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Research Review

Empathy Difficult for Medical Students to Maintain but Possible to Improve

One year ago, a landmark study led by Mohammadreza Hojat, PhD, research professor at the department of psychiatry and human behavior at Thomas Jefferson University, quantified a relationship between physicians’ empathy and their patients’ positive clinical outcomes, suggesting that a physician’s empathy is an important factor associated with clinical competence. The study was published in the March 2011 issue of 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,” which was published in the American Journal of Pharmaceutical Education, Hojat and his team utilized the Jefferson Scale of Empathy with pharmacy and medical students at Midwestern University 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 Health Care 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.”

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 is a validated instrument for measuring empathy in the context of patient care that has been translated into 42 languages so far, and has been used in more than 60 countries. It includes 20 items answered on a seven-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 elder 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 elder 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, and asked questions about what to do in case of emergency, how food service is provided, 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 elder’s concerns.

After the performance was over and students discussed their observations, the JSE was administered to students (posttest 1) and then again a final time seven days later to pharmacy students and 26 days later to medical students (posttest 2).

Empathy scores increased significantly among both pharmacy and medical students between pretest and posttest 1 but returned to the pretest level in posttest 2.

Currently, Hojat and his colleagues are looking into ways to enhance and sustain empathy among medical students by showing them video clips of patient encounters from movies and discussing them in the context of patient care. They plan to possibly include empathy into the medical education curriculum. “Exposure to empathy-enhancing activities throughout health profession training enhances empathy, which is an integral component of a physician’s competence,” says Hojat. “As such, there is a need to create and develop programs and design strategies to improve and maintain empathy in health profession education. In the end, we know that it results in positive clinical outcomes and competent physicians.”

— Source: Thomas Jefferson University