Examining the Trajectory of Empathy and Communication Skills of Emory University School of Medicine Medical Students Open Access

Blair, Jolie (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/q524jn80f?locale=en


Objective: Objective Structured Clinical Examinations (OSCEs) are used in medical education to assess learners’ history-taking, physical examination, counselling, communication and empathy skills. Interactions with standardized patients (SPs) in medical schools simulates a ‘real life’ doctor-patient encounter. Physician empathy is critical, as it is associated with increased patient satisfaction, improved patient adherence, and enhanced quantity and quality of clinical data. Past research indicates that learners’ empathy skills decline throughout medical school due to a multitude of factors including isolation and stress. The objective of this study of this study is to examine the trends in medical learners’ communication and empathy skills directly assessed by SPs. Based on previous literature, we hypothesized that empathy skills would decrease overtime.

Participants and Methods: 114 learners from the Emory University Medical School Class of 2016 completed the End of Foundations (EOF) OSCE in 2013, End of Applications (EOA) OSCE in 2015, and Emergency Medicine (EM) OSCE, either in 2015 or 2016. These OSCEs correspond to years 2, 3, and 4 of the learners’ medical school career. Communication and empathy items were selected from the Master Interview Rating Scale (MIRS) used in individual OSCE cases.

Results: Communication scores declined significantly throughout medical school. Empathy scores initially declined, but increased from Year 3 to Year 4, though not significantly. Male learners’ communication scores were significantly lower than the females’. Male learners’ empathy scores were higher than the females’ though not significantly.

Conclusion: The data indicated an initial decline in empathy, yet it is unclear if empathy declines throughout medical school. Communication skills declined significantly through the three years studied. The MIRS checklist is a validated communication tool, and while it is not specifically designed to measure empathy, components of the checklist contain elements that allow for assessment of empathy skills.  As patient-centered care and patient satisfaction are becoming increasingly important in the healthcare domain, physician communication and empathy play crucial roles in enhancing the doctor-patient encounter. Future research using validated tools to assess empathy will allow for better mapping of the trajectory of learners’ empathy skills throughout medical school.

Table of Contents

Table of Contents


1     Introduction. 9


1.1      An Introduction to Objective Structured Clinical Examinations (OSCEs) 9


1.2      Definition(s) of Communication. 9


1.3      A Definition(s) of Empathy. 10


1.4      Connection between Communication and Empathy. 11


1.5      Arguments for Physician Empathy. 11


1.6      Arguments Against Physician Empathy. 12


1.7      Changes in Empathy Throughout Medical School 13


1.8      Past Study Limitations. 14


2     Methods. 15


2.1      Participants. 15


2.2      Data Collection. 15


2.3      Cases and Items. 16


2.4      Measure of Communication. 17


2.5      Measure of Empathy. 18


2.6      Experimental Procedure. 18


2.7      Statistical Analysis. 19


3     Results. 20


3.1      Communication Scores. 20


3.2      Empathy Scores. 20


4     Discussion. 22


4.1      Limitations. 24


4.2      Future Research. 24


5     Conclusion. 25


6     Appendix 1: Tables. 26


7     Appendix 2: Figures. 33


8     References. 39





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