Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
Auckland City Hospital, Auckland, New Zealand.
Teach Learn Med. 2023 Oct-Dec;35(5):502-513. doi: 10.1080/10401334.2022.2103816. Epub 2022 Aug 5.
Compassion, and related constructs such as empathy, are core values in healthcare, with known benefits for both patients and staff. Yet research on the factors that affect compassion and compassion-related constructs remains scattered. This review systematizes and synthesizes studies investigating the predictors of compassion and related constructs among medical students, allowing for a better understanding of the factors that both positively and negatively contribute to the development of compassionate future physicians. A systematic review of 12 databases for studies from database inception up until April 2020 was conducted. Non-peer-reviewed literature and studies in which >50% of the sample were non-medical students were excluded. Intervention studies were also out of the scope of this review. We assessed risk of bias and confidence in the findings using standardized tools. Data were categorized within the Transactional Model of Physician Compassion, a framework in which compassion is influenced by personal (student), environmental, patient/family, and clinical factors. Of 14,060 retrieved articles, 222 studies were included. Of these, 95% studied student factors, but only 25% studied environmental, 9% studied patient, and 6% studied clinical factors. Predictors of greater compassion included maturity; work and life experiences; personality traits of openness to experience and agreeableness; skills such as perspective taking, reflection, and mindfulness; and positive role modeling. Conversely, negative attitudes/emotions, burnout, stress, detachment, operating in cultures prioritizing knowledge and efficiency over humanistic care, negative role models, time constraints, and heavy workloads predicted lower compassion. Patient-related factors included "difficult" and "noncompliant" patients or those perceived as responsible for their illness. Overall, 60% of studies had a serious risk of bias, particularly confounding and participant selection biases. Medical student compassion is predicted by a wide range of factors relating to the student, their training environment, their patients, and the clinical situation. However, existing research has largely focused on student factors (e.g., sociodemographic and dispositional traits), many of which are not amenable to intervention. Skills such as perspective taking, reflection, and mindfulness are associated with higher compassion and may present opportunities for intervention. There is also strong evidence that environmental factors shape students' compassion. Researchers and educators should continue to explore the impact of patient and clinical factors on students' compassion. Studies remain at high risk of bias.
同情和同理心等相关概念是医疗保健的核心价值观，对患者和医务人员都有好处。然而，关于影响同情和相关概念的因素的研究仍然分散。本综述系统地综合了调查医学生同情心和相关概念预测因素的研究，使人们更好地理解哪些因素积极和消极地促进了富有同情心的未来医生的发展。对从数据库建立之初到 2020 年 4 月的 12 个数据库的研究进行了系统综述。排除了非同行评议文献和超过 50%的样本是非医学生的研究。干预研究也不在本综述的范围内。我们使用标准化工具评估偏倚风险和研究结果的可信度。数据分为医生同情心交易模型内，同情心受个人（学生）、环境、患者/家庭和临床因素影响的框架内。在 14060 篇检索到的文章中，有 222 篇研究被纳入。其中，95%的研究是学生因素，但只有 25%的研究是环境因素，9%的研究是患者因素，6%的研究是临床因素。更具同情心的预测因素包括成熟度、工作和生活经验、开放性和随和性的人格特质、换位思考、反思和正念等技能，以及积极的榜样作用。相反，消极的态度/情绪、倦怠、压力、冷漠、在重视知识和效率而不是人文关怀的文化中运作、消极的榜样、时间限制和工作量大，预示着同情心较低。患者相关因素包括“困难”和“不配合”的患者或那些被认为对自己的疾病负责的患者。总的来说，60%的研究存在严重的偏倚风险，特别是混杂和参与者选择偏倚。医学生的同情心受到与学生、他们的培训环境、他们的患者和临床情况相关的广泛因素的预测。然而，现有的研究主要集中在学生因素（例如，社会人口统计学和性格特征）上，其中许多因素都不容易干预。换位思考、反思和正念等技能与更高的同情心有关，可能为干预提供机会。也有强有力的证据表明，环境因素塑造了学生的同情心。研究人员和教育者应继续探索患者和临床因素对学生同情心的影响。研究仍然存在很高的偏倚风险。
