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Clinician Empathy a Key, Teachable Skill in Medical Education

New research counters the notion that clinician empathy wanes during medical school.

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Source: Thinkstock

By Sara Heath

- Clinician empathy is a core part of patient-provider relationships that many industry experts claim gets lost during the medical education process. That may not in fact be the case, according to a group of researchers from the University of Chicago.

In a study published recently in Medical Education, researchers explained that empathy is a critical trait for providers.

Empathy has been tied to increased medication adherence, fewer malpractice complaints, improved patient satisfaction, and better health outcomes. Respondents to a 2016 study from Massachusetts General Hospital said that clinician empathy is the distinguishing factor in a positive patient-provider interaction.

But most of the literature concludes that medical students lose their empathy throughout the course of their education. This has long presented a serious problem considering the importance of clinician empathy in driving a positive patient experience.

This latest Medical Education study challenges the notion that clinicians lose empathy over their educational experience. Studies need to include more aspects of empathy to yield a more accurate image of clinician empathy.

READ MORE: Driving Physician Empathy Amidst Push for Health IT Use

Researchers usually focus too much on only one type of empathy – cognitive empathy – when both cognitive and affective empathy are critical for clinicians to connect with patient emotions, the U Chicago researchers said.

Cognitive empathy is the clinician’s ability to look at a patient, recognize the patient’s feelings, communicate that recognition, and then behaving accordingly. Affective empathy is actually feeling what the patient is feeling, or having a more visceral and personal reaction to a patient’s health journey.

Previous research has focused too much on cognitive empathy, according to the research team, led by Jean Decety, the Irving B. Harris Distinguished Service Professor in Psychology and Psychiatry at U Chicago.

Healthcare professionals argue that cognitive empathy is more important than affective empathy because it allows doctors to act on a patient’s emotions while distancing themselves as clinicians. This enables clinicians to objectively do their jobs free from emotional attachment.

However, the research team argued that both kinds of empathy are important. Both cognitive and affective empathy allows doctors to accurately tune into a patient’s emotional needs.

READ MORE: To Boost Patient Satisfaction, Try a Little Provider Empathy

The research team investigated both types of empathy by administering two different surveys to 129 medical students at the University of Chicago, Loyola University, and Northwestern University. Participants took each survey three times each year for the first three years of their medical training.

The first survey, the Jefferson Scale of Physician Empathy, is the industry standard for these kinds of studies, Decety explained.

“We sought to replicate the results of previous studies that used this self-report measure,” Decety pointed out. “We did, in fact, see declines in assessment scores over the course of student training, which is in line with other studies that used this method.”

The team also used the Questionnaire of Cognitive and Affective Empathy to objectively assess participant empathy outside of the medical realm. Participant scores increased over time, showing that clinicians became better at picking up patient emotional needs over time, the researchers said.

Specifically, participants improved at perspective taking and understanding others’ emotions, some of the most important empathy skills for a clinician, the research team said. These skills also happen to be the most teachable within medical education.

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That finding is likely not a coincidence, the research team noted. Each of the three schools participating in the study have targeted courses for teaching clinician empathy. Observing that teachable empathy improved over the course of three years in each of these medical schools may confirm the efficacy of those courses, the team posited.

These findings do not conclusively negate original observations about clinician empathy, but instead challenge them. If nothing else, these results show that clinician empathy is nuanced and requires closer inspection.

“We found that changes in empathy during medical training are not necessarily negative—the narrative appears to be much more complicated than we initially thought and illustrates how problematic it is to rely on a single, subjective measure to evaluate a complex psychological construct,” the authors concluded.

In the future, it will be critical for medical educators to monitor empathy of their students. Gauging changes, especially negative changes, to clinician empathy will help educators better target their lessons in identifying patient emotions.

Empathy is key to a strong patient-provider relationship because it allows the clinician to act in the best interest of the patient and usually gives the patient some comfort. Medical educators need to understand how their students learn and develop their empathy skills to ensure students can meet patients’ bodily needs and their emotional needs.

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