Barriers to Empathy: The Curriculum

Jeffrey, David

doi:10.1007/978-3-030-11211-0_7

Cited by 4 publications

(2 citation statements)

References 64 publications

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“…18(p109; emphasis in original) By focusing on how the construct of critical consciousness has, to date, been conceptualized within medical education, this scoping review aims to fill a gap in the literature. The intent is to identify the main elements of critical consciousness in the specific context that is medical education, which, being traditionally more biomedical, 21,22 and sufficiently distinct from other health professions education curricula, is worthy of specific focus. In so doing, we aim to help medical educators develop a better understanding of how a critical pedagogy may inform educational strategies.…”

Section: A C C E P T E Dmentioning

confidence: 99%

Honoring Medicine’s Social Contract: A Scoping Review of Critical Consciousness in Medical Education

et al. 2020

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To explore how the construct of critical consciousness has been conceptualized within the medical education literature and identify the main elements of critical consciousness in medical education so as to inform educational strategies to foster socially conscious physicians. Method In March 2019, the authors conducted a literature search of four databases and Google Scholar, seeking articles discussing critical consciousness in medical education published any time after 1970. Three of the authors screened articles for eligibility. Two transcribed data using a data extraction form and identified preliminary emerging themes, which were then discussed by the whole research team to ensure agreement. Results Of the initial 317 articles identified, 20 met study inclusion criteria. The publication of academic articles around critical consciousness in medical education has expanded substantially since 2017. Critical consciousness has been conceptualized in the medical education literature through four overlapping themes: (1) social awareness, (2) cultural awareness, (3) political awareness, and (4) awareness of educational dynamics.

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Section: A C C E P T E Dmentioning

confidence: 99%

Honoring Medicine’s Social Contract: A Scoping Review of Critical Consciousness in Medical Education

et al. 2020

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“…This was true both for placement and for assessment settings, particularly OSCEs. Research has previously highlighted fake empathy in medical education and practice 36‐38 . Furthermore, research with Physician Associate (PA) students 38 reports identical challenges with the assessment of empathy in OSCEs: students feel compelled to literally ‘tick the empathy box’ and force out rote empathic statements that they do not truly mean.…”

Section: Discussionmentioning

confidence: 99%

How medical school alters empathy: Student love and break up letters to empathy for patients

et al. 2020

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Introduction Medical education is committed to promoting empathic communication. Despite this, much research indicates that empathy actually decreases as students progress through medical school. In qualitative terms, relatively little is known about this changing student relationship with the concept of empathy for patients and how teaching affects it. This study explores that knowledge gap. Methods Adopting a constructivist paradigm, we utilised a research approach new to medical education: Love and Breakup Letter Methodology. A purposive sample of 20 medical students were asked to write love and break up letters to ‘empathy for patients’. The letters were prompts for the focus group discussions that followed. Forty letters and three focus group discussions were thematically analysed. Results The three major themes were: art and artifice; empathic burden; and empathy as a virtue. Students were uncomfortable with the common practice of faking empathic statements, a problem exacerbated by the need to ‘tick the empathy box’ during examinations. Students evolved their own empathic style, progressing from rote empathic statements towards phrases which suited their individual communication practice. They also learned non‐verbal empathy from positive clinician role‐modelling. Students reported considerable empathic burden. Significant barriers to empathy were reported within the hidden curriculum, including negative role‐modelling that socialises students into having less compassion for difficult patients. Students strongly associated empathy with virtue. Conclusions Medical education should address the problem of inauthentic empathy, including faking empathic s in assessments. Educators should remember the value of non‐verbal compassionate communication. The problems of empathic burden, negative role modelling and of finding empathy difficult for challenging patients may account for some of the empathy decline reported in quantitative research. Framing empathy as a virtue may help students utilise empathy more readily when faced with patients they perceive as challenging and may promote a more authentic empathic practice.

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Empathy in Medical Education: Its Nature and Nurture — a Qualitative Study of the Views of Students and Tutors

et al. 2021

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Context Medical education is committed to teaching patient centred communication and empathy. However, quantitative research suggests empathy scores tend to decline as students progress through medical school. In qualitative terms, there is a need to better understand how students and tutors view the practice and teaching of clinical empathy and the phenomenon of empathic erosion. Methods Working within a constructivist paradigm, researchers thematically analysed the individual interview data from a purposive sample of 13 senior students and 9 tutors. Results The four major themes were as follows: (1) ‘the nature of empathy’, including the concept of the innate empathy that students already possess at the beginning of medical school; (2) ‘beyond the formal curriculum’ and the central importance of role modelling; (3) ‘the formal curriculum and the tick-box influence of assessments’; and (4) the ‘durability of empathy’, including ethical erosion and resilience. A garden model of empathy development is proposed — beginning with the innate seeds of empathy that students bring to medical school, the flowering of empathy is a fragile process, subject to both enablers and barriers in the formal, informal, and hidden curricula. Conclusion This study provides insights into empathic erosion in medical school, including the problems of negative role modelling and the limitations of an assessment system that rewards ‘tick-box’ representations of empathy, rather than true acts of compassion. It also identifies factors that should enable the flowering of empathy, such as new pedagogical approaches to resilience and a role for the arts and humanities.

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Barriers to Empathy: The Curriculum

Cited by 4 publications

References 64 publications

Honoring Medicine’s Social Contract: A Scoping Review of Critical Consciousness in Medical Education

Honoring Medicine’s Social Contract: A Scoping Review of Critical Consciousness in Medical Education

How medical school alters empathy: Student love and break up letters to empathy for patients

Empathy in Medical Education: Its Nature and Nurture — a Qualitative Study of the Views of Students and Tutors

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