Stratta Emily C, Riding David M, Baker Paul
John Radcliffe Hospital, Oxford, UK.
The University of Manchester, UK.
Int J Med Educ. 2016 Sep 6;7:286-92. doi: 10.5116/ijme.57b8.48e4.
This study sought to understand whether UK Foundation doctors perceived the phenomena of ethical erosion and empathy decline during their initial period of clinical practice, and if so, why this occurred.
This qualitative study used semi-structured interviews with nine doctors in their first year of clinical practice at Royal Bolton Hospital, UK. Participants were invited to discuss the definition of empathy, how individuals acquire and maintain empathic ability, perceptions of ethical erosion in the self and others, and how clinical experiences have influenced their empathic ability. The interviews were transcribed, and analysed to identify emergent themes.
Each participant reported a conscious acknowledgement of empathy decline in their own and their colleagues' early clinical experiences as doctors. Stressful working environments, the prioritisation of patients' physical rather than psychological well-being, and the attitudes of senior colleagues were all suggested as possible causes. Some doctors believed that specialties with reduced patient contact had a culture which precluded empathy, and influenced their own practice. In addition, some described how their value judgements of patients had affected their ability to empathise. However, all doctors perceived that empathy skills were desirable in senior clinicians, and some believed that educational interventions may be useful in arresting ethical erosion.
Newly qualified doctors are aware of ethical erosion in themselves and their colleagues as they begin clinical practice. This has serious implications for patient care. Improving working conditions may reverse this trend. Empathy skills training within undergraduate and postgraduate curricula may be a useful intervention.
本研究旨在了解英国住院医师在临床实习初期是否察觉到道德侵蚀和同理心下降的现象，若察觉到了，原因是什么。
本定性研究对英国皇家博尔顿医院临床实习第一年的9名医生进行了半结构化访谈。邀请参与者讨论同理心的定义、个体如何获得和维持同理心能力、对自身及他人道德侵蚀的看法，以及临床经历如何影响他们的同理心能力。对访谈进行转录并分析，以确定新出现的主题。
每位参与者都表示，在他们自己以及同事作为医生的早期临床经历中，都有意识地认识到同理心下降。工作环境压力大、优先考虑患者的身体而非心理健康以及资深同事的态度都被认为是可能的原因。一些医生认为，与患者接触较少的专科有一种排除同理心的文化，并影响了他们自己的实践。此外，一些人描述了他们对患者的价值判断如何影响了他们的同理心能力。然而，所有医生都认为资深临床医生需要具备同理心技能，一些人认为教育干预可能有助于阻止道德侵蚀。
新获得资格的医生在开始临床实习时，意识到自己和同事存在道德侵蚀现象。这对患者护理有严重影响。改善工作条件可能会扭转这一趋势。在本科和研究生课程中进行同理心技能培训可能是一种有用的干预措施。
