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Medical Students’ Perspectives on the Factors Affecting Empathy Development During Their Undergraduate Training

Abstract

Introduction

This study investigated the perspectives of medical students on the factors influencing empathy development during their undergraduate training.

Methodology

A descriptive phenomenological approach was used to generate illustrations of empathy development and decline that had educational significance and applicability. Individual online semi-structured interviews were conducted to elicit experiential details from twelve final-year medical students. The interview recordings were transcribed verbatim, and data were analysed employing Braun and Clarke’s thematic analysis method.

Results

The self-reported empathic behavior of medical students seemed to have improved with time in medical school. Students attributed their empathy development to real patient encounters, positive role-modelling by teachers, and attainment of confidence and personal maturity. They identified exams, academic overload, time constraints, personal stresses, negative role models, unconducive learning environments, and lack of formal empathy training as barriers to empathy development.

Conclusion

Medical institutes should identify and address the barriers to empathy development and encourage the holistic development of medical students. Furthermore, medical educators should model their behavior accurately for their increasing roles and responsibilities and support the students in their empathic expressions with patients.

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References

  1. Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;63(606):e76–84.

    Google Scholar 

  2. Decety J, Fotopoulou A. Why empathy has a beneficial impact on others in medicine: unifying theories. Front Behav Neurosci. 2015;8:457.

    Google Scholar 

  3. 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.

    Google Scholar 

  4. Halpern J. What is clinical empathy? J Gen Intern Med. 2003;18(8):670–4.

    Google Scholar 

  5. Gleichgerrcht E, Decety J. Empathy in clinical practice: how individual dispositions, gender and experience moderate empathic concern, burnout and emotional distress in physicians. PLoS One. 2013;8(4):e61526.

  6. Halpern J. From idealized clinical empathy to empathic communication in medical care. Med Health Care Philos. 2014;17(2):301–11.

    Google Scholar 

  7. Halpern J. Gathering the patient’s story and clinical empathy. Perm J. 2012;16(1):52–4.

    Google Scholar 

  8. Jeffrey D. Exploring empathy with medical students: a qualitative longitudinal phenomenological study [Ph.D. Thesis]. 2018. Edinburgh: University of Edinburgh.

  9. Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu N. Practitioner empathy and the duration of the common cold. Fam Med. 2009;41(7):494–501.

    Google Scholar 

  10. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359–64.

    Google Scholar 

  11. 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.

    Google Scholar 

  12. Samra R. Empathy and Burnout in Medicine—Acknowledging Risks and Opportunities. J Gen Intern Med. 2018;33:991–3.

    Google Scholar 

  13. General Medical Council. Professional behaviour and fitness to practice: guidance for medical schools and their students. London: General Medical Council; Medical Schools Council; 2016.

    Google Scholar 

  14. Association of American Medical Colleges. Learning objectives for medical student education: guidelines for medical schools. Medical School Objectives Project, January 1998. Washington, DC: AAMC.

  15. O’Tuathaigh CMP, Nadhirah Idris A, Duggan E, Costa P, Costa MJ. Medical students’ empathy and attitudes towards professionalism: relationship with personality, specialty preference, and medical programme. PLoS One. 2019;14(5):e0215675.

    Google Scholar 

  16. Pohontsch NJ, Stark A, Ehrhardt M, Kötter T, Scherer M. Influences on students’ empathy in medical education: an exploratory interview study with medical students in their third and last year. BMC Med Educ. 2018;18(1):231.

    Google Scholar 

  17. Krishnasamy C, Ong SY, Loo ME, Thistlethwaite J. How does medical education affect empathy and compassion in medical students? A meta-ethnography: BEME Guide No. 57. Med Teach. 2019;41(11):1220–31.

    Google Scholar 

  18. Costa P, Magalhães E, Costa MJ. A latent growth model suggests that the empathy of medical students does not decline over time. Adv Health Sci Educ Theory Pract. 2013;18(3):509–22.

    Google Scholar 

  19. Paro HMS, Silveira PSP, Perotta B, Gannam S, Enns SC, Giaxa RRB, Bonito RF, Martins MA, TempskI PZ. Empathy among medical students: is there a relation with quality of life and burnout? PLoS One. 2014;9(4):e94133.

    Google Scholar 

  20. Tavakol S, Dennick R, Tavakol M. Empathy in UK medical students: differences by gender, medical year and specialty interest. Educ Prim Care. 2011;22(5):297–303.

    Google Scholar 

  21. Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, Veloski J, Gonnella JS. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182–91.

    Google Scholar 

  22. Pedersen R. Empathy development in medical education – a critical review. Med Teach. 2010;32(7):593–600.

    Google Scholar 

  23. Hojat M, LaNoue M. Exploration, and confirmation of the latent variable structure of the Jefferson scale of empathy. Int J Med Educ. 2014;5:73–81.

    Google Scholar 

  24. Tavakol S, Dennick R, Tavakol M. Medical students’ understanding of empathy: a phenomenological study. Med Educ. 2012;46(3):306–16.

    Google Scholar 

  25. Hooker C. Understanding empathy: why phenomenology and hermeneutics can help medical education and practice. Med Health Care Philos. 2015;18(4):541–52.

    Google Scholar 

  26. Smith KE, Norman GJ, Decety J. The complexity of empathy during medical school training: evidence for positive changes. Med Educ. 2017;51(11):1146–59.

    Google Scholar 

  27. Jeffrey D. A meta-ethnography of interview-based qualitative research studies on medical students’ views and experiences of empathy. Med Teach. 2016;38(12):1214–20.

    Google Scholar 

  28. Sulzer SH, Feinstein NW, Wendland CL. Assessing empathy development in medical education: A systematic review. Med Educ. 2016;50(3):300–10.

    Google Scholar 

  29. Spatoula V, Panagopoulou E, Montgomery A. Does empathy change during undergraduate medical education? A meta-analysis. Med Teach. 2019;41(8):895–904.

    Google Scholar 

  30. Elayyan M, Rankin J, Chaarani MW. Factors affecting empathetic patient care behaviour among medical doctors and nurses: an integrative literature review. East Mediterr Health J. 2018;24(3):311–8.

    Google Scholar 

  31. Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398–405.

    Google Scholar 

  32. Sundler AJ, Lindberg E, Nilsson C, Palmér L. Qualitative thematic analysis based on descriptive phenomenology. Nurs Open. 2019;6(3):733–9.

    Google Scholar 

  33. Shrivastava S, Ramasamy J. Use of in-depth interviews in medical education research [letter to the editor]. Muller J Med Sci Res. 2018;9(1):41–2.

    Google Scholar 

  34. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Google Scholar 

  35. Ramani S, Mann K. Introducing medical educators to qualitative study design: twelve tips from inception to completion. Med Teach. 2016;38(5):456–63.

    Google Scholar 

  36. Sutton J, Austin Z. Qualitative research: data collection, analysis, and management. Can J Hosp Pharm. 2015;68(3):226–31.

    Google Scholar 

  37. Tavakol M, Sandars J. Quantitative and qualitative methods in medical education research: AMEE Guide No. 90: Part I. Med Teach. 2014;36(9):746–56.

    Google Scholar 

  38. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245–51.

    Google Scholar 

  39. Stalmeijer RE, Mcnaughton N, Van Mook WN. Using focus groups in medical education research: AMEE Guide No. 91. Med Teach. 2014;36(11):923–39.

    Google Scholar 

  40. Ratanawongsa N, Teherani A, Hauer KE. Third-year medical students’ experiences with dying patients during the internal medicine clerkship: a qualitative study of the informal curriculum. Acad Med. 2005;80(7):641–7.

    Google Scholar 

  41. Cutler JL, Harding KJ, Mozian SA, Wright LL, Pica AG, Masters SR, Graham MJ. Discrediting the notion “working with ‘crazies’ will make you ‘crazy’”: addressing stigma and enhancing empathy in medical student education. Adv Health Sci Educ. 2009;14:487–502.

    Google Scholar 

  42. Norfolk T, Birdi K, Walsh D. The role of empathy in establishing rapport in the consultation: a new model. Med Educ. 2007;41(7):690–7.

    Google Scholar 

  43. Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perceptions of teaching. Brit Med J. 2004;329(7469):770–3.

    Google Scholar 

  44. Barrett-Lennard GT. The phases and focus of empathy. Br J Med Psychol. 1993;66(1):3–14.

    Google Scholar 

  45. Hashim MJ, Major S, Mirza DM, Prinsloo EA, Osman O, Amiri L, McLean M. Medical students learning communication skills in a second language: empathy and expectations. Sultan Qaboos Univ Med J. 2013;13(1):100–6.

    Google Scholar 

  46. Riess H. The impact of clinical empathy on patients and clinicians: understanding empathy’s side effects. AJOB Neurosci. 2015;6(3):51–3.

    Google Scholar 

  47. Nogueira-Martins MC, Nogueira-Martins LA, Turato ER. Medical students’ perceptions of their learning about the doctor-patient relationship: a qualitative study. Med Educ. 2006;40(4):322–8.

    Google Scholar 

  48. Brazeau CM, Schroeder R, Rovi S, Boyd L. Relationships between medical student burnout, empathy, and professionalism climate. Acad Med. 2010;85(Suppl. 10):S33-36.

    Google Scholar 

  49. Michalec B. Learning to cure, but learning to care? Adv Health Sci Educ Theory Pract. 2011;16(1):109–30.

    Google Scholar 

  50. Eikeland HL, Ørnes 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.

    Google Scholar 

  51. Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, Haramati A, Scheffer C. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996–1009.

    Google Scholar 

  52. Bayne H, Neukrug E, Hays D, Britton B. A comprehensive model for optimizing empathy in person-centered care. Patient Educ Couns. 2013;93(2):209–15.

    Google Scholar 

  53. Zenasni F, Boujut E, Woerner A, Sultan S. Burnout and empathy in primary care: three hypotheses. Br J Gen Pract. 2012;62(600):346–7.

    Google Scholar 

  54. Kerasidou A, Horn R. Making space for empathy: Supporting doctors in the emotional labour of clinical care. BMC Med Ethics. 2016;17(1):1–5.

    Google Scholar 

  55. Hamed OA, Alahwal AM, Basri AH, Bukhari BM. Personal, cultural, and academic factors affecting empathy score in third-year medical students. Int J Educ Res. 2015;3(3):727–40.

    Google Scholar 

  56. Costa P, de Carvalho-Filho MA, Schweller M, Thiemann P, Salgueira A, Benson J, Costa MJ, Quince T. Measuring medical students’ empathy: exploring the underlying constructs of and associations between two widely used self-report instruments in five countries. Acad Med. 2017;92(6):860–7.

    Google Scholar 

  57. Bayne HB. Training medical students in empathic communication. J Spec Group Work. 2011;36(4):316–29.

    Google Scholar 

  58. Batt-Rawden SA, Chisolm M, Anton B, Flickinger TE. Teaching empathy to medical students: an updated, systematic review. Acad Med. 2013;88(8):1171–7.

    Google Scholar 

  59. Larsen DP, Butler AC, Lawson AL, Roediger HL. The importance of seeing the patient: Test-enhanced learning with standardized patients and written tests improves clinical application of knowledge. Adv Health Sci Educ Theory Pract. 2013;18(3):409–25.

    Google Scholar 

  60. Halpern J. Empathy and patient-physician conflicts. J Gen Intern Med. 2007;22(5):696–700.

    Google Scholar 

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Acknowledgements

We are thankful to the twelve study participants for their patience, interest, and commitment to the research.

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Authors and Affiliations

Authors

Contributions

Namrata Chhabra planned and conducted the study, analyzed and interpreted the data, and wrote the manuscript. Sahil Chhabra assisted in transcription, data analysis and interpretation, and developing the manuscript. All authors critically reviewed the manuscript and approved the final version. Elize Archer guided and supervised the study, reviewed the contents critically, assisted in analyzing and interpreting the data, and helped write the manuscript.

Corresponding author

Correspondence to Namrata Chhabra.

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The approval to conduct the study was obtained from the Institutional research ethics committee.

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The authors declare no competing interests.

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Chhabra, N., Chhabra, S. & Archer, E. Medical Students’ Perspectives on the Factors Affecting Empathy Development During Their Undergraduate Training. Med.Sci.Educ. 32, 79–89 (2022). https://doi.org/10.1007/s40670-021-01487-5

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Keywords

  • Empathy
  • Medical education
  • Medical students
  • Empathy development
  • Phenomenological approach