Skip to main content

Barriers to Empathy: The Curriculum

  • Chapter
  • First Online:
Exploring Empathy with Medical Students

Abstract

This chapter addresses the formal curriculum and its effects on empathy. The chapter begins with a discussion of whether empathy can be taught. The students describe a lack of teaching about empathy and the neglect of psychosocial aspects of the patient’s situation. They talk about the strong biomedical bias in their teaching and its negative effect of empathy. Other barriers such as negative role models, assessment and feedback are explored in relation to the student–patient relationship.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Archer, E., & Meyer, I. (2018). Teaching empathy to undergraduate medical students: ‘One glove does not fit all’. Medical Education, 52, 1191.

    Article  Google Scholar 

  • Atkinson, P. (1976). The Clinical Experience: An Ethnography of Medical Education (PhD.). Durham University.

    Google Scholar 

  • Batt-Rawden, S., Chisolm, M. S., Anton, B., & Flickinger, T. E. (2013). Teaching empathy to medical students: An updated, systematic review. Academic Medicine, 88, 1171–1177.

    Article  Google Scholar 

  • Bayne, H. B. (2011). Training medical students in empathic communication. The Journal for Specialists in Group Work, 36, 316–329.

    Article  Google Scholar 

  • Bikker, A. P., Mercer, S. W., & Cotton, P. (2012). Connecting, assessing, responding and empowering (CARE): A universal approach to person-centred, empathic healthcare encounters. Education for Primary Care, 23, 454–457.

    Google Scholar 

  • Bleakley, A., & Bligh, J. (2008). Students learning from patients: Let’s get real in medical education. Advances in Health Sciences Education, 13, 89–107.

    Article  Google Scholar 

  • Bloom, S. (1989). The medical school as a social organization: The sources of resistance to change. Medical Education, 23, 228–241.

    Article  Google Scholar 

  • Bombeke, K., Van Roosbroeck, S., De Winter, B., Debaene, L., Schol, S., Van Hal, G., et al. (2011). Medical students trained in communication skills show a decline in patient-centred attitudes: An observational study comparing two cohorts during clinical clerkships. Patient Education and Counseling, 84, 310–318.

    Article  Google Scholar 

  • Bower, D. J., Young, S., Larson, G., Simpson, D., Tipnis, S., Begaz, T., et al. (2009). Characteristics of patient encounters that challenge medical students’ provision of patient-centered care. Academic Medicine, 84, 74–78.

    Article  Google Scholar 

  • Charon, R. (2001). Narrative medicine—A model for empathy, reflection, profession, and trust. JAMA, 286, 1897–1902.

    Article  Google Scholar 

  • Cutler, J., Harding, K., Mozian, S., Wright, L. L., Pica, A. G., Masters, S., et al. (2009). Discrediting the notion “working with ‘crazies’ will make you ‘crazy’”: Addressing stigma and enhancing empathy in medical student education. Advances in Health Sciences Education, 14, 487–502.

    Article  Google Scholar 

  • DasGupta, S., & Charon, R. (2004). Personal illness narratives: Using reflective writing to teach empathy. Academic Medicine, 79, 351–356.

    Article  Google Scholar 

  • du Vaure, C. B., Lemogne, C., Bunge, L., Catu-Pinault, A., Hoertel, N., Ghasarossian, C., et al. (2017). Promoting empathy among medical students: A two-site randomized controlled study. Journal of Psychosomatic Research, 103, 102–107.

    Article  Google Scholar 

  • Dunham, L., Dekhtyar, M., Gruener, G., Cichoskikelly, E., Deitz, J., Elliott, D., et al. (2017). Medical student perceptions of the learning environment in medical school change as students transition to clinical training in undergraduate medical school. Teaching and Learning in Medicine, 29, 383–391.

    Article  Google Scholar 

  • Eikeland, H. L., Ornes, K., Finset, A., & Pedersen, R. (2014). The physician’s role and empathy—A qualitative study of third year medical students. BMC Medical Education, 14, 165–173.

    Article  Google Scholar 

  • Elder, A., & Verghese, A. (2015). Bedside matters—Putting the patient at the centre of teaching and learning. Journal of the Royal College of Physicians of Edinburgh, 45, 186–187.

    Article  Google Scholar 

  • Engel, G. L. (1978). The biopsychosocial model and the education of health professionals. Annals of the New York Academy of Sciences, 310, 169–181.

    Article  Google Scholar 

  • Epstein, R. M. (2014). Realizing Engel’s biopsychosocial vision: Resilience, compassion, and quality of care. The International Journal of Psychiatry in Medicine, 47, 275–287.

    Article  Google Scholar 

  • Feudtner, C., Christakis, D. A., & Christakis, N. A. (1994). Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical environment and personal development. Academic Medicine, 69, 670–679.

    Article  Google Scholar 

  • Fitzgerald, N. M., Heywood, S., Bikker, A. P., & Mercer, S. W. (2014). Enhancing empathy in healthcare: Mixed-method evaluation of a pilot project implementing the CARE Approach in primary and community care settings in Scotland. Journal of Compassionate Health Care, 1, 1.

    Article  Google Scholar 

  • Foster, W., & Freeman, E. (2008). Poetry in general practice education: Perceptions of learners. Family Practice, 25, 294–303.

    Article  Google Scholar 

  • Georgi, E., Petermann, F., & Schipper, M. (2014). Are empathic abilities learnable? Implications for social neuroscientific research from psychometric assessments. Social Neuroscience, 9, 74–81.

    Article  Google Scholar 

  • Goodrich, J. (2012). Supporting hospital staff to provide compassionate care: Do Schwartz Center Rounds work in English hospitals? Journal of the Royal Society of Medicine, 105, 117–122.

    Article  Google Scholar 

  • Griswold, K., Zayas, L., Kernan, J. B., & Wagner, C. M. (2007). Cultural awareness through medical student and refugee patient encounters. Journal of Immigrant and Minority Health, 9, 55–60.

    Article  Google Scholar 

  • Halpern, J. (2001). From Detached Concern to Empathy: Humanizing Medical Practice. Oxford: Oxford University Press.

    Chapter  Google Scholar 

  • Hardy, C. (2017). Empathizing with patients: The role of interaction and narratives in providing better patient care. Medicine, Healthcare and Philosophy, 20, 237–248.

    Article  Google Scholar 

  • Head, B. A., Earnshaw, L. A., Greenberg, R. B., Morehead, R. C., Pfeifer, M. P., & Shaw, M. A. (2012). “I will never forget”: What we learned from medical student reflections on a palliative care experience. Journal of Palliative Medicine, 15, 535–541.

    Article  Google Scholar 

  • Hicks, L. K., Lin, Y., Robertson, D. W., Robinson, D. L., & Woodrow, S. I. (2001). Understanding the clinical dilemmas that shape medical students’ ethical development: Questionnaire survey and focus group study. BMJ, 322, 709–710.

    Article  Google Scholar 

  • Jackson, P., Eugène, F., & Tremblay, M.-P. B. (2015). Improving empathy in the care of pain patients. AJOB Neuroscience, 6, 25–33.

    Article  Google Scholar 

  • Jeffrey, D., & Downie, R. (2016). Empathy—Can it be taught? Journal of the Royal College of Physicians of Edinburgh, 46, 107–112.

    Article  Google Scholar 

  • Karaoglu, N., & Seker, M. (2011). Looking for winds of change with a PBL scenario about communication and empathy. Healthmed, 5, 515–521.

    Google Scholar 

  • Kataoka, H., Iwase, T., Ogawa, H., Mahmood, S., Sato, M., Desantis, J., et al. (2018). Can communication skills training improve empathy? A six-year longitudinal study of medical students in Japan. Medical Teacher, 1–6. https//doi.org/10.1080/0142159X.2018.1460657. Accessed December 23, 2018.

  • Kelm, Z., Womer, J., Walter, J., & Feudtner, C. (2014). Interventions to cultivate physician empathy: A systematic review. BMC Medical Education, 14, 219–230.

    Article  Google Scholar 

  • Kiosses, V. N., Karathanos, V. T., & Tatsioni, A. (2016). Empathy promoting interventions for health professionals: A systematic review of RCTs. Journal of Compassionate Health Care, 3, 7–29.

    Article  Google Scholar 

  • Koblar, S., Cranwell, M., Koblar, S., Carnell, B., & Galletly, C. (2018). Developing empathy: Does experience through simulation improve medical-student empathy? Medical Science Educator, 28, 31–36.

    Article  Google Scholar 

  • Lempp, H., & Seale, C. (2004). The hidden curriculum in undergraduate medical education: Qualitative study of medical students’ perceptions of teaching. BMJ, 329, 770–773.

    Article  Google Scholar 

  • Light, A., Gupta, T., Burrows, A., Nandakumar, M., Daniel, A., & Karthikeyan, S. (2018). Learning empathy: The medical student perspective. The Clinical Teacher. https://doi.org/101111/tct12801. Accessed December 23, 2018.

  • Lim, B., Moriarty, H., & Huthwaite, M. (2011). “Being-in-role’’: A teaching innovation to enhance empathic communication skills in medical students. Medical Teacher, 33, 663–669.

    Article  Google Scholar 

  • Marshall, R., & Bleakley, A. (2009). The death of Hector: Pity in Homer, empathy in medical education. Medical Humanities, 35, 7–12.

    Article  Google Scholar 

  • Michalec, B. (2011). Learning to cure, but learning to care? Advances in Health Sciences Education, 16, 109–130.

    Article  Google Scholar 

  • Montgomery, K. (2006). How Doctors Think: Clinical Judgment and the Practice of Medicine. Oxford: Oxford University Press.

    Google Scholar 

  • Mullen, K., Nicolson, M., & Cotton, P. (2010). Improving medical students’ attitudes towards the chronic sick: A role for social science research. BMC Medical Education, 10, 84–91.

    Article  Google Scholar 

  • Nogueira-Martins, M. C. F., Nogueira-Martins, L. A., & Turato, E. R. (2006). Medical students’ perceptions of their learning about the doctor–patient relationship: A qualitative study. Medical Education, 40, 322–328.

    Article  Google Scholar 

  • Ohm, F., Vogel, D., Sehner, S., Wijnen-Meijer, M., & Harendza, S. (2013). Details acquired from medical history and patients’ experience of empathy—Two sides of the same coin. BMC Medical Education, 13, 67–74.

    Article  Google Scholar 

  • Pedersen, R. (2010). Empathy development in medical education—A critical review. Medical Teacher, 32, 593–600.

    Article  Google Scholar 

  • Perrella, A. (2016). Fool me once: The illusion of empathy in interactions with standardized patients. Medical Teacher, 38, 1285–1287.

    Article  Google Scholar 

  • Plotkin, J. B., & Shochet, R. (2018). Beyond words: What can help first year medical students practice effective empathic communication? Patient Education and Counseling, 101, 2005–2010.

    Article  Google Scholar 

  • Pohontsch, N., Stark, A., Ehrhardt, M., Kötter, T., & Scherer, M. (2018). Influences on students’ empathy in medical education: An exploratory interview study with medical students in their third and last year. BMC Medical Education, 18, 231.

    Article  Google Scholar 

  • Ratanawongsa, N., Teherani, A., & Hauer, K. E. (2005). Third-year medical students’ experiences with dying patients during the internal medicine clerkship: A qualitative study of the informal curriculum. Academic Medicine, 80, 641–647.

    Article  Google Scholar 

  • Roberts, D. H., Newman, L. R., & Schwartzstein, R. M. (2012). Twelve tips for facilitating Millennials’ learning. Medical Teacher, 34, 274–278.

    Article  Google Scholar 

  • Schweller, M., Costa, F. O., Antônio, M. Â. R., Amaral, E. M., & De Carvalho-Filho, M. A. (2014). The impact of simulated medical consultations on the empathy levels of students at one medical school. Academic Medicine, 89, 632–637.

    Article  Google Scholar 

  • Schweller, M., Ribeiro, D. L., Celeri, E. V., & De Carvalho-Filho, M. A. (2017). Nurturing virtues of the medical profession: Does it enhance medical students’ empathy? International Journal of Medical Education, 8, 262.

    Article  Google Scholar 

  • Shapiro, J. (2008). Walking a mile in their patients’ shoes: Empathy and othering in medical students’ education. Philosophy, Ethics, and Humanities in Medicine, 3, 10–21.

    Article  Google Scholar 

  • Shapiro, J. (2011). Perspective: Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training. Academic Medicine, 86, 326–332.

    Article  Google Scholar 

  • Shapiro, J., Morrison, E., & Boker, J. (2004). Teaching empathy to first year medical students: Evaluation of an elective literature and medicine course. Education for Health, 17, 73–84.

    Article  Google Scholar 

  • Shapiro, J., Rucker, L., Boker, J., & Lie, D. (2006). Point-of-view writing: A method for increasing medical students’ empathy, identification and expression of emotion, and insight. Education for Health: Change in Learning and Practice, 19, 96–105.

    Article  Google Scholar 

  • Shapiro, S. M., Lancee, W. J., & Richards-Bentley, C. M. (2009). Evaluation of a communication skills program for first-year medical students at the University of Toronto. BMC Medical Education, 9, 11.

    Article  Google Scholar 

  • Shea, S., & Lionis, C. (2014). Introducing the Journal of Compassionate Health Care. Journal of Compassionate Health Care, 1, 7.

    Article  Google Scholar 

  • Sheikh, H., Carpenter, J., & Wee, J. (2013). Medical student reporting of factors affecting pre-clerkship changes in empathy: A qualitative study. Canadian Medical Education Journal, 4, e26–e34.

    PubMed  PubMed Central  Google Scholar 

  • Stepien, K. A., & Baernstein, A. (2006). Educating for empathy—A review. Journal of General Internal Medicine, 21, 524–530.

    Article  Google Scholar 

  • Tate, P. (2005). Ideas, concerns and expectations. Medicine, 33, 26–27.

    Article  Google Scholar 

  • Tavakol, S., Dennick, R., & Tavakol, M. (2012). Medical students’ understanding of empathy: A phenomenological study. Medical Education, 46, 306–316.

    Article  Google Scholar 

  • Underman, K. (2015). Playing doctor: Simulation in medical school as affective practice. Social Science and Medicine, 136, 180–188.

    Article  Google Scholar 

  • Wayne, S., Dellmore, D., Serna, L., Jerabek, R., Timm, C., & Kalishman, S. (2011). The association between intolerance of ambiguity and decline in medical students’ attitudes toward the underserved. Academic Medicine, 86, 877–882.

    Article  Google Scholar 

  • Wear, D., & Varley, J. D. (2008). Rituals of verification: The role of simulation in developing and evaluating empathic communication. Patient Education and Counseling, 71, 153–156.

    Article  Google Scholar 

  • Wear, D., & Zarconi, J. (2008). Can compassion be taught? Let’s ask our students. Journal of General Internal Medicine, 23, 948–953.

    Article  Google Scholar 

  • Wilkes, M., & Hoffman, J. (2002). Students benefit from experience of hospitalization. Medical Education, 36, 586–587.

    Article  Google Scholar 

  • Wilkes, M., Milgrom, E., & Hoffman, J. R. (2002). Towards more empathic medical students: A medical student hospitalization experience. Medical Education, 36, 528–533.

    Article  Google Scholar 

  • Wündrich, M., Schwartz, C., Feige, B., Lemper, D., Nissen, C., & Voderholzer, U. (2017). Empathy training in medical students—A randomized controlled trial. Medical Teacher, 39, 1096–1098.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David Ian Jeffrey .

Rights and permissions

Reprints and permissions

Copyright information

© 2019 The Author(s)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Jeffrey, D.I. (2019). Barriers to Empathy: The Curriculum. In: Exploring Empathy with Medical Students. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-11211-0_7

Download citation

Publish with us

Policies and ethics