A longitudinal study of empathy in pre-clinical and clinical medical students and clinical supervisors

Abstract

BackgroundAlthough appropriate empathy in health professionals is essential, a loss of empathy can occur during medical education. The structure of clinical learning may be one factor that is implicated in a loss of empathy. This study examines student and doctor empathy, and possible associations between empathy and the structure of clinical learning.MethodsThere were three groups of participants: medical students (n = 281), who completed a longitudinal survey consisting of the Jefferson Scale of Empathy and an open question about empathy at the beginning and end of the 2013 academic year; private doctors (medical practitioners) in South Australia (n = 78) who completed a survey consisting of the Jefferson Scale of Empathy and an open question about empathy at the end of the students’ academic year; and doctors (medical practitioners) from public teaching hospitals (n = 72) in southern Adelaide, South Australia who completed a survey consisting of the Jefferson Scale of Empathy at the end of the students’ academic year .ResultsYear one students’ empathy scores at the end of the year (102.8 ± 17.7) were significantly lower than at the start of the year (112.3 ± 9.6) p < .05). There were no other significant differences in students’ empathy scores by year groups or across the two time points. Empathy scores were almost identical for private and hospital clinicians and higher than average scores for students. Free-text comments highlighted the importance students and doctors place on empathy. Students described issues that adversely affected their empathy, including specific incidents, systemic issues, and course structure, but also described some positive role models. Doctors’ comments focused on the importance of empathy but qualified its meaning in the therapeutic setting.ConclusionMedical students and practitioners alike ascribe importance to empathy in clinical practice, yet its developmental course remains poorly understood with possible decrement across the course of medical education. A more sophisticated understanding of empathy in medical students is needed, with attention to issues that might adversely impact on this crucial aspect of their development.Trial registrationThis was not undertaken as the research did not involve a health care intervention on human participants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0777-z) contains supplementary material, which is available to authorized users.

Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach

“…They feel a strong urge to continuously grow and identify effective feedback as a means toward this goal (Luthar, 2017;Chung et al, 2018;Mestdagh et al, 2018). Complementary studies have corroborated that providing effective feedback enabled students to experience a greater sense of volitional (Joshi et al, 2017;Oommen et al, 2017;Mestdagh et al, 2018) and psychological freedom (Cubi-Molla et al, 2018), an increased sense of fulfillment of personal effectiveness (Holaday et al, 1994;Mahoney et al, 2016) and improved social relatedness (Fond et al, 2018), and interpersonal relationships (Ottenberg et al, 2016;Hill et al, 2018). In addition, effective feedback has been reported to augment feelings of self-perceived academic competency (Younan, 2016;Brass et al, 2017;Everson et al, 2018), enhance defensive coping styles (Bhagat et al, 2015;Jacobs et al, 2015;Cant and Cooper, 2017), and increase IM to attend and participate in class (Bradley et al, 2012;Mabel and Britton, 2018).…”

“…This often leads to professional burnout, a multifactorial syndrome, characterized by high levels of emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment (Walker et al, 2016;Chen et al, 2017;Pape et al, 2018). Studies have reported that even having one burnout symptom can cause negative effects that not only interfere with learning (Mohr et al, 2011;Lopes et al, 2015;Lowe et al, 2016), but can also cause physical (Mahoney et al, 2016) and psychological symptoms (de Paiva et al, 2017;Fond et al, 2018), and even the use of illicit drugs (Brown et al, 2016;Merrill and Carey, 2016;Chen et al, 2017). Recent studies have reported that the development of burnout in health care students can be directly related to low levels of IM in these students (Rosenman et al, 2014;Lowe et al, 2016;Fond et al, 2018;Worly et al, 2018).…”

“…Typically, health care students are idealistic (Rodriguez Zivic et al, 2013;Emerson, 2017) and excited about the choice of their profession (Barie and Ho, 2012;Queen and Hess, 2018;Yang and Shanks, 2018), and hence enter the educational environment with an eagerness to improve the human condition (Delany et al, 2015;Kenney et al, 2018;Melin-Johansson et al, 2018). This enthusiasm should not be misconstrued (Mahoney et al, 2016;Gibson, 2018), but rather nurtured by modifying teaching strategies to make learning more efficient and enjoyable (Ezell et al, 2013;Sluka et al, 2014;Nuffer et al, 2017;Khalil et al, 2018). The succeeding sections present an inductively derived conceptual model to enhance IM in millennial students.…”

“…Research has unequivocally proven that good clinical communication skills have a positive influence on patient satisfaction (Bronson, 2016;Ma et al, 2018), and the overall human and economic costs of client management (Junod Perron et al, 2015;Lamba et al, 2016). Students across all health care disciplines have reported that being able to communicate effectively with their clients has been a source of motivation (Mahoney et al, 2016;Igde and Sahin, 2017;Haque et al, 2018) and reassurance (Sluka et al, 2014;Chan et al, 2017), leading to a more positive view of their competency as health care professionals (Yilmaz et al, 2016;Gibson, 2018;Lysak et al, 2018). It is also a cogent fact that, inadequacies in conducive communication skills have been identified as a one of the major causes of frustration (Nuffer et al, 2017;Khalil et al, 2018) and loss of IM in health care students (Carpenter et al, 2018;Melin-Johansson et al, 2018;Ebert et al, 2019).…”

Navigating Cognitive Dissonance: A Qualitative Content Analysis Exploring Medical Students’ Experiences of Moral Distress in the Emergency Department

“…This transformative process toward internalization of “the way of being a physician,” or professional identity formation (PIF), is influenced by multiple factors in a student's professional and personal life . Clinical experience is a particularly influential factor in a students’ PIF and introduces students to new realities that may conflict with their previously formed ethical ideals and have the potential to lead to burnout and diminished empathy . As such, it is important that educators understand how students are experiencing the clinical environment to best guide them in their PIF.…”