Empathy in Medical Education: Its Nature and Nurture — a Qualitative Study of the Views of Students and Tutors

Abstract

Context Medical education is committed to teaching patient centred communication and empathy. However, quantitative research suggests empathy scores tend to decline as students progress through medical school. In qualitative terms, there is a need to better understand how students and tutors view the practice and teaching of clinical empathy and the phenomenon of empathic erosion. Methods Working within a constructivist paradigm, researchers thematically analysed the individual interview data from a purposive sample of 13 senior students and 9 tutors. Results The four major themes were as follows: (1) ‘the nature of empathy’, including the concept of the innate empathy that students already possess at the beginning of medical school; (2) ‘beyond the formal curriculum’ and the central importance of role modelling; (3) ‘the formal curriculum and the tick-box influence of assessments’; and (4) the ‘durability of empathy’, including ethical erosion and resilience. A garden model of empathy development is proposed — beginning with the innate seeds of empathy that students bring to medical school, the flowering of empathy is a fragile process, subject to both enablers and barriers in the formal, informal, and hidden curricula. Conclusion This study provides insights into empathic erosion in medical school, including the problems of negative role modelling and the limitations of an assessment system that rewards ‘tick-box’ representations of empathy, rather than true acts of compassion. It also identifies factors that should enable the flowering of empathy, such as new pedagogical approaches to resilience and a role for the arts and humanities.

Weak inclusion of the medical humanities in medical education: a qualitative study among Danish medical students

“…Our findings thus point to a fundamental contradiction in medical education: that students, through the introduction of the medical humanities components in the preclinical years are encouraged to become empathic, compassionate and person-centred physicians but that these values are overshadowed by values such as emotional insulation and objectivity. These findings confirm arguments within existing research [ 39 , 46 ], namely, that communication of values on a subtle and hidden level influence students’ valuation of humanistic approaches to medicine, giving rise to personal value conflicts and dilemmas in students who find it difficult to navigate in an educational terrain representing the formal and the informal (hidden) curriculum.…”

What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care

“…Contextual factors such as ‘hidden curriculum’ is also widely known to take place outside the clinical setting, which fosters competitiveness and performance above collaboration 89. Hidden curriculums erode professional behaviour and decreases compassion, empathy and increases cynicism and burn-out among healthcare professionals 89–91. Essentially, authors can hypothesise the reason (mechanism) to why this review’s findings suggests using emotional intelligence components, such as awareness (TP4), to structure the learning process 59…”

“…89 Hidden curriculums erode professional behaviour and decreases compassion, empathy and increases cynicism and burn-out among healthcare professionals. [89][90][91] Essentially, authors can hypothesise the reason (mechanism) to why this review's findings suggests using emotional intelligence components, such as awareness (TP4), to structure the learning process. 59…”

Undergraduate medical education in India: Need for total modification

“…What kind of student should be selected for medical education is an important question which Western countries are trying to grapple with since the 1980s. [6][7][8] Unfortunately, it was also found that innate empathy to fellowmen which every human being has is reduced as the students' progress through their study curriculum; pointing to serious defects in the undergraduate teaching methods. [8] Most of the entrance examination looks for clear-cut answer in the form of "yes" or "no, " but in the real life, the medical practitioners eventually are going to practice in social milieu with many imponderables and empathy.…”

“…[6][7][8] Unfortunately, it was also found that innate empathy to fellowmen which every human being has is reduced as the students' progress through their study curriculum; pointing to serious defects in the undergraduate teaching methods. [8] Most of the entrance examination looks for clear-cut answer in the form of "yes" or "no, " but in the real life, the medical practitioners eventually are going to practice in social milieu with many imponderables and empathy. None of the examinations really tests this faculty anywhere in the world.…”