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JSBCH 2023, 7(1): 1081-1090 |
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Baghian M, Salimi Z, Keshmiri F, Ghasemi Noghabi P, Bidaki R, Hosseini Kasnavie F, et al . Evaluating the Level of Inter Professional Communication and Collaboration Self-Efficacy and Empathy with Patients among Medical Residents in Shahid Sadoughi University of Medical Sciences, Yazd, 2020. JSBCH 2023; 7 (1) :1081-1090
URL: http://sbrh.ssu.ac.ir/article-1-203-en.html
URL: http://sbrh.ssu.ac.ir/article-1-203-en.html
Mohaddese Baghian1 
, Zanire Salimi2 , Fatemeh Keshmiri * 3, Parisa Ghasemi Noghabi2 , Reza Bidaki4 , Fateme Hosseini Kasnavie5 , Tahere Sadeghiyeh5 , Farima Fallah Tafti6
, Zanire Salimi2 , Fatemeh Keshmiri * 3, Parisa Ghasemi Noghabi2 , Reza Bidaki4 , Fateme Hosseini Kasnavie5 , Tahere Sadeghiyeh5 , Farima Fallah Tafti6
1- Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd , Iran
2- Psychiatry and Behavioral Sciences Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
3- Department of Medical Education, Shahid Sadoughi University of Medical Sciences, Yazd , Iran , keshmiri1395@gmail.com
4- 1. Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2. Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
5- Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
6- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2- Psychiatry and Behavioral Sciences Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
3- Department of Medical Education, Shahid Sadoughi University of Medical Sciences, Yazd , Iran , keshmiri1395@gmail.com
4- 1. Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2. Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
5- Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
6- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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| Abstract (HTML) (218 Views)
The Pearson correlation coefficient was used.
* Significant correlation
Linear regression was used.
* Significant relationship
One-way analysis of variance was used for comparison
Variables sharing similar superscript letters were significantly different.
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Evaluating the Level of Inter Professional Communication and Collaboration Self-Efficacy and Empathy with Patients among Medical Residents
Mohadese Baghian a , Zanireh Salimi b , Fatemeh Keshmiri c* , Parisa Ghasemi Noghabi b , Reza Bidaki a,d ,
Fatemeh Hosseini Kasnavie a , Tahere Sadeghiyeh a , Farima Fallah Tafti e
Introduction
Mohadese Baghian a
Fatemeh Hosseini Kasnavie a
a Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
b Psychiatry and Behavioral Sciences Research Center , Mashhad University of Medical Sciences , Mashhad, Iran.
c Department of Medical Education, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
d Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
e Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
b Psychiatry and Behavioral Sciences Research Center , Mashhad University of Medical Sciences , Mashhad, Iran.
c Department of Medical Education, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
d Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
e Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| A R T I C L E I N F O | A B S T R A C T | |
| ORIGINAL ARTICLE |
Background: Medical assistants spend numerous hours of their day in the work environment, which may influence their performance. Empathy with the patients has a significant impact on the treatment process. This study was conducted among residents of different medical disciplines to determine self-efficacy in inter professional collaboration and empathy in dealing with the patients.
Methods: This was a descriptive-analytical cross-sectional study on all medical residents at Shahid Sadoughi University of Medical Sciences. Data was collected via the following questionnaires: demographic (including age, gender, marital status, year of study, and specialty), Jefferson’s scale of empathy, self-efficacy, and Hagemeier’s interring professional collaboration.
Results: Of the 162 questionnaires distributed, 135 were received (response rate = 83.33%). The mean age and work experience were 31.42 ± 4.56 and 2.70 ± 4.18 years, respectively. Self-efficacy scores in inter professional cooperation and teamwork was at a good level and empathy scores were at a moderate level. There was a significant relationship between marital status and self-efficacy (p = 0.03). Empathy was related to medical residents’ level of interest in their field (p = 0.019). There was no gender difference in empathy (p = 0.77) and self-efficacy scores (p = 0.36). However, males had higher inter professional communication scores compared to females (p = 0.001). Psychiatric residents had the highest and orthopedic residents had the lowest scores in empathy with the patients, empathic patient care, and emotional separation.
Conclusion: This study showed that medical residents had an acceptable level of self-efficacy and empathy, which differed among medical fields. Similar studies should be conducted to therefore assemble an educational program for medical residents to increase empathic patient care and achieve inter professional cooperation goals.
Keywords: Empathy, Inter professional relations, Medical residency, Physicians, Self-efficacy
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Article History:
Received: 01 Jan 2023 Revised: 18 Apr 2023 Accepted: 22 Apr 2023 |
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*Corresponding Author:
Fatemeh Keshmiri Email: keshmiri1395@gmail.com Tel: +98 35 38265559 |
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Citation: Baghian M, Salimi Z, Keshmiri F, Ghasemi Noghabi P, Bidaki R, Hosseini Kasnavie F, Sadeghyie T, et al. Evaluating the Level of Inter Professional Communication and Collaboration Self-Efficacy and Empathy with Patients among Medical Residents in Shahid Sadoughi University of Medical Sciences, Yazd, 2020. Journal of Social Behavior and Community Health (JSBCH). 2023; 7(1): 1081-1090.
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In the past decades, the importance of patient safety and the quality of patient service has noticeably emerged, resulting in the development of various strategies to achieve them. According to the World Health Organization report in 2010, one of these strategies is inter professional education and collaboration. Inter professional collaboration is the cooperation of the health system personnel with each other, regardless of their professions, and their connection with the patients, the patient’s family, and the community to deliver the overall best patient service achievable (Van Diggele et al., 2020). The Accreditation Council for Graduate Medical Education’s (ACGME’) outcome project investigated the interpersonal skills of medical residents to evaluate their overall performance and enhance residency educational programs (Swing, 2002). A study performed by Keshmiri (2019) also showed the low scoring of inter professional cooperation among healthcare team members and concluded that these skills should be applied to educational programs. Therefore, inter professional communication is a skill of high significance that should be implied to the educational programs of all healthcare workers to enhance the quality of patient service.
Studies show that self-efficacy beliefs can influence inter professional and interpersonal communication. Bandura’s self-efficacy theory states a positive correlation between the individual’s level of engagement in this type of communication
and task-specific communication self-efficacy (Hagemeier et al., 2014). Furthermore, self-efficacy is essential for behavior change and a valuable predictor of behavior (Bandura, 1977). Self-efficacy defines how people think, feel, and behave. In its early stages, it is formed as a result of successive support and the execution of realistic programs, rather than self-convincing and believing that "I think" and "I can" (Van Diggele et al., 2020).
Empathy is the ability to put one's-self in the shoes of others and thus better understand their feelings and experiences. Empathy consists of two parts; a cognitive part, which is the ability to recognize the feelings and experiences of others, and the emotional part, which consists of sharing their feelings and experiences. However, in medical practice, the latter domain is usually neglected (Eklund and summer, 2021). Empathy is communication that harmonizes a person with the feelings and thoughts of others, connects him to the social world, helps others, and prevents harm (Hall and Shwartz, 2019). Empathy is linked to various factors, including social skills, sense of altruism, flexibility, ability to be patient and tolerant, sense of humor, positive attitude towards the elderly, history taking ability and correct clinical examination; gender, personality, educational experiences and positive relationship with parents (Shariat and Kaykhavoni, 2010). Empathy with patients is necessary for proper treatment and increases patient satisfaction (Moralle et al., 2016). However, due to the lack of a unique definition and inadequate measuring tools, the overall research performed in this field is limited (Shariat and Kaykhavoni, 2010). Different studies presented diverse results regarding the role of factors affecting the level of empathy in doctors (Kheirabadi et al., 2016). There is a controversy between previous studies regarding empathy. Some studies have shown that the level of empathy decreases with the increase in education level, while others have defined empathy as a fixed personality trait and believe that the level of empathy always remains constant ( Kheirabadi et al.,2016).
and task-specific communication self-efficacy (Hagemeier et al., 2014). Furthermore, self-efficacy is essential for behavior change and a valuable predictor of behavior (Bandura, 1977). Self-efficacy defines how people think, feel, and behave. In its early stages, it is formed as a result of successive support and the execution of realistic programs, rather than self-convincing and believing that "I think" and "I can" (Van Diggele et al., 2020).
Empathy is the ability to put one's-self in the shoes of others and thus better understand their feelings and experiences. Empathy consists of two parts; a cognitive part, which is the ability to recognize the feelings and experiences of others, and the emotional part, which consists of sharing their feelings and experiences. However, in medical practice, the latter domain is usually neglected (Eklund and summer, 2021). Empathy is communication that harmonizes a person with the feelings and thoughts of others, connects him to the social world, helps others, and prevents harm (Hall and Shwartz, 2019). Empathy is linked to various factors, including social skills, sense of altruism, flexibility, ability to be patient and tolerant, sense of humor, positive attitude towards the elderly, history taking ability and correct clinical examination; gender, personality, educational experiences and positive relationship with parents (Shariat and Kaykhavoni, 2010). Empathy with patients is necessary for proper treatment and increases patient satisfaction (Moralle et al., 2016). However, due to the lack of a unique definition and inadequate measuring tools, the overall research performed in this field is limited (Shariat and Kaykhavoni, 2010). Different studies presented diverse results regarding the role of factors affecting the level of empathy in doctors (Kheirabadi et al., 2016). There is a controversy between previous studies regarding empathy. Some studies have shown that the level of empathy decreases with the increase in education level, while others have defined empathy as a fixed personality trait and believe that the level of empathy always remains constant ( Kheirabadi et al.,2016).
Decreased empathy and increased stress positively relate to medical errors (West et al., 2006). In addition, residents' distress, particularly job burnout, harms their practice habits and behaviors, including empathy with patients (Seeberger et al., 2020). On the other hand, physicians' empathy has led to better treatment outcomes, increased safety and security of patients, and less misbehavior in dealing with them (Riess et al., 2012).
Several studies have shown that educational programs for healthcare workers and students can significantly improve the level of empathy and self-efficacy among them. A study conducted among intensive care unit health workers indicated that a simulation training program improved the confidence and self-efficacy of the learners (Nogi et al., 2020). Another study concluded that students that participated in a student hotspot program showed greater self-efficacy and empathy (Collins et al., 2020).
Educational programs are mainly designed and applied based on clinical setting outcomes and principles. Considering that the research results regarding empathy in medical education and medical students have shown significant weakness, comprehensive planning should be performed to develop cooperation skills among medical residents. Therefore, it is essential to determine the level of empathy with patients and the self-efficacy of medical residents regarding inter professional cooperation and communication. This information can be a starting point for planning education programs to achieve inter professional cooperation goals.
Methods
This descriptive-analytical cross-sectional study was performed among medical residents who studied at the Shahid Sadoughi University of Medical Sciences, Yazd, Iran, from March 2020 to March 2021. The inclusion criteria were the participants' willingness to join the study. Exclusion criteria were guest residents from other universities and residents who had started their residency in the university for less than three months.
Educational programs are mainly designed and applied based on clinical setting outcomes and principles. Considering that the research results regarding empathy in medical education and medical students have shown significant weakness, comprehensive planning should be performed to develop cooperation skills among medical residents. Therefore, it is essential to determine the level of empathy with patients and the self-efficacy of medical residents regarding inter professional cooperation and communication. This information can be a starting point for planning education programs to achieve inter professional cooperation goals.
Methods
This descriptive-analytical cross-sectional study was performed among medical residents who studied at the Shahid Sadoughi University of Medical Sciences, Yazd, Iran, from March 2020 to March 2021. The inclusion criteria were the participants' willingness to join the study. Exclusion criteria were guest residents from other universities and residents who had started their residency in the university for less than three months.
Measurement
The study tools included the following questionnaires: demographic, Jefferson’s scale of empathy, Hagemeier interprofessional collaboration, and self-efficacy. The demographic questionnaire included data on basic variables including the participant’s age, gender, marital status, education year, and field of education. Other variables included self-efficacy and interprofessional collaboration. The Jefferson’s Scale of Empathy questionnaire for physicians and health care personnel is a 20-item scale concluding four domains. Each domain is scored based on a 5-point Likert scale.
Data collection
Participants scored their level of empathy with the patients on a scale ranging from zero to 100. Self-efficacy was evaluated using the self-efficacy in interprofessional collaboration and communication questionnaire. This questionnaire includes 33 items in four domains that are designed based on the Interprofessional Education Collaborative (IPEC) core competencies framework (Keshmiri, 2021). The internal consistency of the self-efficacy questionnaire was previously evaluated and was found to be appropriate (internal consistency coefficient > 0.75, Cronbach’s alpha > 0.70).
Data collection
Participants scored their level of empathy with the patients on a scale ranging from zero to 100. Self-efficacy was evaluated using the self-efficacy in interprofessional collaboration and communication questionnaire. This questionnaire includes 33 items in four domains that are designed based on the Interprofessional Education Collaborative (IPEC) core competencies framework (Keshmiri, 2021). The internal consistency of the self-efficacy questionnaire was previously evaluated and was found to be appropriate (internal consistency coefficient > 0.75, Cronbach’s alpha > 0.70).
Data analysis
The collected data were analyzed using the statistical package for social sciences (SPSS) software version 23. Comparison of continuous variables between study groups was performed using the analysis of variance (ANOVA), while the chi-square test was used to compare categorical variables between groups. The Pearson correlation coefficient and linear regression were used to evaluate the relationship between questionnaire scores and other study variables. The level of statistical significance was p < 0.05.
Sampling was performed based on census sampling using the convenience sampling method. The study protocol was approved by the Ethical Committee of the Yazd University of Medical Sciences (Code: IR.SSU.MEDICINE.REC.1399.032). Regarding that this study was conducted during the COVID-19 pandemic, data collection was performed through in-person and online questionnaire distribution.
Results
135 out of the 162 distributed questionnaires were filled by the participants (response
rate = 83.33%). The mean age of the 135 participants was 31.42 ± 4.56 years old, and the mean work experience was 2.70 ± 4.18 years. The majority of participants (57%) reported a high level of interest in their specialty. The demographic characteristics of the study participants are presented in Table 1.
Sampling was performed based on census sampling using the convenience sampling method. The study protocol was approved by the Ethical Committee of the Yazd University of Medical Sciences (Code: IR.SSU.MEDICINE.REC.1399.032). Regarding that this study was conducted during the COVID-19 pandemic, data collection was performed through in-person and online questionnaire distribution.
Results
135 out of the 162 distributed questionnaires were filled by the participants (response
rate = 83.33%). The mean age of the 135 participants was 31.42 ± 4.56 years old, and the mean work experience was 2.70 ± 4.18 years. The majority of participants (57%) reported a high level of interest in their specialty. The demographic characteristics of the study participants are presented in Table 1.
| Table 1. Demographic characteristics of study participants | |||
| Variable | Frequency | Percentage | |
| Gender | Male | 59 | 43.7 |
| Female | 76 | 56.3 | |
| Specialty | Internal Medicine | 15 | 11.1 |
| Cardiology | 13 | 9.6 | |
| Pediatrics | 15 | 11.1 | |
| Surgery | 13 | 9.6 | |
| Psychiatrics | 13 | 9.6 | |
| Infectious diseases | 6 | 4.4 | |
| Urology | 8 | 5.9 | |
| Orthopedics | 7 | 5.2 | |
| Ophthalmology | 11 | 8.1 | |
| Radiology | 12 | 8.9 | |
| Ear-Nose-throat | 9 | 6.7 | |
| Obstetrics and Gynecology | 13 | 9.6 | |
| Marital status | Single | 38 | 28.1 |
| Married | 97 | 71.9 | |
| Previous admission history | 22 | 16.3 | |
| Chronic diseases in relatives | 76 | 56.3 | |
| Frequent referrals | 18 | 13.3 | |
| Interest in the specialty | None | 2 | 1.5 |
| Low | 5 | 3.7 | |
| Moderate | 51 | 37.8 | |
| High | 77 | 57.0 | |
The mean self-efficacy score of the participants was 131.91 ± 13.14, which was considered good. The highest score in the self-efficacy questionnaire was related to the "efficient communication with patient" domain (43.57 ± 5.15). The mean score of the domains of the self-efficacy questionnaire is shown in Table 2. The mean score for empathy was 65.28 ± 7.09, viewed as moderate. The highest score in the empathy questionnaire was related to the item "the patient would feel better if he/she notices my empathy" (4.44 ± 0.59), and the lowest score was related to the phrase "I try to think like my patients because this is effective in their treatment process" (3.17 ± 1.04). The mean score of the domains of the empathy questionnaire is presented in Table 2.
| Table 2. Mean scores of questionnaire domains among the study participants | |||
| Questionnaire | Domain | Mean | Standard deviation |
| Self-efficacy | Efficient communication with patient | 43.57 | 5.15 |
| Patient involvement | 31.44 | 3.82 | |
| Interprofessional teamwork | 39.85 | 4.46 | |
| Interprofessional cooperation | 17.02 | 1.91 | |
| Total score | 131.91 | 13.14 | |
| Empathy | Empathic care | 39.67 | 4.83 |
| Placing one-self in the patient’s shoes | 15.20 | 1.98 | |
| Separation of emotions | 10.40 | 2.10 | |
| Total score | 65.28 | 7.09 | |
There was a significant positive correlation between the total scores of self-efficacy with empathy (r = 0.46, p = 0.016) and the patient involvement domain of the empathy questionnaire (r = 0.41, p = 0.03). The correlation between empathy and Self-efficacy domains is illustrated in Table 3.
| Table 3. Correlation between domains of empathy and self-efficacy questionnaires among study participants | ||||||
| Empathy | Self-efficacy | |||||
| Efficient communication with the patient | Patient involvement | Inter professional teamwork | Inter professional cooperation | Total score | ||
| Empathic care | r | 0.36 | ||||
| p | 0.07 | |||||
| Placing one-self in patient’s shoes | r | 0.33 | ||||
| p | 0.10 | |||||
| Separation of emotions | r | 0.35 | ||||
| p | 0.07 | |||||
| Total score | r | 0.32 | 0.41 | 0.24 | 0.24 | 0.46 |
| p | 0.10 | 0.03* | 0.22 | 0.22 | 0.016* | |
* Significant correlation
There was a positive relationship between the self-efficacy score and marital status (being married) (p = 0.03). There was also a significant relation between a high empathy score and high interest in the field (p = 0.02). The relationship between demographic variables and self-efficacy and empathy scores is presented in Table 4.
| Table 4. Correlation between demographic variables and empathy and self-efficacy total scores among study participants | ||||||
| Variable | Empathy | Self-efficacy | ||||
| Unstandardized B | Beta | p | Unstandardized B | Beta | p | |
| Empathy | 0.92 | 0.56 | 0.04* | |||
| Self-efficacy | ||||||
| Age | -0.91 | -0.06 | 0.80 | 1.92 | 0.40 | 0.21 |
| Gender | 0.94 | 0.07 | 0.44 | -3.24 | -0.23 | 0.55 |
| Field of education | -0.18 | -0.09 | 0.26 | -0.75 | -0.61 | 0.81 |
| Marital status (married) | 0.14 | 0.01 | 0.91 | -12.81 | -0.67 | 0.03* |
| Work experience | 0.50 | 0.29 | 0.18 | -3.16 | -0.51 | 0.12 |
| Interest in the specialty | 2.27 | 0.20 | 0.02* | -4.12 | -0.25 | 0.31 |
| Admission experience | 1.07 | 0.05 | 0.50 | -3.10 | -0.07 | 0.83 |
| Chronic disease in relatives | -0.63 | -0.04 | 0.60 | 9.58 | 0.53 | 0.09 |
| Frequent referrals | -1.56 | -0.07 | 0.38 | 0.08 | 0.002 | 0.99 |
* Significant relationship
The mean inter professional cooperation score was significantly higher in male residents in comparison to female residents (p = 0.01). A comparison of the domain scores of empathy and self-efficacy between gender and education fields is shown in Table 5.
| Table 5. Comparison of domain scores of empathy and self-efficacy between gender and specialty among study participants | ||||||||||
| variable | Self-efficacy | Empathy | ||||||||
| Efficient communication with patient | Patient involvement | Inter professional teamwork | Inter professional cooperation | Total score | Empathic care | Placing one-self in patient’s shoes | Separation of emotions | Total score | ||
| Gender Mean ± SD |
Male | 42.80 ± 4.60 | 32.00 ± 1.22 | 40.40 ± 1.67 | 18.60 ± 1.51 | 133.80 ± 7.5 | 39.32 ± 5.25 | 15.47 ± 2.02 | 10.28 ± 2.22 | 65.08 ± 7.85 |
| Female | 43.38 ± 4.38 | 31.47 ± 3.54 | 38.52 ± 2.71 | 18.19 ± 1.28 | 129.57 ± 9.5 | 39.94 ± 4.48 | 15.00 ± 1.93 | 10.50 ± 2.00 | 65.44 ± 6.49 | |
| p | 0.79 | 0.75 | 0.15 | 0.01* | 0.36 | 0.45 | 0.16 | 0.56 | 0.77 | |
| Specialty Mean ± SD |
Internal Medicine | 39.06 ± 3.19b | 10.33 ± 1.98 | 64.26 ± 5.32a | ||||||
| Cardiology | 39.30 ± 4.25b | 10.92 ± 2.01 | 65.30 ± 6.27a | |||||||
| Pediatrics | 40.66 ± 5.43 | 10.20 ± 2.07 | 66.40 ± 7.40 | |||||||
| Surgery | 38.76 ± 6.80 | 9.38 ± 1.60 | 63.53 ± 9.03a | |||||||
| Psychiatrics | 46.15 ± 3.31 | 11.76 ± 2.12 | 74.46 ± 5.34a | |||||||
| Infectious diseases | 38.33 ± 6.80 | 8.83 ± 2.31 | 63.33 ± 6.34a | |||||||
| Urology | 40.50 ± 4.65 | 11.50 ± 1.77 | 67.33 ± 6.84 | |||||||
| Orthopedics | 35.71 ± 4.34b | 8.57 ± 1.90 | 59.00 ± 6.87a | |||||||
| Ophthalmology | 38.72 ± 2.83b | 10.27 ± 2.19 | 64.09 ± 6.15a | |||||||
| Radiology | 38.91 ± 3.84b | 11.08 ± 1.78 | 64.83 ± 4.80a | |||||||
| Ear-Nose-throat | 39.22 ± 2.58b | 10.55 ± 2.35 | 63.88 ± 5.30a | |||||||
| Obstetrics and Gynecology | 38.07 ± 4.57b | 10.30 ± 2.01 | 63.15 ± 6.61a | |||||||
| p | 0.76 | 0.10 | 0.51 | 0.67 | 0.48 | 0.001* | 0.32 | 0.021 | 0.001* | |
Variables sharing similar superscript letters were significantly different.
Discussion
The findings of this study showed that the scores of self-efficacy in interprofessional cooperation of the residents were at good levels, while the score of empathy was at a moderate level. Furthermore, there was a positive correlation between marital status and scores of self-efficacy, and the scores of empathy were significantly correlated with the level of interest in the specialty.
One of the main findings of this study was that it revealed a moderate level of empathy among medical residents. This study was conducted during the COVID-19 pandemic, impacting the participants' psychological health and communication skills. Furthermore, increased workload, work stress, and increased number of patients due to the pandemic might have contributed to the reduced empathy among medical residents. Studies have shown that an increased level of distress can reduce the level of empathy of medical residents (Jin et al., 2020). Other studies have also shown that the COVID-19 pandemic reduced empathy with patients (Wilkinson et al., 2017). The findings of this study showed a significant difference in the scores of the empathy questionnaire between medical specialties. These findings indicated that residents in specialties that are exposed to emergency cases and have high work stress and mortality rates have lower empathy levels with patients compared to residents of specialties that do not have these conditions. Empathy is an essential asset for communication and cooperation with the patient. Empathy depends on the physician's inherent skill of understanding the patient's feelings and can be represented in various fields, including speaking with the patient, thinking and concentrating, patient care, history taking, and understanding the patient's feelings (Guidi and Traversa, C, 2021) . Similar to the findings of our study, previous studies showed that the need for empathy and the level of empathy with patients were different between different medical specialties (eg., Moudatsou et al., 2020; Kheirabadi et al., 2016; Walocha et al., 2013). Several studies showed a generally high level of empathy with patients among different medical specialties (eg., Kheirabadi et al., 2016; Hassankhani et al., 2014; Walocha et al., 2013). In contrast to the findings of this study, other studies indicated that the level of empathy was affected by the physician's demographic characteristics (age, gender, and marital status) and cultural factors. It has also been shown that previous work experience can affect empathy due to its effect on the physician's patience and resilience (Park et al., 2016). This dis-concordance of results might be related to the following factors: the close age range of our participants, the high-stress condition of the residents due to the COVID-19 pandemic, and the different cultural backgrounds of this study in comparison to previous studies.
One of the main findings of this study was that it revealed a moderate level of empathy among medical residents. This study was conducted during the COVID-19 pandemic, impacting the participants' psychological health and communication skills. Furthermore, increased workload, work stress, and increased number of patients due to the pandemic might have contributed to the reduced empathy among medical residents. Studies have shown that an increased level of distress can reduce the level of empathy of medical residents (Jin et al., 2020). Other studies have also shown that the COVID-19 pandemic reduced empathy with patients (Wilkinson et al., 2017). The findings of this study showed a significant difference in the scores of the empathy questionnaire between medical specialties. These findings indicated that residents in specialties that are exposed to emergency cases and have high work stress and mortality rates have lower empathy levels with patients compared to residents of specialties that do not have these conditions. Empathy is an essential asset for communication and cooperation with the patient. Empathy depends on the physician's inherent skill of understanding the patient's feelings and can be represented in various fields, including speaking with the patient, thinking and concentrating, patient care, history taking, and understanding the patient's feelings (Guidi and Traversa, C, 2021) . Similar to the findings of our study, previous studies showed that the need for empathy and the level of empathy with patients were different between different medical specialties (eg., Moudatsou et al., 2020; Kheirabadi et al., 2016; Walocha et al., 2013). Several studies showed a generally high level of empathy with patients among different medical specialties (eg., Kheirabadi et al., 2016; Hassankhani et al., 2014; Walocha et al., 2013). In contrast to the findings of this study, other studies indicated that the level of empathy was affected by the physician's demographic characteristics (age, gender, and marital status) and cultural factors. It has also been shown that previous work experience can affect empathy due to its effect on the physician's patience and resilience (Park et al., 2016). This dis-concordance of results might be related to the following factors: the close age range of our participants, the high-stress condition of the residents due to the COVID-19 pandemic, and the different cultural backgrounds of this study in comparison to previous studies.
The findings of this study showed that among the self-efficacy domains, the inter professional cooperation domain had the lowest scores. This finding indicates the need for educational improvement for medical residents to improve their skills in this domain.
One of the limitations of this study was the COVID-19 pandemic that required a higher level of empathy; however, the implementation of social distancing might have reduced the interaction time between patient and physician. Another limitation of this study was the small sample size due to the busy schedule of the residents because of work conditions and psychological stress.
Conclusion
Our findings showed that the level of self-efficacy among medical residents was good while the level of empathy with patients was moderate. Empathy was affected by medical specialty and interest in the specialty but was independent of demographic characteristics, including age, gender, and work experience. Therefore, educational interventions should be executed to improve empathy among medical residents. In conclusion, to assemble an executive educational program, we recommend that similar studies be conducted on medical residents in different universities, specialties, and periods for more accurate results and to remove the effect of the COVID-19 pandemic.
Acknowledgment
This manuscript is extracted from the thesis of the doctorate course in general medicine, the proposal of which has been approved by the Department of Psychiatry of Shahid Sadoughi University of Medical Sciences, Yazd. The authors of this article consider it needs to thank the members of the research council, all students, and medical assistants of this university who helped us in all stages of this study.
One of the limitations of this study was the COVID-19 pandemic that required a higher level of empathy; however, the implementation of social distancing might have reduced the interaction time between patient and physician. Another limitation of this study was the small sample size due to the busy schedule of the residents because of work conditions and psychological stress.
Conclusion
Our findings showed that the level of self-efficacy among medical residents was good while the level of empathy with patients was moderate. Empathy was affected by medical specialty and interest in the specialty but was independent of demographic characteristics, including age, gender, and work experience. Therefore, educational interventions should be executed to improve empathy among medical residents. In conclusion, to assemble an executive educational program, we recommend that similar studies be conducted on medical residents in different universities, specialties, and periods for more accurate results and to remove the effect of the COVID-19 pandemic.
Acknowledgment
This manuscript is extracted from the thesis of the doctorate course in general medicine, the proposal of which has been approved by the Department of Psychiatry of Shahid Sadoughi University of Medical Sciences, Yazd. The authors of this article consider it needs to thank the members of the research council, all students, and medical assistants of this university who helped us in all stages of this study.
Conflict of interest
The authors declare no conflict of interest in conducting the study and preparing the manuscript.
Authors’ contribution
The authors declare no conflict of interest in conducting the study and preparing the manuscript.
Authors’ contribution
Designing and conducting the study, F. B; Designing the study, T. S and F. H. K; Designing conducting and statistical analysis, F. K; Writing and submitting and revising, F. F. T., Z. S and P. G. N; All stages of conducting the study, revising and finalizing, R. B.
References
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological review, 84(2), 191.
Collins, L., Sicks, S., Hass, R. W., Vause-Earland, T., Ward, J., et al. (2021). Self-efficacy and empathy development through interprofessional student hotspotting. Journal of Interprofessional Care, 35(2), 320-323. Avalable at: https:// doi.org/10.1080/13561820.2020.1712337.
Eklund, J. H., & Meranius, M. S. (2021). Toward a consensus on the nature of empathy: A review of reviews. Patient Education and Counseling, 104(2), 300-307.
Guidi, C., & Traversa, C. (2021). Empathy in patient care: from ‘Clinical Empathy’to ‘Empathic Concern’. Medicine, Health Care and Philosophy, 24, 573-585.
Hagemeier, NE, Hess, R, Hagen, KS & Sorah, EL.(2014). Impact of an interprofessional communication course on nursing, medical, and pharmacy students’ communication skill self-efficacy beliefs. American Journal of Pharmaceutical Education, 78(10). Doi: 10.5688/ajpe7810186. PMID: 25657373; PMCID: PMC4315208.
Hall, J. A., & Schwartz, R. (2019). Empathy present and future. The Journal of social psychology, 159(3), 225-243.
Hassankhani, H, Aghdam, AM, Rahmani, A & Mohammadpoorfard, Z. (2014).The relationship between learning motivation and self-efficacy among nursing students. Research and Development in Medical Education. 4(1), 97-101. Doi: 10.15171/rdme.2015.016.
Jin, J., Li, H., Song, W., Jiang, N., Zhao, W., et al. (2020). The mediating role of psychological capital on the relation between distress and empathy of medical residents: a cross-sectional survey. Medical Education Online, 25(1). Doi.org/10.1080/10872981.2019.1710326.
Keshmiri, F. (2019). Assessment of the interprofessional collaboration of healthcare team members: validation of Interprofessional Collaborator Assessment Rubric (ICAR) and pilot study. Journal of Military Medicine, 21(6), 647-656.
Keshmiri, F. (2021). Relationship between Self-efficacy and Attitudes towards Interprofessional collaboration and Communication in Learners of Different disciplines of Medical Sciences. Strides in Development of Medical Education, 18(1), 1-8. Doi.org/10.22062/sdme.2020.193866.1015.
Kheirabadi, G., Haji, R. M., Mahki, B., Masaiely, N., Yahaei, M., et al. (2016). Empathy with Patients in Medical Sciences Faculty Physicians at Isfahan University of Medical Sciences, Iran. Journal of Research in Behavioural Sciences, 14(2), 154-160. PMID: 3423510
Moralle, M. R., Preston, J. S., Chen, L., & Berberian, W. S. (2016). An exploratory study of empathy in resident physicians at an urban medical center. International Journal of Caring Sciences, 9(2), 526.
Moudatsou, M., Stavropoulou, A., Philalithis, A., & Koukouli, S. (2020). The role of empathy in health and social care professionals. Healthcare, 8(1), 26. MDPI, 2020.
Nogi, M., Wong, L. C., Yamanaka, A. B., Richardson, K., Ng-Osorio, J., et al. (2020). An evaluation of an interprofessional simulation training session on end-of-life-care conversations in the intensive care unit. Journal of Interprofessional Education & Practice, 21, 100357. Doi.org/10.1016/j.xjep.2020.100357.
Park, C., Lee, Y. J., Hong, M., Jung, C. H., Synn, Y., et al. (2016). A multicenter study investigating empathy and burnout characteristics in medical residents with various specialties. Journal of Korean medical science, 31(4), 590-597. Doi: 10.3346/jkms. 2016. 31.4.590.
Riess, H., Kelley, J. M., Bailey, R. W., Dunn, E. J., & Phillips, M. (2012). Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. Journal of general internal medicine, 27(10), 1280-1286. PMID: 22549298; PMCID: PMC3445669.
Seeberger, A., Lönn, A., Hult, H., Weurlander, M., & Wernerson, A. (2020). Can empathy be preserved in medical education?. International Journal of Medical Education, 11, 83.
Shariat, S. V., & Kaykhavoni, A. (2010). Empathy in medical residents at Iran University of Medical Sciences. Iranian journal of psychiatry and clinical psychology, 16(3), 248-256. URL: http://ijpcp.iums.ac.ir/article-1-1090-en.html.
Swing, S. R. (2002). Assessing the ACGME general competencies: general considerations and assessment methods. Academic Emergency Medicine, 9(11), 1278-1288.
van Diggele, C., Roberts, C., Burgess, A., & Mellis, C. (2020). Interprofessional education: tips for design and implementation. BMC Medical Education, 20(2), 1-6.
Walocha, E., Tomaszewski, K., Wilczek-Rużyczka, E., & Walocha, J. (2013). Empathy and burnout among physicians of different specialities. Folia Medica Cracoviensia, 53(2).
West, C. P., Huschka, M. M., Novotny, P. J., Sloan, J. A., Kolars, J. C., Habermann, T. M., & Shanafelt, T. D. (2006). Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. Jama, 296(9), 1071-1078. Doi: 10.1001/ jama.296.9. 1071.
Wilkinson, H., Whittington, R., Perry, L., & Eames, C. (2017). Examining the relationship between burnout and empathy in healthcare professionals: A systematic review. Burnout research, 6, 18-29. Doi.org/10.1016/j.burn.2017. 06.003.
References
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological review, 84(2), 191.
Collins, L., Sicks, S., Hass, R. W., Vause-Earland, T., Ward, J., et al. (2021). Self-efficacy and empathy development through interprofessional student hotspotting. Journal of Interprofessional Care, 35(2), 320-323. Avalable at: https:// doi.org/10.1080/13561820.2020.1712337.
Eklund, J. H., & Meranius, M. S. (2021). Toward a consensus on the nature of empathy: A review of reviews. Patient Education and Counseling, 104(2), 300-307.
Guidi, C., & Traversa, C. (2021). Empathy in patient care: from ‘Clinical Empathy’to ‘Empathic Concern’. Medicine, Health Care and Philosophy, 24, 573-585.
Hagemeier, NE, Hess, R, Hagen, KS & Sorah, EL.(2014). Impact of an interprofessional communication course on nursing, medical, and pharmacy students’ communication skill self-efficacy beliefs. American Journal of Pharmaceutical Education, 78(10). Doi: 10.5688/ajpe7810186. PMID: 25657373; PMCID: PMC4315208.
Hall, J. A., & Schwartz, R. (2019). Empathy present and future. The Journal of social psychology, 159(3), 225-243.
Hassankhani, H, Aghdam, AM, Rahmani, A & Mohammadpoorfard, Z. (2014).The relationship between learning motivation and self-efficacy among nursing students. Research and Development in Medical Education. 4(1), 97-101. Doi: 10.15171/rdme.2015.016.
Jin, J., Li, H., Song, W., Jiang, N., Zhao, W., et al. (2020). The mediating role of psychological capital on the relation between distress and empathy of medical residents: a cross-sectional survey. Medical Education Online, 25(1). Doi.org/10.1080/10872981.2019.1710326.
Keshmiri, F. (2019). Assessment of the interprofessional collaboration of healthcare team members: validation of Interprofessional Collaborator Assessment Rubric (ICAR) and pilot study. Journal of Military Medicine, 21(6), 647-656.
Keshmiri, F. (2021). Relationship between Self-efficacy and Attitudes towards Interprofessional collaboration and Communication in Learners of Different disciplines of Medical Sciences. Strides in Development of Medical Education, 18(1), 1-8. Doi.org/10.22062/sdme.2020.193866.1015.
Kheirabadi, G., Haji, R. M., Mahki, B., Masaiely, N., Yahaei, M., et al. (2016). Empathy with Patients in Medical Sciences Faculty Physicians at Isfahan University of Medical Sciences, Iran. Journal of Research in Behavioural Sciences, 14(2), 154-160. PMID: 3423510
Moralle, M. R., Preston, J. S., Chen, L., & Berberian, W. S. (2016). An exploratory study of empathy in resident physicians at an urban medical center. International Journal of Caring Sciences, 9(2), 526.
Moudatsou, M., Stavropoulou, A., Philalithis, A., & Koukouli, S. (2020). The role of empathy in health and social care professionals. Healthcare, 8(1), 26. MDPI, 2020.
Nogi, M., Wong, L. C., Yamanaka, A. B., Richardson, K., Ng-Osorio, J., et al. (2020). An evaluation of an interprofessional simulation training session on end-of-life-care conversations in the intensive care unit. Journal of Interprofessional Education & Practice, 21, 100357. Doi.org/10.1016/j.xjep.2020.100357.
Park, C., Lee, Y. J., Hong, M., Jung, C. H., Synn, Y., et al. (2016). A multicenter study investigating empathy and burnout characteristics in medical residents with various specialties. Journal of Korean medical science, 31(4), 590-597. Doi: 10.3346/jkms. 2016. 31.4.590.
Riess, H., Kelley, J. M., Bailey, R. W., Dunn, E. J., & Phillips, M. (2012). Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. Journal of general internal medicine, 27(10), 1280-1286. PMID: 22549298; PMCID: PMC3445669.
Seeberger, A., Lönn, A., Hult, H., Weurlander, M., & Wernerson, A. (2020). Can empathy be preserved in medical education?. International Journal of Medical Education, 11, 83.
Shariat, S. V., & Kaykhavoni, A. (2010). Empathy in medical residents at Iran University of Medical Sciences. Iranian journal of psychiatry and clinical psychology, 16(3), 248-256. URL: http://ijpcp.iums.ac.ir/article-1-1090-en.html.
Swing, S. R. (2002). Assessing the ACGME general competencies: general considerations and assessment methods. Academic Emergency Medicine, 9(11), 1278-1288.
van Diggele, C., Roberts, C., Burgess, A., & Mellis, C. (2020). Interprofessional education: tips for design and implementation. BMC Medical Education, 20(2), 1-6.
Walocha, E., Tomaszewski, K., Wilczek-Rużyczka, E., & Walocha, J. (2013). Empathy and burnout among physicians of different specialities. Folia Medica Cracoviensia, 53(2).
West, C. P., Huschka, M. M., Novotny, P. J., Sloan, J. A., Kolars, J. C., Habermann, T. M., & Shanafelt, T. D. (2006). Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. Jama, 296(9), 1071-1078. Doi: 10.1001/ jama.296.9. 1071.
Wilkinson, H., Whittington, R., Perry, L., & Eames, C. (2017). Examining the relationship between burnout and empathy in healthcare professionals: A systematic review. Burnout research, 6, 18-29. Doi.org/10.1016/j.burn.2017. 06.003.
Type of Study: Original Article |
Subject:
Education & Health
Received: 2023/01/1 | Accepted: 2023/04/22 | Published: 2023/05/4
Received: 2023/01/1 | Accepted: 2023/04/22 | Published: 2023/05/4
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