Empathy difficult for medical students
April 1, 2012
Empathy difficult for medical students
One year ago, a landmark study quantified a relationship between physicians' empathy and their patients' positive clinical outcomes and suggested that a physician's empathy is an important factor associated with clinical competence. The study1 was led by Mohammadreza Hojat, PhD, research professor, Department of Psychiatry and Human Behavior at Thomas Jefferson University, Philadelphia, PA, and published in the journal Academic Medicine.
As a follow-up to that landmark study, Hojat asked if it were possible to improve or even maintain physicians' empathy as a way to further enhance patient care.
Hojat's team found that empathy can indeed be improved. In an article called, "Impact of a workshop about aging on the empathy scores of pharmacy and medical students,"2 which was published in the American Journal of Pharmaceutical Education, Hojat and his team used the Jefferson Scale of Empathy with pharmacy and medical students at Midwestern University, Glendale, AZ, before and after a 40-minute workshop. During the workshop, students observed and discussed a theatrical performance about the challenges of aging. The results showed that the workshop increased empathy significantly from pre-test to post-test in both groups of students. However, empathy scores were not sustained.
"Our results from this study are encouraging," says Hojat, also the director of the Jefferson Longitudinal Study of Medical Education in the Center for Research in Medical Education and Healthcare at Jefferson Medical College "Given our previous finding that empathy tends to decline during the education of health professionals, we are excited to learn that with targeted educational activities, empathy scores can improve, and that can potentially lead to positive clinical outcomes."3
Participants in the empathy workshop study included 187 first-year students in the Chicago College of Pharmacy and 183 first-year students in the Chicago College of Osteopathic Medicine at Midwestern University. Before starting the workshop, the Jefferson Scale of Empathy (JSE) was administered. This instrument is validated for measuring empathy in the context of patient care. It has been translated into 42 languages, and it has been used in more than 60 countries. It includes 20 items answered on a 7-point Likert scale developed based on a definition of empathy as a predominantly cognitive attribute that involves an understanding of the patient's experiences, concerns, and perspectives, combined with a capacity to communicate this understanding and an intention to help.
After the students completed the JSE, a 10-minute performance began. One actor portrayed an elderly person who was being admitted to a long-term assisted-care living facility. The other actor portrayed the assistant manager of the facility. The actors (volunteer students) were coached to follow the script written by Hojat and given to them prior to the workshop. The actor who played the role of the elderly person wore eye goggles covered with petroleum jelly to simulate visual impairment, earplugs to simulate hearing problems, and a walker to simulate movement problems. The actor assumed a demanding personality, exhibiting impatient behavior and using a grumpy tone of voice. The actor asked questions about what to do in case of emergency, how food service was provided, what were schedules for taking their medicine, and other issues. The actor who played the assistant manager showed more concern about rules and regulations related to running the facility than about attempting to understand the elderly person's concerns.
After the performance was over and students discussed their observations, the JSE was administered to students (post-test one) and then again seven days later to pharmacy students and 26 days later to medical students (post-test two).
Empathy scores increased significantly among pharmacy and medical students between pretest and post-test one, but returned to the pretest level in post-test two.
References
- Rosenthal S, Howard B, Schlussel Y, et al. Humanism at heart: Preserving empathy in third-year medical students. Acad Med 2012; 86:350-358.
- Van Winkle L, Fjortoft N, Hojat M. Impact of a workshop about aging on the empathy scores of pharmacy and medical students. J Pharm Ed 2012; 76. Doi: 10.5688/ajpe7619.
- Hojat M, Vergare M, Maxwell K, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med 2009; 84:1,182-1,191.
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