Shapiro Johanna, Youm Julie, Kheriaty Aaron, Pham Tiffany, Chen Yanjun, Clayma Ralph
Department of Family Medicine, University of California Irvine School of Medicine, Irvine, California, USA.
Department of Emergency Medicine, University of California Irvine School of Medicine, Irvine, California, USA.
Educ Health (Abingdon). 2019 May-Aug;32(2):53-61. doi: 10.4103/efh.EfH_133_18.
Prior studies have shown a marked drop in empathy among students during their third (clinical) year of medical school. Curricula developed to address this problem have varied greatly in content and have not always been subjected to validated measures of impact.
In 2015, we initiated a Human Kindness (HK) curriculum for the initial 2 years of medical school. This mandatory 12-h curriculum (6 h/year) included an innovative series of lectures and patient interactions with regard to compassion and empathy in the clinical setting. Both quantitative (Jefferson Scale of Empathy [JSE]) and qualitative data were collected prospectively to evaluate the impact of the HK curriculum.
In the initial Pilot Year, neither 1 (Group 1) nor 2 (Group 2) year medical students showed pre-post changes in JSE scores. Substantial changes were made to the curriculum based on faculty and student evaluations. In the following Implementation Year, both the new 1 (Group 3) and the now 2 year (Group 4) students, who previously experienced the Pilot Year, showed significant improvements in post-course JSE scores; this improvement remained valid across subanalyses of gender, age, and student career focus (e.g., internal medicine, surgery, etc.). Despite the disappointingly flat initial Pilot Year JSE scores, the 3 year students (Group 2) who experienced only the Pilot Year of the curriculum (i.e., 2 year students at the time of the Pilot Year) had subsequent JSE scores that did not show the typical decline associated with the clinical years. Students generally evaluated the HK curriculum positively and rated it as being important to their medical education and development as a physician.
A required preclinical curriculum focused on HK resulted in significant improvements in medical student empathy; this improvement was maintained during the 1 clinical year of training.
先前的研究表明,医学院校学生在三年级(临床实习年)时同情心显著下降。为解决这一问题而开发的课程在内容上差异很大,且并非总是经过有效的效果评估。
2015年,我们在医学院校的前两年启动了一项“人性善良(HK)”课程。这一为期12小时的必修课(每年6小时)包括一系列关于临床环境中同情心和同理心的创新讲座及患者互动。我们前瞻性地收集了定量数据(杰斐逊同理心量表[JSE])和定性数据,以评估HK课程的效果。
在最初的试点年,一年级(第一组)和二年级(第二组)医学生的JSE分数在课程前后均未出现变化。根据教师和学生的评估,对课程进行了大幅调整。在接下来的实施年,之前经历过试点年的新一年级(第三组)和现在的二年级(第四组)学生在课程后的JSE分数均有显著提高;在按性别、年龄和学生职业重点(如内科、外科等)进行的亚分析中,这一提高均有效。尽管试点年令人失望的JSE分数持平,但仅经历了课程试点年的三年级学生(第二组,即试点年时的二年级学生)随后的JSE分数并未出现与临床实习年相关的典型下降。学生们总体上对HK课程评价积极,并认为该课程对他们的医学教育和成为一名医生的发展很重要。
一门专注于HK的临床前必修课使医学生的同理心有了显著提高;这种提高在一年的临床培训中得以保持。