Exploring empathy with medical students: a qualitative longitudinal phenomenological study

Abstract

Contribution The main contribution offered by my research is an increased understanding of medical students’ perceptions of empathy and the factors that influence this. By using an innovative method in medical education research, the study contributes to research methodology. Background Empathy is accepted as a fundamental part of the patient-doctor relationship and essential for effective clinical care. Current societal opinions are that some healthcare professionals lack empathy and that medical students become less empathetic during their training, although the reasons for this are not understood. If this perceived decline is to be addressed, medical educators need to understand students’ perspectives of the factors that influence their empathy. Aims of the research The study sought to gain a deeper understanding of the development of medical students’ empathy and the factors influencing this during their undergraduate training. It is hoped that this understanding may lead to improvements in medical education and patient care. Methods Ethical approval for the study was granted by the University. A phenomenological approach was adopted, which involved listening to the students’ views and experiences of their course. Serial, semi-structured, indepth, interviews were conducted with sixteen medical students. Each year the student completed an hour-long interview over three years. One group of eight students were followed during the preclinical years of the course (years 1-3) and the other group, during the clinical years (years 4-6). The interviews were audio-recorded, transcribed, coded using qualitative data analysis software (N Vivo), and analysed using an interpretative phenomenological approach. Findings The students in the preclinical years described empathy as a personal attribute, emphasising its emotional dimension. In the clinical years, students viewed empathy differently: as a complex relational process with the patient, which varied in depth and quality according to the clinical context. They described the tensions between connecting with and detachment from a patient. Students indicated influences which enhanced their empathy, including patient contact and positive role models. They also identified barriers to empathy, including: the medical school culture, a biomedical bias in the curriculum, a lack of patient contact, negative role models and teaching of professionalism as distancing from patients. The preclinical group of students reported gaining in self-confidence during their course. The clinical group described how their empathy with patients had increased but they detected a conflict between empathy and efficiency. Conclusions The use of an innovative longitudinal, phenomenological approach in medical education research generated new understanding of a complex interpersonal view of empathy and highlighted aspects of a ‘hidden curriculum’. The students maintained that their contact with patients was the most useful way of developing empathy. They expressed a desire to connect emotionally with patients but were uncertain how to balance this connection with professional detachment. They described a marked biomedical emphasis in their course and perceived that teaching on professionalism encouraged a distancing from patients. In contrast to the widely-reported opinion that there has been a decline in medical students’ empathy, this study suggested that students perceived that their empathy increased during their training. However, some students had learned distancing behaviours to hide their empathetic feelings. In the light of this research, it is hoped that medical educators will develop ways of supporting students to deal appropriately with their own emotions and those of patients.