Strides in Development of Medical Education

Document Type : Original Article

Authors

1 Medical Education, Kerman University of Medical Sciences, Keman, Iran

2 Counseling of Midwifery, Bam University of Medical Sciences, Bam, Iran

Abstract

Background and Objectives Empathy is one of the main skills in establishing a relationship between physicians and patients, and in order to increase this sense in students, it is necessary to introduce systematic and active programs into medical education. The aim of this study is to determine the effect of an educational intervention based on a health belief model on empowering the sense of empathy in medical students. Methods This was a quasi-experimental intervention conducted on two groups of 80 medical students involved in the internship program from Tehran University of Medical Sciences in 2015. Sampling was done randomly, and the subjects were randomly assigned to two groups, experimental and control. In the pre-test phase, all students completed a three-dimensional questionnaire including demographic data; a valid, reliable, and standardized Jefferson empathy questionnaire; and a section comprising questions designed by the researcher based on the constructs of the health belief model. Educational intervention was conducted only for the experimental group. To measure the results of educational intervention, the standardized patient questionnaires and the questionnaires completed by the students were used. Data were analyzed by means of frequency, percentage, mean and standard deviation, ANOVA, and independent t-tests. Results Before the intervention, the two groups were similar and comparable in terms of demographic variables. After the intervention, there was a significant difference in the mean scores of perceived susceptibility (P < 0.001) and perceived severity (P = 0.002) between the two groups. The mean scores of perceived barriers and perceived benefits were significant among the two groups (P < 0.001). In addition, there were significant differences in the constructs of self-efficacy and cues to action three months after intervention (P < 0.001). Conclusions Training based on the health belief model was effective in empowering the sense of empathy among medical students. Training on empathy skills is recommended in order to increase patient satisfaction, promote health outcomes, and increase job satisfaction among physicians.

Keywords

  1. Eikeland HL, Ornes K, Finset A, Pedersen R. The physician’s role and empathy - a qualitative study of third year medical students. BMC Med Educ. 2014;14:165. doi: 10.1186/1472-6920-14-165. [PubMed: 25108627].
  2. Hojat M. Empathy in Patient Care: Antecedents, Development, Measurement, and Outcomes. New York: Springer; 2006.
  3. Pedersen R. Empathy: a wolf in sheep’s clothing? Med Health Care Philos. 2008;11(3):325–35. doi: 10.1007/s11019-007-9104-0. [PubMed:17926143].
  4. Neumann M, Wirtz M, Bollschweiler E, Mercer SW, Warm M, Wolf J, et al. Determinants and patient-reported long-term outcomes of physician empathy in oncology: a structural equation modelling approach. Patient Educ Couns. 2007;69(1-3):63–75. doi:10.1016/j.pec.2007.07.003. [PubMed: 17851016].
  5. Sulzer SH, Feinstein NW, Wendland CL. Assessing empathy development in medical education: a systematic review. Med Educ. 2016;50(3):300–10. doi: 10.1111/medu.12806. [PubMed: 26896015].
  6. Strekalova YA, Krieger JL, Neil J, Caughlin JP, Kleinheksel AJ, Kotranza A. I understand how you feel: The language of empathy in virtual clinical training. J Lang Soc Psychol. 2016;36(1):61–79. doi:10.1177/0261927x16663255.
  1. Neumann M, Edelhauser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996–1009. doi: 10.1097/ACM.0b013e318221e615. [PubMed: 21670661].
  2. Zachariae R, Pedersen CG, Jensen AB, Ehrnrooth E, Rossen PB, von der Maase H. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. Br J Cancer. 2003;88(5):658–65. doi:10.1038/sj.bjc.6600798. [PubMed: 12618870].
  3. Kim SS, Kaplowitz S, JohnstonMV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27(3):237–51. doi: 10.1177/0163278704267037. [PubMed: 15312283].
  4. Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P. Is there hardening of the heart during medical school? Acad Med. 2008;83(3):244–9. doi: 10.1097/ACM.0b013e3181637837. [PubMed: 18316868].
  5. Pollak KI, Arnold R, Alexander SC, Jeffreys AS, Olsen MK, Abernethy AP, et al. Do patient attributes predict oncologist empathic responses and patient perceptions of empathy? Support Care Cancer. 2010;18(11):1405–11. doi: 10.1007/s00520-009-0762-8. [PubMed:19838742].
  6. Preusche I, Lamm C. Reflections on empathy in medical education:What can we learn from social neurosciences? Adv Health Sci Educ Theory Pract. 2016;21(1):235–49. doi: 10.1007/s10459-015-9581-5. [PubMed:25597025].
  7. Colliver JA, Conlee MJ, Verhulst SJ, Dorsey JK. Reports of the decline of empathy during medical education are greatly exaggerated: a reexamination of the research. Acad Med. 2010;85(4):588–93. doi:10.1097/ACM.0b013e3181d281dc. [PubMed: 20354372].
  1. Derksen F, Olde Hartman TC, van Dijk A, Plouvier A, Bensing J, Lagro-Janssen A. Consequences of the presence and absence of empathy during consultations in primary care: A focus group study with patients. Patient Educ Couns. 2017;100(5):987–93. doi:10.1016/j.pec.2016.12.003. [PubMed:27989493].
  2. Morse DS, Edwardsen EA, Gordon HS. Missed opportunities for interval empathy in lung cancer communication. Arch Intern Med. 2008;168(17):1853–8. doi: 10.1001/archinte.168.17.1853. [PubMed:18809811].
  1. Everson N, Levett-Jones T, Lapkin S, Pitt V, van der Riet P, Rossiter R, et al. Measuring the impact of a 3D simulation experience on nursing students’ cultural empathy using a modified version of the

Kiersma-Chen Empathy Scale. J Clin Nurs. 2015;24(19-20):2849–58. doi:10.1111/jocn.12893. [PubMed: 26178187].

  1. Chen AM, Kiersma ME, Yehle KS, Plake KS. Impact of an Aging Simulation Game on Pharmacy Students’ Empathy for Older Adults. Am J Pharm Educ. 2015;79(5):65. doi: 10.5688/ajpe79565. [PubMed: 26396274].
  2. Mikkonen K, Kyngas H, Kaariainen M. Nursing students’ experiences of the empathy of their teachers: a qualitative study. Adv Health Sci Educ Theory Pract. 2015;20(3):669–82. doi: 10.1007/s10459-014-9554-0. [PubMed: 25266998].
  3. Abu-Akel A, Fischer-Shofty M, Levkovitz Y, Decety J, Shamay-Tsoory S. The role of oxytocin in empathy to the pain of conflictual out-group members among patients with schizophrenia. Psychol

Med. 2014;44(16):3523–32. doi: 10.1017/S003329171400097X. [PubMed:25065955].

  1. Chen DC, Pahilan ME, Orlander JD. Comparing a self-administered measure of empathy with observed behavior among medical students. J Gen Intern Med. 2010;25(3):200–2. doi: 10.1007/s11606-009-1193-4. [PubMed: 20013070].
  2. Pashler H, McDaniel M, Rohrer D, Bjork R. Learning styles: concepts and evidence. Psychol Sci Public Interest. 2008;9(3):105–19. doi:10.1111/j.1539-6053.2009.01038.x. [PubMed: 26162104].
  3. Green EC, Murphy E. Health belief model. The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. 23. 2014. p. 766–9.
  4. Siddiqui TR, Ghazal S, Bibi S, Ahmed W, Sajjad SF. Use of the health belief model for the assessment of public knowledge and household preventive practices in Karachi, Pakistan, a dengue-endemic city. PLoS Negl Trop Dis. 2016;10(11). e0005129. doi: 10.1371/journal.pntd.0005129. [PubMed: 27832074].
  5. Carpenter CJ. A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Commun. 2010;25(8):661–9. doi: 10.1080/10410236.2010.521906. [PubMed:

21153982].

  1. Jonason PK, Lyons M, Bethell EJ, Ross R. Different routes to limited empathy in the sexes: Examining the links between the dark triad and empathy. Pers Individ Dif. 2013;54(5):572–6. doi:

10.1016/j.paid.2012.11.009.

  1. Duesenberg M, Weber J, Schulze L, Schaeuffele C, Roepke S, Hellmann-Regen J, et al. Does cortisol modulate emotion recognition and empathy? Psychoneuroendocrinology. 2016;66:221–7. doi:10.1016/j.psyneuen.2016.01.011. [PubMed: 26851697].
  1. Zilioli S, Ponzi D, Henry A, Maestripieri D. Testosterone, cortisol and empathy: Evidence for the dual-hormone hypothesis. Adapt Human Behav Physiol. 2014;1(4):421–33. doi: 10.1007/s40750-014-0017-x.
  2. Fernndez-Olano C, Montoya-Fernndez J, Salinas-Snchez AS. Impact of clinical interview training on the empathy level of medical students and medical residents. Med Teach. 2008;30(3):322–4. doi:10.1080/01421590701802299. [PubMed: 18509879].
  1. Williams B, Brown T, McKenna L, Boyle MJ, Palermo C, Nestel D, et al. Empathy levels among health professional students: a cross-sectional study at two universities in Australia. Adv Med Educ Pract. 2014;5:107–13. doi: 10.2147/AMEP.S57569. [PubMed: 24833947].
  2. Khademalhosseini M, Khademalhosseini Z,Mahmoodian F. Comparison of empathy score among medical students in both basic and clinical levels. J Adv Med Educ Prof. 2014;2(2):88–91. [PubMed: 25512926].
  3. Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach. 2012;34(4):305–11. doi: 10.3109/0142159X.2012.644600.[PubMed: 22455699].
  4. Ahrweiler F, Neumann M, Goldblatt H, Hahn EG, Scheffer C. Determinants of physician empathy during medical education: hypothetical conclusions from an exploratory qualitative survey of practicing physicians. BMC Med Educ. 2014;14:122. doi: 10.1186/1472-6920-14-122.[PubMed: 24952736].