|
 
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| REVIEW ARTICLE |
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| Year : 2020 | Volume
: 10
| Issue : 2 | Page : 38-40 |
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Empathy in medical education: Can 'kindness' be taught, learned and assessed?
Md Anwarul Azim Majumder1, Nkemcho Ojeh1, Sayeeda Rahman2, Bidyadhar Sa3
1 Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
2 School of Medicine, American University of Integrative Sciences, Bridgetown, Barbados
3 Centre for Medical Sciences Education, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago
| Date of Submission | 09-Mar-2020 |
| Date of Acceptance | 16-Apr-2020 |
| Date of Web Publication | 13-May-2020 |
Correspondence Address:
Md Anwarul Azim Majumder
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus
Barbados
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/AIHB.AIHB_14_20
Empathy is considered a core element of professionalism in medicine in the era of patient-centred care. Physicians with higher levels of empathy have greater clinical competence and deliver improved physician empathetic communication resulting in better patient outcomes. Empathy contributes to patient compliance, patient enablement and clinical outcomes. Studies done across the world have pointed to a decline in the empathy levels among health professional students as they progress through undergraduate education and training. Medical curricula should provide ample opportunity for students to develop empathy and display-related attributes such as emotional intelligence and self-esteem. Curriculum reform in medicine is needed to enable mandatory training to teach and inculcate these attributes to help physicians have better patient interactions and ultimately improve the quality of care.
Keywords: Assess, empathy, medical education, students, teach
How to cite this article:
Azim Majumder MA, Ojeh N, Rahman S, Sa B. Empathy in medical education: Can 'kindness' be taught, learned and assessed?. Adv Hum Biol 2020;10:38-40 |
How to cite this URL:
Azim Majumder MA, Ojeh N, Rahman S, Sa B. Empathy in medical education: Can 'kindness' be taught, learned and assessed?. Adv Hum Biol [serial online] 2020 [cited 2023 Mar 30];10:38-40. Available from: https://www.aihbonline.com/text.asp?2020/10/2/38/284284 |
| Introduction | |  |
Empathy is considered a core element of professionalism in medicine in the era of patient-centred care. The role of empathy in improving doctor–patient relationships and patient outcomes is well established.[1] Medical students' empathy has been widely researched and demonstrated that physicians who display higher levels of empathy have greater clinical competence, deliver better patient outcomes and exhibit lower physician burnout with higher well-being.[2],[3],[4] Patients' satisfaction is found to be influenced by the perceived empathy of their physicians. Improved physician empathetic communication contributes to patient compliance, patient enablement and higher ratings in clinical competence.[5],[6] Physician empathy seems to even indirectly prevent depression resulting in increased well-being in patients.[7] Whereas unempathetic medical care can lead to poor health outcomes resulting in patients being less willing to adhere to treatment,[8] increased physician empathy is found to be associated with reduced healthcare costs.[9] Empathic physicians evaluate patients by taking psychosocial factors in health and illness into consideration, using a 'biopsychosocial' rather than the 'biomedical' model of disease to treat disease.[10]
| Discussion | | |
Trying to find an answer to 'Empathy: Lost or Found in Medical Education?'[11] – Singh found mixed results, empathy levels may decrease, remain stable or increase among tomorrow's doctors. Studies done across the world have pointed to a decline in the empathy levels among health professional students as they progressed through undergraduate education and training.[12],[13],[14],[15] In a recent review involving studies from twenty different countries, Andersen et al.[16] demonstrated significantly lower levels of empathy in medical students (14 out of 30 studies) as they progress through their educational programmes. Hojat et al.[14] examined empathy in medical students using the Jefferson Scale of Physician Empathy, noting a small, yet clinically significant decrease in total empathy score. Bellini and Shea[15] noted a decline in empathy among residents using the Interpersonal Reactivity Index. However, a number of international studies recorded either no change or an increase in empathy during the course of medical training.[17],[18],[19],[20],[21],[22],[23] The trend of declining or no change of empathy is troubling, given the importance of physician empathy in patients' health outcomes.
Several factors could be attributed to this declining empathy: traditional and didactic teaching, hidden curriculum, institutional culture, greater focus on technologic rather than humanistic aspects of medicine, lack of role models, increased student and resident numbers, lack of resources, emphasis on research, practice of managed care and defensive medicine and increased litigation.[24],[25],[26],[27],[28],[29] Some researchers have blamed the instruments which were used to assess empathy, noting that these instruments 'may not be measuring anything meaningful to clinical practice or patient satisfaction'; for example, employing student self-assessments was found to be 'an ineffective way to measure empathy'.[30] It is now widely recommended that medical curricula should provide ample opportunity for students to develop empathy and attributes such as emotional intelligence.[3],[13] Teaching, assessing and enhancing these attributes 'must be considered a mandate' - 'not just declared desirable' as learning outcomes.[31] Hojat et al. recommended to consider empathy as a supplementary measure for medical admissions decisions.[2],[32] Although the importance of inclusion of empathy has been highly regarded in medical curricula, 'no widespread or well-studied curricula exist to teach clinical empathy' in medical education.[4] Padmanabhan[33] emphasised the need for the development of a full empathy-based curriculum, which would allow 'the self-determined interest of students to express itself while avoiding the rigorous expectations of a competency-based curriculum.'[33]
Can empathy be learned during medical education and training? Evidence from medical education studies shows positive results.[34],[35] Systematic training of humanistic qualities is required not only throughout undergraduate and postgraduate training but also for follow-up courses in professional careers.[11] Targeted training programmes to cultivate empathy should include humanities and arts in the medical curriculum.[36],[37] Educational interventions and assessment in medical curricula have been found to be effective in maintaining and enhancing empathy in students. Reviews of interventions geared towards improving empathy indicate that these can enhance empathy in medical students and physicians.[9],[38] However, Singh highlighted the lack of authentic (valid and reliable) assessment instruments to assess the multidimensional nature of empathy in medical education.[11] In their review of 18 articles that dealt with empathy-enhancing educational interventions in medical curricula, Batt-Rawden et al.[39] found significant improvements in empathic behaviour in medical students using various assessment and intervention tools. The main interventions to assess empathy used by various medical schools included patient narrative and creative arts (creative writing, blogging, drama, poetry, fiction and film),[40] reflective essays,[41] drama,[42] communication skills training,[43] problem-based learning,[44] interpersonal skills training,[45] patient interview,[46],[47] experiential learning[48],[49] and empathy interventions.[50] In one study, a successful intervention to improve medical students' empathy, an educational approach of 'authentic' patient representation (through DVD) and self-reflection was used.[51] In another study, 'clinical realism' and repeated writing exercises about the life of a character with an illness was shown to have the potential to increase medical students' empathy,[52] In yet another study, a simulation activity with standardised patients improved the empathy levels of medical students.[53] Serious narrative training was suggested as a way for students to improve empathy and professionalism.[54],[55] A recent study[4] conducted in France demonstrated that forum theatre (applied drama) significantly increased empathy scores among medical students with the participation of two forum theatre sessions.
| Conclusion | | |
Despite its well-established relevance in medical education, empathy is still being treated poorly in the curriculum. Empathy is a highly desirable professional trait that medical education needs to promote. This should be explicitly taught and embedded within the curriculum to help physicians to interact better with patients to improve the quality of patient care. Reform of medical curricula is required to enable mandatory training to teach and instill empathy and related attributes among medical students and physicians.
Financial support and sponsorship
Nil.
Conflicts of interest
Dr. Md Anwarul Azim Majumder and Dr. Bidyadhar Sa are in the Editorial Board of Advances in Human Biology. The other authors Dr. Nkemcho Ojeh and Dr. Sayeeda Rahamn report no conflicts of interest in this work.
| References | | |
| 1. | Schrooten I, de Jong MD. If you could read my mind: The role of healthcare providers' empathic and communicative competencies in clients' satisfaction with consultations. Health Commun 2017;32:111-8.  |
| 2. | Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Empathy in medicine national norms for the Jefferson scale of empathy: A nationwide project in osteopathic medical education and empathy (POMEE). J Am Osteopath Assoc 2019;119:520-32. |
| 3. | Sa B, Ojeh N, Majumder MA, Nunes P, Williams S, Rao SR, et al. The relationship between self-esteem, emotional intelligence, and empathy among students from six health professional programs. Teach Learn Med 2019;31:536-43. |
| 4. | Sevrain-Goideau M, Gohier B, Bellanger W, Annweiler C, Campone M, Coutant R. Forum theater staging of difficult encounters with patients to increase empathy in students: Evaluation of efficacy at The University of Angers Medical School. BMC Med Educ 2020;20:58. |
| 5. | Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof 2004;27:237-51. |
| 6. | Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med 2011;86:359-64. |
| 7. | Neumann M, Wirtz M, Bollschweiler E, Mercer SW, Warm M, Wolf J, et al. Determinants and patient-reported long-term outcomes of physician empathy in oncology: A structural equation modelling approach. Patient Educ Couns 2007;69:63-75. |
| 8. | Riess H. The science of empathy. J Patient Exp 2017;4:74-7. |
| 9. | Kelm Z, Womer J, Walter JK, Feudtner C. Interventions to cultivate physician empathy: A systematic review. BMC Med Educ 2014;14:219. |
| 10. | Striet U. Attitudes towards psychosocial factors in medicine. An appraisal of the ATSIM scale. Med Educ 1980;14:259-66. |
| 11. | Singh S. Empathy: Lost or found in medical education? Med Gen Med 2005;7:74. |
| 12. | Nunes P, Williams S, Sa B, Stevenson K. A study of empathy decline in students from five health disciplines during their first year of training. Inter J Med Educ 2011;2:12-7. |
| 13. | Youssef FF, Nunes P, Sa B, Williams S. An exploration of changes in cognitive and emotional empathy among medical students in the Caribbean. Int J Med Educ 2014;5:185-92. |
| 14. | Hojat M, Mangione S, Nasca TJ, Rattner S, Erdmann JB, Gonnella JS, et al. An empirical study of decline in empathy in medical school. Med Educ 2004;38:934-41. |
| 15. | Bellini LM, Shea JA. Mood change and empathy decline persist during three years of internal medicine training. Acad Med 2005;80:164-7. |
| 16. | Andersen FA, Johansen AB, 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 Med Educ 2020;20:52. |
| 17. | Magalhães E, Salgueira AP, Costa P, Costa MJ. Empathy in senior year and first year medical students: A cross-sectional study. BMC Med Educ 2011;11:52. |
| 18. | Tavakol S, Dennick R, Tavakol M. Empathy in UK medical students: Differences by gender, medical year and specialty interest. Educ Prim Care 2011;22:297-303. |
| 19. | Roh MS, Hahm BJ, Lee DH, Suh DH. Evaluation of empathy among Korean medical students: A cross-sectional study using the Korean version of the Jefferson Scale of Physician Empathy. Teach Learn Med 2010;22:167-71. |
| 20. | Kataoka HU, Koide N, Ochi K, Hojat M, Gonnella JS. Measurement of empathy among Japanese medical students: Psychometrics and score differences by gender and level of medical education. Acad Med 2009;84:1192-7. |
| 21. | Lee BK, Bahn GH, Lee WH, Park JH, Yoon TY, Baek SB. The relationship between empathy and medical education system, grades, and personality in medical college students and medical school students. Korean J Med Educ 2009;21:117-24. |
| 22. | Mostafa A, Hoque R, Mostafa M, Rana MM, Mostafa F. Empathy in undergraduate medical students of Bangladesh: Psychometric analysis and differences by gender, academic year, and specialty preferences. ISRN Psychiatry 2014;2014:375439. |
| 23. | Quince TA, Kinnersley P, Hales J, da Silva A, Moriarty H, Thiemann P, et al. Empathy among undergraduate medical students: A multi-Centre crosssectional comparison of students beginning and approaching the end of their course. BMC Med Educ 2016;16:92. |
| 24. | Evans BJ, Stanley RO, Burrows GD. Measuring medical students' empathy skills. Br J Med Psychol 1993;66(Pt 2):121-33. |
| 25. | Marcus ER. Empathy, humanism and the professionalisation process of medical education. Acad Med 1999;74:1211-5. |
| 26. | Skeff KM, Mutha S. Role models – Guiding the future of medicine. N Engl J Med 1998;339:2015-7. |
| 27. | Spencer J. Decline in empathy in medical education: How can we stop the rot? Med Educ 2004;38:916-8. |
| 28. | West CP, Shanafelt TD. The influence of personal and environmental factors on professionalism in medical education. BMC Med Educ 2007;7:29. |
| 29. | Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med 2011;86:996-1009. |
| 30. | Sulzer SH, Feinstein NW, Wendland CL. Assessing empathy development in medical education: A systematic review. Med Educ 2016;50:300-10. |
| 31. | Mishra S. Do we need to change the medical curriculum: Regarding the pain of others. Indian Heart J 2015;67:187-91. |
| 32. | Hojat M, Erdmann JB, Gonnella JS. Personality assessments and outcomes in medical education and the practice of medicine: AMEE Guide No. 79. Med Teach 2013;35:e1267-301. |
| 33. | Padmanabhan V. The need for empathy based medical education. Arch Med Health Sci 2019;7:13613-7. |
| 34. | Feighny KM, Arnold L, Monaco M, Munro S, Earl B. In pursuit of empathy and its relationship to physician communication skills: Multidimensional empathy training for medical students. Ann Behav Sci Med Educ 1998;5:13-21. |
| 35. | Wilkes M, Milgrom E, Hoffman JR. Towards more empathic medical students: A medical student hospitalization experience. Med Educ 2002;36:528-33. |
| 36. | Strickland MA, Gambala CT, Rodenhauser P. Medical education and the arts: A survey of U.S. medical schools. Teach Learn Med 2002;14:264-7. |
| 37. | Majumder MA. Should medical humanities be a part of the undergraduate medical curriculum? South East Asia J Public Health 2013;2:68-9. |
| 38. | Patel S, Pelletier-Bui A, Smith S, Roberts MB, Kilgannon H, Trzeciak S, et al. Curricula for empathy and compassion training in medical education: A systematic review. PLoS One 2019;14:e0221412. |
| 39. | Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: An updated, systematic review. Acad Med 2013;88:1171-7. |
| 40. | Muszkat M, Yehuda AB, Moses S, Naparstek Y. Teaching empathy through poetry: A clinically based model. Med Educ 2010;44:503. |
| 41. | DasGupta S, Charon R. Personal illness narratives: Using reflective writing to teach empathy. Acad Med 2004;79:351-6. |
| 42. | Van Winkle LJ, Fjortoft N, Hojat M. Impact of a workshop about aging on the empathy scores of pharmacy and medical students. Am J Pharm Educ 2012;76:9. |
| 43. | Bombeke K, Van Roosbroeck S, De Winter B, Debaene L, Schol S, Van Hal G, et al. Medical students trained in communication skills show a decline in patient-centred attitudes: An observational study comparing two cohorts during clinical clerkships. Patient Educ Couns 2011;84:310-8. |
| 44. | Karaoglu N, Seker M. Looking for winds of change with a PBL scenario about communication and empathy. Health Med 2011;5:515-21. |
| 45. | Tiuraniemi J, Läärä R, Kyrö T, Lindeman S. Medical and psychology students' self-assessed communication skills: A pilot study. Patient Educ Couns 2011;83:152-7. |
| 46. | Kommalage M. Using videos to introduce clinical material: Effects on empathy. Med Educ 2011;45:514-5. |
| 47. | Shapiro SM, Lancee WJ, Richards-Bentley CM. Evaluation of a communication skills program forfirst-year medical students at the University of Toronto. BMC Med Educ 2009;9:11. |
| 48. | Bunn W, Terpstra J. Cultivating empathy for the mentally ill using simulated auditory hallucinations. Acad Psychiatry 2009;33:457-60. |
| 49. | Varkey P, Chutka DS, Lesnick TG. The aging game: Improving medical students' attitudes toward caring for the elderly. J Am Med Dir Assoc 2006;7:224-9. |
| 50. | Bayne HB. Training medical students in empathic communication. J Spec Group Work 2011;36:316-29. |
| 51. | Miller SR. A curriculum focused on informed empathy improves attitudes toward persons with disabilities. Perspect Med Educ 2013;2:114-25. |
| 52. | McDonald P, Ashton K, Barratt R, Doyle S, Imeson D, Meir A, et al. Clinical realism: A new literary genre and a potential tool for encouraging empathy in medical students. BMC Med Educ 2015;15:112. |
| 53. | Schweller M, Costa FO, Antônio MÂ, Amaral EM, de Carvalho-Filho MA. The impact of simulated medical consultations on the empathy levels of students at one medical school. Acad Med 2014;89:632-7. |
| 54. | Craig JL. Retention of interviewing skills learned byfirst-year medical students: A longitudinal study. Med Educ 1992;26:276-81. |
| 55. | Singh S. The stone circle. CMAJ 2005;172:522. |
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