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Empathy in Residency Years
Impens, A. J. [2]
Henderson, K. [12]
Rizkalla, M. N. [4]
Ivlovic, K. [1]

Journal: Journal of Osteopathic Medicine Date: 2017/11, 117(11):Pages: e128-e130. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2017.141/html)

Keywords:

cross sectional study [597]
empathy [50]
medical students [402]
osteopathic medicine [1540]
residency [206]
USA [1086]

Abstract:

Research Question: To measure empathy in osteopathic medical residents. Aims of the study are to study differences/similarities in empathy level across program years and specialty type and to assess whether degree of the use of touch and interest/use of OMM was related to self-reported empathy levels. We report on 1 year of data collection and present cross-sectional data only. Statement of Significance: Physician empathy is correlated to better patient compliance, medical outcomes, and reduced physician burnout. It is widely accepted that empathy is a vital component in the professional development of physicians and affects quality of care and patient outcomes. Knowing if and when empathy changes from osteopathic medical student to resident to practicing physician can help pinpoint opportune times to enhance/maintain empathy levels and could be informative for medical education efforts. The 2011 systematic review by Neuman et al concluded there is a decline in empathy during medical school and residency, which is especially evident in longitudinal studies. Most studies, however, have been conducted on allopathic students and residents. To our knowledge, there is only 1 study that followed a group of medical students into their residency years (Hojat et al, 2005). In this study, however, empathy during medical school was a self-reported measure while empathy during the residency years was measured by evaluation by program directors. Furthermore, the authors were unable to locate any studies on empathy levels in osteopathic residency programs, demonstrating a gap in this field. Methods: The Jefferson Scale of Empathy (JSE) and questions regarding the residents’ current use of touch and frequency of OMM were administered to residents of the Illinois MWU-OPTI. JSE consists of 20 items that are answered on a 7-point Likert scale, with total possible scores ranging from 20-140 (higher score indicates more empathy). In addition to demographic information, we assessed experience with OMM, level of interest in OMM, frequency of use of OMM, and degree of the use of touch through 7-point Likert scales (1 = strongly disagree, 7 = strongly degree). This study was approved by MWU-IRB. Data Analyses: Differences between residents on empathy scores according to specialty type, year in program, type of program (MD, DO, or combined), and other variables of interests were analyzed using t tests, χ2, ANOVAs, or correlations as appropriate for the types of variables. Significance levels were assessed with 2-tailed tests and P≤.05. Results: 95 (85 DO) residents completed the survey. Average empathy score for MDs was 118.8 (SD, 11.61; range 100-134) compared with 115.41 (SD, 12.5; range 83-140) for DOs. 70% of MD residents were male compared with 48.9% of DO residents. The majority of residents were in PGY 2 and PGY 3 (70% of the MD residents; 77.6% of DO residents). All MD residents and 69% of DO residents were in family medicine residency programs. Nineteen percent of DOs were in an emergency medicine and 11% in an OB/GYN program. No statistically significant differences were found between MDs or DO residents, year in program, or program type. A statistically significant difference was found in specialty type, with emergency medicine residents scoring lower compared with family medicine or OB/GYN residents. The average empathy scores for EM residents was 106.93 (SD, 9.93) compared with 117.89 (SD, 12.4) for family medicine and 115.2 (SD, 10.12) for OB/GYN. Several questions assessed attitudes with respect to volunteering, type of patients deserving health care, comfort with diversity, and decisions to enter chosen profession. Statistically significant correlations were found for the emergency medicine residents between empathy and volunteering (–.6; I do not volunteer because it hinders my ability to get ahead), medical authoritarianism (–.58; Conscientious patients deserve better health care than those with self-inflicted problems) and medical egalitarianism (.5; We should do what we can to equalize health care for different groups). Statistically significant correlations were found for the family medicine residents between total empathy score and volunteering (–.34), openness (.26; Even after I made up my mind about something, I am willing to consider other opinions), medical authoritarianism (–.36), medical egalitarianism (.48), and conflict with diversity (.47; I am comfortable helping others who are different from me culturally). DOs also completed several questions related to osteopathic philosophy and their current use of OMM. Moderate significant correlations were found for the total sample between empathy score and role of osteopathic philosophy in attending medical school (.3) and choosing to take OMM as an elective if it had not been required (.37). When dividing the sample by subspecialty, no significant correlations were found between these variables and total empathy scores for the EM and OB/GYN residents. Conclusion: We are reporting results of a small, cross-sectional study conducted in a limited number of specialty programs and limited to 1 geographic area, thus hindering the generalizability of the results. We were unable to conduct subanalyses based on sex/training given the small sample size of MDs. Sex differences, specifically higher empathy scores for female participants, has been reported elsewhere. Residents in this sample scored fairly high in empathy (118 for MDs and 115 for DOs). For comparison, Hojat and Gonnella (2015) reported an average empathy score of 114 (SD, 10.4) for US medical students. We did find a statistically significant difference in empathy score between medical specialties, with emergency medicine residents scoring much lower. Such a difference (although not of the same magnitude) has been reported elsewhere. Hojat (2000) reported that those in people-oriented specialties scored significantly higher (115; SD 9.9) compared with those in more technology-oriented specialties (112.34; SD 11.02). There is some ambiguity, however, as to how to classify emergency medicine. It is sometimes included in the people-oriented specialties or included in the “other medical subspecialty” category. Although we did not find a statistically significant difference in empathy levels between DOs reporting current use of OMM in their clinical encounters and those who did not, a trend can be reported. Of the 85 DOs in the sample, 15 did not use OMM in their clinical encounters. Their average empathy score was 111 (SD, 10.8) compared with 116 (SD, 12.35) for those who did use OMM in their clinical encounters. We are planning continued data collection to enable us to conduct subanalyses (eg, sex differences) and also to follow individuals longitudinally through their residency years.

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