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1.  The physician’s role and empathy – a qualitative study of third year medical students 
BMC Medical Education  2014;14:165.
Empathy is important in ensuring the quality of the patient-physician relationship. Several studies have concluded that empathy declines during medical training, especially during the third year. However, there is little empirical research on what may influence a medical student’s empathy. In addition, studies of empathy in medicine have generally been dominated by quantitative approaches, primarily self-assessment questionnaires. This is a paradox given the complexity and importance of empathy. In this paper we explore medical students’ opinions of what may foster or inhibit empathy during medical school, with a particular emphasis on how empathy is influenced by the initiation into the physician’s role.
We performed semi-structured qualitative interviews with 11 third year medical students. Content analysis was used to analyse the transcribed interviews.
Five aspects of the the physician’s role and the students’ role acquisition emerged when the students were asked to describe what may influence their empathy: 1) Becoming and being a professional, 2) Rules concerning emotions and care, 3) Emotional control, 4) The primary importance of biomedical knowledge, and 5) Cynicism as a coping strategy.
This study suggest that the described inhibitors of empathy may originate in the hidden curriculum and reinforce each other, creating a greater distance between the physician and the patient, and possibly resulting in decreased empathy. Mastering biomedical knowledge is an important part of the students’ ideals of the physician’s role, and sometimes objective and distanced ideals may suppress empathy and the students’ own emotions.
PMCID: PMC4128827  PMID: 25108627
Empathy; Medical education; Professionalism
2.  Observed communication skills: how do they relate to the consultation content? A nation-wide study of graduate medical students seeing a standardized patient for a first-time consultation in a general practice setting 
In this study, we wanted to investigate the relationship between background variables, communication skills, and the bio-psychosocial content of a medical consultation in a general practice setting with a standardized patient.
Final-year medical school students (N = 111) carried out a consultation with an actor playing the role of a patient with a specific somatic complaint, psychosocial stressors, and concerns about cancer. Based on videotapes, communication skills and consultation content were scored separately.
The mean level of overall communication skills had a significant impact upon the counts of psychosocial issues, the patient's concerns about cancer, and the information and planning parts of the consultation content being addressed. Gender and age had no influence upon the relationship between communication skills and consultation content.
Communication skills seem to be important for final-year students' competence in addressing sensitive psychosocial issues and patients' concerns as well as informing and planning with patients being representative for a fairly complex case in general practice. This result should be considered in the design and incorporation of communication skills training as part of the curriculum of medical schools.
PMCID: PMC2213643  PMID: 17996053
3.  Life satisfaction and resilience in medical school – a six-year longitudinal, nationwide and comparative study 
This study examined the relationship between life satisfaction among medical students and a basic model of personality, stress and coping. Previous studies have shown relatively high levels of distress, such as symptoms of depression and suicidal thoughts in medical undergraduates. However despite the increased focus on positive psychological health and well-being during the past decades, only a few studies have focused on life satisfaction and coping in medical students. This is the first longitudinal study which has identified predictors of sustained high levels of life satisfaction among medical students.
This longitudinal, nationwide questionnaire study examined the course of life satisfaction during medical school, compared the level of satisfaction of medical students with that of other university students, and identified resilience factors. T-tests were used to compare means of life satisfaction between and within the population groups. K-means cluster analyses were applied to identify subgroups among the medical students. Analysis of Variance (ANOVA) and logistic regression analyses were used to compare the subgroups.
Life satisfaction decreased during medical school. Medical students were as satisfied as other students in the first year of study, but reported less satisfaction in their graduation year. Medical students who sustained high levels of life satisfaction perceived medical school as interfering less with their social and personal life, and were less likely to use emotion focused coping, such as wishful thinking, than their peers.
Medical schools should encourage students to spend adequate time on their social and personal lives and emphasise the importance of health-promoting coping strategies.
PMCID: PMC1592096  PMID: 16984638

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