Curricula for empathy and compassion training in medical education: A systematic review

Abstract

Background Empathy and compassion are vital components of health care quality; however, physicians frequently miss opportunities for empathy and compassion in patient care. Despite evidence that empathy and compassion training can be effective, the specific behaviors that should be taught remain unclear. We synthesized the biomedical literature on empathy and compassion training in medical education to find the specific curricula components (skills and behaviors) demonstrated to be effective. Methods We searched CENTRAL, MEDLINE, EMBASE, and CINAHL using a previously published comprehensive search strategy. We screened reference lists of the articles meeting inclusion criteria to identify additional studies for potential inclusion. Study inclusion criteria were: (1) intervention arm in which subjects underwent an educational curriculum aimed at enhancing empathy and/or compassion; (2) clearly defined control arm in which subjects did not receive the curriculum; (3) curriculum was tested on physicians (or physicians-in-training); and (4) outcome measure assessing the effect of the curriculum on physician empathy and/or compassion. We performed a qualitative analysis to collate and tabulate effects of tested curricula according to recommended methodology from the Cochrane Handbook. We used the Cochrane Collaboration’s tool for assessing risk of bias. Results Fifty-two studies (total n = 5,316) met inclusion criteria. Most (75%) studies found that the tested curricula improved physician empathy and/or compassion on at least one outcome measure. We identified the following key behaviors to be effective: (1) sitting (versus standing) during the interview; (2) detecting patients’ non-verbal cues of emotion; (3) recognizing and responding to opportunities for compassion; (4) non-verbal communication of caring (e.g. eye contact); and (5) verbal statements of acknowledgement, validation, and support. These behaviors were found to improve patient perception of physician empathy and/or compassion. Conclusion Evidence suggests that training can enhance physician empathy and compassion. Training curricula should incorporate the specific behaviors identified in this report.

Forum theater staging of difficult encounters with patients to increase empathy in students: evaluation of efficacy at The University of Angers Medical School

“…In two recent systematic reviews of interventions to cultivate physician empathy, Kelm et al [1]. selected 64 studies that quantitatively assessed changes in empathy, and Patel et al [11] selected 52 studies that were controlled. More than half have been directed toward residents or physicians, that is professionals advanced in their medical training and already engaged in a specialty, which may be considered as relatively late in the curriculum [1,11].…”

“…selected 64 studies that quantitatively assessed changes in empathy, and Patel et al [11] selected 52 studies that were controlled. More than half have been directed toward residents or physicians, that is professionals advanced in their medical training and already engaged in a specialty, which may be considered as relatively late in the curriculum [1,11]. The sample size was 11 to 439 subjects (median 78), the interventions lasted 40 min to 96 h (median 12 h), and 42 studies (66%) reported a significant increase in empathy [1].…”

Empathy among Medical Students is an Essential Requirement to be a Respectable and Holistic Medical Doctor

“…[28][29][30][31][32] Thereafter, medical schools should incorporate and emphasize the curriculum including hidden ones to improve empathy and other professional expertise. 33,34…”

Empathy in Action

“…The broader area of empathy or compassion training for medical trainees and physicians has found that these individuals can learn specific behaviors (such as sitting down when talking to patients or offering supportive verbal statements) that improve ratings of their degree of empathy or compassion. 2 More narrowly, regarding how to talk with patients with serious illness, the VitalTalk curriculum, typically delivered as a multisession program, has been shown to enhance the communication skills and increase the frequency of empathetic behaviors of participants. 3,4 And even more specifically, regarding how a clinician should communicate and behave when providing care to a dying child, educators have developed an interdisciplinary simulation for trainees and clinical staff to learn ways to appropriately and compassionately manage such situations.…”

“…5 However, in terms of improving how patients or parents perceive clinicians' intentions and behaviors, doubt exists as to whether these educational efforts actually work because studies are either lacking, limited, or negative. 2,6 Not only is the literature insufficient to know what works, we clinicians also need to be wary of assuming that our self-assessment of how well we express empathy correlates with how patients (or parents) perceive us, because it does not correlate. 7 And the notion that if we employ the skill of "perspective taking" and take someone else's perspective we will be able to figure out what they want is also not backed up by evidence; it is far better to ask what someone wants than to try to guess.…”