Empathy: Lost or Found in Medical Education?

Sonal Singh, MD

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In This Article

Or Can Empathy Only Be Lost?

One should not assume that empathic skills are acquired automatically during clinical training. There is a need for systematic training of humanistic qualities in medical schools and residency programs. Studies have shown that although interviewing skills can be learned, they decline in the clinical years as students learn medical problem solving.[15] So if medical students are to graduate with their original empathy intact, follow-up courses are warranted. There is a need to teach interpersonal communication skills, including the ability to grasp both verbal and nonverbal cues from patients.

Research in this area has been hampered partly by the multidimensional nature of empathy, a lack of conceptual clarity, and the absence of reliable instruments and operational tools to measure the phenomenon. Instruments that measure empathic response from the patient's perspective, such as the Consultation and Relational Empathy (CARE) Measure developed by Mercer and colleagues,[16] will play a valuable role in this assessment. Researchers need to develop targeted educational programs that will cultivate empathy. Ultimately, it is only the patient who can tell us whether trainees demonstrate empathy in a particular situation. Some schools have tried to promote the humanities in medicine, and nearly half of all US medical schools include arts in the curriculum. Over two thirds of US medical schools support extracurricular activities despite the absence of strong evidence of efficacy.[17] Some programs also encourage role-playing, which may be a useful instrument.

On a more personal level, I had initially hesitated in showing empathy, but the nonverbal cues had shown me the right direction. In the first instance, it had been the sight of a desperate mother crying over her boy's dead body. In the second instance, my patient's eyes seemed to yearn for something more than the medicines. Writing about my patients' stories has been an instrument of healing for me in several instances.[18] "Narrative medicine," which uses instruments, such as reflective writing, is being taught in more and more medical schools.[19] Students can improve their capacity for empathy, reflection, and professionalism through serious narrative training. Although the mechanism by which narrative training benefits doctors and patients is still under investigation, "By bridging the divides that separate physicians from patients, narrative medicine offers opportunities for respectful, empathic, and nourishing medical care.[20]" Although the data suggest that empathy is indeed hard to teach, and may in fact be lost during medical training, it is through narrative, perhaps, that what has been lost can be discovered or regained.

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