1. STFM Conference on Medical School Education February 7, 2015 Melanie Wooten, MS-4 Dr. Melanie Tucker, Ph.D. Dr. Lloyda Williamson, M.D. The Art of Empathy: Does Exposure to a Humanities-Based Extracurricular Activity Affect Empathy Changes in Third-Year Medical Students?

2. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

3. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

4. Purpose “To determine whether exposure to a humanities-based extracurricular activity, “The Art of Medicine Rounds,” at the University of Alabama School of Medicine – Tuscaloosa campus – affects changes in empathy among third-year medical students. This study will survey incoming, treatment-naïve, third-year medical students and utilize a validated empathy scale for medical students the Jefferson Scale of Empathy – Student version, (JSE-S) in order to assess changes in empathy over a 6-month and 12-month period. Students will be monitored for number-of-times attended to “The Art of Medicine Rounds.”

5. Purpose “To determine whether exposure to a humanities-based extracurricular activity, “The Art of Medicine Rounds,” at the University of Alabama School of Medicine – Tuscaloosa campus – affects changes in empathy among third-year medical students. This study will survey incoming, treatment-naïve, third-year medical students and utilize a validated empathy scale for medical students the Jefferson Scale of Empathy – Student version, (JSE-S) in order to assess changes in empathy over a 6-month and 12-month period. Students will be monitored for number-of-times attended to “The Art of Medicine Rounds.”

6. Purpose “To determine whether exposure to a humanities-based extracurricular activity, “The Art of Medicine Rounds,” at the University of Alabama School of Medicine – Tuscaloosa campus – affects changes in empathy among third-year medical students. This study will survey incoming, treatment-naïve, third-year medical students and utilize a validated empathy scale for medical students the Jefferson Scale of Empathy – Student version, (JSE-S) in order to assess changes in empathy over a 6-month and 12-month period. Students will be monitored for number-of-times attended to “The Art of Medicine Rounds.”

7. Purpose “To determine whether exposure to a humanities-based extracurricular activity, “The Art of Medicine Rounds,” at the University of Alabama School of Medicine – Tuscaloosa campus – affects changes in empathy among third-year medical students. This study will survey incoming, treatment-naïve, third-year medical students and utilize a validated empathy scale for medical students the Jefferson Scale of Empathy – Student version, (JSE-S) in order to assess changes in empathy over a 6-month and 12-month period. Students will be monitored for number-of-times attended to “The Art of Medicine Rounds.”

8. Purpose “To determine whether exposure to a humanities-based extracurricular activity, “The Art of Medicine Rounds,” at the University of Alabama School of Medicine – Tuscaloosa campus – affects changes in empathy among third-year medical students. This study will survey incoming, treatment-naïve, third-year medical students and utilize a validated empathy scale for medical students the Jefferson Scale of Empathy – Student version, (JSE-S) in order to assess changes in empathy over a 6-month and 12-month period. Students will be monitored for number-of-times attended to “The Art of Medicine Rounds.”

9. Purpose “To determine whether exposure to a humanities-based extracurricular activity, “The Art of Medicine Rounds,” at the University of Alabama School of Medicine – Tuscaloosa campus – affects changes in empathy among third-year medical students. This study will survey incoming, treatment-naïve, third-year medical students and utilize a validated empathy scale for medical students the Jefferson Scale of Empathy – Student version, (JSE-S) in order to assess changes in empathy over a 6-month and 12-month period. Students will be monitored for number-of-times attended to “The Art of Medicine Rounds.”

10. Research Questions Does participation in “The Art of Medicine Rounds” affect empathy changes in third-year medical students? If so, does it correlate with positive or negative change? Is there a correlation between the number-of-times attended to “The Art of Medicine Rounds” and scoring on the empathy scale?

11. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

12. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

13. What exactly is empathy? “A predominantly cognitive attribute that involves understanding of the patient’s experiences, concerns, and perspectives, and a capability to communicate this understanding.” (Hojat 2009)

15. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

16. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

17. Why is empathy important? Empathy leads to:  Personal growth  Career satisfaction  Optimal clinical outcomes Empathy > Sympathy Empathy can be taught  Targeted educational programs  Up to 10 different approaches have been described in the literature Clinical Outcomes Empathy Sympathy

18. Why is empathy important? Empathy leads to:  Personal growth  Career satisfaction  Optimal clinical outcomes Empathy > Sympathy Empathy can be taught  Targeted educational programs  Up to 10 different approaches have been described in the literature Clinical Outcomes Empathy Sympathy

19. Why is empathy important? Medical School Objectives Project (MSOP) of the AAMC, 1998  “Physicians must be compassionate and empathetic in caring for patients…” American Board of Internal Medicine (ABIM), 1983  Evaluation of Humanistic Qualities of the Internist  Empathy should be cultivated and assessed as an essential educational activity in graduate medical education

20. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

21. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

22. How do you score empathy? Jefferson Medical College  Jefferson Scale of Empathy  Validated  20 questions  7-point Likert scale Strongly disagree  strongly agree Positive and negative scored items  Scores can range from 20-140 Higher the score  higher empathy!  Age, gender, and specialty information Example question:  “Physicians should try to stand in their patients’ shoes when providing care to them.” “I believe that every human mind feels pleasure in doing good to another.” - Thomas Jefferson

23. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

24. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

25. Methods Consented third-year medical students at the Tuscaloosa branch campus of UASOM JSE-S given at three time points:  0 months – baseline empathy score  6 months  12 months Monitored for attendance at “The Art of Medicine Rounds”  Occur monthly  Students were not required to attend “The Art of Medicine Rounds” to participate in this study Statistical analysis

26. The Art of Medicine Rounds

27. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

28. Outline Purpose and research questions What exactly is empathy? Why is empathy important? How do you score empathy? Methods Results Questions

29. Results Demographics 24 third-year medical students > 75% recruited Male-to-female = 15:9 Age Majority of individuals were between 22-27 years old (18/24) Primary care vs. specialty 0 months – 12 primary care, 9 specialty, 3 undecided 6 months – 10 primary care, 9 specialty, 5 undecided

30. Results JSE-S0 months6 months Mean111109 Standard Deviation1112 Range90-13081-128 JSE-SnRange Decrease in score16-1 to -15 Increase in score7+1 to +17 No change1

31. Results Paired t-test analysis  All subjects – not significant (0.177)  Females – not significant (0.936)  Males – not significant (0.085)  Primary care vs. surgery (6 month) – not significant (0.591)  Primary care vs. surgery + undecided (6 month) – not significant (0.464) However, females had significantly higher scores than males on both administrations of the JSE-S  0 month – significant (0.046)  6 month – significant (0.006) Attendance to Art of Medicine Rounds did not show any correlation between changes in empathy scores  Only 10/24 participants attended; most have only attended 1 time

32. Results Compared to previous studies utilizing the JSE-S, my results have not yet demonstrated:  Significant change in empathy scores over the third year of medical school  A difference in empathy scores between students interested in primary care vs. specialties However, the mean score did decline over 6 months and there is a gender difference seen in empathy scores at both time points

33. What are the next steps? Complete the study! Still need 12 month data! Continue this study at the Tuscaloosa Campus Expand to other sites (Birmingham, Huntsville, and Montgomery) Additional variables that can be researched?

34. Any Questions?

35. References Hojat M, Gonnella J, and Maxwell K. Jefferson Scales of Empathy (JSE) Professional Manual & User’s Guide. Jefferson Medical College of Thomas Jefferson University – Center for Research in Medical Education and Health Care. December 2009. Hojat M, Vergare MJ, Maxwell K, Brainard G, et al. The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School. Academic Medicine. 2009; 84(9), 1182-1191. Hojat M, Gonnella JS, Mangione S, Nasca TJ, et al. Empathy in medical students as related to academic performance, clinical competence and gender. Medical Education. 2002;36, 522-527. Shapiro J, Morrison EH, and Boker JR. Teaching Empathy to First Year Medical Students: Evaluation of an Elective Literature and Medicine Course. Education for Health. 2004;17(1), 73-84. Horowitz HW. Poetry on rounds: a model for the integration of humanities into residency training. Lancet. 1996;347, 447-449. Anderson R and Schiedermayer D. The Art of Medicine through the Humanities: an overview of a one- month humanities elective for fourth year students. Medical Education. 2003;37, 560-562. Torppa MA, Makkonen E, Mårtenson C, and Pitkälä KH. A qualitative analysis of student Balint groups in medical education: Contexts and triggers of case presentations and discussion themes. Patient Education and Counseling. 2008;72, 5-11. Neumann M, Edelhäuser F, Tauschel D, Fischer MR, et al. Empathy Decline and Its Reasons: A Systematic Review of Studies with Medical Students and Residents. Academic Medicine. 2011;86(8), 996-1009.

36. BIG thank you to Dr. Tucker and Dr. Williamson for all of their guidance, as well as Nelle Williams, Dr. Blum, Dr. Higginbotham, and all of the study participants! Thank You!