Changes in the empathy levels of a group of undergraduate medical students: A longitudinal study
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Abstract
Background. The concept of empathy in students has gained significant attention in medical education. Whether implementing formal educational interventions to promote long-term and effective empathy levels leads to sustained increased empathy levels in students, is however less clear.
Objectives. The study aimed to evaluate the trajectory of medical students’ self-perceived empathy levels during their 6-year MB ChB degree.
Methods. A longitudinal, prospective study was conducted over 4 years. A cohort of 292 medical students was invited to participate. Participants completed the Jefferson Scale of Empathy for Students (JSE-S) at three intervals during their studies. The students attended two workshops related to empathic patient interactions during this time. The JSE-S mean score by age and gender was compared, making use of a linear regression model.
Results. A total of 119 students completed the study. Students’ total empathy levels were similar during the first and the last measuring point (110), but there was a significant rise in the intermediate measuring point (113.3). When the male and female cohorts’ scores were interpreted separately, both genders demonstrated a similar pattern to the total score, although females’ JSE-S scores were higher than the males.
Conclusion. The results of the study confirm that educational interventions can increase students’ self-perceived empathy levels; however, we suggest that students require reinforcement and multiple opportunities to practise and observe empathic communication with patients to sustain high levels of empathy. Follow-up sessions to specifically target the promotion of empathy should be implemented; otherwise the long-term effect of educational interventions might be limited.
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References
Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA 2000;284(8):1021-1027. https://doi.org/10.1001/jama.284.8.1021
Zachariae R, Pedersen CG, Jensen AB, et al. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self- efficacy, and perceived control over the disease. Br J Cancer 2003;88(5):658-665. https://doi.org/10.1038/sj.bjc.6600798
Lamiani G, Dordoni P, Vegni E, Barajon I. Caring for critically ill patients: Clinicians’ empathy promotes job satisfaction and does not predict moral distress. Front Psychology 2020;10:2902. https://doi.org/10.3389/fpsyg.2019.02902
Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well- being and enhanced empathy among internal medicine residents. J Gen Intern Med 2005;20(7):559-564. https://doi.org/10.1111/j.1525-1497.2005.0108.x
Hojat M, Gonnella JS, Nasca TJ, et al. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry 2002;159(9):1563-1569. https://doi.org/10.1176/appi.ajp.159.9.1563
TanL,LeMK,YuCC,etal.Definingclinicalempathy:Agroundedtheoryapproachfrom the perspective of healthcare workers and patients in a multicultural setting. BMJ Open 2021;11(9):e045224. https://doi.org/10.1136/bmjopen-2020-045224
Jeffrey D, Downie R. Empathy – can it be taught? J Royal Coll Physicians Edin 2016;46(2):107-112. https://doi.org/10.4997/JRCPE.2016.210
KelmZ,WomerJ,WalterJK,FeudtnerC.Interventionstocultivatephysicianempathy: A systematic review. BMC Med Educ 2014;14(1):1-11. https://doi.org/10.1186/1472- 6920-14-219
Batt-Rawden SA, Chisolm MS, Anton B, Flickinger TE. Teaching empathy to medical students: An updated, systematic review. Acad Med 2013;88(8):1171-1177. https:// doi.org/10.1097/ACM.0b013e318299f3e3
Archer E, Meyer IS. Applying empathic communication skills in clinical practice: Medical students’ experiences. South Afr Family Pract 2021;63(1):5244. https://doi. org/10.4102/safp. v63i1.5244
Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med 2009;84(9):1182-1191. https://doi.org/10.1097/ACM.0b013e3181b17e55
Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. J Gen Intern Med 2007;22(10):1434-1438. https://doi.org/10.1007/ s11606-007-0298-x
Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach 2012;34(4):305- 311. https://doi.org/10.3109/0142159X.2012.644600
Papageorgiou A, Miles S, Fromage M. Does medical students’ empathy change during their 5-year MB BS degree? Educ Health 2018;31(3):142.
Spatoula V, Panagopoulou E, Montgomery A. Does empathy change during undergraduate medical education? A meta-analysis. Med Teach 2019;41(8):895-904. https://doi.org/10.1080/0142159X.2019.1584275
Vallabh K. Psychometrics of the student version of the Jefferson Scale of Physician Empathy (JSPE-S) in final-year medical students in Johannesburg in 2008. S Afr J Bioethics Law 2011;4(2):63-68.
Archer E, Turner R. Measuring empathy in a group of South African undergraduate medical students using the student version of the Jefferson Scale of Empathy. Afr J Primary Health Care Fam Med 2019;11(1):1-5. https://doi.org/10.4102/phcfm. v11i1.1956
Blanco JM, Caballero F, Álvarez S, Plans M, Monge D. Searching for the erosion of empathy in medical undergraduate students: A longitudinal study. BMJ Open 2020;10(12):e041810. https://bmjopen.bmj.com/content/10/12/e041810
Kataoka H, Iwase T, Ogawa H, et al. Can communication skills training improve empathy? A six-year longitudinal study of medical students in Japan. Med Teach 2019;41(2):195-200.
Berg K, Majdan JF, Berg D, Veloski J, Hojat M. Medical students’ self-reported empathy and simulated patients’ assessments of student empathy: An analysis by gender and ethnicity. Acad Med 2011;86(8):984-988. https://doi.org/10.1097/ ACM.0b013e3182224f1f
Bleakley A, Bligh J, Browne J. Let’s get real: Medical students learning from, with and about patients. In: Medical Education for the Future. Advances in Medical Education. Dordrecht: Springer, 2011;1:187-200. https://doi.org/10.1007/978-90-481-9692-0_13
Christov-Moore L, Simpson EA, Coudé G, Grigaityte K, Iacoboni M, Ferrari PF. Empathy: Gender effects in brain and behavior. Neurosci Biobehav Rev 2014;46:604- 627. https://doi.org/10.1016/j.neubiorev.2014.09.001
Gallagher P, Moriarty H, Huthwaite M, Lim B. Challenging some assumptions about empathy. Clin Teach 2017;14(6):437-440. https://doi.org/10.1111/tct.12607
Light A, Gupta T, Burrows A, Nandakumar M, Daniel A, Karthikeyan S. Learning empathy: The medical student perspective. Clin Teach 2019;16(1):76-77. https://doi. org/10.1111/tct.12801
Southworth E, Gleason SH. COVID 19: A cause for pause in undergraduate medical education and catalyst for innovation. HEC Forum 2021;33(1):125-142. https://doi. org/10.1007/s10730-020-09433-5.
Stepien KA, Baernstein A. Educating for empathy. J Gen Intern Med 2006;21(5):524- 530. https://doi.org/10.1111/j.1525-1497.2006. 00443.x
Williams B, Brown T, McKenna L, et al. Student empathy levels across 12 medical and health professions: An interventional study. J Compassionate Health Care 2015;2(1):1-6. https://doi.org/10.1186/s40639-015-0013-4