(Kelm+ 2014)*

Title: Interventions to cultivate physician empathy: a systematic review

DOI or Website Link:

Publication:

Authors:

  • Zak Kelm,

  • James Womer,

  • Jennifer K Walter and

  • Chris Feudtner

  • Email author

Date: Published: 14 October 2014

Affiliation(s):

Citation:

Abstract:

Background

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....

Conclusions

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

Definition:

(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."

Benefits:

(Were any benefits of empathy mentioned?)

"Physician empathy has been associated with

  • higher levels of patient satisfaction [6–12],

  • adherence to medical recommendations or regimens [10, 13–16],

  • and improved clinical outcomes [6, 16–20].

Moreover, empathy appears to

  • positively influence physicians themselves, as empathy has been linked to lower burnout [21],

  • higher well-being [21–23],

  • higher ratings of clinical competence [3],

  • and less medical-legal risk [24–26].

  • 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 [28–32],

  • and tend to spend significantly more time and energy on biomedical inquiry and offering medical explanations to patients [8, 32].

  • 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 [34–39].

  • 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 [6–20]."

Methods:

(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. [93] used 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?)

Physician

Measurements:

(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.

Result:

(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:

Notes:

(Any other relevant information)

  • 64 papers evaluated

References

  1. Association of American Medical Colleges (AAMC): Learning Objectives for Medical Student Education: Guidelines for Medical Schools. [https://members.aamc.org/eweb/upload/Learning%20Objectives%20for%20Medical%20Student%20Educ%20Report%20I.pdf]

  2. American Medical Association (AMA): Principles of Medical Ethics. [http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/principles-medical-ethics.page?]

  3. Hojat M, Gonnella JS, Mangione S, Nasca TJ, Veloski JJ, Erdmann JB, Callahan CA, Magee M: Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002, 36: 522-527. 10.1046/j.1365-2923.2002.01234.x.

    1. Google Scholar

  4. Hemmerdinger JM, Stoddart SDR, Lilford RJ: A systematic review of tests of empathy in medicine. BMC Med Educ. 2007, 7: 24-10.1186/1472-6920-7-24.

  1. Mercer SW, Reynolds WJ: Empathy and quality of care. Br J Gen Pract. 2002, 52 (Suppl): S9-S12.

  1. Derksen F, Bensing J, Lagro-Janssen A: Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013, 63: e76-e84. 10.3399/bjgp13X660814.

  1. Bertakis KD, Roter D, Putnam SM: The relationship of physician medical interview style to patient satisfaction. J Fam Pract. 1991, 32: 175-181.

  1. Epstein RM, Hadee T, Carroll J, Meldrum SC, Lardner J, Shields CG: “Could this be something serious?” Reassurance, uncertainty, and empathy in response to patients’ expressions of worry. J Gen Intern Med. 2007, 22: 1731-1739. 10.1007/s11606-007-0416-9.

  1. Hojat M, Louis DZ, Maxwell K, Markham FW, Wender RC, Gonnella JS: A brief instrument to measure patients’ overall satisfaction with primary care physicians. Fam Med. 2011, 43: 412-417.

  1. Kim SS, Kaplowitz S, Johnston MV: The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004, 27: 237-251. 10.1177/0163278704267037.

  1. Pollack KI, Alexander SC, Tulsky JA, Lyna P, Coffman CJ, Dolor RJ, Gulbrandsen P, Ostbye T: Physician empathy and listening: associations with patient satisfaction and autonomy. J Am Board Fam Med. 2011, 24: 665-672. 10.3122/jabfm.2011.06.110025.

  1. Zachariae R, Pedersen CG, Jensen AB, Ehrnrooth E, Rossen PB, Von der Maase H: Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. Br J Cancer. 2003, 88: 658-665. 10.1038/sj.bjc.6600798.

  1. Stewart MA: What is a successful doctor-patient interview? A study of interactions and outcomes. Soc Sci Med. 1984, 19: 167-175. 10.1016/0277-9536(84)90284-3.

  1. Squier RW: A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships. Soc Sci Med. 1990, 30: 325-339. 10.1016/0277-9536(90)90188-X.

  1. Zolnierek KB: Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009, 47: 826-834. 10.1097/MLR.0b013e31819a5acc.

  1. Attar HS, Chandramani S: Impact of physician empathy on migraine disability and migraineur compliance. Ann Indian Acad Neurol. 2012, 15: S89-S94.

  1. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS: Physicians' empathy and clinical outcomes for diabetic patients. Acad Med. 2011, 86: 359-364. 10.1097/ACM.0b013e3182086fe1.

  1. Lobchuk MM, Bokhari SA: Linkages among empathic behaviors, physical symptoms, and psychological distress in patients with ovarian cancer: a pilot study. Oncol Nurs Forum. 2008, 35: 808-814. 10.1188/08.ONF.808-814.

  1. Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu M: Practitioner empathy and the duration of the common cold. Fam Med. 2009, 41: 494-501.

  1. Rakel D, Barrett B, Zhang Z, Hoeft T, Chewning B, Marchard L, Scheder J: Perceptions of empathy in the therapeutic encounter: Effects on the common cold. Patient Educ Couns. 2011, 85: 390-397. 10.1016/j.pec.2011.01.009.

  1. Thomas MR, Dyrbye LN, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD: How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med. 2007, 22: 177-183. 10.1007/s11606-006-0039-6.

  1. DiLalla LF, Hull SK, Dorsey JK: Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teach Learn Med. 2004, 16: 165-170. 10.1207/s15328015tlm1602_8.

  1. Shanafelt TD, West C, Zhao X, Novotny P, Kolars J, Habermann T, Sloan J: Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med. 2005, 20: 559-564. 10.1007/s11606-005-0102-8.

  1. Beckman HB, Markakis KM, Suchman AL, Frankel RM: The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med. 1994, 154: 1365-1370. 10.1001/archinte.1994.00420120093010.

  1. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM: Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997, 277: 553-559. 10.1001/jama.1997.03540310051034.

  1. Moore PJ, Adler NE, Robertson PA: Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. West J Med. 2000, 173: 244-250. 10.1136/ewjm.173.4.244.

  1. Epstein RM, Franks P, Shields CG, Meldrum SC, Miller KN, Campbell TL, Fiscella K: Patient-centered communication and diagnostic testing. Ann Fam Med. 2005, 3: 415-421. 10.1370/afm.348.

  1. Pollak KI, Arnold RM, Jeffreys AS, Alexander SC, Olsen MK, Abernethy AP, Sugg Skinner C, Rodriguez KL, Tulsky JA: Oncologist communication about emotion during visits with patients with advanced cancer. J Clin Oncol. 2007, 25: 5748-5752. 10.1200/JCO.2007.12.4180.

  1. Easter DW, Beach W: Competent patient care is dependent upon attending to empathic opportunities presented during interview sessions. Curr Surg. 2004, 61: 313-318. 10.1016/j.cursur.2003.12.006.

  1. Eide H, Frankel R, Haaversen ACB, Vaupel KA, Graugaard PK, Finset A: Listening for feelings: identifying and coding empathic and potential empathic opportunities in medical dialogues. Patient Educ Couns. 2004, 54: 291-297. 10.1016/j.pec.2003.09.006.

  1. Levinson W, Gorawara-Bhat R, Lamb J: A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000, 284: 1021-1027. 10.1001/jama.284.8.1021.

  1. Morse DS, Edwardsen EA, Gordon HS: Missed opportunities for interval empathy in lung cancer communication. Arch Intern Med. 2008, 168: 1853-1858. 10.1001/archinte.168.17.1853.

  1. Goore Z, Mangione-Smith R, Elliott MN, McDonald L, Kravitz RL: How much explanation is enough? A study of parent requests for information and physician responses. Ambul Pediatr. 2001, 1: 326-332. 10.1367/1539-4409(2001)001<0326:HMEIEA>2.0.CO;2.

  1. Bellini LM, Shea JA: Mood change and empathy decline persist during three years of internal medicine training. Acad Med. 2005, 80: 164-167. 10.1097/00001888-200502000-00013.

  1. Chen DC, Lew R, Hershman W, Orlander J: A cross-sectional measurement of medical student empathy. J Gen Intern Med. 2007, 22: 1434-1438. 10.1007/s11606-007-0298-x.

  1. Chen DC, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH: Characterizing changes in student empathy throughout medical school. Med Teach. 2012, 34: 305-311. 10.3109/0142159X.2012.644600.

  1. Hojat M, Mangione S, Nasca TJ, Rattner S, Erdmann JB, Gonnella JS, Magee M: An empirical study of decline in empathy in medical school. Med Educ. 2004, 38: 934-941. 10.1111/j.1365-2929.2004.01911.x.

  1. Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, Haramati A, Scheffer C: Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011, 86: 996-1009. 10.1097/ACM.0b013e318221e615.

  1. Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P: Is there hardening of the heart during medical school?. Acad Med. 2008, 83: 244-249. 10.1097/ACM.0b013e3181637837.

  1. Stepien KA, Baernstein A: Educating for empathy: a review. J Gen Intern Med. 2006, 21: 524-530. 10.1111/j.1525-1497.2006.00443.x.

  1. Hojat M: Ten approaches for enhancing empathy in health and human services cultures. J Health Hum Serv Adm. 2009, 31: 412-450.

  1. (AIRAGNES + 2014)

  2. Airagnes G, Consoli SM, Morlhon OD, Galliot AM, Lemogne C, Jaury P: Appropriate training based on Balint groups can improve the empathic abilities of medical students: a preliminary study. J Psychosom Res. 2014, 76: 426-429. 10.1016/j.jpsychores.2014.03.005.

  1. (BAYNE 2011)

  2. Bayne HB: Training medical students in empathic communication. JSGW. 2011, 36: 316-329.

  1. (BAYS + 2014)

  2. Bays AM, Engelberg RA, Back AL, Ford DW, Downey L, Shannon SE, Doorenbos AZ, Edlund B, Christianson P, Arnold RW, O’Connor K, Kross EK, Reinke LF, Feemster LC, Fryer-Edwards K, Alexander SC, Tulsky JA, Curtis JR: Interprofessional communication skills training for serious illness: evaluation of a small-group, simulated patient intervention. J Palliat Med. 2014, 17: 159-166. 10.1089/jpm.2013.0318. Google Scholar

  3. (BOND + 2013)

  4. Bond AR, Mason HF, Lemaster CM, Shaw SE, Mullin CS, Holick EA, Saper RB: Embodied health: the effects of a mind-body course for medical students. Med Educ Online. 2013, 18: 1-8.Google Scholar

  5. (BONVICINI + 2009)

  6. Bonvicini KA, Perlin MJ, Bylund CL, Carroll G, Rouse RA, Goldstein MG: Impact of communication training on physician expression of empathy in patient encounters. Patient Educ Couns. 2009, 75: 3-10. 10.1016/j.pec.2008.09.007.

  1. (BOSSE + 2012)

  2. Bosse HM, Schultz JH, Nickel M, Lutz T, Möltner A, Jünger J, Huwendiek S, Nikendei C: The effect of using standardized patients or peer role play on ratings of undergraduate communication training: a randomized controlled trial. Patient Educ Couns. 2012, 87: 300-306. 10.1016/j.pec.2011.10.007.

  1. (BUNN + 2009)

  2. Bunn W, Terpstra J: Cultivating empathy for the mentally ill using simulated auditory hallucinations. Acad Psychiatry. 2009, 33: 457-460. 10.1176/appi.ap.33.6.457.

  1. (CAHAN + 2010)

  2. Cahan MA, Larkin AC, Starr S, Wellman S, Haley HL, Sullivan K, Shah S, Hirsh M, Litwin D, Quirk M: A human factors curriculum for surgical clerkship students. Arch Surg. 2010, 145: 1151-1157. 10.1001/archsurg.2010.252.

  1. (CATALDO + 2005)

  2. Cataldo KP, Peeden K, Geesey ME, Dickerson L: Association between balint training and physician empathy and work satisfaction. Fam Med. 2005, 37: 328-331.

  1. (CHUNHARAS + 2013)

  2. Chunharas A, Hetrakul P, Boonyobol R, Udomkitti T, Tassanapitikul T, Wattanasirichaigoon D: Medical students themselves as surrogate patients increased satisfaction, confidence, and performance in practicing injection skill. Med Teach. 2013, 35: 308-313. 10.3109/0142159X.2012.746453.

  1. (CINAR + 2012)

  2. Cinar O, AK M, Sutcigil L, Congologlu ED, Canbaz H, Kilic E, Ozmenler KN: Communication skills training for emergency medicine residents. Eur J Emerg Med. 2012, 19: 9-13. 10.1097/MEJ.0b013e328346d56d.

  1. (DAEPPEN + 2011)

  2. Daeppen JB, Fortini C, Bertholet N, Bonvin R, Berney A, Michaud PA, Layat C, Gaume J: Training medical students to conduct motivational interviewing: a randomized controlled trial. Patient Educ Couns. 2012, 87: 313-318. 10.1016/j.pec.2011.12.005.

  1. (DELVAUX + 2005)

  2. Delvaux N, Merckaert I, Marchal S, Libert Y, Conradt S, Boniver J, Etienne AM, Fontaine O, Janne P, Klastersky J, Melot C, Reynaert C, Scalliet P, Slachmuylder JL, Razavi D: Physicians’ communication with a cancer patient and a relative: a randomized study assessing the efficacy of consolidation workshops. Cancer. 2005, 103: 2397-2411. 10.1002/cncr.21093.

  1. (DIKICI + 2009)

  2. Dikici MF, Yaris F, Cubukcu M: Teaching medical students how to break bad news: a Turkish experience. J Cancer Educ. 2009, 24: 246-248. 10.1080/08858190902972814.

  1. (DOW + 2007)

  2. Dow AW, Leong D, Anderson A, Wenzel RP: Using theater to teach clinical empathy: a pilot study. J Gen Intern Med. 2007, 22: 1114-1118. 10.1007/s11606-007-0224-2.

  1. (FALLOWFIELD + 2002)

  2. Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R: Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomized controlled trial. Lancet. 2002, 359: 650-656. 10.1016/S0140-6736(02)07810-8.

  1. (FARNILL + 1997)

  2. Farnill D, Todisco J, Hayes SC, Bartlett D: Videotaped interviewing of non-English speakers: training for medical students with volunteer clients. Med Educ. 1997, 31: 87-93. 10.1111/j.1365-2923.1997.tb02464.x.

  1. (FERNANDEZ-OLANO 2008)

  2. Fernández-Olano C, Montoya-Fernández J, Salinas-Sánchez AS: Impact of clinical interview training on the empathy level of medical students and medical residents. Med Teach. 2008, 30: 322-324. 10.1080/01421590701802299.

  1. (FINE + 1977)

  2. Fine VK, Therrien ME: Empathy in the doctor-patient relationship: skill training for medical students. J Med Educ. 1977, 52: 752-757.

  1. (GARCIA + 2013)

  2. Garcia D, Bautista O, Venereo L, Coll O, Vassena R, Vernaeve V: Training in empathic skills improves the patient-physician relationship during the first consultation in a fertility clinic. Fertil Steril. 2013, 99: 1413-1418. 10.1016/j.fertnstert.2012.12.012.

  1. (GHETTI + 2009)

  2. Ghetti C, Chang J, Gosman G: Burnout, psychological skills, and empathy: balint training in obstetrics and gynecology residents. J Grad Med Educ. 2009, 1: 231-235.

  1. (HARLAK + 2008)

  2. Harlak H, Gemalmaz A, Gurel FS, Dereboy C, Ertekin K: Communication skills training: effects on attitudes toward communication skills and empathic tendency. Educ Health (Abingdon). 2008, 21: 62.

  1. (HART + 2006)

  2. Hart CN, Drotar D, Gori A, Lewin L: Enhancing parent-provider communication in ambulatory pediatric practice. Patient Educ Couns. 2006, 63: 38-46. 10.1016/j.pec.2005.08.007.

  1. (HOJAT 2013)

  2. Hojat M, Axelrod D, Spandorfer J, Mangione S: Enhancing and sustaining empathy in medical students. Med Teach. 2013, 35: 996-1001. 10.3109/0142159X.2013.802300.

  1. (JENKINS + 2002)

  2. Jenkins V, Fallowfield L: Can communication skills training alter physicians’ beliefs and behavior in clinics?. J Clin Oncol. 2002, 20: 765-769. 10.1200/JCO.20.3.765.

  1. (KARAOGLU + 2011)

  2. Karaoglu N, Seker M: Looking for winds of change with a PBL scenario about communication and empathy. HealthMED. 2011, 5: 515-521.

  1. (KRAMER + 1989)

  2. Kramer D, Ber R, Moores M: Increasing empathy among medical students. Med Educ. 1989, 23: 168-173. 10.1111/j.1365-2923.1989.tb00881.x.

  1. (KRASNER + 2009)

  2. Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, Quill TE: Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009, 302: 1284-1293. 10.1001/jama.2009.1384.

  1. (KUSHNER + 2014)

  2. Kushner RF, Zeiss DM, Feinglass JM, Yelen M: An obesity educational intervention for medical students addressing weight bias and communication skills using standardized patients. BMC Med Educ. 2014, 14: 53-10.1186/1472-6920-14-53.

  1. (LIÉNARD + 2010)

  2. Liénard A, Merckaert I, Libert Y, Bragard I, Delvaux N, Etienne AM, Marchal S, Meunier J, Reynaert C, Slachmuylder JL, Razavi D: Is it possible to improve residents breaking bad news skills? A randomized study assessing the efficacy of a communication skills training program. Br J Cancer. 2010, 103: 171-177. 10.1038/sj.bjc.6605749.

  1. (LIÉNARD2+ 2010)

  2. Liénard A, Merckaert I, Libert Y, Bragard I, Delvaux N, Etienne AM, Marchal S, Meunier J, Reynaert C, Slachmuylder JL, Razavi D: Transfer of communication skills to the workplace during clinical rounds: impact of a program for residents. PLoS One. 2010, 5: e12426-10.1371/journal.pone.0012426.

  1. (LIM + 2011)

  2. Lim BT, Moriarty H, Huthwaite M: “Being-in-role”: A teaching innovation to enhance empathic communication skills in medical students. Med Teach. 2011, 33: e663-e669. 10.3109/0142159X.2011.611193.

  1. (MISRA-HEBERT + 2012)

  2. Misra-Hebert AD, Isaacson JH, Kohn M, Hull AL, Hojat M, Papp KK, Calabrese L: Improving empathy of physicians through guided reflective writing. Int J Med Educ. 2012, 3: 71-77.

  1. (MITCHELL + 2011)

  2. Mitchell S, Heyden R, Heyden N, Schroy P, Andrew S, Sadikova E, Wiecha J: A pilot study of motivational interviewing training in a virtual world. J Med Internet Res. 2011, 13: e77-10.2196/jmir.1825.

  1. (NORFOLK + 2009)

  2. Norfolk T, Birdi K, Patterson F: Developing therapeutic rapport: a training validation study. Qual Prim Care. 2009, 17: 99-106.

  1. (OZCAN + 2012)

  2. Ozcan CT, Oflaz F, Bakir B: The effect of a structured empathy course on the students of a medical and a nursing school. Int Nurs Rev. 2012, 59: 532-538. 10.1111/j.1466-7657.2012.01019.x.

  1. (PACALA + 1995)

  2. Pacala JT, Boult C, Bland C, O’Brien J: Aging game improves medical students’ attitudes toward caring for elders. Gerontol Geriatr Educ. 1995, 15: 45-57.

  1. (POOLE + 1980)

  2. Poole AD, Sanson-Fisher RW: Long-term effects of empathy training on the interview skills of medical students. Patient Couns Health Educ. 1980, 2: 125-127. 10.1016/S0738-3991(80)80053-X.

  1. (RAZAVI + 2003)

  2. Razavi D, Merckaert I, Marchal S, Libert Y, Conradt S, Boniver J, Etienne AM, Fontaine O, Janne P, Klastersky J, Reynaert C, Scalliet P, Slachmuylder JL, Delvaux N: How to optimize physicians’ communication skills in cancer care: results of a randomized study assessing the usefulness of posttraining consolidation workshops. J Clin Oncol. 2003, 21: 3141-3149. 10.1200/JCO.2003.08.031.

  1. (RIESS 2011)

  2. Riess H, Kelley JM, Bailey R, Konowitz PM, Gray ST: Improving empathy and relational skills in otolaryngology residents: a pilot study. Otolaryngol Head Neck Surg. 2011, 144: 120-122. 10.1177/0194599810390897.

  1. (RIESS 2012)

  2. Riess H, Kelley JM, Bailey RW, Dunn EJ, Phillips M: Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. J Gen Intern Med. 2012, 27: 1280-1286. 10.1007/s11606-012-2063-z.

  1. (ROSENTHAL + 2011)

  2. Rosenthal S, Howard B, Schlussel YR, Herrigel D, Smolarz BG, Gable B, Vasquez J, Grigo H, Kaufman M: Humanism at heart: preserving empathy in third-year medical students. Acad Med. 2011, 86: 350-358. 10.1097/ACM.0b013e318209897f.

  1. (ROTER + 1995)

  2. Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP: Improving physicians’ interviewing skills and reducing patients' emotional distress. Arch Intern Med. 1995, 155: 1877-1884. 10.1001/archinte.1995.00430170071009.

  1. (ROTER + 2004)

  2. Roter DL, Larson S, Shinitzky H, Chernoff R, Serwint JR, Adamo G, Wissow L: Use of an innovative video feedback technique to enhance communication skills training. Med Educ. 2004, 38: 145-157. 10.1111/j.1365-2923.2004.01754.x.

  1. (SANDS + 2008)

  2. Sands SA, Stanley P, Charon R: Pediatric narrative oncology: Interprofessional training to promote empathy, build teams, and prevent burnout. J Support Oncol. 2008, 6: 307-312.

  1. (SANSON-FISHER + 1978)

  2. Sanson-Fisher RW, Poole AD: Training medical students to empathize: an experimental study. Med J Aust. 1978, 1: 473-476.

  1. (SANSON-FISHER + 1980)

  2. Sanson-Fisher RW, Poole AD: Simulated patients and the assessment of medical students’ interpersonal skills. Med Educ. 1980, 14: 249-253. 10.1111/j.1365-2923.1980.tb02269.x.

  1. (SCHELL + 2013)

  2. Schell JO, Green JA, Tulsky JA, Arnold RM: Communication skills training for dialysis decision-making and end-of-life care in nephrology. Clin J Am Soc Nephrol. 2013, 8: 675-680. 10.2215/CJN.05220512.

  1. (SCHOLER + 2008)

  2. Scholer SJ, Brokish PA, Mukherjee AB, Gigante J: A violence-prevention program helps teach medical students and pediatric residents about childhood aggression. Clin Pediatr (Phila). 2008, 47: 891-900. 10.1177/0009922808319965.

  1. (SCHWELLER + 2014)

  2. Schweller M, Costa FO, Antonio MA, Amaral EM, de Carvalho-Filho MA: The impact of simulated medical consultations on the empathy levels of students at one medical school. Acad Med. 2014, 89: 632-637. 10.1097/ACM.0000000000000175.

  1. (SHAPIRO + 2004)

  2. Shapiro J, Morrison E, Boker J: Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. Educ Health (Abingdon). 2004, 17: 73-84. 10.1080/13576280310001656196.

  1. (SHAPIRO + 2006)

  2. Shapiro J, Rucker L, Boker J, Lie D: Point-of-view writing: A method for increasing medical students’ empathy, identification and expression of emotion, and insight. Educ Health (Abingdon). 2006, 19: 96-105. 10.1080/13576280500534776.

  1. (SHAPIRO + 1998)

  2. Shapiro SL, Schwartz GE, Bonner G: Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998, 21: 581-599. 10.1023/A:1018700829825.

  1. (SHAPIRO +2009)

  2. Shapiro SM, Lancee WJ, Richards-Bentley CM: Evaluation of a communication skills program for first-year medical students at the University of Toronto. BMC Med Educ. 2009, 9: 11-10.1186/1472-6920-9-11.

  1. (SMITH 1995)

  2. Smith R, Lyles J, Mettler J: A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study. Acad Med. 1995, 70: 729-732. 10.1097/00001888-199508000-00019.

  1. (SRIPADA + 2011)

  2. Sripada BN, Henry DB, Jobe TH, Winer JA, Schoeny ME, Gibbons RD: A randomized controlled trial of a feedback method for improving empathic accuracy in psychotherapy. Psychol Psychother. 2011, 84: 113-127. 10.1348/147608310X495110.

  1. (TIURANIEMI + 2011)

  2. Tiuraniemi J, Läärä R, Kyrö T, Lindeman S: Medical and psychology students’ self-assessed communication skills: A pilot study. Patient Educ Couns. 2011, 83: 152-157. 10.1016/j.pec.2010.05.013.

  1. (TULSKY 2011)

  2. Tulsky JA, Arnold RM, Alexander SC, Olsen MK, Jeffreys AS, Rodriguez KL, Pollack KI: Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial. Ann Intern Med. 2011, 155: 593-601. 10.7326/0003-4819-155-9-201111010-00007.

  1. (VAN WINKLE + 2012)

  2. Van Winkle LJ, Fjortoft N, Hojat M: Impact of a workshop about aging on the empathy scores of pharmacy and medical students. Am J Pharm Educ. 2012, 76: 9-10.5688/ajpe7619.

  1. (VARKEY + 2006)

  2. Varkey P, Chutka DS, Lesnick TG: The Aging Game: improving medical students’ attitudes toward caring for the elderly. J Am Med Dir Assoc. 2006, 7: 224-229. 10.1016/j.jamda.2005.07.009.

  1. (WALTERS + 2007)

  2. Walters P, Tylee A, Fisher J, Goldberg D: Teaching junior doctors to manage patients who somatise: is it possible in an afternoon?. Med Educ. 2007, 41: 995-1001. 10.1111/j.1365-2923.2007.02833.x.

  1. (WINEFIELD + 2000)

  2. Winefield HR, Chur-Hansen A: Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase?. Med Educ. 2000, 34: 90-94. 10.1046/j.1365-2923.2000.00463.x.

  1. (WOLF + 1987)

  2. Wolf FM, Woolliscrof JO, Calhoun JG, Boxer GJ: A controlled experiment in teaching students to respond to patients’ emotional concerns. J Med Educ. 1987, 62: 25-34.

  1. (YANG + 2013)

  2. Yang KT, Yang JH: A study of the effect of a visual arts-based program on the scores of Jefferson scale for physician empathy. BMC Med Educ. 2013, 13: 142-10.1186/1472-6920-13-142.

  1. Lelorain S, Bredart A, Dolbeault S, Sultan S: A systematic review of the associations between empathy measures and patient outcomes in cancer care. Psychooncology. 2012, 21: 1255-1264. 10.1002/pon.2115.

  1. Satterfield JM, Hughes E: Emotion skills training for medical students: a systematic review. Med Educ. 2007, 41: 935-941. 10.1111/j.1365-2923.2007.02835.x.

  1. Pedersen R: Empirical research on empathy in medicine-A critical review. Patient Educ Couns. 2009, 76: 307-322. 10.1016/j.pec.2009.06.012.

  1. Hojat M, Mangione S, Nasca TJ, Cohen MJM, Gonnella JS, Erdmann JB, Veloski J, Magee M: The Jefferson Scale of Physician Empathy: Development and preliminary psychometric data. Educ Psychol Meas. 2001, 61: 349-365. 10.1177/00131640121971158.

  1. Hojat M, Gonnella JS, Nasca TJ, Mangione S, Veloksi JJ, Magee M: The Jefferson Scale of Physician Empathy: Further psychometric data and differences by gender and specialty at item level. Acad Med. 2002, 77: S58-S60. 10.1097/00001888-200210001-00019.

  1. Tavakol S, Dennick R, Tavakol M: Psychometric properties and confirmatory factor analysis of the Jefferson Scale of Physician Empathy. BMC Med Educ. 2011, 11: 54-10.1186/1472-6920-11-54.

  1. Berg K, Majdan JF, Berg D, Veloski J, Hojat M: A comparison of medical students’ self-reported empathy with simulated patients’ assessments of the students’ empathy. Med Teach. 2011, 33: 388-391. 10.3109/0142159X.2010.530319.

  1. Glasner KM, Markham FW, Adler HM, McManus PR, Hojat M: Relationships between scores on the Jefferson Scale of physician empathy, patient perceptions of physician empathy, and humanistic approaches to patient care: a validation study. Med Sci Monit. 2007, 13: CR291-CR294.