Lecat Paul, Dhawan Naveen, Hartung Paul J, Gerzina Holly, Larson Robert, Konen-Butler Cassandra
Northeast Ohio Medical University (NEOMED), College of Medicine, Rootstown, OH, USA.
J Patient Exp. 2020 Dec;7(6):1260-1270. doi: 10.1177/2374373520916323. Epub 2020 Apr 8.
Empathy is critical for optimal patient experience with health-care providers. Verbal empathy is routinely taught to medical students, but nonverbal empathy, including touch, less so. Our objective was to determine whether instruction encouraging empathic touch and eye gaze at exit can impact behaviors and change patient-perceived empathy.
A randomized, controlled, double-blinded trial of 34 first-year medical students was conducted during standardized patient (SP) interviews. A video either encouraging empathic touch and eye gaze at exit or demonstrating proper hand hygiene (control) was shown. Encounter videos were analyzed for touch and eye gaze at exit. The Jefferson Scale of Patient Perceptions of Physician Empathy was used to measure correlations. Intervention students were surveyed regarding patient touch.
Of this, 23.5% of intervention students touched the SP versus zero controls; 88.2% of intervention students demonstrated eye gaze at exit. Eye gaze at exit positively impacted patient-perceived empathy (correlation = 0.48, > .001). Survey responses revealed specific barriers to touch.
Medical students may increase perceived empathy using eye gaze at exit. Instruction on empathic touch and sustained eye gaze at exit at the medical school level may be useful in promoting empathic nonverbal communication. Medical educators should consider providing specific instructions on how to appropriately touch patients during history-taking. This is one of the few studies to explore touch with patients and the first ever to report the positive correlation of a health provider's sustained eye gaze at exit with the patient's perceived empathy. Further studies are needed to explore barriers to empathic touch.
同理心对于患者获得与医护人员相处的最佳体验至关重要。言语同理心是医学生常规学习的内容，但非言语同理心，包括触摸，受到的关注较少。我们的目标是确定在问诊结束时鼓励共情触摸和目光接触的指导是否会影响行为并改变患者所感受到的同理心。
在标准化患者（SP）访谈期间，对34名一年级医学生进行了一项随机、对照、双盲试验。播放了一段视频，视频内容要么是鼓励在问诊结束时进行共情触摸和目光接触，要么是演示正确的手部卫生（对照组）。对问诊视频进行分析，以观察问诊结束时的触摸和目光接触情况。使用杰斐逊医生同理心患者感知量表来测量相关性。对接受干预的学生进行了关于患者触摸情况的调查。
其中，23.5%的接受干预的学生触摸了标准化患者，而对照组为零；88.2%的接受干预的学生在问诊结束时表现出目光接触。问诊结束时的目光接触对患者所感受到的同理心有积极影响（相关性 = 0.48，P <.001）。调查回复揭示了触摸方面的具体障碍。
医学生可以通过在问诊结束时进行目光接触来提高患者所感受到的同理心。在医学院层面开展关于共情触摸和问诊结束时持续目光接触的指导，可能有助于促进共情的非言语交流。医学教育工作者应考虑提供关于在病史采集过程中如何适当触摸患者的具体指导。这是为数不多的探索与患者触摸的研究之一，也是有史以来第一项报告医护人员问诊结束时持续目光接触与患者所感受到的同理心呈正相关的研究。需要进一步研究来探索共情触摸的障碍。
