Empathy Training For Medical Students Through A Blended Learning Communication Skills Training Programme: A Mixed-Methods Study

Abstract

Background and Aims: Empathy is an important foundation of the doctor-patient relationship and leads to improved patient and physician satisfaction as well improved clinical outcomes. Studies have shown a decline in empathy levels among medical students over the course of their medical education and the lack of effective empathy training has been postulated to be an underlying reason. However, what constitutes effective empathy training remains a question that continues to be debated in medical education. This study aims to examine this question through evaluating the impact of a communication skills training program that focuses on teaching medical students the skills in responding to emotion in serious illness conversations as a key learning outcome. Methods: An enhanced one-week long communication training program using blended learning will be delivered to sixth-year medical students (N=214) in the 2018-2019 academic year. It consists of a 2-hour small group tutorial for experiential learning via role-play, and pre- and post-tutorial online training consisting of e-Lectures, interactive, video-based exercises and reflective writing. A mixed-methods approach for program evaluation will be used. Changes in students’ self-efficacy in empathic communication skills over time will be assessed using self-administered questionnaires pre-training, 6-weeks, and 6-months post-training using paired t-tests. Additionally, changes in students’ attitudes toward empathy in clinical care will be measured with the Jefferson Scale of Empathy – Medical Students version (JSE-S) at the same time points. Qualitative data in the form of video recordings of the small group tutorials as well as students’ written reflections on the course will be imported into qualitative analysis software (Nvivo) and undergo coding by two independent researchers, using thematic analysis based on grounded theory until data saturation is achieved. Results: In the evaluation of the pilot phase of this communication skills training program on serious illness communication for sixth-year medical students in Hong Kong (N=185), 78% of students noted that they learned about empathy in their reflective writings on the key lessons from the program. Content analysis illustrated that the lessons around empathy fall into 3 themes: the skills in perspective-taking (cognitive empathy), the skills in communicating empathy (listening, nonverbal and verbal communication skills), and attitudes about the importance of physician empathy in clinical care. The study cohort of 214 medical students in the sixth-year class will have completed the communication training program by the end of the 2018-19 academic year. The authors will report the preliminary results for the pre-post (6 week) comparison and qualitative data from the on-going thematic analysis of video recordings and course reflection for approximately half of the class. Conclusion: Preliminary evaluation of a pilot communication skills training program has shown that such a program has the potential to impact on the attitudinal and skills-based dimensions of clinical empathy. Examining the impact of the communication training program through a mixed-methods approach combining both qualitative and quantitative analyses may provide important insights on how such a program can be effective for empathy training.