![]() ![]() Physician empathy has been associated with higher levels of patient satisfaction, adherence to medical recommendations or regimens, and improved clinical outcomes. While there is some disagreement regarding the exact components of empathy, there is wide consensus that physician empathy significantly affects patients in a variety of ways. Most constructions of empathy have in common, however, an understanding of the emotional states of others and expression of this understanding. Others describe four components of the empathy construct: 1) emotive, the ability to imagine and share a patient’s psychological state or feelings 2) moral, the physician’s internal motivation to express empathy 3) cognitive, the intellectual ability to identify and understand a patient’s perspectives and emotions and 4) behavioral, the ability to communicate this understanding of the patient’s perspectives and emotions. Some researchers define physician empathy as a “cognitive attribute that involves an ability to understand the patient’s inner experiences and perspective and a capability to communicate this understanding”. Within the field of medicine, there is disagreement regarding the precise definition of empathy. These statements illustrate that the field of medicine is not only committed to producing and upholding the most knowledgeable and skillful physicians possible, but also the most caring and empathic. Similarly, the American Medical Association’s first principle of medical ethics asserts the following: “A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights”. In their Learning Objectives for Medical School Education, the Association of American Medical Colleges states that, “physicians must be compassionate and empathetic in caring for patients”. Future research should strive to increase the sample of high-quality designs through more randomized, controlled studies with valid measures, explicit reporting of intervention strategies and procedures, and long-term efficacy assessments. Although the current empathy intervention literature is limited by a variety of methodological weaknesses, a sample of high-quality study designs provides initial support for the notion that physician empathy can be enhanced through interventions. Physician empathy appears to be an important aspect of patient and physician well-being. 8 of 10 studies with highly rigorous designs, however, found that targeted interventions did increase empathy. Overall, the 64 included studies were characterized by relatively poor research designs, insufficient reporting of intervention procedures, low incidence of patient-report empathy assessment measures, and inadequate evaluations of long-term efficacy. We qualitatively synthesized the findings of qualified studies by extracting data for ten study metrics: 1) source population, 2) sample size, 3) control group, 4) random assignment, 5) intervention type, 6) intervention duration, 7) assessment strategy, 8) type of outcome measure, 9) outcome assessment time frame, and 10) whether a statistically significant increase in empathy was reported. Of the 1,415 articles identified, 64 met inclusion criteria. We systematically searched PubMed, EMBASE, Web of Science and PsychINFO in June of 2014 to identify articles that quantitatively assessed changes in empathy due to interventions among medical students, residents, fellows and physicians. In this paper, we synthesize the published literature regarding interventions that were quantitatively evaluated to detect changes in empathy among medical students, residents, fellows and physicians. Physician empathy is both theoretically and empirically critical to patient health, but research indicates that empathy declines throughout medical school and is lower than ideal among physicians. ![]()
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