Background: Empathy is essential to forming strong patient-physician relationships that enable physicians to provide better healthcare. In the medical education literature, empathy consists of cognitive, affective, behavioural, and moral domains. Studies have measured declines in empathy during medical training. Researchers speculate that factors within formal, informal, and hidden curricula contribute to empathic decline. Several frameworks suggest that empathy in the moral domain (i.e., the inner motivation to accept patients unconditionally, commit to understanding patients, and help patients achieve their needs) is the most fundamental to the empathic response. Studying the factors that influence moral empathy during training is important to developing insights into the reasons for the demonstrated declines in resident empathy.
Methods: Descriptive phenomenology was used to address the research objective. Medical residents from various specialties participated in lightly structured interviews concerning their experiences. Interview transcripts were inductively and collaboratively analyzed to construct a preliminary set of factors that influence moral empathy. These factors informed the creation of a script for a verbatim theatre play that was performed for an audience of residents, educators, learners, researchers, and scholars. Following the play, audience participants completed a survey that served as a member-check of the factors that contributed to the final construction of factors.
Results: The results were constructed as three categories under which seven factors are nested. These categories are: Innate Capacity, Previous Personal Encounters, and Specific Patient Encounters. With the exception of a few, most factors do not directly influence residents’ moral empathy but rather challenge their ability to act on their moral empathy.
Discussion: These results offer unique insights into the declines in empathy that have been previously reported in the medical education literature, while also highlighting a moral-behavioural tension that has implications for competency-based medical education, the four-factor model of empathy, and the assessment of empathy in medical education. Future work may build on the results of this study to develop an assessment tool for moral empathy and to elucidate the relationships between the domains of empathy in order to arrive at a more refined conceptualization of the construct. / Thesis / Master of Science (MSc) / Empathy—the ability to comprehend the experiences of others—is an important tool that enables physicians to build relationships with patients, which helps them provide better healthcare. Studies have shown that empathy declines during medical training due to a variety of factors. Frameworks describing the empathic response suggest that one’s inner motivation to accept patients unconditionally, commit to understanding patients, and help patients achieve their needs may be fundamental to providing clinical care with empathy. As such, the goal of this study was to explore the factors that influence these inner motivations of residents in order to gain insights about the evidence that purports residents to demonstrate less empathy as they progress in their training. To address this objective, 10 medical residents from various specialties were interviewed about their experiences, the data were analyzed by way of a descriptive phenomenological methodology, and the initial findings were presented as a verbatim theatre play as a means of member-checking the proposed results. After viewing the play, an audience of medical residents, educators, learners, researchers, and scholars provided feedback through a survey that contributed to the final conclusions of the study. In this regard, the study shows that, apart from a few factors, residents’ inner motivations to be empathic are not significantly influenced during medical training. Rather, certain factors associated with residency affect their ability to deliver on their inner motivations. This study offers insights into the role of motivation in empathic decline, assessment of empathy during medical training, and potential significance of a tension between one’s motivation to be empathic and the opportunities that they are afforded to be empathic during residency.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/24598 |
| Date | January 2019 |
| Creators | Pieris, Dilshan |
| Contributors | Grierson, Lawrence, Health Science Education |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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