Educating for empathy. A review.

OBJECTIVE Empathy in the medical setting is appreciation of the patient's emotions and expression of that awareness to the patient. Named as an essential learning objective by the American Association of Medical Colleges, empathy is believed to significantly influence patient satisfaction, adherence to medical recommendations, clinical outcomes, and professional satisfaction. The objective of this study was to identify effective strategies to enhance empathy in undergraduate medical students. DATA SOURCES We searched PubMed for studies that address the effectiveness of strategies for teaching empathy to medical students. We identified 13 peer-reviewed, English language, qualitative and quantitative studies reporting primary data on interventions that aim to foster empathy in undergraduate medical students, using Medical Subject Heading terms education, medical, undergraduate or student, medical crossed with empathy. RESULTS These studies indicate that empathy may be amenable to positive change with a range of interventional strategies. Communication skill workshops addressing the behavioral dimension of empathy show greatest quantitative impact on participants. However, current studies are challenged by varying definitions of empathy, small sample sizes, lack of adequate control groups, and variation among existing empathy measurement instruments. CONCLUSION Given the methodological limitations of the available studies, and uncertainty about which dimensions of empathy should be addressed, larger studies using validated measurement tools are recommended.

[1]  M. Therrien,et al.  Empathy in the doctor-patient relationship: skill training for medical students. , 1977, Journal of medical education.

[2]  R. Sanson-Fisher,et al.  TRAINING MEDICAL STUDENTS TO EMPATHIZE AN EXPERIMENTAL STUDY , 1978, The Medical journal of Australia.

[3]  R. Sanson-Fisher,et al.  Long-term effects of empathy training on the interview skills of medical students. , 1980, Patient counselling and health education.

[4]  E L La Monica,et al.  Construct validity of an empathy instrument. , 1981, Research in nursing & health.

[5]  R A Diseker,et al.  An analysis of empathy in medical students before and following clinical experience. , 1981, Journal of medical education.

[6]  Mark H. Davis.  Measuring individual differences in empathy: Evidence for a multidimensional approach. , 1983 .

[7]  M. Stewart,et al.  What is a successful doctor-patient interview? A study of interactions and outcomes. , 1984, Social science & medicine.

[8]  D. Brown,et al.  A comparison of four empathy instruments in simulated patient-medical student interactions. , 1985, Journal of medical education.

[9]  A. Mehrabian,et al.  Emotional empathy and associated individual differences , 1988 .

[10]  R. Ber,et al.  Increasing empathy among medical students , 1989, Medical education.

[11]  B. Evans,et al.  Lectures and skills workshops as teaching formats in a history‐taking skills course for medical students , 1989, Medical education.

[12]  R. Squier.  A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships. , 1990, Social science & medicine.

[13]  D. Roter,et al.  The relationship of physician medical interview style to patient satisfaction. , 1991, The Journal of family practice.

[14]  T. Marteau,et al.  Factors influencing the communication skills of first‐year clinical medical students , 1991, Medical education.

[15]  J. Morse,et al.  Exploring empathy: a conceptual fit for nursing practice? , 1992, Image--the journal of nursing scholarship.

[16]  M Lipkin,et al.  Physician satisfaction with primary care office visits. Collaborative Study Group of the American Academy on Physician and Patient. , 1993, Medical care.

[17]  B. Evans,et al.  Measuring medical students' empathy skills. , 1993, British Journal of Medical Psychology.

[18]  R. Frankel,et al.  The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. , 1994, Archives of internal medicine.

[19]  M. Stewart.  Effective physician-patient communication and health outcomes: a review. , 1995, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[20]  Judith A. Hall,et al.  Effectiveness of interventions to improve patient compliance: a meta-analysis. , 1998, Medical care.

[21]  N. Adler,et al.  Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. , 2000, The Western journal of medicine.

[22]  H. Winefield,et al.  Evaluating the outcome of communication skill teaching for entry‐level medical students: does knowledge of empathy increase? , 2000, Medical education.

[23]  J. Kleijnen,et al.  Influence of context effects on health outcomes: a systematic review , 2001, The Lancet.

[24]  Thomas J. Nasca,et al.  The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data , 2001 .

[25]  E. Vermeire,et al.  Patient adherence to treatment: three decades of research. A comprehensive review , 2001, Journal of clinical pharmacy and therapeutics.

[26]  Philip A. Berry,et al.  From Detached Concern to Empathy: Humanizing Medical Practice , 2001, BMJ : British Medical Journal.

[27]  J S Gonnella,et al.  Empathy in medical students as related to academic performance, clinical competence and gender , 2002, Medical education.

[28]  S. Mercer,et al.  Empathy and quality of care. , 2002, The British journal of general practice : the journal of the Royal College of General Practitioners.

[29]  Thomas J Nasca,et al.  Physician empathy: definition, components, measurement, and relationship to gender and specialty. , 2002, The American journal of psychiatry.

[30]  L. Deloney,et al.  The medical student as patient navigator as an approach to teaching empathy. , 2002, American journal of surgery.

[31]  R. Downie.  Towards more empathic medical students: a medical student hospitalization experience , 2002, Medical education.

[32]  T. Lancaster,et al.  Literature and medicine: evaluating a special study module using the nominal group technique , 2002, Medical education.

[33]  Lisa M Bellini,et al.  Variation of mood and empathy during internship. , 2002, JAMA.

[34]  Lynn Hunt,et al.  All the world's a stage: the use of theatrical performance in medical education , 2003, Medical education.

[35]  A. Jensen,et al.  Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease , 2003, British Journal of Cancer.

[36]  M. Johnston,et al.  The Effects of Physician Empathy on Patient Satisfaction and Compliance , 2004, Evaluation & the health professions.

[37]  Gang Xu,et al.  A Visitor's Guide to Effect Sizes – Statistical Significance Versus Practical (Clinical) Importance of Research Findings , 2004, Advances in health sciences education : theory and practice.

[38]  David Heaney,et al.  The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. , 2004, Family practice.

[39]  L. DiLalla,et al.  Effect of Gender, Age, and Relevant Course Work on Attitudes Toward Empathy, Patient Spirituality, and Physician Wellness , 2004, Teaching and learning in medicine.

[40]  J. Benbassat,et al.  What Is Empathy, and How Can It Be Promoted during Clinical Clerkships? , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[41]  M. Magee,et al.  An empirical study of decline in empathy in medical school , 2004, Medical education.

[42]  Sayantani Dasgupta,et al.  Personal Illness Narratives: Using Reflective Writing to Teach Empathy , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[43]  Elizabeth Morrison,et al.  Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. , 2004, Education for health.

[44]  E. Larson,et al.  Clinical empathy as emotional labor in the patient-physician relationship. , 2005, JAMA.

[45]  J. Shea,et al.  Mood Change and Empathy Decline Persist during Three Years of Internal Medicine Training , 2005, Academic medicine : journal of the Association of American Medical Colleges.

[46]  PhD Dr. Jodi Halpern MD.  What is clinical empathy? , 2007, Journal of General Internal Medicine.