee Kim
- Department of Medical Education, Dongguk University School of Medicine, 32 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10326 South Korea
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Tisdale CE, Black AC, Jain S, Lowther E, Madeline L, Troup C, Nathaniel T, Fowler LA. The Impact of Meeting Patients with Neurological Disorders on Medical Student Empathy. MEDICAL SCIENCE EDUCATOR 2020; 30:1561-1568. [PMID: 34457824 PMCID: PMC8368363 DOI: 10.1007/s40670-020-01102-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 06/13/2023]
Abstract
PURPOSE Empathy tends to decline during medical education, typically beginning in the third year of medical school and often continuing throughout residency and the physician's medical career. The purpose of this study was to determine if first year medical student empathy is affected by small group interactions with patients with neurological disorders, and to investigate if changes in empathy persisted over time. MATERIALS AND METHODS Eighty first year medical students participating in a Neuroscience Module interacted with a variety of neurological patients in a small group informational session. Prior to the experience, participants completed the Jefferson Scale of Physician Empathy-Student (JSPE-S) version. After the experience, students completed a post-test JSPE-S questionnaire, and a final post-post-test JSPE-S questionnaire was completed 5 weeks later. Empathy scores were compared with a repeated measures MANOVA. The relationship between gender and empathy, and the effect of the age of the neurological patients on empathy scores were also examined. RESULTS Empathy scores for seventy-one students who completed the JSPE-S questionnaires were analyzed. Students had significantly higher empathy immediately after the patient interaction experience, and the change in empathy was sustained over the course of 5 weeks (p = 0.015). The age of the neurological patients had a significant effect on empathy scores. There was no significant difference between empathy scores and gender. CONCLUSIONS This study supports the incorporation of a group patient interaction experience into the medical school curriculum as an inexpensive and practical method of enhancing medical student empathy in a non-clinical setting.
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Affiliation(s)
| | - Asa C. Black
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Sandip Jain
- Department of Medicine, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Ervin Lowther
- Department of Radiology, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Lee Madeline
- Department of Radiology, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Chris Troup
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - Thomas Nathaniel
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC USA
| | - L. A. Fowler
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC USA
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Brekalo Prso I, Mocny-Pachońska K, Trzcionka A, Pezelj-Ribaric S, Paljevic E, Tanasiewicz M, Persic Bukmir R. Empathy amongst dental students: An institutional cross-sectional survey in Poland and Croatia. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:687-694. [PMID: 33462930 DOI: 10.1111/eje.12557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/21/2020] [Accepted: 05/29/2020] [Indexed: 06/12/2023]
Abstract
AIM To determine and compare levels of empathy and its dimensions in Polish and Croatian dental students. METHODS Fourth- and fifth-year dental students (N = 193) at the University of Rijeka and University of Silesia completed questionnaires to determine levels of overall empathy and its dimensions: compassionate care (CC), perspective taking (PT) and ability to stand in someone else's shoes (ASSES). Total empathy and its dimensions were analysed depending on the country of origin, year of study and gender of the participants. The HPS version of the Jefferson Scale of Physician Empathy was used to conduct the research. Statistical analysis was performed using the Mann-Whitney U test. RESULTS The analysis showed no significant differences in total empathy level between Polish and Croatian students (P = .838). However, separate analysis of empathy items showed significant differences between the two groups. Croatian students obtained significantly higher average PT values (P = .021), whilst Polish students had significantly higher CC scores (P < .001). Analysis of Croatian respondents revealed significantly higher ASSES scores in the fourth- and fifth-year students (P = .047). Analysis in the Polish group demonstrated an increase in PT scores from the fourth to the fifth year of study (P = .008). CONCLUSION Croatian students scored higher on items associated with cognitive empathy, whilst Polish students displayed higher values in the aspect of emotional empathy. The present results demonstrated an increase in cognitive empathy level in Polish students, whilst in their Croatian colleagues, the level of cognitive empathy decreased with the progression of the academic programme.
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Affiliation(s)
- Ivana Brekalo Prso
- Department of Endodontics and Restorative Dentistry, Faculty of Dental medicine, University of Rijeka, Rijeka, Croatia
- University of Osijek, Osijek, Croatia
| | - Katarzyna Mocny-Pachońska
- Department of Conservative Dentistry with Endodontics, School of Medicine with the Division of Dentistry, Medical University of Silesia in Katowice, Bytom, Poland
| | - Agata Trzcionka
- Department of Conservative Dentistry with Endodontics, School of Medicine with the Division of Dentistry, Medical University of Silesia in Katowice, Bytom, Poland
| | - Sonja Pezelj-Ribaric
- University of Osijek, Osijek, Croatia
- Department of Oral Medicine and Periodontology, Faculty of Dental medicine, University of Rijeka, Rijeka, Croatia
| | - Ema Paljevic
- Department of Endodontics and Restorative Dentistry, Faculty of Dental medicine, University of Rijeka, Rijeka, Croatia
| | - Marta Tanasiewicz
- Department of Conservative Dentistry with Endodontics, School of Medicine with the Division of Dentistry, Medical University of Silesia in Katowice, Bytom, Poland
| | - Romana Persic Bukmir
- Department of Endodontics and Restorative Dentistry, Faculty of Dental medicine, University of Rijeka, Rijeka, Croatia
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Givron H, Desseilles M. Decline of Empathy after the First Internship: Towards a More Functional Empathy? SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1070246ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Research has shown a decline in empathy as medical studies progress. Among various hypotheses, an explanation track evoked is the first contact with the internship.
Objectives This quasi-experimental study was designed to examine the impact of the first internship in medical students. Our research question was: “to what extent the first internship may decreased the empathy’s scores of our 3d year medical students?”
Methods We measured the empathy of 220 third year medical students before and after their first internship (3 weeks) in family medicine. Using online surveys methodology, we collected data about empathy (“Interpersonal Reactivity Index”: IRI), epidemiology, professional orientation choices.
Results Statistical analyses revealed a small but significant decrease in IRI’s “fantasy,” “empathic concern” and “personal distress” subscales.
Conclusion These results suggest a potential impact of the first internship on empathic skills. The fact that the students’ score for the “personal distress” subscale (which characterizes a difficulty in managing their emotions) decreases is actually a rather good thing. These data raise the question of the “function” of this loss of empathy. The fact that this score decreases after first internship, may indicate a positive change for these medical students: towards better emotional regulation and more functional affective empathy.
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Affiliation(s)
- Hélène Givron
- Département de Psychologie, Faculté de médecine, Université de Namur, Belgique
- Institut Transitions, Université de Namur, Belgique
| | - Martin Desseilles
- Institut Transitions, Université de Namur, Belgique
- Clinique Psychiatrique des Frères Alexiens, Henri-Chapelle, Belgique – Département de Psychologie, Faculté de médecine, Université de Namur, Belgique
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Santiago LM, Rosendo I, Coutinho ML, Maurício KS, Neto I, Simões JA. Comparing empathy in medical students of two Portuguese medicine schools. BMC MEDICAL EDUCATION 2020; 20:153. [PMID: 32404095 PMCID: PMC7218824 DOI: 10.1186/s12909-020-02034-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/05/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND Empathy is paramount in the doctor-patient relationship being a comprehensive and multidimensional concept. Self-ratings of empathy change across the years of medical education only when the Jefferson Scale of Physicians Empathy is used, with a worrying decrease being found throughout the years in Medicine Schools. As there are only few studies on the factors influencing medical student's empathy, particularly of the curricular model, this study aimed to compare the levels of empathy of medicine students of two Schools with different curricular models in central Portugal, the Faculty of Medicine - University of Coimbra (FMUC) and the Faculty of Health Sciences - University of Beira Interior (FCS-UBI). METHODS Cross-sectional observational study with the Jefferson Scale of Physician Empathy - students' Portuguese version (JSPE - spv) to 1st, 3rd and 6th year students of the 2017/2018 academic year with descriptive and inferential statistical analysis (p < 0.05). RESULTS Size representative sample of 795 students. Higher total empathy score (TES) (p = 0.008) and "Perspective taking" (p = 0.001) in FCS-UBI were found. JSPE-TES was higher in FCS-UBI, 3rd year (p = 0.038). Higher FCS-UBI "Perspective taking" in the 1st year (p = 0.030) and 6th year (p = 0.044), for "Compassionate care" in the 3rd (p = 0.019) and for "Standing in the patient's shoes" in the 1st year (p = 0.018) and in FMUC for "Compassionate care" in the 1st year (p = 0.037) and the "Standing in the patient's shoes" in year 3 (p = 0.002) were found. Higher levels of empathy were found in FCS-UBI female students, for JSPE-TES (p = 0.045) and "Perspective taking" (p = 0.001). CONCLUSION Higher empathy levels in FCS-UBI were found, with different results in the third year suggesting influence of the medical course teaching characteristics between the two Medicine schools, student's empathy levels being higher when earlier and more intense contact with patients accompanied by skilled tutors was developed.
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Affiliation(s)
- Luiz Miguel Santiago
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal.
- General Practice/Family Medicine Clinic of the University of Coimbra, Coimbra, Portugal.
- CEISUC, Coimbra, Portugal.
| | - Inês Rosendo
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
- USF Coimbra Centro, ARS Centro, Coimbra, Portugal
- CINTESIS, Porto, Portugal
| | | | | | - Isabel Neto
- Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
| | - José Augusto Simões
- CINTESIS, Porto, Portugal
- Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal
- USF Caminhos do Cértoma, ARS Centro, Coimbra, Portugal
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Xu RH, Wong ELY, Lu SYJ, Zhou LM, Chang JH, Wang D. Validation of the Toronto Empathy Questionnaire (TEQ) Among Medical Students in China: Analyses Using Three Psychometric Methods. Front Psychol 2020; 11:810. [PMID: 32411062 PMCID: PMC7199516 DOI: 10.3389/fpsyg.2020.00810] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/01/2020] [Indexed: 12/30/2022] Open
Abstract
This study aimed to validate the simplified Chinese version of the Toronto Empathy Questionnaire (cTEQ) for use with the Chinese population. The original English version of the TEQ was translated into simplified Chinese based on international criteria. Psychometric analyses were performed based on three psychometric methods: classical test theory (CTT), item response theory (IRT), and Rasch model theory (RMT). Differential item functioning analysis was adopted to check possible item bias caused by responses from different subgroups based on sex and ethnicity. A total of 1296 medical students successfully completed the TEQ through an online survey; 75.2% of respondents were female and the average age was 19 years old. Forty students completed the questionnaire 2 weeks later to assess the test–retest reliability of the questionnaire. Confirmatory factor analysis supported a 3-factor structure of the cTEQ. The CTT analyses confirmed that the cTEQ has sound psychometric properties. However, IRT and RMT analyses suggested some items might need further modifications and revisions.
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Affiliation(s)
- Richard Huan Xu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Eliza Lai-Yi Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Sabrina Yu-Jun Lu
- Faculty of Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling-Ming Zhou
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Jing-Hui Chang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
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Steinmair D, Richter F, Löffler-Stastka H. Relationship between Mentalizing and Working Conditions in Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072420. [PMID: 32252375 PMCID: PMC7178150 DOI: 10.3390/ijerph17072420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/28/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023]
Abstract
Mentalizing describes the human ability to comprehend one's own and others' mental states and is seen as one of the core competencies of psychotherapists. Current research has emphasized the importance of both early dyadic attachment as well as broader sociocultural environmental input on the development of mentalizing. This study investigates whether mentalizing skills, operationalized via reflective functioning (RF), might be influenced by training and working conditions. This study was a matched case-control comparison, cross-sectional study. RF was assessed in a total of 10 psychotherapy trainees working in private practice at the beginning (group A; n = 5) and end (group B; n = 5) of their psychotherapy training (training association: Gestalt Therapy, Institute of Integrative Gestalttherapy Vienna) and in a total of 40 health professionals (institution: General Hospital Vienna-Social Medical Center South, Vienna, Department of Psychiatry, acute psychiatric ward) at the beginning of (group C; n = 20) and without (group D; n = 20) mentalization based therapy training. The participants differed from each other regarding their training, but participants of the same institution were matched. RF scores were significantly higher in group A and B than in group C and D (A,C: p = 0.0065, Odds Ratio (OR): 0.0294; A,D: p = 0.0019, OR: 0.0132; B,C: p = 0.0065, OR: 0.0294, B,D: p = 0.0019, OR: 0.0132). RF scores were not significantly different among groups A and group B (A,B: p > 0.9999) or between groups C and D (C,D: p = 0.6050). The current study suggests that mentalizing skills might be rather slow to improve by training, but that they might be influenced by the context.
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Affiliation(s)
- Dagmar Steinmair
- Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, Dunant-Platz 1, 3100 St. Pölten, Austria;
| | - Felix Richter
- Department of Psychoanalysis und Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis und Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Correspondence:
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Assing Hvidt E, Søndergaard J, Hvidt NC, Wehberg S, Büssing A, Andersen CM. Development in Danish medical students' empathy: study protocol of a cross-sectional and longitudinal mixed-methods study. BMC MEDICAL EDUCATION 2020; 20:54. [PMID: 32075639 PMCID: PMC7031973 DOI: 10.1186/s12909-020-1967-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Clinical empathy has been associated with positive outcomes for both physicians and patients such as: more accurate diagnosis and treatment, increased patient satisfaction and compliance, and lower levels of burnout and stress among physicians. International studies show mixed results regarding the development of empathy among future physicians associating medical education with decline, stability or increase in empathy levels. These mixed results are due to several study limitations. In Denmark, no investigation of Danish medical students' empathy trajectory has yet been conducted wherefore such a study is needed that optimizes the study design of earlier studies. METHODS The aim of the study is to examine and analyze empathy levels and empathy changes among Danish medical students from the four medical faculties in Denmark, employing a cross-sectional and longitudinal mixed-methods design including a control group of non-medical students. By supplementing cross-sectional and longitudinal questionnaire studies with a focus group interview study it is the aim to identify and analyze factors (including educational) that are perceived by medical students to influence the development of empathy and its expression in clinical care. DISCUSSION The results of the study will provide insight into the trajectory of medical students' empathy and in undergraduate and graduate students' experiences with and perceptions of empathy development. In addition, the study will provide evidence to support further research on how targeted educational programmes can best be designed to educate empathic and patient-centered physicians.
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Affiliation(s)
- E Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark.
- Department for the Study of Culture, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - J Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - N C Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - S Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - A Büssing
- Institute of Integrative Medicine, Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany
| | - C M Andersen
- Department for Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Andersen FA, Johansen ASB, Søndergaard J, Andersen CM, Assing Hvidt E. Revisiting the trajectory of medical students' empathy, and impact of gender, specialty preferences and nationality: a systematic review. BMC MEDICAL EDUCATION 2020; 20:52. [PMID: 32066430 PMCID: PMC7027232 DOI: 10.1186/s12909-020-1964-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/07/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND Empathy allows a physician to understand the patient's situation and feelings and respond appropriately. Consequently, empathy gives rise to better diagnostics and clinical outcomes. This systematic review investigates the level of empathy among medical students across the number of educational years and how this level relates to gender, specialty preferences, and nationality. METHOD In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the authors conducted a systematic search of studies published between February 2010 and March 2019 investigating the level of empathy among medical students. The databases PubMed, EMBASE, and PsycINFO were searched. Studies employing quantitative methodologies and published in English or Scandinavian language and examining medical students exclusively were included. RESULTS Thirty studies were included of which 24 had a cross-sectional and 6 a longitudinal study design. In 14 studies, significantly lower levels of empathy were reported by increase in the number of educational years. The remaining 16 studies identified both higher, mixed and unchanged levels. In 18 out of 27 studies it was reported that females had higher empathy scores than males. Only three out of nine studies found an association between empathy scores and specialty preferences. Nine out of 30 studies reported a propensity towards lower mean empathy scores in non-Western compared to Western countries. CONCLUSION The results revealed equivocal findings concerning how the empathy level among medical students develops among medical students across numbers of educational years and how empathy levels are associated with gender, specialty preferences, and nationality. Future research might benefit from focusing on how students' empathy is displayed in clinical settings, e.g. in clinical encounters with patients, peers and other health professionals.
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Affiliation(s)
| | | | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Christina Maar Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
- Department for the Study of Culture, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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Ahmadian Yazdi N, Soltani Arabshahi K, Bigdeli S, Ghaffarifar S. Challenges in promoting clinical empathy skills in medical students: A content analysis study. Med J Islam Repub Iran 2020; 33:104. [PMID: 31934564 PMCID: PMC6946919 DOI: 10.34171/mjiri.33.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Empathy is a key clinical skill in the medical profession, and many studies have reported a decline in it among medical students during their years of education; especially, in the clinical stage, and this affective decline persists in the physician-hood. This study aimed to explore the participants' perceptions about challenges for promoting clinical empathy in training stages. Methods: A qualitative design using content analysis was applied. Semi-structured interviews were applied to obtain data. Individual interviews were conducted with 14 interns and six clinical professors. The data were analyzed through conventional content analysis and the credibility, trustworthiness, and conformability of the data were confirmed. Results: Data analysis led to the extraction of two main categories, including overt and covert challenges, and also four categories and nine sub-categories. Conclusion: Resolving clinical empathy challenges in medical students requires financial and human resources, and training on the principles of effective doctor-patient interactions. Furthermore, professionalism should be strengthened in professors, and both official and hidden curricula should be revised accordingly.
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Affiliation(s)
- Nahid Ahmadian Yazdi
- Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Soltani Arabshahi
- Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran
| | - Shoaleh Bigdeli
- Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran
| | - Saeideh Ghaffarifar
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Karayiannis G, Papastavrou E, Farmakas A, Tsangari H, Noula M, Roupa Z. Exploration of empathy in Cyprus nursing and health care students: A mixed method study. Nurse Educ Pract 2020; 42:102686. [PMID: 31901489 DOI: 10.1016/j.nepr.2019.102686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/30/2022]
Abstract
Developing professionals who are perceptive to the needs of patients and can respond by expressing empathetic behavior is one of the aims of health care education. The aim of this study was to explore the level of empathy in health care students through a mixed method. The quantitative approach included the use of the Jefferson Scale of Empathy and the qualitative a focus group approach to further deepen into the descriptive results. 869 health care students (RR=81%) participated in the study and the level of empathy ranged from 42 to 139 with a mean score of 100.6 (20-140 scale). Significant statistical differences were found between the disciplines (F=8.6, p-value<0.001) and gender (p-value<0.001) with nursing students and women scoring the higher levels. Two focus groups of ten participants each were conducted with 3rd and 4th year nursing students. Four themes were derived from the analysis of these data a) empathy as an imperative component of care b) contact with the clinical reality c) the influence of family and choice of studies d) gender stereotypes. There is a lack of mixed methodologies in the empathy research and this study provided the opportunity of a better understanding of the health care students' views.
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30
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Akgün Ö, Akdeniz M, Kavukcu E, Avcı HH. Medical Students' Empathy Level Differences by Medical Year, Gender, and Specialty Interest in Akdeniz University. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520940658. [PMID: 32923670 PMCID: PMC7446269 DOI: 10.1177/2382120520940658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/12/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND As an important feature in patient-physician communication for both primary and clinical care, empathy is one of the basic competencies that physicians should possess. The primary aim of this study was to evaluate the level of empathy among medical students in all years of medical training using two different instruments: the Jefferson Scale of Physician Empathy (for clinical empathy level) and the Toronto Empathy Questionnaire (for general empathy level). MATERIALS AND METHODS This study is a cross-sectional descriptive study conducted in 2017-2018 academic year with students studying at Akdeniz University Faculty of Medicine. Data collection form, Toronto Empathy Questionnaire (TEQ) and Jefferson Scale of Physician Empathy (JSPE) was applied to the students by the researchers. The statistical analysis was carried out by using IBM-SPSS version 23 for Mac OS. T-test, ANOVA test, Spearman and Pearson correlation analysis were used for comparisons. RESULTS The mean TEQ score of the students was 52.8/65 and the JSPE-S score was 80.3/100. TEQ scores of students increased up to 4th year and then decreased, but the difference between the years was not statistically significant. The third year students' JSPE-S scores were significantly higher than that of the sixth year students. CONCLUSION While the clinical empathy levels of medical students decreased significantly after 3rd year, the general empathy levels decreased less. This result shows us that we should review our medical education curriculum and educational environment, and should initiate initiatives, and devote more time to empathy education in order to prevent the decrease in empathy level and increase empathy during medical education.
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Affiliation(s)
- Özge Akgün
- Department of Family Medicine, Faculty of Medicine, Akdeniz University Hospital, Akdeniz University, Antalya, Turkey
| | - Melahat Akdeniz
- Department of Family Medicine, Faculty of Medicine, Akdeniz University Hospital, Akdeniz University, Antalya, Turkey
| | - Ethem Kavukcu
- Department of Sports Medicine, Faculty of Medicine, Akdeniz University Hospital, Akdeniz University, Antalya, Turkey
| | - Hasan Hüseyin Avcı
- Department of Family Medicine, Faculty of Medicine, Akdeniz University Hospital, Akdeniz University, Antalya, Turkey
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Azim Majumder M, Ojeh N, Rahman S, Sa B. Empathy in medical education: Can 'kindness' be taught, learned and assessed? ADVANCES IN HUMAN BIOLOGY 2020. [DOI: 10.4103/aihb.aihb_14_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sa B, Ojeh N, Majumder MAA, Nunes P, Williams S, Rao SR, Youssef FF. The Relationship Between Self-Esteem, Emotional Intelligence, and Empathy Among Students From Six Health Professional Programs. TEACHING AND LEARNING IN MEDICINE 2019; 31:536-543. [PMID: 31075996 DOI: 10.1080/10401334.2019.1607741] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Theory: Psychosocial skills such as communication, empathy, and emotional intelligence are now considered key attributes of health professionals. Self-esteem is another important construct that is less well studied. Self-esteem is important because low levels have been linked to depression, suicide, and eating disorders. Given that health professional students experience high levels of stress and are at increased risk for similar psychopathology, self-esteem may be an important variable in student well-being and performance after graduation. Hypotheses: This study sought to explore self-esteem during students' 1st year of training hypothesizing that several would demonstrate low self-esteem. It is also hypothesized that emotional intelligence and empathy would be associated with self-esteem. Method: A cross-sectional survey was conducted, and data were gathered from dental, medical, nursing, optometry, pharmacy and veterinary students. Self-report questionnaires assessing self-esteem, emotional intelligence, and empathy were completed and demographic information was collected. Scores were calculated and differences between groups analyzed with analysis of variance and chi-square testing. Pearson's correlation was used to assess associations between the constructs. Results: The mean self-esteem score was 26.2 ± 2.3 but 21% of the sample evidenced low self-esteem. There was no difference in the proportion of students demonstrating low self-esteem among programs. Gender did not have a significant effect on self-esteem scores, though ethnicity did. Emotional intelligence scores were higher among male individuals than among female. Emotional intelligence and empathy showed a small association with self-esteem. Conclusions: A significant proportion of health professional students suffer from low self-esteem during their 1st year of study. Such students may be more susceptible to the stresses associated with study and the development of psychopathology. More research needs to be conducted to explore the relationships between self-esteem, emotional intelligence, and empathy with a view to strengthening training in these areas and managing the challenges faced by health professional students.
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Affiliation(s)
- Bidyadhar Sa
- Centre for Medical Sciences Education, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Nkemcho Ojeh
- Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados, West Indies
| | | | - Paula Nunes
- Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
| | - Stella Williams
- Centre for Medical Sciences Education, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Suresh Rangoji Rao
- Department of Preclinical Sciences, The Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Farid F Youssef
- Department of Preclinical Sciences, The Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Ponnamperuma G, Yeo SP, Samarasekera DD. Is empathy change in medical school geo-socioculturally influenced? MEDICAL EDUCATION 2019; 53:655-665. [PMID: 30891799 DOI: 10.1111/medu.13819] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/08/2018] [Accepted: 01/09/2019] [Indexed: 05/24/2023]
Abstract
CONTEXT There is convincing evidence that physician empathy leads to better patient care. As a result, there has been considerable research interest in investigating how empathy changes during undergraduate medical studies. Early (generally North American) studies raised concerns that medical training causes a decline in empathy. More recent studies (conducted around the world) have begun to suggest that either a slight increase or decrease in empathy occurs during undergraduate medical training, which has led some to argue that empathy changes indiscriminately (with no discernible pattern). This paper explores whether there is evidence to suggest that empathy changes indiscriminately or with a discernible geo-sociocultural pattern during undergraduate medical training. METHODS Literature that investigated change in empathy during undergraduate medical training was reviewed. Cross-sectional and longitudinal studies were tabulated separately according to their respective geographical locations. The tabulated results were analysed to investigate whether empathy changed similarly or differently within different geographical locations. RESULTS The studies reviewed indicate similar patterns of empathy change within approximate geo-sociocultural clusters. Whereas US studies predominantly show small but significant decreases in empathy, Far Eastern studies mostly show small but significant increases in empathy as undergraduates progress through the medical course. CONCLUSIONS These results suggest that change in empathy during undergraduate medical education is not as indiscriminate (patternless) as once thought. Additionally, these results support the notion that empathy is a locally construed global construct.
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Affiliation(s)
- Gominda Ponnamperuma
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Su Ping Yeo
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dujeepa D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Souza MC, Mendes IAC, Martins JCA, de Godoy S, Souza-Junior VD, Trevizan MA, Santos SSD, de Oliveira LMN, Ventura MCAA, Ventura CAA. Empathizing and systemizing profiles of Brazilian and Portuguese nursing undergraduates. Nurs Ethics 2019; 27:221-229. [DOI: 10.1177/0969733019833132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aim: To analyze the empathizing and systemizing profiles of Brazilian and Portuguese nursing undergraduates. Background: Empathy is a fundamental skill for nursing practice and should be analyzed during the student’s education. Methods: Descriptive study with cross-sectional design. Participants were 968 undergraduate students, including 215 (22.2%) Brazilians from a university in the state of São Paulo and 753 (77.8%) Portuguese students from a higher education institution in central Portugal. The Portuguese and Brazilian versions of the Empathizing/Systemizing Quotient have good internal consistency and reliability. Ethical considerations: In Brazil, approval for the study was obtained from the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing (protocol 191/2016) and in Portugal, from the Ethics Committee of the Health Sciences Research Unit: Nursing, Coimbra Higher School of Nursing (protocol P362-09/2016). Results: Most (86%) participants were female and aged between 20 and 24 years. In the general profile analysis between both groups, the domains “Social Skills,” “Contents,” and “Processes” scored higher. Gender differences exist for the feeling of empathy and systemizing, as women scored better on the short version of the Empathy Quotient and men on the Systemizing Quotient. Conclusion: As demonstrated in the domain scores for “Social Skills,” “Contents,” and “Processes,” the undergraduate nursing students analyzed have the ability to deal intuitively and spontaneously with social situations; they are also characterized as methodical people, who like to follow rules, and experience practice better than theory, and the women have a higher empathetic level than men, who in turn are more systemizing.
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Fragkos KC, Sotiropoulos I, Frangos CC. Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016). World J Meta-Anal 2019; 7:1-30. [DOI: 10.13105/wjma.v7.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/16/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Konstantinos C Fragkos
- GI Services, University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
- Medical School, University College London, London WC1E 6BT, United Kingdom
| | - Ioannis Sotiropoulos
- Department of Accounting and Finance, University of Ioannina, Psathaki 481 00 Preveza, Greece
| | - Christos C Frangos
- Greek Research Institute for the Study of Quantitative, Social and Biomedical Problems, Athens 141 21, Greece
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Effects of intermittent theta burst stimulation applied to the left dorsolateral prefrontal cortex on empathy and impulsivity in healthy adult males. Brain Cogn 2018; 128:37-45. [DOI: 10.1016/j.bandc.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/16/2018] [Accepted: 11/06/2018] [Indexed: 12/30/2022]
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Pohontsch NJ, Stark A, Ehrhardt M, Kötter T, Scherer M. Influences on students' empathy in medical education: an exploratory interview study with medical students in their third and last year. BMC MEDICAL EDUCATION 2018; 18:231. [PMID: 30290824 PMCID: PMC6173872 DOI: 10.1186/s12909-018-1335-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 09/26/2018] [Indexed: 05/04/2023]
Abstract
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.
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Affiliation(s)
- N J Pohontsch
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Stark
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Ehrhardt
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Kötter
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - M Scherer
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Haque M, Sa B, Majumder MAA, Islam MZ, Othman NSAB, Lutfi SNNB, Kibria GM, Salam A, Ismail MH, Abdullah SL. Empathy among undergraduate medical students: A cross-sectional study in one Malaysian public medical school. Ann Afr Med 2018; 17:183-188. [PMID: 30588931 PMCID: PMC6330787 DOI: 10.4103/aam.aam_57_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Bidyadhar Sa
- The Centre for Medical Sciences Education, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies, Trinidad and Tobago
| | - Md. Anwarul Azim Majumder
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados, West Indies
| | - Md. Zakirul Islam
- The Department of Pharmacology, Eastern Medical College, Comilla, Kabila, Dhaka-Chittagong Highway, Burichang 3520, Bangladesh
| | - Nur Syamirah Aishah Binti Othman
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Siti Nur Najihah Binti Lutfi
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Golam Mohammad Kibria
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Abdus Salam
- Medical Education and Quality Assurance, Asia Metropolitan University, No.6, Jalan Lembah Bandar Seri Alam, 81750 Johor Bahru, Malaysia
| | - Mohd Hafizi Ismail
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Shahidah Leong Abdullah
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
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Personal and Job Factors Associated with Teachers’ Active Listening and Active Empathic Listening. SOCIAL SCIENCES 2018. [DOI: 10.3390/socsci7070117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Active listening is important for effective interpersonal communication, a prerequisite for successful teaching. The presented cross-sectional study examined personal and work factors associated to active listening in 3.995 Greek schools’ educators of all teaching levels and specialties. The study questionnaire posted on official and main teachers’ portals included personal and working data items, the Active Empathic Listening Scale (AELS), and the Active Listening Attitude Scale (ALAS). Multiple linear regression was used to identify independently associated factors with AELS and ALAS dimensions, and standardized regression coefficients were performed to measure the effect of independent variables. Regarding AELS, gender had the greatest effect on the Sensing subscale, followed by age and mental health promotion training. Years of teaching had the greatest effect on Processing subscale, followed by higher studies. Gender had the greatest effect on Responding subscale, followed by age, higher studies, and mental health promotion training. Concerning ALAS, mental health promotion training and support from colleagues had the greatest effect on Listening attitude subscale, gender and mental health promotion training had the greatest effect on Listening skill subscale, and gender, age, and years of teaching had the greatest effect on Conversation opportunity subscale. The identification of enhancing factors like training in mental health promotion could significantly contribute in designing training that can simultaneously benefit teachers’ skills and students’ psychosocial well-being.
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Li CQ, Ma Q, Liu YY, Jing KJ. Are parental rearing patterns and learning burnout correlated with empathy amongst undergraduate nursing students? Int J Nurs Sci 2018; 5:409-413. [PMID: 31406856 PMCID: PMC6626275 DOI: 10.1016/j.ijnss.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 12/19/2022] Open
Abstract
Objective Empathy can help establish harmonious nurse-patient relationships. We aimed to assess the status of empathy, and explore the relationship between learning burnout, parental rearing patterns and empathy amongst nursing students. Method A questionnaire survey that employed the Learning Burnout Scale, the Short-Form Egna Minnenav Barndoms Uppfostran (s-EMBU) and the Jefferson Scale of Empathy was conducted amongst 562 nursing students. The data were analysed on the basis of descriptive statistic and correlation analysis was used. Results Empathy is negatively correlated with learning burnout, parental rejection and overprotection and showed no positive correlation with parental emotional warmth. Conclusions Educators should pay attention to nursing students' feelings and learning burnout status and take positive measures to improve the empathy level of the students. Positive parental rearing patterns also help cultivate empathy.
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Affiliation(s)
- Chao-Qun Li
- School of Nursing, Hebei University, Baoding, Hebei, China
| | - Qian Ma
- School of Nursing, Hebei University, Baoding, Hebei, China
| | - Yu-Ying Liu
- School of Nursing, Hebei University, Baoding, Hebei, China
| | - Kun-Juan Jing
- School of Nursing, Hebei University, Baoding, Hebei, China
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Biswas B, Haldar A, Dasgupta A, Mallick N, Karmakar A. An Epidemiological Study on Empathy and its Correlates: A Cross-sectional Assessment among Medical Students of a Government Medical College of India. Indian J Psychol Med 2018; 40:364-369. [PMID: 30093748 PMCID: PMC6065120 DOI: 10.4103/ijpsym.ijpsym_109_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Empathy is a desirable quality in every clinician. It is a crucial determinant of patient-physician communication and relation. There are very few existent Indian studies on empathy of medical students and its correlates. AIM The aim of the study was to assess empathy level of medical students and its correlates. METHODOLOGY It was a cross-sectional, hospital-based, analytical observational study conducted from July to November 2017. In total, 249 undergraduate medical students of a medical college of Kolkata were interviewed with a structured schedule. The schedule comprised of the sociodemographic questionnaire, career satisfaction, future career choice, and Jefferson Scale of Empathy. RESULTS The mean empathy score was 98.5 ± 12.5. Third-semester students had higher empathy scores (102.4 ± 12.4) compared to fifth (97.2 ± 12.9) and seventh semester (95.0 ± 10.9) students. The difference between the mean scores of different semesters was statistically significant. Female students were more empathic than male students. In the multivariable linear regression model, sex, semester, residence, career satisfaction, future career choice, and current place of living were significant predictors of empathy scores. CONCLUSION Empathy level of medical students of our study was quite low compared to other studies conducted outside India. Empathy eroded with semester, which supports earlier pieces of evidence in this regard.
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Affiliation(s)
- Bijit Biswas
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
| | - Anima Haldar
- Department of Community Medicine, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Aparajita Dasgupta
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
| | - Nazrul Mallick
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
| | - Anubrata Karmakar
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
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Abe K, Niwa M, Fujisaki K, Suzuki Y. Associations between emotional intelligence, empathy and personality in Japanese medical students. BMC MEDICAL EDUCATION 2018; 18:47. [PMID: 29587725 PMCID: PMC5870303 DOI: 10.1186/s12909-018-1165-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/19/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND It is known that empathic communication is important for physicians to achieve higher patient satisfaction and health outcomes. Emotional intelligence (EI), empathy and personality in medical students predict students' individual disposition and their emotional and empathic perceptions. This study aimed to investigate: 1) The association between empathy, EI and personality, and 2) Gender differences in the association between empathy, EI and personality. METHOD Participants were 357 1st year medical students from 2008 to 2011 at one medical school in Japan. Students completed self-report questionnaires comprising three validated instruments measuring EI: Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), empathy: Jefferson Scale of Physician Empathy- student version (JSPE) and personality: NEO-Five-Factor Inventory (NEO-FFI), which explores 5 dimensions of personality Neuroticism (N), Extraversion (E), Openness to experience (O), Agreeableness (A), and Conscientiousness (C). RESULTS Pearson Correlations showed weak association between TEIQue-SF and JSPE. TEIQue-SF and NEO-FFI showed positive correlation for E and C, and strong negative correlation for N and weak positive correlation for A and O. Weak positive correlation between JSPE and the NEO-FFI were observed for E and A. Although effect sizes were small, N, A and empathy were significantly higher in females (unpaired t-test). However, hierarchical multiple-regression analysis when controlling for gender and personality showed no association between EI, empathy and gender. A, TEIQue-SF and N were found to make small contributions in respect of predictions for JSPE. Personality contributed significantly to the prediction of TEIQue-SF. N had the largest independent negative contribution (β = - 0,38). CONCLUSION In our study population of 1st year medical students, females had significantly higher N, A and empathy scores than males. Medical students' N score was strongly negatively associated with EI. Empathy was weakly associated with EI and A. However, when controlling gender and personality in regression analysis, gender did not affect EI and empathy, rather personality is the most important factor. Our findings indicate that N is a major factor that negatively affects EI. It is important to mitigate N using thoughtful training, taking into account students' personalities, to reduce N. In future studies, we will assess how communication trainings for students might enhance EI.
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Affiliation(s)
- Keiko Abe
- Medical Educational Development Center, Gifu University, Gifu, Japan
- College of Nursing, Aichi Medical University, Nagakute, Japan
| | - Masayuki Niwa
- Medical Educational Development Center, Gifu University, Gifu, Japan
| | - Kazuhiko Fujisaki
- Medical Educational Development Center, Gifu University, Gifu, Japan
| | - Yasuyuki Suzuki
- Medical Educational Development Center, Gifu University, Gifu, Japan
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Empathy Variation in General Practice: A Survey among General Practitioners in Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030433. [PMID: 29498682 PMCID: PMC5876978 DOI: 10.3390/ijerph15030433] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/07/2018] [Accepted: 02/28/2018] [Indexed: 12/30/2022]
Abstract
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.
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Ferreira-Valente A, Monteiro JS, Barbosa RM, Salgueira A, Costa P, Costa MJ. Clarifying changes in student empathy throughout medical school: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1293-1313. [PMID: 27465064 DOI: 10.1007/s10459-016-9704-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/21/2016] [Indexed: 05/07/2023]
Abstract
Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.
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Affiliation(s)
- Alexandra Ferreira-Valente
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, Gualtar, 4710-057, Braga, Portugal
- 3B PT Government Associate Laboratory, Braga, Guimarães, Portugal
- University Lusíada of Lisbon, Lisbon, Portugal
| | - Joana S Monteiro
- USF Odisseia, Maia, Portugal
- Faculty of Medicine, Oporto University, Porto, Portugal
| | | | - Ana Salgueira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, Gualtar, 4710-057, Braga, Portugal
- 3B PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, Gualtar, 4710-057, Braga, Portugal
- 3B PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Manuel J Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, Gualtar, 4710-057, Braga, Portugal.
- 3B PT Government Associate Laboratory, Braga, Guimarães, Portugal.
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Tariq N, Rasheed T, Tavakol M. A Quantitative Study of Empathy in Pakistani Medical Students: A Multicentered Approach. J Prim Care Community Health 2017; 8:294-299. [PMID: 28645236 PMCID: PMC5932734 DOI: 10.1177/2150131917716233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To examine the empathy level of undergraduate medical students in Pakistan. Three hypotheses are developed based on the literature review. (1) Female medical students have a higher level of empathy than do male students. (2) Empathy scores vary during the medical school years in Pakistani students. (3) Medical students interested in people-oriented specialties would score higher than the students interested in technology-oriented specialties. METHODS This is a quantitative inquiry approach using a cross-sectional design of 1453 students from 8 Pakistani medical schools, both private and state. The sample consists of 41.1% (n = 597) male students and 58.9% (n = 856) female students. Empirical data are collected using the Jefferson Scale of Physician Empathy (JSPE), a well-validated self-administered questionnaire. RESULTS The mean empathy score among students is 4.77 with a standard deviation of 0.72. The results show that there is no statistically significant association between the empathy scores and gender, t(1342.36) = -0.053, P = .95). There is a statistically significant difference between the empathy scores and the years of medical school, F(14, 1448) = 4.95, P = .01. Concerning the specialty interests, there is no statistically significant difference between the empathy score and specialty interests. CONCLUSION The findings of this study showed that in Western countries, medical students performed better than Pakistani medical students on the empathy scale. This finding has important implications for Pakistani medical educators to improve the interpersonal skills of medical students in the context of patient care. Inconsistent with our expectations and experiences, our findings do not support that female medical students scored better than their male counterparts on the empathy scale. Because of the nature of a cross-sectional study, it is impossible to argue the decline of empathy during medical school training.
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Affiliation(s)
- Nabia Tariq
- Shifa College of Medicine Islamabad, Islamabad, Pakistan
| | - Tariq Rasheed
- Social Security Hospital Rawalpindi, Islamabad, Pakistan
| | - Mohsen Tavakol
- The University of Nottingham, Nottingham, Nottinghamshire, UK
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Active Empathic Listening Scale (AELS): Reliability and Validity in a Nationwide Sample of Greek Educators. SOCIAL SCIENCES 2017. [DOI: 10.3390/socsci6040113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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The Toronto Empathy Questionnaire: Reliability and Validity in a Nationwide Sample of Greek Teachers. SOCIAL SCIENCES 2017. [DOI: 10.3390/socsci6020062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Rosenzweig J, Blaizot A, Cougot N, Pegon-Machat E, Hamel O, Apelian N, Bedos C, Munoz-Sastre MT, Vergnes JN. Effect of a Person-Centered Course on the Empathic Ability of Dental Students. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.11.tb06219.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Julien Rosenzweig
- Department of Epidemiology and Public Health and Research Platform of Toulouse Dental Faculty; Paul Sabatier University; France
| | - Alessandra Blaizot
- Department of Public Health; Lille Dental Faculty; Lille 2 University; France
| | - Nancie Cougot
- Department of Restorative and Endodontic Dentistry; Paris Diderot Dental Faculty; Paris France
| | - Estelle Pegon-Machat
- Department of Epidemiology and Public Health; Dental Faculty; Université d'Auvergne; Clermont-Ferrand France
| | - Olivier Hamel
- Department of Epidemiology and Public Health; Dental Faculty; Paul Sabatier University; Laboratory of Medical Ethics; Faculty of Medicine; Paris Descartes University; Toulouse EA 4569 France
| | - Nareg Apelian
- Division of Oral Health and Society; Faculty of Dentistry; McGill University; Montréal Québec Canada
| | - Christophe Bedos
- Division of Oral Health and Society; Faculty of Dentistry; McGill University; Montréal Québec Canada
- École de Sante Publique; Université de Montréal; Montréal Québec Canada
| | | | - Jean-Noel Vergnes
- Department of Epidemiology and Public Health and Research Platform of Toulouse Dental Faculty; Paul Sabatier University; Toulouse France
- Division of Oral Health and Society; Faculty of Dentistry; McGill University; Montréal Québec Canada
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Ferreira-Valente A, Costa P, Elorduy M, Virumbrales M, Costa MJ, Palés J. Psychometric properties of the Spanish version of the Jefferson Scale of Empathy: making sense of the total score through a second order confirmatory factor analysis. BMC MEDICAL EDUCATION 2016; 16:242. [PMID: 27647296 PMCID: PMC5028960 DOI: 10.1186/s12909-016-0763-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/06/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND Empathy is a key aspect of the physician-patient interactions. The Jefferson Scale of Empathy (JSE) is one of the most used empathy measures of medical students. The development of cross-cultural empathy studies depends on valid and reliable translations of the JSE. This study sought to: (1) adapt and assess the psychometric properties in Spanish students of the Spanish JSE validated in Mexican students; (2) test a second order latent factor model. METHODS The Spanish JSE was adapted from the Spanish JSE-S, resulting in a final version of the measure. A non-probabilistic sample of 1104 medical students of two Spanish medical schools completed a socio-demographic and the Spanish JSE-S. Descriptive statistics, along with a confirmatory factor analysis, the average variance extracted (AVE), Cronbach's alphas and composite reliability (CR) coefficients were computed. An independent samples t-test was performed to access sex differences. RESULTS The Spanish JSE-S demonstrated acceptable to good sensitivity (individual items - except for item 2 - and JSE-S total score: -2.72 < Sk < 0.35 and -0.77 < Ku < 7.85), convergent validity (AVE: between 0.28 and 0.45) and reliability (Cronbach's alphas: between 0.62 and 0.78; CR: between 0.62 and 0.87). The confirmatory factor analysis supported the three-factor solution and the second order latent factor model. CONCLUSIONS The findings provide support for the sensitivity, construct validity and reliability of the adapted Spanish JSE-S with Spanish medical students. Data confirm the hypothesized second order latent factor model. This version may be useful in future research examining empathy in Spanish medical students, as well as in cross-cultural studies.
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Affiliation(s)
- Alexandra Ferreira-Valente
- University of Minho, School of Health Sciences, Life and Health Sciences Research Institute, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Patrício Costa
- University of Minho, School of Health Sciences, Life and Health Sciences Research Institute, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Marta Elorduy
- Universitat Internacional de Catalunya, School of Medicine and Health Sciences, Josep Trueta s/n 08165 Sant Cugat del Vallès, Barcelona, Spain
| | - Montserrat Virumbrales
- Universitat Internacional de Catalunya, School of Medicine and Health Sciences, Josep Trueta s/n 08165 Sant Cugat del Vallès, Barcelona, Spain
| | - Manuel J. Costa
- University of Minho, School of Health Sciences, Life and Health Sciences Research Institute, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Jorge Palés
- University of Barcelona, School of Medicine, Casanova 143, 08036 Barcelona, Spain
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Ávila RFD, Morais DD, Bomfim AJ, Chagas MHN. Empatia e reconhecimento de expressões faciais de emoções básicas e complexas em estudantes de Medicina. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
RESUMO Objetivo Avaliar a empatia e a capacidade de reconhecimento de emoções básicas e complexas e suas correlações em estudantes de Medicina. Métodos O desenho do estudo foi transversal. Foram avaliados 86 alunos do 3º e 4º ano do curso de Medicina de uma faculdade de Medicina do interior do estado de São Paulo com os seguintes instrumentos: (i) escala Jefferson de empatia, (ii) tarefa de Reconhecimento de Expressões Faciais de emoções básicas (REF) e (iii) Reading the mind in the eyes test (RMEt). Resultados A média geral de acertos no REF foi 15,6 (DP: ±2,3). Houve diferença estatisticamente significante no número de acertos da emoção tristeza no sexo feminino comparado com o masculino (t84 = 2,30; p = 0,02). Em relação ao RMEt, a média geral de acertos foi de 26,5 (DP: ±3,3) com diferença estatisticamente significante entre os gêneros com maior número de acertos entre as estudantes do sexo feminino (t84 = 3,43; p < 0,01). O escore total médio na escala de empatia foi 121,3 (DP: ±9,8). Houve correlação positiva fraca entre o escore total da escala de empatia e o número de acertos para a emoção tristeza (r = 0,29; p < 0,01). Conclusão O número de acertos para a emoção tristeza no REF e o escore total do RMEt foi maior no sexo feminino comparado com sexo masculino. Além disso, a empatia parece estar diretamente relacionada com a capacidade de reconhecer a emoção tristeza. Outros estudos parecem pertinentes para avaliar de forma mais profunda aspectos de empatia e reconhecimento de expressões faciais da emoção em estudantes de medicina.
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