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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 2  |  Page : 38-40

Empathy in medical education: Can 'kindness' be taught, learned and assessed?


1 Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
2 School of Medicine, American University of Integrative Sciences, Bridgetown, Barbados
3 Centre for Medical Sciences Education, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago

Date of Submission09-Mar-2020
Date of Acceptance16-Apr-2020
Date of Web Publication13-May-2020

Correspondence Address:
Md Anwarul Azim Majumder
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus
Barbados
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_14_20

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  Abstract 


Empathy is considered a core element of professionalism in medicine in the era of patient-centred care. Physicians with higher levels of empathy have greater clinical competence and deliver improved physician empathetic communication resulting in better patient outcomes. Empathy contributes to patient compliance, patient enablement and clinical outcomes. Studies done across the world have pointed to a decline in the empathy levels among health professional students as they progress through undergraduate education and training. Medical curricula should provide ample opportunity for students to develop empathy and display-related attributes such as emotional intelligence and self-esteem. Curriculum reform in medicine is needed to enable mandatory training to teach and inculcate these attributes to help physicians have better patient interactions and ultimately improve the quality of care.

Keywords: Assess, empathy, medical education, students, teach


How to cite this article:
Azim Majumder MA, Ojeh N, Rahman S, Sa B. Empathy in medical education: Can 'kindness' be taught, learned and assessed?. Adv Hum Biol 2020;10:38-40

How to cite this URL:
Azim Majumder MA, Ojeh N, Rahman S, Sa B. Empathy in medical education: Can 'kindness' be taught, learned and assessed?. Adv Hum Biol [serial online] 2020 [cited 2022 Sep 27];10:38-40. Available from: https://www.aihbonline.com/text.asp?2020/10/2/38/284284




  Introduction Top


Empathy is considered a core element of professionalism in medicine in the era of patient-centred care. The role of empathy in improving doctor–patient relationships and patient outcomes is well established.[1] Medical students' empathy has been widely researched and demonstrated that physicians who display higher levels of empathy have greater clinical competence, deliver better patient outcomes and exhibit lower physician burnout with higher well-being.[2],[3],[4] Patients' satisfaction is found to be influenced by the perceived empathy of their physicians. Improved physician empathetic communication contributes to patient compliance, patient enablement and higher ratings in clinical competence.[5],[6] Physician empathy seems to even indirectly prevent depression resulting in increased well-being in patients.[7] Whereas unempathetic medical care can lead to poor health outcomes resulting in patients being less willing to adhere to treatment,[8] increased physician empathy is found to be associated with reduced healthcare costs.[9] Empathic physicians evaluate patients by taking psychosocial factors in health and illness into consideration, using a 'biopsychosocial' rather than the 'biomedical' model of disease to treat disease.[10]


  Discussion Top


Trying to find an answer to 'Empathy: Lost or Found in Medical Education?'[11] – Singh found mixed results, empathy levels may decrease, remain stable or increase among tomorrow's doctors. Studies done across the world have pointed to a decline in the empathy levels among health professional students as they progressed through undergraduate education and training.[12],[13],[14],[15] In a recent review involving studies from twenty different countries, Andersen et al.[16] demonstrated significantly lower levels of empathy in medical students (14 out of 30 studies) as they progress through their educational programmes. Hojat et al.[14] examined empathy in medical students using the Jefferson Scale of Physician Empathy, noting a small, yet clinically significant decrease in total empathy score. Bellini and Shea[15] noted a decline in empathy among residents using the Interpersonal Reactivity Index. However, a number of international studies recorded either no change or an increase in empathy during the course of medical training.[17],[18],[19],[20],[21],[22],[23] The trend of declining or no change of empathy is troubling, given the importance of physician empathy in patients' health outcomes.

Several factors could be attributed to this declining empathy: traditional and didactic teaching, hidden curriculum, institutional culture, greater focus on technologic rather than humanistic aspects of medicine, lack of role models, increased student and resident numbers, lack of resources, emphasis on research, practice of managed care and defensive medicine and increased litigation.[24],[25],[26],[27],[28],[29] Some researchers have blamed the instruments which were used to assess empathy, noting that these instruments 'may not be measuring anything meaningful to clinical practice or patient satisfaction'; for example, employing student self-assessments was found to be 'an ineffective way to measure empathy'.[30] It is now widely recommended that medical curricula should provide ample opportunity for students to develop empathy and attributes such as emotional intelligence.[3],[13] Teaching, assessing and enhancing these attributes 'must be considered a mandate' - 'not just declared desirable' as learning outcomes.[31] Hojat et al. recommended to consider empathy as a supplementary measure for medical admissions decisions.[2],[32] Although the importance of inclusion of empathy has been highly regarded in medical curricula, 'no widespread or well-studied curricula exist to teach clinical empathy' in medical education.[4] Padmanabhan[33] emphasised the need for the development of a full empathy-based curriculum, which would allow 'the self-determined interest of students to express itself while avoiding the rigorous expectations of a competency-based curriculum.'[33]

Can empathy be learned during medical education and training? Evidence from medical education studies shows positive results.[34],[35] Systematic training of humanistic qualities is required not only throughout undergraduate and postgraduate training but also for follow-up courses in professional careers.[11] Targeted training programmes to cultivate empathy should include humanities and arts in the medical curriculum.[36],[37] Educational interventions and assessment in medical curricula have been found to be effective in maintaining and enhancing empathy in students. Reviews of interventions geared towards improving empathy indicate that these can enhance empathy in medical students and physicians.[9],[38] However, Singh highlighted the lack of authentic (valid and reliable) assessment instruments to assess the multidimensional nature of empathy in medical education.[11] In their review of 18 articles that dealt with empathy-enhancing educational interventions in medical curricula, Batt-Rawden et al.[39] found significant improvements in empathic behaviour in medical students using various assessment and intervention tools. The main interventions to assess empathy used by various medical schools included patient narrative and creative arts (creative writing, blogging, drama, poetry, fiction and film),[40] reflective essays,[41] drama,[42] communication skills training,[43] problem-based learning,[44] interpersonal skills training,[45] patient interview,[46],[47] experiential learning[48],[49] and empathy interventions.[50] In one study, a successful intervention to improve medical students' empathy, an educational approach of 'authentic' patient representation (through DVD) and self-reflection was used.[51] In another study, 'clinical realism' and repeated writing exercises about the life of a character with an illness was shown to have the potential to increase medical students' empathy,[52] In yet another study, a simulation activity with standardised patients improved the empathy levels of medical students.[53] Serious narrative training was suggested as a way for students to improve empathy and professionalism.[54],[55] A recent study[4] conducted in France demonstrated that forum theatre (applied drama) significantly increased empathy scores among medical students with the participation of two forum theatre sessions.


  Conclusion Top


Despite its well-established relevance in medical education, empathy is still being treated poorly in the curriculum. Empathy is a highly desirable professional trait that medical education needs to promote. This should be explicitly taught and embedded within the curriculum to help physicians to interact better with patients to improve the quality of patient care. Reform of medical curricula is required to enable mandatory training to teach and instill empathy and related attributes among medical students and physicians.

Financial support and sponsorship

Nil.

Conflicts of interest

Dr. Md Anwarul Azim Majumder and Dr. Bidyadhar Sa are in the Editorial Board of Advances in Human Biology. The other authors Dr. Nkemcho Ojeh and Dr. Sayeeda Rahamn report no conflicts of interest in this work.



 
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