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Published in: Journal of General Internal Medicine 10/2012

01-10-2012 | Original Research

Empathy Training for Resident Physicians: A Randomized Controlled Trial of a Neuroscience-Informed Curriculum

Authors: Helen Riess, MD, John M. Kelley, PhD, Robert W. Bailey, BS, Emily J. Dunn, BA, Margot Phillips, MD

Published in: Journal of General Internal Medicine | Issue 10/2012

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Abstract

Background

Physician empathy is an essential attribute of the patient–physician relationship and is associated with better outcomes, greater patient safety and fewer malpractice claims.

Objective

We tested whether an innovative empathy training protocol grounded in neuroscience could improve physician empathy as rated by patients.

Design

Randomized controlled trial.

Intervention

We randomly assigned residents and fellows from surgery, medicine, anesthesiology, psychiatry, ophthalmology, and orthopedics (N = 99, 52% female, mean age 30.6 ± 3.6) to receive standard post-graduate medical education or education augmented with three 60-minute empathy training modules.

Main Measure

Patient ratings of physician empathy were assessed within one-month pre-training and between 1–2 months post-training with the use of the Consultation and Relational Empathy (CARE) measure. Each physician was rated by multiple patients (pre-mean = 4.6 ± 3.1; post-mean 4.9 ± 2.5), who were blinded to physician randomization. The primary outcome was change score on the patient-rated CARE.

Key Results

The empathy training group showed greater changes in patient-rated CARE scores than the control (difference 2.2; P = 0.04). Trained physicians also showed greater changes in knowledge of the neurobiology of empathy (difference 1.8; P < 0.001) and in ability to decode facial expressions of emotion (difference 1.9; P < 0.001).

Conclusions

A brief intervention grounded in the neurobiology of empathy significantly improved physician empathy as rated by patients, suggesting that the quality of care in medicine could be improved by integrating the neuroscience of empathy into medical education.
Literature
1.
go back to reference Nunes P, Williams S, Stevenson K. A study of empathy decline in students from five health disciplines during their first year of training. Int J Med Educ. 2011;2:12–7.CrossRef Nunes P, Williams S, Stevenson K. A study of empathy decline in students from five health disciplines during their first year of training. Int J Med Educ. 2011;2:12–7.CrossRef
2.
go back to reference Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182–91.PubMedCrossRef Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182–91.PubMedCrossRef
3.
go back to reference Bellini LM, Shea JA. Mood changes and empathy decline persist during internal medicine residency training. Acad Med. 2005;80:164–7.PubMedCrossRef Bellini LM, Shea JA. Mood changes and empathy decline persist during internal medicine residency training. Acad Med. 2005;80:164–7.PubMedCrossRef
4.
go back to reference Neumann M, Edelhäuser F, Tauschel D, et al. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996–1009.PubMedCrossRef Neumann M, Edelhäuser F, Tauschel D, et al. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996–1009.PubMedCrossRef
5.
go back to reference Colliver JA, Conlee MJ, Verhulst SJ, Dorsery JK. Reports of the decline of empathy during medical education are greatly exaggerated: A reexamination of the research. Acad Med. 2010;85(4):588–93.PubMedCrossRef Colliver JA, Conlee MJ, Verhulst SJ, Dorsery JK. Reports of the decline of empathy during medical education are greatly exaggerated: A reexamination of the research. Acad Med. 2010;85(4):588–93.PubMedCrossRef
6.
go back to reference Medical School Objectives Project. Learning Objectives for Medical Education: Guidelines for Medical Schools. Association of American Medical Colleges, 1998. Medical School Objectives Project. Learning Objectives for Medical Education: Guidelines for Medical Schools. Association of American Medical Colleges, 1998.
7.
go back to reference Chaudhry HJ, Rhyne J, Cain FE, Young A, Crane M, Bush F. Maintenance of licensure: protecting the public, promoting quality health care. J Med Regul. 2010;96(1):1–8. Chaudhry HJ, Rhyne J, Cain FE, Young A, Crane M, Bush F. Maintenance of licensure: protecting the public, promoting quality health care. J Med Regul. 2010;96(1):1–8.
8.
go back to reference Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. J Am Med Assoc. 2002;287(22):2951–7.CrossRef Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. Patient complaints and malpractice risk. J Am Med Assoc. 2002;287(22):2951–7.CrossRef
9.
go back to reference Halpern J. from detached concern to empathy: Humanizing medical practice. Paperbackth ed. New York: Oxford University Press; 2010. Halpern J. from detached concern to empathy: Humanizing medical practice. Paperbackth ed. New York: Oxford University Press; 2010.
10.
go back to reference Brennan TA, Leape LL, Laird NM. Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard medical practice study I. N Engl J Med. 1991;324:370–6.PubMedCrossRef Brennan TA, Leape LL, Laird NM. Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard medical practice study I. N Engl J Med. 1991;324:370–6.PubMedCrossRef
11.
go back to reference Marci CD, Riess H. The clinical relevance of psychophysiology: Support for the psychobiology of empathy and psychodynamic process. Am J Psychother. 2005;59(3):213–26.PubMed Marci CD, Riess H. The clinical relevance of psychophysiology: Support for the psychobiology of empathy and psychodynamic process. Am J Psychother. 2005;59(3):213–26.PubMed
12.
go back to reference Kelley JM, Lembo AJ, Ablon JS, et al. Patient and practitioner influences on the placebo effect in irritable bowel syndrome. Psychosom Med. 2009;71(7):789–97.PubMedCrossRef Kelley JM, Lembo AJ, Ablon JS, et al. Patient and practitioner influences on the placebo effect in irritable bowel syndrome. Psychosom Med. 2009;71(7):789–97.PubMedCrossRef
13.
go back to reference Kaptchuk TJ, Kelley JM, Conboy LA, et al. Components of placebo effect: Randomised controlled trial in patients with Irritable Bowel Syndrome. Br Med J. 2008;336:998–1003.CrossRef Kaptchuk TJ, Kelley JM, Conboy LA, et al. Components of placebo effect: Randomised controlled trial in patients with Irritable Bowel Syndrome. Br Med J. 2008;336:998–1003.CrossRef
14.
go back to reference Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz CG. J S. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359–64.PubMedCrossRef Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz CG. J S. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359–64.PubMedCrossRef
15.
go back to reference Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. J Am Med Assoc. 2009;302(12):1284–93.CrossRef Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. J Am Med Assoc. 2009;302(12):1284–93.CrossRef
16.
go back to reference Decety J, Yang C, Chen Y. Physicians down-regulate their pain empathy response: An event-related brain potential study. Neuroimage. 2010;50:1676–82.PubMedCrossRef Decety J, Yang C, Chen Y. Physicians down-regulate their pain empathy response: An event-related brain potential study. Neuroimage. 2010;50:1676–82.PubMedCrossRef
17.
go back to reference Harris J. The evolutionary neurobiology, emergence and facilitation of empathy. In: Farrow TFD, Woodruff PWR, eds. Empathy in mental illness. Cambridge: Cambridge University Press; 2007:506. Harris J. The evolutionary neurobiology, emergence and facilitation of empathy. In: Farrow TFD, Woodruff PWR, eds. Empathy in mental illness. Cambridge: Cambridge University Press; 2007:506.
18.
go back to reference Neumann M, Bensing J, Mercer S, Ernstmann N, Ommen O, Pfaff H. Analyzing the "nature" and "specific effectiveness" of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Educ Couns. 2009;74(3):339–46.PubMedCrossRef Neumann M, Bensing J, Mercer S, Ernstmann N, Ommen O, Pfaff H. Analyzing the "nature" and "specific effectiveness" of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Educ Couns. 2009;74(3):339–46.PubMedCrossRef
19.
go back to reference Decety J, Jackson PL. The functional architecture of human empathy. Behav Cogn Neurosci Rev. 2004;3:71–100.PubMedCrossRef Decety J, Jackson PL. The functional architecture of human empathy. Behav Cogn Neurosci Rev. 2004;3:71–100.PubMedCrossRef
20.
go back to reference Decety J. Dissecting the neural mechanisms mediating empathy. Emotion Review. 2011;3(1):92–108.CrossRef Decety J. Dissecting the neural mechanisms mediating empathy. Emotion Review. 2011;3(1):92–108.CrossRef
21.
go back to reference Riess H. Biomarkers in the psychotherapeutic relationship: the role of physiology, neurobiology, and biological correlates of E.M.P.A.T.H.Y. Harv Rev Psychiatry. 2011;19(3):162–74.PubMedCrossRef Riess H. Biomarkers in the psychotherapeutic relationship: the role of physiology, neurobiology, and biological correlates of E.M.P.A.T.H.Y. Harv Rev Psychiatry. 2011;19(3):162–74.PubMedCrossRef
22.
go back to reference Smith RC, Lyles JS, Mettler JA, et al. A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study. Acad Med. 1995;70(8):729–32.PubMedCrossRef Smith RC, Lyles JS, Mettler JA, et al. A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study. Acad Med. 1995;70(8):729–32.PubMedCrossRef
23.
go back to reference Alder J, Christen R, Zemp E, Bitzer J. Communication skills training in obstetrics and gynaecology: whom should we train? A randomized controlled trial. Arch Gynecol Obstet. 2007;276:605–612.PubMedCrossRef Alder J, Christen R, Zemp E, Bitzer J. Communication skills training in obstetrics and gynaecology: whom should we train? A randomized controlled trial. Arch Gynecol Obstet. 2007;276:605–612.PubMedCrossRef
24.
go back to reference Stein T, Frankel RM, Krupat E. Enhancing clinician communication skills in a large healthcare organization: a longitudinal case study. Patient Educ Couns. 2005;58(1):4–12.PubMedCrossRef Stein T, Frankel RM, Krupat E. Enhancing clinician communication skills in a large healthcare organization: a longitudinal case study. Patient Educ Couns. 2005;58(1):4–12.PubMedCrossRef
25.
go back to reference Riess H. Empathy in medicine—A neurobiological perspective. J Am Med Assoc. 2010;304(14):1604–5.CrossRef Riess H. Empathy in medicine—A neurobiological perspective. J Am Med Assoc. 2010;304(14):1604–5.CrossRef
26.
go back to reference Riess H, Kelley JM, Bailey RW, Konowitz PM, Gray ST. Improving empathy and relational skills in otolaryngology residents: a pilot study. Otolaryngol Head Neck Surg. 2011;144(1):120–2.PubMedCrossRef Riess H, Kelley JM, Bailey RW, Konowitz PM, Gray ST. Improving empathy and relational skills in otolaryngology residents: a pilot study. Otolaryngol Head Neck Surg. 2011;144(1):120–2.PubMedCrossRef
27.
go back to reference Carr L, Iacoboni M, Dubeau M, Mazziotta JC, Lenzi GL. Neural mechanisms of empathy in humans: a relay from neural systems for imitation to limbic areas. Proc Natl Acad Sci. 2003;100(9):5497–502.PubMedCrossRef Carr L, Iacoboni M, Dubeau M, Mazziotta JC, Lenzi GL. Neural mechanisms of empathy in humans: a relay from neural systems for imitation to limbic areas. Proc Natl Acad Sci. 2003;100(9):5497–502.PubMedCrossRef
28.
go back to reference Saarela MV, Hlushchuk Y, Williams AC, Schürmann M, Kalso E, Hari R. The compassionate brain: humans detect intensity of pain from another's face. Cereb Cortex. 2007;17(1):230–7.PubMedCrossRef Saarela MV, Hlushchuk Y, Williams AC, Schürmann M, Kalso E, Hari R. The compassionate brain: humans detect intensity of pain from another's face. Cereb Cortex. 2007;17(1):230–7.PubMedCrossRef
29.
go back to reference Hammond DC. Hypnotic induction and suggestion: An introductory manual. 1st ed. Des Plaines, IL: The American Society of Clinical Hypnosis; 1988. Hammond DC. Hypnotic induction and suggestion: An introductory manual. 1st ed. Des Plaines, IL: The American Society of Clinical Hypnosis; 1988.
31.
go back to reference Mercer SW, Maxwell M, Heaney D, Watt GCM. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004;21(6):699–705.PubMedCrossRef Mercer SW, Maxwell M, Heaney D, Watt GCM. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract. 2004;21(6):699–705.PubMedCrossRef
32.
go back to reference Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.PubMedCrossRef Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.PubMedCrossRef
33.
go back to reference Ekman P. Emotions revealed: Recognizing faces and feelings to improve communication and emotional life. New York: Holt; 2004. Ekman P. Emotions revealed: Recognizing faces and feelings to improve communication and emotional life. New York: Holt; 2004.
34.
go back to reference Hojat M, Mangione S, Nasca TJ, et al. The Jefferson Scale of Physician Empathy: Development and preliminary psychometric data. Educ Psychol Meas. 2001;61:349–65.CrossRef Hojat M, Mangione S, Nasca TJ, et al. The Jefferson Scale of Physician Empathy: Development and preliminary psychometric data. Educ Psychol Meas. 2001;61:349–65.CrossRef
36.
go back to reference Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
37.
go back to reference Hemmerdinger JM, Samuel DR Stoddart SDR, Lilford RJ. A systematic review of tests of empathy in medicine. BMC Med Educ. 2007;7(24). Hemmerdinger JM, Samuel DR Stoddart SDR, Lilford RJ. A systematic review of tests of empathy in medicine. BMC Med Educ. 2007;7(24).
38.
go back to reference Bieber C, Muller KG, Blumenstiel K, et al. A shared decision-making communication training program for physicians treating fibromyalgia patients: effects of a randomized controlled trial. J Psychosom Res. 2008;64:13–20.PubMedCrossRef Bieber C, Muller KG, Blumenstiel K, et al. A shared decision-making communication training program for physicians treating fibromyalgia patients: effects of a randomized controlled trial. J Psychosom Res. 2008;64:13–20.PubMedCrossRef
39.
go back to reference Brown LD, De Negri B, Hernandez O, Domingueq L, Sanchack JH, Roter DL. An evaluation of the impact of training Honduran health care providers in interpersonal communication. Int J Qual Health Care. 2000;12(6):595–01.CrossRef Brown LD, De Negri B, Hernandez O, Domingueq L, Sanchack JH, Roter DL. An evaluation of the impact of training Honduran health care providers in interpersonal communication. Int J Qual Health Care. 2000;12(6):595–01.CrossRef
40.
go back to reference Roter DL, Rosenbaum J, de Negri B, Renaud D, DiPrete-Brown L, Hernandez O. The effects of a continuing medical education programme in interpersonal communication skills on doctor practice and patient satisfaction in Trinidad and Tobago. Med Educ. 1998;32:181–9.PubMedCrossRef Roter DL, Rosenbaum J, de Negri B, Renaud D, DiPrete-Brown L, Hernandez O. The effects of a continuing medical education programme in interpersonal communication skills on doctor practice and patient satisfaction in Trinidad and Tobago. Med Educ. 1998;32:181–9.PubMedCrossRef
41.
Metadata
Title
Empathy Training for Resident Physicians: A Randomized Controlled Trial of a Neuroscience-Informed Curriculum
Authors
Helen Riess, MD
John M. Kelley, PhD
Robert W. Bailey, BS
Emily J. Dunn, BA
Margot Phillips, MD
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 10/2012
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-012-2063-z

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