Teng Valerie Chan, Nguyen Cathina, Hall Karen Thomson, Rydel Tracy, Sattler Amelia, Schillinger Erika, Weinlander Eva, Lin Steven
San Jose-O'Connor Hospital Family Medicine Residency Program, San Jose, California, USA.
Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA.
Clin Teach. 2017 Dec;14(6):441-445. doi: 10.1111/tct.12608. Epub 2017 Feb 6.
The phenomenon of empathy decline among medical students during training is widely accepted, with evidence based largely on studies using self-administered instruments. Recently, researchers have called into question this phenomenon, in light of new findings that suggest a discrepancy between self-administered empathy scores and observed empathic behaviours: for example, during objective structured clinical examinations (OSCEs). Our objective was to compare observed empathy among medical students in different clerkship years using an OSCE.
Participants were medical students in their first or second year of clinical clerkships, enrolled in a required family medicine clerkship at Stanford University. Participants completed an OSCE that was directly observed by trained faculty staff, who used the Measure of Patient-Centered Communication (MPCC) instrument to measure empathic behaviours. Statistics were used to determine correlations between observed empathy and the students' year of clerkship, gender, and specialty preference.
A total of 129 medical students, evenly divided by gender and clerkship year, participated. There was a possible trend towards higher MPCC scores among students in their second clerkship year compared with students in their first year (p = 0.09), which became more significant when adjusted for outlier effects (p = 0.05). There was no difference in performance by gender. Students interested in a 'people-oriented' specialty scored higher in 'handling the patient's frustration' compared with those who are interested in a 'technology-oriented' specialty.
In our study, observed empathic behaviours were not lower in the second compared with the first year of clerkship training. More research is warranted to investigate the apparent discrepancy between self-administered empathy scores and observed empathic behaviours. New findings suggest a discrepancy between self-administered empathy scores and observed empathic behaviours.
医学生在培训期间共情能力下降的现象已被广泛认可，相关证据主要基于使用自我评估工具的研究。最近，鉴于新的研究结果表明自我评估的共情分数与观察到的共情行为之间存在差异，例如在客观结构化临床考试（OSCE）中，研究人员对这一现象提出了质疑。我们的目的是通过OSCE比较不同实习年份医学生的观察到的共情能力。
参与者为斯坦福大学必修家庭医学实习课程的临床实习一、二年级医学生。参与者完成了由训练有素的教职员工直接观察的OSCE，这些员工使用以患者为中心的沟通测量（MPCC）工具来测量共情行为。使用统计学方法确定观察到的共情能力与学生的实习年份、性别和专业偏好之间的相关性。
共有129名医学生参与，按性别和实习年份平均分配。与一年级学生相比，二年级学生的MPCC分数可能有更高的趋势（p = 0.09），在调整异常值影响后变得更显著（p = 0.05）。性别之间的表现没有差异。对“以人为本”专业感兴趣的学生在“处理患者挫折感”方面的得分高于对“技术导向”专业感兴趣的学生。
在我们的研究中，观察到的共情行为在实习培训的第二年并不比第一年低。有必要进行更多研究来调查自我评估的共情分数与观察到的共情行为之间明显的差异。新的研究结果表明自我评估的共情分数与观察到的共情行为之间存在差异。
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