Quinn Mariah A, Grant Lisa M, Sampene Emmanuel, Zelenski Amy B
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
WMJ. 2020 Dec;119(4):258-262.
Empathy is essential for good patient care. It underpins effective communication and high-quality, relationship-centered care. Empathy skills have been shown to decline with medical training, concordant with increasing physician distress and burnout.
We piloted a 6-month curriculum for interns (N = 27) during the 2015-2016 academic year at the University of Wisconsin-Madison. The course included: (1) review of literature on physician well-being and clinical empathy, (2) instruction on the neurobiology of empathy and compassion, (3) explanation of stress physiology and techniques for mitigating its effects, (4) humanities-informed techniques, and (5) introductions to growth mindset and mindful awareness. To measure effectiveness, we compared empathy and burnout scores before and after the course.
The course was well-attended. Intern levels of burnout and empathy remained stable over the study period. In multivariable modeling, we found that for each session an intern attended, their emotional exhaustion declined by 3.65 points (P = 0.007), personal accomplishment increased by 2.69 points (P = 0.001), and empathic concern improved by 0.82 points (P = 0.066). The course was well-liked. Learners reported applying course content inside and outside of work and expressed variable preferences for content and teaching methods.
Skills in empathic and self-care can be taught together to reduce the decline of empathy and well-being that has been seen during internship. In this single-center pilot, resident physicians reported using these skills both inside and outside of work. Our curriculum has the potential to be adopted by other residency programs.
同理心对于优质的患者护理至关重要。它是有效沟通以及高质量的、以关系为中心的护理的基础。研究表明，随着医学培训的进行，同理心技能会下降，这与医生苦恼和职业倦怠的增加相一致。
在2015 - 2016学年，我们在威斯康星大学麦迪逊分校为实习医生（N = 27）试行一个为期6个月的课程。该课程包括：（1）关于医生福祉和临床同理心的文献综述；（2）同理心和同情心的神经生物学指导；（3）压力生理学解释以及减轻其影响的技巧；（4）基于人文学科的技巧；（5）成长型思维和正念意识介绍。为衡量效果，我们比较了课程前后的同理心和职业倦怠得分。
课程的参与度很高。在研究期间，实习医生的职业倦怠和同理心水平保持稳定。在多变量建模中，我们发现实习医生每参加一次课程，他们的情感耗竭就会下降3.65分（P = 0.007），个人成就感会增加2.69分（P = 0.001），同理心关怀会提高0.82分（P = 0.066）。该课程很受欢迎。学习者报告称在工作内外都应用了课程内容，并对内容和教学方法表达了不同的偏好。
可以同时教授同理心和自我护理技能，以减少实习期间出现的同理心和福祉下降的情况。在这个单中心试点中，住院医生报告在工作内外都使用了这些技能。我们的课程有被其他住院医师培训项目采用的潜力。
