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Can Training Increase Physicians’ Empathy with Patients?

May 8, 2012
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Training resulted in improvements in how patients perceived their interactions with resident physicians


A group of researchers at Massachusetts General Hospital (MGH) in Boston maintain that resident physician’s participation in a brief training program that is designed to increase empathy with their patients has resulted in significant improvements in how patients perceive their interactions with residents.  The report from the MGH team will appear in the Journal of General Internal Medicine.
Helen Reiss, M.D., of hospital’s Department of Psychiatry, who led the study (she is also chief technology officer of Empathetics LLC, which was formed to bring the training to a wider audience), says the most exciting finding of the study is that empathy can be taught and that improved empathy can be perceived by the patients. According to MGH, some studies have found that medical training is often accompanied by a drop in empathy, and some have pinpointed the third year of medical school. According to Reiss, possible reasons are self-protection by medical trainees against their own emotional distress and a desensitization that occurs from performing potentially painful procedures.
Recent studies have revealed the neurological basis of empathy. Reiss built on that information to develop a protocol involving three 60-minute training sessions that begin with focusing on the neurobiology of emotion and go on to address recognition of facial expressions and other non-verbal emotional cues, emotional self-awareness and strategies for dealing with challenging patients or delivering bad clinical news. The sessions also include techniques for recognizing the impact of stress and fatigue on one's own behavior and regulating personal stress responses.
The study enrolled 99 residents and clinical fellows in Medicine, Surgery, Anesthesia, Psychiatry, Orthopedics and Ophthalmology from MGH or the Massachusetts Eye and Ear Infirmary. Half were randomly assigned to participate in the empathy training sessions while the others continued their standard program. At the outset of the study, several of the patients seen by each study participant completed a standard assessment of their most recent interaction with the physician. The survey asked patients to rank how well the physician did in “making you feel at ease,” “fully understanding your concerns,” “showing care and compassion” and similar measures. 
The three training sessions were delivered over four-week periods to groups of six to 15 residents in the same specialty, starting within a month of the initial patient ratings. One to two months after training sessions were completed, another group of patients was asked to assess their interactions with their participating physicians—both those who completed the empathy training and the control group. In addition, participating residents completed before-and-after tests of their knowledge of the neurobiology and physiology of emotion, assessments of their ability to decode facial expressions and the value they placed on empathic communication, along with self-assessment of their empathy-related attitudes and skills. 
According to MGH, study participants who completed the training course showed significant improvement in patient ratings of their empathic behavior, while the control group showed a decline in empathy during the study period. Training-group participants also had significantly greater improvement in knowledge of the mechanisms underlying empathy and in their ability to perceive and decode facial expression of emotion. There were no differences between the groups in self-reported attitudes about the importance of empathy or in improved empathy outside of patient interactions. Participants in the training course were overwhelmingly positive about the benefits of the course. 
Reiss says the study is the first to show that a neurobiologically informed training program results in statistically significant improvement at the level of patient perception, without necessarily increasing the time physicians spend with patients.