Try walking in their shoes. Physicians and Empathy.

By Daniel Cabrera (@CabreraERDR)

Empathy is important, no doubt about it.

Empathy is on the #meded main stage recently, its importance in healthcare has been highlighted by studies showing its relationship to patient outcomes, physician burnout and even rates of litigation.  Empathy is an emotional state, where the observer develops the capacity to understand and share the feelings and perspective of someone else.

Clinical empathy is a more specific and complex construct commonly used in the realm of medical education and patient care.

Clinical empathy is structured around four different dimensions: (1) emotive; the ability to imagine others perspectives and emotions, (2) moral; the motivation to empathize, (3) cognitive; the ability to identify emotions and perspectives and (4) behavioral; the ability to convey understanding.

Over the last twenty years, the recognition of empathy as a cognitive skill that can be taught and refined (and not a personality trait)  has led to the creation and implementation of empathy curricula in undergraduate and postgraduate medical education, including some live and online courses such as VitalTalk and Empathics. This is a major step in recognizing communication and other soft skills as fundamental for caring for people.

Empathy is also important in education, in its influence on the relationship between teacher and student.

While medical education has changed significantly in recent decades, but many of us can still remember faculty with aggressive or even abusive approaches to team management, bedside skills and didactic teaching styles.  In this model the teacher has almost complete ownership of the student, pushing them towards the limits of the clinical and emotional performance; it was the old school method of break it in order to make it.

This paradigm reveals an near complete lack of empathy from the teacher towards the student, where the person in power is  dismissive or cruel. Interestingly, this phenomenon has an empiric basis with correlations showing that people in higher levels of power show less empathy and interest for people in lower power levels, even if the higher position is only recent and transitory.

The life of a resident (house officer/ registrar) is hard in many ways: increasing debt, uncertainty about work opportunities after training, lack of control over a schedule, hard physical requirements, challenging emotional experiences, impostor syndrome, fear of unjustified retaliation, burnout, depression, anxiety, fear of abuse from supervisors, etc. All of us who are now faculty experienced some of this during residency (and may still be experiencing it). Our duty as educators is to acknowledge these challenges and demonstrate empathy towards our residents as they work with us to address necessary changes.

Empathic teachers are able to understand their students better, and adapt curricula and strategies to help learners perform better. Empathic teachers have better self-awareness and lower burn out rates. Most significantly demonstrating empathy is the right way to do stuff.

My anecdotal experience is that empathy is what differentiates a good teacher from a master. My institution rewards the best clinical teacher annually (as chosen by the residents and fellows). The faculty member who consistently gets named Teacher of the Year is the one, in addition to clinical and scholarly prowess, is able to create relationships with learners.

These are the two keys, (1) the creation of a nurturing and structured relationship between teacher and learner, while keeping clear boundaries and rules, and (2) the ability to metaphorically walk in the shoes of a learner, understanding the challenges they face.

How do you build such a relationship? Well, it requires significant time and emotional investment. It also requires some structure. Here is some advice adapted from Mendes (Building Classroom Relationships. September 2003, Volume 61, Number 1. Pages 56-59)

  • Acknowledge all interactions.
  • Use students’ names, skills, ideas, and knowledge in your discussions—without mentioning weaknesses or confidential information.
  • Use self-disclosure when appropriate.
  • Be a real person.
  • Use responses beginning with “I agree,” “I appreciate,” and “I respect.”
  • Ask students about their interests.
  • Pay attention to students’ nonverbal responses and make adjustments as you capture their interest or hit neutral ground.
  • Build on what you hear from students by sharing stories, interests, and worries.
  • Display empathy with individuals by communicating what you think their needs or feelings might be.
  • Listen actively. Match students’ expressions and conveyed moods. Paraphrase their message, when appropriate.
  • Know your students’ world and go there first to open the relationship door.

The ultimate goal of the master Clinician Educator is to adopt strategies that build empathy with our learners.  Without empathy the effectiveness of our education interventions suffer.

Image by Roland Lakis via flickr under Creative Commons License CC2.0

References and further reading