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Clinical Examiners, Simulated Patients, and Student Self-assessed Empathy in Medical Students During a Psychiatry Objective Structured Clinical Examination

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Abstract

Objectives

This tudy aims to assess and compare objective and subjective scores of empathy in final-year medical students by using firstly a validated student self-assessment just prior to the psychiatry objective structured clinical examination (OSCE), and then comparing this to clinical examiner's and simulated patient's (SP’s) assessments of empathy of students using a Global Rating of Empathy scale (GRE) during a psychiatry OSCE.

Methods

In 2011, all final-year medical students in the University College Dublin were invited to complete a subjective, self-assessed empathy questionnaire (The Jefferson scale of physician empathy—student version (JSPE-S)). They were also assessed for empathy in four OSCEs by the clinical examiner and the SP acting in that OSCE scenario.

Results

Included in the analysis were 163 of 184 final-year students JSPE-S (88.6 %) questionnaires. The female students scores on the JSPE-S were significantly higher than those of their male peers (t = 3.34, p = 0.001). Concurrent validity was greater between the SPs’ assessments of empathy in the OSCE and the JSPE-S score than between the clinical examiners assessments of empathy and the JSPE-S score (r = 0.23, p < 0.005; r = 0.14, p < 0.08). Inter-rater reliability of SP's and clinical examiner's using the GRE was found to be high (F = 0.868 (df = 171, 171), p value <0.001).

Conclusions

SPs may be valid assessors of empathy in medical students during an OSCE.

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References

  1. Bleakley A, Bligh J. Students learning from patients: Let’s get real in medical education. Adv Health Sci Educ Theory Pract. 2008;13:89–107.

    Article  PubMed  Google Scholar 

  2. Brownell AKW, Côté L. Senior residents’ views on the meaning of professionalism and how they learn about it. Acad Med. 2001;76:734–7.

    Article  CAS  PubMed  Google Scholar 

  3. Stewart MA. Effective physician–patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.

    CAS  PubMed Central  PubMed  Google Scholar 

  4. Beckman HB, Frankel RM. Training practitioners to communicate effectively in cancer care: it is the relationship that counts. Patient Educ Couns. 2003;50:85–9.

    Article  PubMed  Google Scholar 

  5. Coulehan J, Platt F, Egner B, et al. ''Let me see if I have this right''.: words that build empathy. Ann Intern Med. 2001;135:221–7.

    Article  CAS  PubMed  Google Scholar 

  6. Rees-Lewis JC. Patients views on quality of care in general practice: literature review. Soc Sci Med. 1994;39:655–71.

    Article  Google Scholar 

  7. Levinson W, Gorawa-Bhat R, Lamb J. A study of patient cues and physician responses in primary care and surgical settings. JAMA. 2000;284:1021–7.

    Article  CAS  PubMed  Google Scholar 

  8. Larson EB, Yao X. Clinical empathy as emotional labour in the patient physician relationship. JAMA. 2005;293:1100–6.

    Article  CAS  PubMed  Google Scholar 

  9. Shapiro J. How do physicians teach empathy in the primary care setting? Acad Med. 2002;77:323–8.

    Article  PubMed  Google Scholar 

  10. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358–67.

    Article  PubMed  Google Scholar 

  11. Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well-being and enhanced empathy among internal medical residents. J Gen Intern Med. 2005;20:559–64.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: Definition, components, measurement and relationship to gender and specialty. Am J Psychiatry. 2002;159:1563–9.

    Article  PubMed  Google Scholar 

  13. Hojat M, Gonnella JS, Mangione S, et al. Empathy in medical students as related to academic performance, clinical competence, and gender. Med Educ. 2002;36:522–7.

    Article  CAS  PubMed  Google Scholar 

  14. Henry SG. Playing doctors. JAMA. 2005;294:2138–9.

    Article  CAS  PubMed  Google Scholar 

  15. Berg K, Majden J, Berg D, Veloski J, Hojat M. Medical students’ self-reported empathy and simulated patients’ assessments of student empathy: an analysis by gender and ethnicity. Acad Med. 2011;86:984–8.

    Article  PubMed  Google Scholar 

  16. Macnaughton J. The dangerous practice of empathy. Lancet. 2009;373:1940–1.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Stein and Stein. In: Stein E, Stein W, editors. On the Problem of Empathy. Washington DC: ICS Publications; 1989.

    Chapter  Google Scholar 

  18. Pedersen R. Empirical research on empathy in medicine—a critical review. Patient Educ Couns. 2009;76:307–22.

    Article  PubMed  Google Scholar 

  19. Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52(suppl):S9–13.

    PubMed Central  PubMed  Google Scholar 

  20. Hemmerdinger JM, Stoddart SDR, Lilford RL. A systematic review of tests of empathy in medicine. BMC Med Educ. 2007;7:24.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Hodges B. Creating, monitoring, and improving a psychiatry OSCE: a guide for faculty. Acad Psychiatry. 2002;26:134–61.

    Article  PubMed  Google Scholar 

  22. Wallace J, Rao R, Haslam R. Simulated patients and objective structured clinical examinations: review of their use in medical education. Adv Psychiatr Treat. 2002;8:342–8.

    Article  Google Scholar 

  23. Brenner A. Uses and limitations of simulated patients in psychiatric education. Acad Psychiatry. 2009;33:112–9.

    Article  PubMed  Google Scholar 

  24. Mellsop GW, Joanna MD, Selim El B, David M. Patients' appraisal of psychiatric trainee interview skills. Academic Psychiatry. 2012;36:374–79.

    Article  PubMed  Google Scholar 

  25. Whelan P, Church L, Kadry K. Using standardized patients’ marks in scoring postgraduate psychiatry OSCEs. Acad Psychiatry. 2009;33:319–22.

    Article  PubMed  Google Scholar 

  26. Bennett AJ, Arnold LM, Welge JA. Use of standardized patients during a psychiatry clerkship. Acad Psychiatry. 2006;30:185–90.

    Article  PubMed  Google Scholar 

  27. Hojat M, Mangione S, Nasca TJ, et al. The Jefferson Scale of Empathy: development and preliminary psychometric data. Educ Psychol Meas. 2001;61:349–65.

    Article  Google Scholar 

  28. Hojat M, Gonella JS, Nasca TJ, et al. Empathy scores in medical school and ratings of empathic behavior in residency training 3 years later. J Social Psychol. 2005;145:663–72.

    Article  PubMed  Google Scholar 

  29. Hojat M, Mangione S, Nasca TJ, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38:934–41.

    Article  PubMed  Google Scholar 

  30. Mangione S, Kane GC, Caruso JW, et al. Assessment of empathy in different years of internal medicine training. Med Teach. 2002;24:370–3.

    Article  PubMed  Google Scholar 

  31. Hojat M, Gonella JS, Nasca TJ, et al. Empathy scores in medical school and ratings of empathic behaviour in residency training 3 years later. J Soc Psychol. 2005;145:663–72.

    Article  PubMed  Google Scholar 

  32. Di Lillo M, Cicchetti A, Scalzo AL, Taroni F, Hojat M. The Jefferson Scale of Physician Empathy: preliminary psychometrics and group comparisons in Italian physicians. Acad Med. 2009;84:1198–202.

    Article  PubMed  Google Scholar 

  33. Kataoka HU, Koide N, Ochi K, Hojat M. Measurement of empathy among Japanese medical students: psychometrics and score differences by gender and level of medical education. Acad Med. 2009;84:1192–7.

    Article  PubMed  Google Scholar 

  34. Rahimi-Madiseh M, Tavakol M, Dennick R, Nasiri J. Empathy in Iranian medical students: a preliminary psychometric analysis and differences by gender and year of medical school. Med Teach. 2010;32:e471–8.

    Article  PubMed  Google Scholar 

  35. Berg K, Majdan JF, Berg D, Veloski J, Hojat M. A comparison of medical students' self-reported empathy with simulated patients' assessments of the students' empathy. Med Teach. 2011;33:388–91.

    Article  PubMed  Google Scholar 

  36. Hojat M, Vergare MJ, Maxwell K, et al. The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School. Acad Med. 2009;84:1182–91.

    Article  PubMed  Google Scholar 

  37. Tavakol S, Dennick R, Tavakol M. Psychometric properties and confirmatory factor analysis of the Jefferson Scale of Physician Empathy. BMC Med Educ. 2011;11:54.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Schwartzman E, Hsu DI, Law AV, Chung EP. Assessment of patient communication skills during OSCE: Examining effectiveness of a training program in minimizing inter-grader variability. Patient Educ Couns. 2011;83:472–7.

    Article  PubMed  Google Scholar 

  39. Colliver JA, Willis MS, Robbs RS, et al. Assessment of empathy in a standardized-patient examination. Teach Learn Med. 1998;10:8.

    Article  Google Scholar 

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Disclosures

On behalf of all the authors, the corresponding authors states that there are no conflicts of interest.

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Correspondence to Karen O′Connor.

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O′Connor, K., King, R., Malone, K.M. et al. Clinical Examiners, Simulated Patients, and Student Self-assessed Empathy in Medical Students During a Psychiatry Objective Structured Clinical Examination. Acad Psychiatry 38, 451–457 (2014). https://doi.org/10.1007/s40596-014-0133-8

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  • DOI: https://doi.org/10.1007/s40596-014-0133-8

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