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(Kelm+ 2014)*

Title: Interventions to cultivate physician empathy: a systematic review
DOI or Website Link:  
  • Zak Kelm, 
  • James Womer, 
  • Jennifer K Walter and 
  • Chris Feudtner
Date:  Published: 14 October 2014


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. 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 appears to be an important aspect of patient and physician well-being. 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. 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.

Topic Area:
 (In which field / sector / perspective was this study conducted?)
  • Physician empathy 
  • Medical education 

(How was empathy defined?)

"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
  •  [5]. Most constructions of empathy have in common, however, an understanding of the emotional states of others and expression of this understanding."

(Were any benefits of empathy mentioned?)

"Physician empathy has been associated with 
  • higher levels of patient satisfaction [612], 
  • adherence to medical recommendations or regimens [101316],
  •  and improved clinical outcomes [61620].
 Moreover, empathy appears to
  • positively influence physicians themselves, as empathy has been linked to lower burnout [21],
  •  higher well-being [2123], 
  • higher ratings of clinical competence [3], 
  • and less medical-legal risk [2426]. 
  • Physician empathy may even reduce health care costs, as patient centered communication styles have been associated with lower diagnostic test expenditures [27]."

Problems (problems associated with a lack of empathy)

 Studies indicate that 
  • "physicians often overlook or miss empathic opportunities during patient encounters [2832],
  •  and tend to spend significantly more time and energy on biomedical inquiry and offering medical explanations to patients [832].
  •  In one study, physicians acknowledged or explored empathic opportunities only 10% of the time [32]. 
  • Patient reports also point to a shortage of physician empathy [33]
  • . Yet, not only is there a shortage of empathy among medical students and physicians, numerous studies show that empathy declines throughout medical training, in both medical school and residency [3439].
  •  As trainees experience an increase in personal distress from burnout, higher rates of depression and decreased quality of life during their training, they are less likely to experience or demonstrate empathy. This distress is potentially promoted by deficiencies in several aspects of the medical curricula, including the formal (e.g. lack of formal empathy training), informal (e.g. inadequate mentors, shorter hospital stays, and inappropriate learning environments), and hidden (e.g. mistreatment of students and high workload) medical curricula [38].
  • The lack of empathy among physicians and the decline in empathy throughout medical training offer reasons for concern, especially given the relationship between physician empathy and patient health and well-being [620]."

 (What were the methods and interventions used to train empathy?)
  •   “communication skills training” 
  •  didactic material (i.e., lecture, videotape and handouts) 
  • training workshops in which medical students practiced their communications skills by interviewing standardized patients and receiving feedback. 
  •  “role playing” intervention
  •  “humanities,” including reflective writing, a literature course, and theater
  •  Shapiro et al. [93used a reflective writing intervention, in which medical students wrote essays from the point of view of either hypothetical or standardized patients.
  • “motivational interviewing training,” a counseling approach aimed at patient behavior change.
  • “balint training,” which entails small group discussions focused on patient emotions. 
  • mindfulness-based stress reduction (MBSR), a type of meditation characterized by nonjudgmental, moment-to-moment awareness
  • problem-based learning sessions that focused on empathy and communication.
  • “motivational interviewing training,” a counseling approach aimed at patient behavior change. 
  •  “other.” variety of intervention types.
  • "Riess et al. [82] created an empathy training protocol that included education in the 
    • neurobiology and 
    • physiology of empathy,
    • real-time biofeedback during physician-patient encounters, and 
    • mindfulness exercises."

Target Group:  
(Who participated in this study / training?)

About the assessment: How was the change in empathy measured before/after the intervention/method?) 
  • Self-report measures involved a self-report survey
  • Jefferson Scale of Physician Empathy (JSPE) (most common)
  • Empathic Tendency Scale (ETS), 
  • Empathic Skill Scale (ESS), 
  • Balanced Emotional Empathy Scale (BEES),
  •  Empathy Construct Rating Scale (ECRS), and
  •  Interpersonal Reactivity Index (IRI)
  • Bonvicini et al. [46] used trained observers and an empathy coding system to evaluate physician empathy during audiotaped recordings of physician-patient interactions. 
  • other-report measures 
  • tests requiring decoding of emotional facial expressions.

(What was the result?)

"Although considerably more research must be undertaken, the present study provides valuable insight into the current state of the empathy intervention literature and suggests that targeted interventions may be able to cultivate physician empathy.

 The reported shortage of empathy and decline in empathy during medical training only amplifies the importance of finding reliable interventions for physicians and physicians-in-training. Indeed, heightened empathy among medical practitioners could not only lead to a more ethical healthcare system, but also to enhanced health and well-being for patients and practitioners themselves."

Posted By:  


(Any other relevant information)
  • 64 papers evaluated


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