1. 1. Newcastle University 2. Hull York Medical School
Student and Educator Perspectives on Clinical Empathy and the Teaching of Compassion
Dr Craig A1, Dr Atkinson J1, Dr Alberti H1, Dr Laughey W2, Brown M2, Finn G2
1. Newcastle University 2. Hull York Medical School
Introduction
The General Medical Council clearly outlines that doctors in training must have the required communication and interpersonal skills to demonstrate empathy and compassion.1
This study seeks to understand medical student and educators’ views on empathy, compassion and ethical erosion. The aim is to investigate whether compassion can be taught within medical school curricula and how this can be achieved.
Early Findings and Discussion
Student -” I think time when its been passively taught is when you are actually out on placement.”
Role modeling
While none of our participants felt compassion and empathy can be taught in the classroom, all interviewees mentioned role models as a powerful teaching tool. Both educators and students suggested that clinical tutors be reminded of the importance of their behavior when with medical students.
Educator – “students need to be shown how to deal with their feelings of empathy and compassion. Not to squash them down but to feel, acknowledge and demonstrate them”
An environment that allows compassion and empathy to flourish
The majority of those interviewed discussed the effect of time pressure and stress on one’s ability to be a good role model. Students discussed the prevailing culture within their cohort. One student felt that the lack of diversity and the privileged upbringing of some medical students hindered their cohort’s ability to truly empathise with the patients they meet.
Educator- “role modelling is key “
Defining compassion
and empathy
Educator – “ its poor role modelling. Role modelling of stressed professionals who perceive they don’t have the time to act as empathically as they should”
In his book ‘Against Empathy. The Case for Rational Compassion’ Paul Bloom considers the varying interpretations of empathy and where they stand alongside compassion. He believes that while ‘cognitive empathy’ (attempting to understand others) may allow us to act with compassion, empathy in the sense of “feeling what you think others are feeling2” is an unhelpful pursuit that can lead to suffering. He views compassion as kindness and ‘a strong motivation to improve the other’s wellbeing.’2 All our interviewees felt that compassion and empathy were integral to being a good doctor, but their definitions varied.
Student “medical school can be a bit of a bubble…it leads to an us and them between doctors and patients. We could never be in that situation and that leads to ethical erosion.”
Ethical Erosion
Defined as ‘an empirically observed phenomenon whereby medical students and doctors become less morally sensitive and ethically aware due to increasing cynicism.’
Students recognised this phenomenon of ethical erosion in their peer group possibly as a coping strategy. All study participants, student and educators alike, felt we should act against this attrition of empathy.
Educator “when we teach students professionalism maybe they think acting professionally is to show some compassion, but not too much”
Professionalism
Both educators and students expressed concern that displaying overt emotional responses can make them appear unprofessional.
Educator “as a clinician you have to be careful about crossing professional boundaries”
Methodology
To date we have interviewed six educators and three fourth- and fifth-year medical students. Using an interview schedule developed in collaboration with Hull York Medical School we conducted semi-structured interviews and have started to code our participants responses in a thematic analysis. Today we wish to provide you with our initial findings from our 9 interviews.
OSCE empathy and the empathic statement
Participants felt that the empathic statement can, on its own, feel empty. Students felt that use of these statements promotes a culture of ‘faking it. ’ Educators felt they were able to identify those students who were unable to communicate empathy effectively.
Educator “you see people responding in a tick box manner… and I suspect it does more harm than good”
Educator “if it becomes a OSCE based skill session, very much like ICE students can do it badly and then it becomes another tick box exercise, ”
Contacts
Dr Jane Atkinson:
Dr Alison Craig:
References
General Medical Council. Generic professional capabilities framework [Internet] Available from:
Bloom, P., 2017. Against empathy: The case for rational compassion. Random House.
 "ethical erosion." Oxford Reference. 18 Nov