Impact of serious illness communication skills training on medical students’ empathic attitudes and self-efficacy in empathic communication

Abstract

Background: Handling emotions is a common challenge for physicians when communicating bad news regarding serious illness. Communication training programs often focus on skills training, yet it is also important to assess their impact on other key determinants of behavior including attitudes and selfefficacy. This study aims to examine whether a serious illness communication training program can impact on medical students’ empathic attitudes and self-efficacy in empathic communication. Summary of Work: A one-week blended learning communication training program is delivered to sixthyear medical students (N=214) in 2018-2019. It consists of small group skills practice via role-play, and online training involving lectures, video-based exercises and reflective writing. A mixed-methods approach for program evaluation is used. Participants completed surveys with the Jefferson Scale of Empathy - Medical Students version (JSE-S) to assess attitudes toward empathy in patient care and self-rated preparedness in using specific empathic communication skills at baseline (T1), six weeks (T2), and between three to six months post-training (T3). Changes in mean JSE-S scores and preparedness levels were compared using paired t-tests. Qualitative data from written course reflections on the key lessons related to empathy were coded using thematic analysis. Summary of Results: Analysis to date indicates mean JSE-S scores at T2 were higher (110.41 vs 113.5, P = .055) and significantly higher at T3 (115.47, P = .017) compared to those at T1. Self-assessed preparedness in using empathic communication skills was significantly higher at T2 compared T1 (P <.01) and T3 compared to T2 (P < .02). Content analysis categorized the key lessons around empathy into three themes: the skills in understanding the feelings of others, the skills in communicating empathy, and positive attitudes regarding empathic behaviors in patient care. Discussion and Conclusions: Triangulation of data through a mixed-methods approach supports the effect of the communication training program on improving learner empathic attitudes and self-efficacy in empathic communication. The increase in mean JSE-S scores and preparedness levels from six weeks to between three and six months post-training supports the notion that these effects can be sustained and even enhanced long-term. Take-home Messages: A blended learning serious illness communication training program can foster learners’ development of empathic attitudes and self-efficacy in empathic communication.