Understanding moral empathy: A verbatim‐theatre supported phenomenological exploration of the empathy imperative

Abstract

Objectives: Several studies have measured a decline in empathy during medical training, speculating that factors within the formal, informal and hidden curricula are responsible for this phenomenon. Although the medical education literature describes the moral domain of empathy as most fundamental to the empathic response, most research into the decline has examined the cognitive, affective and behavioural domains. This study distinguishes itself by focusing on how moral empathy is affected through training. Methods: Ten medical residents from core education specialties at McMaster University participated in lightly structured interviews concerning their training experiences.Interview transcripts were analysed by way of a descriptive phenomenological approach. Analyses afforded descriptions of the way medical training influences moral empathy. These descriptions were then used to generate a verbatim theatre play that was performed for an audience of residents, educators, learners, researchers and scholars. Following the play, audience participants completed a survey to member-check the descriptions and to glean other reflective experiences in resident training that impact moral empathy. The survey results informed revisions to the codebook that was subsequently used to re-analyse the interview transcripts. This resulted in a final, refined version of the influence of training on learner moral empathy. Results:The findings suggest that a resident's sense of moral empathy relies upon the notion of an innate capacity for empathy, and is influenced by their clinical and classroom education, and specific experiences with patients during training.Importantly, these factors are rarely experienced as having a direct deleterious impact on residents' moral empathy but rather are experienced as challenges to their ability to act on their moral empathy. Conclusions:The study promotes reflection of what it means to experience empathy in the moral domain. The description offers a new perspective from which to view empathic declines that have been previously reported, while also highlighting a moral-behavioural tension that has implications for competency-based assessment and the way empathy is conceptualised in medical education.

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

“…Referring to quantitative research findings showing that in many (but not all) medical educational contexts in the world, medical students’ self-reported empathy declines as their education progresses [ 33 ] scholars point to powerful curricula biases and other hidden influences at the level of organizational structure and culture, affecting how students prioritize the medical humanities and the amount of time invested herein [ 34 – 36 ]. Empirical research confirms this tendency by showing that despite adding medical humanities to the undergraduate medical curriculum, committed to teaching the value of empathic- and compassionate care, medical students experience that socialization processes within their educational environment teaches them something very different: that emotional detachment, objectivity and value neutrality are key attributes of a competent and professional physician [ 28 , 37 – 40 ].…”

Dissecting the dissection experience: Whither the need for humanising the cadaver

“…By demonstrating that humanisation (and its corollary benefits) is a priority for medical programmes, students may be more likely to accept this as a core value and thus, err on the side of humanisingrather than dehumanising-coping techniques. 2 Rather than placing this onus on students, efforts to encourage humanisation should come from medical faculty.…”

“…1 In the moral domain, empathy is the inner motivation to unconditionally accept, understand, and help others; the cognitive domain involves using imagination to understand and predict the thoughts, feelings, and actions of others; the affective domain reflects a vicarious emotional response to another's perceived emotional experiences; and the behavioural domain refers to actions that communicate an understanding of another's perspectives. 1,2 Empathy, in medical education, can be considered in terms of four domains: cognitive, affective, behavioural, and moral. This framework is described to contextualise a discussion inspired by an article in this issue of Medical Education exploring willed body donation in medical learners.…”

“…Conversely, students seeking emotional connection through humanising coping strategies (e.g., naming, identification, and intentional respect for the donor) likely maintain the roles of ‘patient’ and ‘teacher’, engendering a sense of respect while also reconciling the roles versus anonymity tension through embracing—rather than rejecting—these roles 5,9 . Such coping strategies may also facilitate positive emotional connections with cadavers by providing a humanistic frame of reference with which students can relate 2,3,5,6 . In this way, students may offset negative emotions associated with dissection and develop empathic skills, as well as a sense of purpose and responsibility, that promote behavioural empathy and positive attitudes with cadavers and, eventually, future patients 3–6,9 .…”

“…However, rather than placing this onus on students, efforts to encourage humanisation should come from medical faculty. By demonstrating that humanisation (and its corollary benefits) is a priority for medical programmes, students may be more likely to accept this as a core value and thus, err on the side of humanising—rather than dehumanising—coping techniques 2 …”