Investigating the Relation Between Self-assessment and Patients' Assessments of Physicians-in-training Empathy: a Multicentric, Observational, Cross-sectional Study in Three Teaching Hospitals in Brazil

Overview

Journal BMJ Open

Specialty General Medicine

Date 2019 Jun 28

PMID 31243037

Citations 10

Authors

Monica Oliveira Bernardo

Dario Cecilio-Fernandes

Alba Regina de Abreu Lima

Julian Furtado Silva

Hugo Dugolin Ceccato

Manuel Joao Costa

Marco Antonio de Carvalho-Filho

Affiliations

Soon will be listed here.

Abstract

Objectives: This study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training.

Design: A multicentric, observational, cross-sectional study.

Setting: This study was conducted in three public teaching hospitals in Brazil.

Participants: From the 668 patients invited to participate in this research, 566 (84.7%) agreed. Of these, 238 (42%) were male and 328 (58%) were female. From the invited 112 physicians in training, 86 (76.8%) agreed. Of the 86 physicians in training, 35 (41%) were final-year medical students and 51 (59%) were residents from clinical and surgical specialties. The gender distribution was 39 (45%) males and 47 (51%) females.

Primary And Secondary Outcome Measures: Physicians in training filled the Jefferson Scale of Physician Empathy (JSE) and the Interpersonal Reactivity Index. Patients answered the Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy Scale (CARE).

Results: This study found non-significant correlations between patient and physicians-in-training self-assessments, except for a weak correlation (0.241, p<0.01) between the JSPPPE score and the JSE compassionate care subscore. CARE and JSPPPE scales proved to be valid and reliable instruments.

Conclusions: Physicians-in-training self-assessments of empathy differ from patient assessments. Knowledge about empathy derived from self-assessment studies probably does not capture the perspective of the patients, who are key stakeholders in patient-centred care. Future research on the development of physician empathy or on outcomes of educational interventions to foster empathy should include patient perspectives.

Citing Articles

Effectiveness of a modified Balint group process on empathy and psychological skills employing Kirkpatrick's evaluation framework.

Antoun J, Khater B, Itani H, Naous J, Romani M PeerJ. 2023; 11:e15279.

PMID: 37483957 PMC: 10362841. DOI: 10.7717/peerj.15279.

Real Patient Participation in Workplace-Based Assessment of Health Professional Trainees: A Scoping Review.

Nemir A, Pearson M, Kitchin V, Wilbur K Eval Health Prof. 2023; 47(3):283-295.

PMID: 37254849 PMC: 11351003. DOI: 10.1177/01632787231180275.

Empathy levels among health professional students at a large midwestern public university - a cross-sectional study.

Wenger K, Reist L, Achenbach A, Dukes K, Fravel M, Knockel L BMC Med Educ. 2023; 23(1):123.

PMID: 36804003 PMC: 9940672. DOI: 10.1186/s12909-023-04090-x.

Understanding of empathetic communication in acute hospital settings: a scoping review.

Haribhai-Thompson J, McBride-Henry K, Hales C, Rook H BMJ Open. 2022; 12(9):e063375.

PMID: 36171029 PMC: 9528576. DOI: 10.1136/bmjopen-2022-063375.

Game of Mirrors: Health Profiles in Patient and Physician Perceptions.

Fineschi D, Acciai S, Napolitani M, Scarafuggi G, Messina G, Guarducci G Int J Environ Res Public Health. 2022; 19(3).

PMID: 35162218 PMC: 8834689. DOI: 10.3390/ijerph19031201.

References

Grosseman S, Novack D, Duke P, Mennin S, Rosenzweig S, Davis T . Residents' and standardized patients' perspectives on empathy: issues of agreement. Patient Educ Couns. 2014; 96(1):22-8. DOI: 10.1016/j.pec.2014.04.007. View

Ferreira-Valente A, Monteiro J, Barbosa R, Salgueira A, Costa P, Costa M . Clarifying changes in student empathy throughout medical school: a scoping review. Adv Health Sci Educ Theory Pract. 2016; 22(5):1293-1313. DOI: 10.1007/s10459-016-9704-7. View

Eva K, Regehr G . Self-assessment in the health professions: a reformulation and research agenda. Acad Med. 2005; 80(10 Suppl):S46-54. DOI: 10.1097/00001888-200510001-00015. View

Hojat M, Axelrod D, Spandorfer J, Mangione S . Enhancing and sustaining empathy in medical students. Med Teach. 2013; 35(12):996-1001. DOI: 10.3109/0142159X.2013.802300. View

Hojat M, DeSantis J, Gonnella J . Patient Perceptions of Clinician's Empathy: Measurement and Psychometrics. J Patient Exp. 2017; 4(2):78-83. PMC: 5513637. DOI: 10.1177/2374373517699273. View

Davis D, Mazmanian P, Fordis M, Harrison R, Thorpe K, Perrier L . Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006; 296(9):1094-102. DOI: 10.1001/jama.296.9.1094. View

Chaitoff A, Rothberg M, Windover A, Calabrese L, Misra-Hebert A, Martinez K . Physician Empathy Is Not Associated with Laboratory Outcomes in Diabetes: a Cross-sectional Study. J Gen Intern Med. 2018; 34(1):75-81. PMC: 6318196. DOI: 10.1007/s11606-018-4731-0. View

Hojat M, Vergare M, Maxwell K, Brainard G, Herrine S, Isenberg G . The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009; 84(9):1182-91. DOI: 10.1097/ACM.0b013e3181b17e55. View

Cleave-Hogg D, Morgan P . Experiential learning in an anaesthesia simulation centre: analysis of students' comments. Med Teach. 2002; 24(1):23-6. DOI: 10.1080/00034980120103432. View

10.

Costa P, Magalhaes E, Costa M . A latent growth model suggests that empathy of medical students does not decline over time. Adv Health Sci Educ Theory Pract. 2012; 18(3):509-22. DOI: 10.1007/s10459-012-9390-z. View

11.

Hojat M, Gonnella J, Mangione S, Nasca T, Veloski J, Erdmann J . Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002; 36(6):522-7. DOI: 10.1046/j.1365-2923.2002.01234.x. View

12.

Batt-Rawden S, Chisolm M, Anton B, Flickinger T . Teaching empathy to medical students: an updated, systematic review. Acad Med. 2013; 88(8):1171-7. DOI: 10.1097/ACM.0b013e318299f3e3. View

13.

Bokken L, Rethans J, van Heurn L, Duvivier R, Scherpbier A, van der Vleuten C . Students' views on the use of real patients and simulated patients in undergraduate medical education. Acad Med. 2009; 84(7):958-63. DOI: 10.1097/ACM.0b013e3181a814a3. View

14.

Smith K, Norman G, Decety J . The complexity of empathy during medical school training: evidence for positive changes. Med Educ. 2017; 51(11):1146-1159. PMC: 5657391. DOI: 10.1111/medu.13398. View

15.

Paro H, Daud-Gallotti R, Tiberio I, Pinto R, Martins M . Brazilian version of the Jefferson Scale of Empathy: psychometric properties and factor analysis. BMC Med Educ. 2012; 12:73. PMC: 3528616. DOI: 10.1186/1472-6920-12-73. View

16.

Bratek A, Bulska W, Bonk M, Seweryn M, Krysta K . Empathy among physicians, medical students and candidates. Psychiatr Danub. 2015; 27 Suppl 1:S48-52. View

17.

Avasarala S, Whitehouse S, Drake S . Internship and Empathy: Variations Across Time and Specialties. South Med J. 2015; 108(10):591-5. DOI: 10.14423/SMJ.0000000000000347. View

18.

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. PMC: 3529296. DOI: 10.3399/bjgp13X660814. View

19.

Kane G, Gotto J, Mangione S, West S, Hojat M . Jefferson Scale of Patient's Perceptions of Physician Empathy: preliminary psychometric data. Croat Med J. 2007; 48(1):81-6. PMC: 2080494. View

20.

Borracci R, Doval H, Celano L, Ciancio A, Manente D, Calderon J . Patients' perceptions of argentine physicians' empathy based on the jefferson scale of patient's perceptions of physician empathy: Psychometric data and demographic differences. Educ Health (Abingdon). 2017; 30(1):19-25. DOI: 10.4103/1357-6283.210513. View