Loureiro José, Gonçalves-Pereira Manuel, Trancas Bruno, Caldas-de-Almeida J M, Castro-Caldas Alexandre
Serviço de Cardiologia, Hospital Fernando Fonseca, Amadora, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 2:431-42. Epub 2011 Dec 31.
Empathy is a key feature of the doctor-patient relationship. Several studies have shown a link between empathic relationships and clinical outcomes. However, reports of a decline in empathy over the course of undergraduate medical education and medical practice have raised concern among medical educators. Our study focuses on the exploration of the temporal stability of attitudes towards empathy in first-year medical students. We also aimed to characterise this sample regarding attitudes towards empathy and its associations with socio-demographic determinants, motives for entering Medicine and professional expectations. Finally, we wanted to contribute to the preliminary validation in Portugal of the Jefferson Scale of Physician Empathy, students' version (JSPE-S), following Hojat's definition of empathy as a predominantly cognitive concept.
We selected a non-randomized sample of 81 first-year medical students, in Lisbon. For the evaluation of the motives for choosing Medicine as a career, we adapted a questionnaire based on the items reported by Vaglum and associates. For self-report assessment of attitudes towards empathy, we used a Portuguese translation of the JSPE- -S. Finally, we analysed the evolution of empathy-related attitudes through a six-month period that included Medical Psychology teaching (given that the curriculum would be expected to raise empathy-driven attitudes and skills).
The JSPE-S total score increased from baseline to follow-up assessments (p=0.001). At the baseline, we found a negative correlation between the "status/security" motivation index and the JSPE-S "standing in patient shoes" component, while there was a positive correlation between the "people oriented" motivation index and the JSPE-S "compassionate care" factor. Psychometric properties were acceptable for both the JSPE-S and the motivation questionnaire.
In general, our findings support the idea that empathy can be learnt in medical schools. This study also provides evidence for the validation of the JSPE-S and for the acceptability of an instrument assessing motivation for medical school, in Portugal. Albeit weak, the correlations between motivational factors and empathy components deserve further exploration in research.
同理心是医患关系的关键特征。多项研究表明，共情关系与临床结果之间存在联系。然而，有报告称，在本科医学教育和医疗实践过程中，同理心有所下降，这引发了医学教育工作者的担忧。我们的研究重点是探索一年级医学生对同理心态度的时间稳定性。我们还旨在描述该样本对同理心的态度及其与社会人口学决定因素、进入医学领域的动机和职业期望的关联。最后，我们希望根据霍贾特将同理心定义为主要认知概念的观点，为葡萄牙对杰斐逊医生同理心量表学生版（JSPE-S）的初步验证做出贡献。
我们在里斯本选取了81名一年级医学生的非随机样本。为了评估选择医学作为职业的动机，我们根据瓦格鲁姆及其同事报告的项目改编了一份问卷。对于同理心态度的自我报告评估，我们使用了JSPE-S的葡萄牙语翻译版本。最后，我们分析了包括医学心理学教学在内的六个月期间与同理心相关态度的演变（因为预计该课程会培养以同理心为驱动的态度和技能）。
从基线评估到随访评估，JSPE-S总分有所增加（p=0.001）。在基线时，我们发现“地位/安全感”动机指数与JSPE-S“站在患者角度”分量表之间呈负相关，而“以人为本”动机指数与JSPE-S“ compassionate care”因子之间呈正相关。JSPE-S和动机问卷的心理测量特性均可接受。
总体而言，我们的研究结果支持同理心可以在医学院校习得这一观点。本研究还为JSPE-S的验证以及葡萄牙一种评估医学院校动机的工具的可接受性提供了证据。尽管动机因素与同理心成分之间的相关性较弱，但值得在研究中进一步探索。
