‘I’m sorry to hear that’—Empathy and Empathic Dissonance: the Perspectives of PA Students

Abstract

Context Our understanding of clinical empathy could be enhanced through qualitative research-research currently underrepresented in the field. Physician associates within the UK undergo an intensive 2-year postgraduate medical education. As a new group of health professionals, they represent a fresh pair of eyes through which to examine clinical empathy, its nature and teaching. Methods Working with a constructivist paradigm, utilising grounded theory methodology, researchers studied 19 purposively sampled physician associate students in two UK medical schools. One-to-one semi-structured interviews were transcribed verbatim. Data were analysed using a grounded theory approach. Results The global themes were the pathways to empathy, empathy modifiers and empathic dissonance a novel term to describe the discomfort students experience when pressurised into making empathic statements they don't sincerely feel. Students preferred using non-verbal over verbal expressions of empathy. A conceptual model is proposed. The more substantial empathic pathway, affective empathy, involves input from the heart. An alternative empathy, more constrained, comes from the head: cognitive empathy was considered a solution to time pressure and emotional burden. Formal teaching establishes empathic dissonance, a problem which stems from over-reliance on the empathic statement as the means to deliver clinical empathy. Conclusions This study furthers our understanding of the construct and teaching of empathy. It identifies empathic barriers, especially time pressure. It proposes a novel concept-empathic dissonance-a concept that challenges medical educationalists to reframe future empathy teaching.

How medical school alters empathy: Student love and break up letters to empathy for patients

“…Also evident in our data, and previously reported in PA student research, 38 is the tendency of medical education to socialise students into the belief that whilst some patients ‘deserve’ empathy, others do not. Students were influenced by negative comments supervisors make about ‘difficult’ patients.…”

“…This was true both for placement and for assessment settings, particularly OSCEs. Research has previously highlighted fake empathy in medical education and practice 36‐38 . Furthermore, research with Physician Associate (PA) students 38 reports identical challenges with the assessment of empathy in OSCEs: students feel compelled to literally ‘tick the empathy box’ and force out rote empathic statements that they do not truly mean.…”

“…Research has previously highlighted fake empathy in medical education and practice 36‐38 . Furthermore, research with Physician Associate (PA) students 38 reports identical challenges with the assessment of empathy in OSCEs: students feel compelled to literally ‘tick the empathy box’ and force out rote empathic statements that they do not truly mean. As with research on PA students, this study has identified that medical students experience empathic dissonance 38 —the discomfort students feel when are forced into making statements of empathy they do not truly mean.…”

“…Furthermore, research with Physician Associate (PA) students 38 reports identical challenges with the assessment of empathy in OSCEs: students feel compelled to literally ‘tick the empathy box’ and force out rote empathic statements that they do not truly mean. As with research on PA students, this study has identified that medical students experience empathic dissonance 38 —the discomfort students feel when are forced into making statements of empathy they do not truly mean. Our data also suggest that this lack of authenticity, frustration with the assessment system and the problem of empathic dissonance risk breeding a general student cynicism towards the practice of empathy.…”

“…This study also highlights factors within the hidden curriculum 11 with similar potential to deter student empathy. Some factors have been previously reported, including the tendency for medical education to prioritise the ‘science stuff’ 47 and the negative role modelling that implies there is no time for empathy in the real world of clinical practice 38 …”