Beyond empathy decline: Do the barriers to compassion change across medical training?

Abstract

Background: Despite being a mandated, foundational value in healthcare, research on compassion remains limited. Studying the individual, patient, clinical, and contextual factors that interfere with compassion—the “barriers”—may clarify our understanding of the origins of compassion and identify potential targets for improving patient-centred care. Studies of the related construct of empathy have suggested that medical students report declines with increasing clinical experience. In contrast, when comparing physicians with medical students, increased clinical experience predicts lower barriers to compassion. Whether—and how—a similar experience-related decline in the factors that interfere with compassion occurs across medical training remains unknown.Aims: To describe how the barriers to compassion vary across clinical training in medical students.Method: New Zealand medical students (N = 351) in their clinical years (Years 4–6) completed measures of the Barriers to Physician Compassion (BPCQ) and potential covariates such as demographics, work burden factors, and dispositional factors. The BPCQ indexes the extent to which barriers in four domains (individual, patient, clinical, and contextual) interfere with a physician/student’s compassion towards patients. Analyses of variance and regression analyses were used to explore the effect of year level on the four types of barriers.Results: Year 4 students reported slightly lower student-related, environmental and patient/family-related (but not clinical) barriers than Year 6 students (effect size: ɷ2 < 0.05); all barriers increased comparably across training. Controlling for relevant confounds, regression analyses confirmed that lower year level predicted lower barriers to compassion. Higher self-compassion, but not gender, predicted lower barriers.Conclusions: In extending studies of empathy decline, this report suggests that students experience higher barriers to compassion as clinical training progresses. This is in contrast to existing studies contrasting physicians with medical students, where greater experience was associated with lower perceived barriers to compassion. Self-compassion may offset increases in barriers to care.

Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies

“…Our research also mirrors related research, which found that barriers to compassionate care seem to increase as students progress through medical school [ 61 ]. Our finding that time pressure and organisational culture contribute to a decline in empathy corroborates the extensive evidence on the inverse relationship between empathy and burnout among healthcare practitioners [ 2 , 3 , 62 – 65 ] and students [ 39 ].…”

Artificial intelligence technologies and compassion in healthcare: A systematic scoping review

“…Compassionate caregiving has been described as involving meaningful actions to alleviate suffering and meet individual needs and prevent further suffering ( Durkin et al, 2021 ). Compassionate behaviors ( Straughair, 2019 ) are taught through pedagogy ( Hendry, 2019 ), learning objectives ( Lown, 2016 ; Sinclair et al, 2021 ; Wang et al, 2022 ) assessment ( Lown et al, 2016 ), and skills sets such as reflective listening ( Braillon and Taiebi, 2020 ; Su et al, 2021 ). Healthcare research has examined compassion from the perspective of: the predictors of compassion in healthcare professionals ( Fernando and Consedine, 2014 ; Bleiker et al, 2020 ; Pavlova et al, 2022 ); how care environment and organizational culture affect compassion ( Casagrande, 2016 ; Ali and Terry, 2017 ; Dev et al, 2019 ; Tehranineshat et al, 2019 ; Wiljer et al, 2019 ; Ali et al, 2022 ); compassion-maintaining strategies and interventions ( Blomberg et al, 2016 ; Terry et al, 2017 ; Flores and Brown, 2018 ; Baguley et al, 2020 ; Hopkins et al, 2021 ; Malenfant et al, 2022 ); compassionate leadership ( Dewar and Cook, 2014 ; de Zulueta, 2015 ; Lown et al, 2019 ; West et al, 2020 ); and regulation of compassionate caregiving ( Harris et al, 2019 ; Pedersen and Roelsgaard Obling, 2019 ).…”

Role Modeling Kindness at the Bedside

“…A steep decline in empathy occurs with the greatest frequency in the clinical years of medical school. Psychological protections to decrease burnout and emotional distress may result in medical students dissociating from patients and creating barriers that diminish kindness in patient-doctor interactions [3].…”