Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
BMC Med Educ. 2014 Jun 22;14:122. doi: 10.1186/1472-6920-14-122.
Empathy is an outcome-relevant physician characteristic and thus a crucial component of high-quality communication in health care. However, the factors that promote and inhibit the development of empathy during medical education have not been extensively researched. Also, currently there is no explicit research on the perspective of practicing physicians on the subject. Therefore the aim of our study was to explore physicians' views of the positive and negative influences on the development of empathy during their medical education, as well as in their everyday work as physicians.
We administered a written Qualitative Short Survey to 63 physicians in seven specialties. They were able to respond anonymously. Our open-ended question was: "What educational content in the course of your studies and/or your specialist training had a positive or negative effect on your empathy?" We analyzed the data using thematic content analysis following Mayring's approach.
Forty-two physicians took part in our survey. All together, they mentioned 68 specific factors (37 positive, 29 negative, 2 neutral) from which six themes emerged: 1. In general, medical education does not promote the development of empathy. 2. Recognizing the psycho-social dimensions of care fosters empathy. 3. Interactions with patients in medical practice promote empathy. 4. Physicians' active self-development through reflective practice helps the development of empathy. 5. Interactions with colleagues can both promote and inhibit empathy through their role modeling of empathic and non-empathic behavior. 6. Stress, time pressure, and adverse working conditions are detrimental to empathy development.
Our results provide an overview of what might influence the development of clinical empathy, as well as hypothetical conclusions about how to promote it. Reflective practice seems to be lacking in current medical curricula and could be incorporated. Raising physicians' awareness of the psycho-social dimension of disease, and of the impact of peer influence and role modeling, seems promising in this regard, too. Stress and well-being seem to be closely related to physician empathy, and their modulation must take into account individual, social, and organizational factors. Further research should investigate whether or how these hypothetical conclusions can deepen our understanding of the determinants of physician empathy in order to help its promotion.
同理心是与结果相关的医生特征，因此是医疗保健中高质量沟通的关键组成部分。然而，促进和抑制医学教育中同理心发展的因素尚未得到广泛研究。此外，目前尚无关于实习医生对此主题的明确研究。因此，我们研究的目的是探讨医生对医学教育过程中以及作为医生日常工作中同理心发展的积极和消极影响的看法。
我们向 7 个专业的 63 名医生发放了书面定性短问卷。他们可以匿名回答。我们的开放式问题是：“在您的学习过程中和/或专科培训中，哪些教育内容对您的同理心产生了积极或消极的影响？”我们使用梅林方法的主题内容分析对数据进行了分析。
42 名医生参与了我们的调查。他们总共提到了 68 个具体因素（37 个积极，29 个消极，2 个中立），从中出现了 6 个主题：1. 一般来说，医学教育不会促进同理心的发展。2. 认识到关怀的心理社会维度可以培养同理心。3. 与患者在医疗实践中的互动可以促进同理心。4. 医生通过反思性实践主动进行自我发展有助于同理心的发展。5. 同事之间的互动可以通过他们对同理心和非同理心行为的榜样作用来促进和抑制同理心。6. 压力、时间压力和不利的工作条件不利于同理心的发展。
我们的研究结果提供了一个概述，说明哪些因素可能影响临床同理心的发展，并提出了关于如何促进同理心发展的假设性结论。反思性实践似乎在当前的医学课程中缺乏，可以将其纳入其中。提高医生对疾病心理社会维度的认识，以及对同伴影响和榜样作用的认识，在这方面似乎也很有希望。压力和幸福感似乎与医生的同理心密切相关，其调节必须考虑到个人、社会和组织因素。进一步的研究应该调查这些假设性结论是否或如何能够加深我们对医生同理心决定因素的理解，以帮助促进同理心。
