Assessing empathy development in medical education: a systematic review

Abstract

Introduction Empathy in doctor-patient relationships is a familiar topic for medical scholars, and a crucial goal for medical educators. Nonetheless, there are persistent disagreements in the research literature concerning how best to evaluate empathy among physicians, and whether empathy declines or increases across medical education. Some researchers have argued that the instruments used to study “empathy” may not be measuring anything meaningful to clinical practice or to patient satisfaction. Methods We performed a systematic review to learn how empathy is conceptualized in medical education research. How do researchers define the central construct of empathy, and what do they choose to measure? How well do definitions and operationalizations match? Results Among the 109 studies that met our search criteria, 20% failed to define the central construct of empathy at all, and only 13% had an operationalization that was well-matched to the definition provided. The majority of studies were characterized by internal inconsistencies and vagueness in both the conceptualization and operationalization of empathy, constraining the validity and usefulness of the research. The methods most commonly used to measure empathy relied heavily on self-report and cognition divorced from action, and may therefore have limited power to predict the presence or absence of empathy in clinical settings. Finally, the large majority of studies treated empathy itself as a black box, using global construct measurements that are unable to shed light on the underlying processes that produce empathic response. Discussion We suggest that future research should follow the lead of basic scientific research that conceptualizes empathy as relational—an engagement between a subject and an object—rather than a personal quality that may be modified wholesale through appropriate training.

Empathy and compassion in the health-related literature: disciplinary and topic trends and gaps

“…The numbers indicate that while C appears in the literature without E, there are no instances in the results where E appears without C. This suggests the distinction commonly made between E and C for theoretical purposes may not be as useful in practice as in theory. Finding 1 is consistent with results presented by Sulzer, Feinstein, and Wendland [3] in their review of 109 studies aimed at assessing empathy development in medical education. The authors found that most of the studies they reviewed were characterized by internal inconsistencies and vagueness in the conceptualization of E, pointing out that the methods most commonly used to measure E relied on self-report and cognition divorced from action, and as a result may not be able to predict the presence or absence of E in clinical settings.…”

Communicating with a Human Voice: Developing a Relational Model of Empathy

“…37 Empathic motivation, attention, listening skills and understanding combine to increase rapport. 37 Empathy as a relational concept deepens with continuity of care, 21 which is diffi cult to achieve in the UK; many patients feel they cannot relate to 'their' general practitioner. 38 Attention involves active listening as a doctor seeks the underlying hidden agenda each patient brings, listening to their story and allowing time to pass.…”

“…[16][17][18][19][20] I hope to stimulate debate and to suggest ways of bridging the empathy gap in practice and medical education, and so enhance patient care. 13,21,22 Empathy Differing definitions of empathy highlight its varied dimensions; some focusing on understanding the patient's view (cognitive), others on sharing feelings (affective). 13,23,24 The complexity of empathy is described elsewhere; here I argue for a broader approach which embraces empathy's cognitive, affective, behavioural and moral aspects.…”

“…18,19,[25][26][27][28] Empathy may also be seen as a personal attribute or as a relational concept, depending on the context for its expression. 19,21,23 Empathy may occur at superfi cial or deep levels according to the clinical context. 29 For instance, during an OSCE examination with a simulated patient, a superfi cial level of empathy may suffi ce, but in planning end of life care with a patient and their family, a deeper level is required.…”

When I say … empathy

“…This has resulted in definitions of ‘clinical empathy’ (empathy in a health care setting) as predominantly cognitive, a tendency traceable to Osler's influential essay Aequanimitas . A recent systematic review of empathy in the medical literature found that 85% of articles which offer a definition of empathy describe it as a cognitive ability …”