The Effect of Practitioner Empathy on Patient Satisfaction : A Systematic Review of Randomized Trials.

BACKGROUND: Practitioners who deliver enhanced empathy may improve patient satisfaction with care. Patient satisfaction is associated with positive patient outcomes ranging from medication adherence to survival. PURPOSE: To evaluate the effect of health care practitioner empathy on patient satisfaction, using a systematic review of randomized trials. DATA SOURCES: Ovid MEDLINE, CINAHL, PsycInfo, Cochrane Central Register of Controlled Trials, and Scopus to 23 October 2023. STUDY SELECTION: Randomized trials published in any language that evaluated the effect of empathy on improving patient satisfaction as measured on a validated patient satisfaction scale. DATA EXTRACTION: Data extraction, risk-of-bias assessments, and strength-of-evidence assessments were done by 2 independent reviewers. Disagreements were resolved through consensus. DATA SYNTHESIS: Fourteen eligible randomized trials (80 practitioners; 1986 patients) were included in the analysis. Five studies had high risk of bias, and 9 had some concerns about bias. The trials were heterogeneous in terms of geographic locations (North America, Europe, Asia, and Africa), settings (hospital and primary care), practitioner types (family and hospital physicians, anesthesiologists, nurses, psychologists, and caregivers), and type of randomization (individual patient or clustered by practitioner). Although all trials suggested a positive change in patient satisfaction, inadequate reporting hindered the ability to draw definitive conclusions about the overall effect size. LIMITATIONS: Heterogeneity in the way that empathy was delivered and patient satisfaction was measured and incomplete reporting leading to concerns about the certainty of the underpinning evidence. CONCLUSION: Various empathy interventions have been studied to improve patient satisfaction. Development, testing, and reporting of high-quality studies within well-defined contexts is needed to optimize empathy interventions that increase patient satisfaction. PRIMARY FUNDING SOURCE: Stoneygate Trust. (PROSPERO: CRD42023412981).

A survey of clinical empathy training at UK medical schools.

BACKGROUND: The benefits of enhancing practitioner empathy include better patient outcomes and improved job satisfaction for practitioners. Evidence suggests empathy can be taught and empathy is listed as an outcome for graduates in the General Medical Council requirements. Despite this, empathy training is not mandatory on medical school curricula and the extent to which medical students are given empathy-specific training is unknown. AIM: To conduct a survey of empathy training currently offered to medical students in UK medical schools. METHODS: An invitation to participate in an online survey was sent to all UK medical schools (n = 40). The survey was developed through a consultancy and pilot process to ensure validity and reliability. Questions explored what empathy-focused training is offered, and asked educators whether or not they believed that current provision of empathy training is sufficient. In parallel, medical school websites were searched to identify what information regarding empathy-focused training is described as being part of the degree course. Descriptive statistics were used to describe empathy training delivery from the results of the online materials survey and closed survey questions. Thematic analysis was used to explore free text comments. RESULTS: Response rate was 70% (28/40), with 28 medical schools included in the analysis. Twenty-six schools reported that their undergraduate curriculum included some form of empathy-focused training with variation in what, when and how this is delivered. Thematic analysis revealed two overarching themes with associated sub-themes: (i) empathy-focused training and development (considering where, when and how empathy training should be integrated); (ii) challenges presented by including empathy on the curriculum (considering the system, students and faculty). All schools agreed empathy training should be on the undergraduate curriculum. CONCLUSION: This is the first nationwide survey of empathy-focused training at UK medical schools. While some form of empathy-focused training appears to be provided on the undergraduate curriculum at most UK medical schools, empathy is rarely specifically assessed. Most medical educators do not feel their school does enough to promote empathy and the majority would like to offer more.

Teaching an empathy-focused approach to difficult consultations: a pilot session and co-production evaluation workshop.

BACKGROUND: Patients who are annoyed, upset, angry or uncooperative may be categorised as having behavioural problems, shifting the blame from healthcare providers to patients. This can exacerbate the problem. Adopting an empathic approach to such consultations can reduce anger and frustration and improve patient care. APPROACH: A pilot teaching session was introduced to the second year of the medical degree at Leicester Medical School with the aim of preparing students to deal with difficult consultations and helping them to understand the impact of empathy in such situations. The teaching involved the use of prior reading, videos and simulated patients acting the role of angry and frustrated patients. It was delivered to groups of 8 students by a team of 20 GP tutors. Approximately 300 second year medical students took part in the session. EVALUATION: Ninety per cent of students felt they had a better understanding of how an empathic approach could help in difficult consultations. Most GP tutors also felt better prepared to deal with difficult consultations because of teaching the session. Following the initial evaluation, a co-production workshop was convened comprising of tutors, students and patient representatives to review the teaching materials and evaluation. Potential improvements to the session were identified. CONCLUSION: We were able to deliver a successful pilot session that improved students' understanding of the skills needed and had a positive impact on GP tutors involved in the session. A subsequent co-production workshop identified key strategies to improve the session for future years.

Involving medical students in the planning and delivery of a vaccination and health screening outreach clinic.

Improving access to healthcare for people experiencing homelessness can be achieved via outreach clinics. Involving medical students in homeless healthcare projects leads to increased understanding of the social determinants of health and positive changes in student perception of this vulnerable patient group. Projects such as this can increase the social accountability of medical schools, with the potential to have a positive effect on health in the local community. Third-year medical students on GP placement were given the opportunity to design and deliver temporary clinics to the homeless population in Corby with the support of Public Health Northamptonshire. The study aimed to evaluate this educational intervention by exploring the students' motivation, experience and ideas on sustainability of the project via a focus group. Humanitarianism and the opportunity to meet patients face-to-face during the pandemic were motivating factors for joining the project. Students felt the educational experience was valuable, providing exposure to a patient group not often encountered in medical school. They gained an understanding of some of the challenges faced by this population. Some said this project forced them to address their unconscious biases and cited that to be a reason why projects like this should be mandatory. The learning experience made students consider funding and the organisation of healthcare. This study found that hands-on learning can provide educational and rewarding experiences for medical students. Positive experiences in the GP setting may impact career choices and allow them consider leadership and public health.

Social prescribing by students: the design and delivery of a social prescribing scheme by medical students in general practice.

Background Social prescribing is a means of enabling primary care professionals to refer people to a range of local, non-clinical services. Medical students at a large GP surgery in Corby designed, implemented and led a social prescribing service for the practice's patients. Through the project students gained an understanding of social prescribing in an authentic setting. Methods During a 12 week GP placement students collated information on local organisations, charities and schemes into a social prescribing directory. A clinic was set up and a social prescribing protocol created to enable suitable patients to be referred to the service. Students educated staff and collected feedback on how the service should run. Patients referred to the service were seen by medical students, who identified suitable social prescribing opportunities. Follow up was arranged to encourage patient engagement with services. The student-led service has been successfully integrated with the work of the new PCN link worker. Outcome Medical students were able successfully identify social prescribing opportunities for patients referred to them in primary care. Experential learning enabled them to develop an understanding of social prescribing and its place in healthcare. Discussion Medical students successfully designed and delivered a social prescribing intervention providing authentic educational experience in real-life clinical practice. The introduction of a Primary Care Network link worker enhanced this work and student input has continued in the ongoing service. It is hoped the scheme will be rolled out across the Primary Care curriculum in Leicester.

In Vivo Quantification of Peroxisome Tethering to Chloroplasts in Tobacco Epidermal Cells Using Optical Tweezers.

Peroxisomes are highly motile organelles that display a range of motions within a short time frame. In static snapshots, they can be juxtaposed to chloroplasts, which has led to the hypothesis that they are physically interacting. Here, using optical tweezers, we tested the dynamic physical interaction in vivo. Using near-infrared optical tweezers combined with TIRF microscopy, we were able to trap peroxisomes and approximate the forces involved in chloroplast association in vivo in tobacco (Nicotiana tabacum) and observed weaker tethering to additional unknown structures within the cell. We show that chloroplasts and peroxisomes are physically tethered through peroxules, a poorly described structure in plant cells. We suggest that peroxules have a novel role in maintaining peroxisome-organelle interactions in the dynamic environment. This could be important for fatty acid mobilization and photorespiration through the interaction with oil bodies and chloroplasts, highlighting a fundamentally important role for organelle interactions for essential biochemistry and physiological processes.

Stacks off tracks: a role for the golgin AtCASP in plant endoplasmic reticulum-Golgi apparatus tethering.

The plant Golgi apparatus modifies and sorts incoming proteins from the endoplasmic reticulum (ER) and synthesizes cell wall matrix material. Plant cells possess numerous motile Golgi bodies, which are connected to the ER by yet to be identified tethering factors. Previous studies indicated a role for cis-Golgi plant golgins, which are long coiled-coil domain proteins anchored to Golgi membranes, in Golgi biogenesis. Here we show a tethering role for the golgin AtCASP at the ER-Golgi interface. Using live-cell imaging, Golgi body dynamics were compared in Arabidopsis thaliana leaf epidermal cells expressing fluorescently tagged AtCASP, a truncated AtCASP-ΔCC lacking the coiled-coil domains, and the Golgi marker STtmd. Golgi body speed and displacement were significantly reduced in AtCASP-ΔCC lines. Using a dual-colour optical trapping system and a TIRF-tweezer system, individual Golgi bodies were captured in planta. Golgi bodies in AtCASP-ΔCC lines were easier to trap and the ER-Golgi connection was more easily disrupted. Occasionally, the ER tubule followed a trapped Golgi body with a gap, indicating the presence of other tethering factors. Our work confirms that the intimate ER-Golgi association can be disrupted or weakened by expression of truncated AtCASP-ΔCC and suggests that this connection is most likely maintained by a golgin-mediated tethering complex.

Software-based analysis of bacteriophage genomes, physical ends, and packaging strategies.

BACKGROUND: Phage genome analysis is a rapidly growing field. Recurrent obstacles include software access and usability, as well as genome sequences that vary in sequence orientation and/or start position. Here we describe modifications to the phage comparative genomics software program, Phamerator, provide public access to the code, and include instructions for creating custom Phamerator databases. We further report genomic analysis techniques to determine phage packaging strategies and identification of the physical ends of phage genomes. RESULTS: The original Phamerator code can be successfully modified and custom databases can be generated using the instructions we provide. Results of genome map comparisons within a custom database reveal obstacles in performing the comparisons if a published genome has an incorrect complementarity or an incorrect location of the first base of the genome, which are common issues in GenBank-downloaded sequence files. To address these issues, we review phage packaging strategies and provide results that demonstrate identification of the genome start location and orientation using raw sequencing data and software programs such as PAUSE and Consed to establish the location of the physical ends of the genome. These results include determination of exact direct terminal repeats (DTRs) or cohesive ends, or whether phages may use a headful packaging strategy. Phylogenetic analysis using ClustalO and phamily circles in Phamerator demonstrate that the large terminase gene can be used to identify the phage packaging strategy and thereby aide in identifying the physical ends of the genome. CONCLUSIONS: Using available online code, the Phamerator program can be customized and utilized to generate databases with individually selected genomes. These databases can then provide fruitful information in the comparative analysis of phages. Researchers can identify packaging strategies and physical ends of phage genomes using raw data from high-throughput sequencing in conjunction with phylogenetic analyses of large terminase proteins and the use of custom Phamerator databases. We promote publication of phage genomes in an orientation consistent with the physical structure of the phage chromosome and provide guidance for determining this structure.

Using Optical Tweezers Combined with Total Internal Reflection Microscopy to Study Interactions Between the ER and Golgi in Plant Cells.

Optical tweezers have been used to trap and micro-manipulate several biological specimens ranging from DNA, macromolecules, organelles, to single-celled organisms. Using a combination of the refraction and scattering of laser light from a focused laser beam, refractile objects are physically captured and can be moved within the surrounding media. The technique is routinely used to determine biophysical properties such as the forces exerted by motor proteins. Here, we describe how optical tweezers combined with total internal reflection fluorescence microscopy (TIRF) can be used to assess physical interactions between organelles, more specifically the ER and Golgi bodies in plant cells.

Microcrystal manipulation with laser tweezers.

X-ray crystallography is the method of choice to deduce atomic resolution structural information from macromolecules. In recent years, significant investments in structural genomics initiatives have been undertaken to automate all steps in X-ray crystallography from protein expression to structure solution. Robotic systems are widely used to prepare crystallization screens and change samples on synchrotron beamlines for macromolecular crystallography. The only remaining manual handling step is the transfer of the crystal from the mother liquor onto the crystal holder. Manual mounting is relatively straightforward for crystals with dimensions of >25 µm; however, this step is nontrivial for smaller crystals. The mounting of microcrystals is becoming increasingly important as advances in microfocus synchrotron beamlines now allow data collection from crystals with dimensions of only a few micrometres. To make optimal usage of these beamlines, new approaches have to be taken to facilitate and automate this last manual handling step. Optical tweezers, which are routinely used for the manipulation of micrometre-sized objects, have successfully been applied to sort and mount macromolecular crystals on newly designed crystal holders. Diffraction data from CPV type 1 polyhedrin microcrystals mounted with laser tweezers are presented.

Communicating effectively with inclusion health populations: 2022 ICCH symposium.

OBJECTIVE: To describe communication strategies for clinical practice that allow practitioners to work more effectively with marginalised population groups and to discuss how to incorporate these into medical practice. METHODS: Active practitioners working in inclusion health and people with lived experience of homelessness and the asylum-seeking process shared their perspectives in the symposium at the 2022 International Conference on Communication in Healthcare (ICCH) and a subsequent conference on empathy in healthcare. The views of attendees were sought. SYMPOSIUM DISCUSSION: We describe the perspectives shared at the symposia under two main themes: communication needs in people experiencing homelessness and migrant populations, and trauma-informed practice. CONCLUSIONS: People experiencing homelessness have more communication challenges compared to the general adult population. Migrant, refugee, and asylum-seeking populations also face the complexity of negotiating unfamiliar healthcare, legal and social systems with the added burden of language barriers. Trauma-informed practice provides a useful framework that can improve communication with these groups.

On the need for empathy in the acute hospital setting.

This article reviews the need for empathy, and what happens in its absence in an acute hospital setting, using the example of a homeless man in an emergency department. Three simple but meaningful changes that all healthcare practitioners can make are recommended to promote empathy.

A collaboration on teaching communication by text.

BACKGROUND: Since the start of the pandemic, text-based communication with patients has become increasingly common. Leicester Medical School introduced experiential teaching in this field in 2014 but identified a need to develop teaching on the key skills required for effective consultations. Shout 85258 offers a text messaging support service for anyone who is struggling with their mental health. They have developed an evidence-based training programme enabling volunteers to deliver quality crisis support via the medium of text messaging. APPROACH: Leicester Medical School and Shout 85258 collaborated, developing a small group teaching session for delivery to second-year medical students. The training programme and framework developed by Shout 85258 was used as the basis for a 1.5-hour session with didactic teaching and experiential role play. It was hoped that the collaboration would raise the profile of Shout 85258 in the student body. EVALUATION: The students enjoyed the mixture of didactic teaching and role play. They saw the relevance of the topic and recognised the key difficulties of text-based consultations such as in rapport building. Tutors valued the structure of the session and the framework provided. The session raised the profile of Shout 85258 amongst students and tutors. Further evaluation is needed to measure changes in the use of the service or volunteering by students following the session. IMPLICATIONS: Text-based consultation is an increasingly important area of communication in health care. Collaborating with a charitable organisation allowed sharing of established best practice in this area and raised the profile of the charity within the student body.

A collaboration on teaching and assessing triadic consultation skills.

Introduction: Teaching triadic consultation skills is becoming increasingly prevalent at medical schools but is included by few schools in summative assessments. We describe a collaboration between Leicester and Cambridge Medical Schools to share teaching practice and the development of an objective structure clinical examination (OSCE) station to assess these important skills. Methods: We agreed on the broad components of the process skills of a triadic consultation and wrote a framework. We used the framework to develop OSCE criteria and suitable case scenarios. The triadic consultation OSCEs were used in our summative assessments at Leicester and Cambridge. Results: Student feedback on teaching was largely positive. The OSCEs at both institutions performed effectively provided a fair and reliable test and had good face validity. Student performance was similar in both schools. Discussion and conclusion: Our collaboration provided peer support and enabled the production of a framework for teaching and assessing triadic consultations that is likely to be generalisable to other medical schools. We were able to reach a consensus on what skills should be included in the teaching of triadic consultations and to co-design an OSCE station to effectively assess those skills. Innovation: Collaboration between two medical schools using a constructive alignment principle allowed the efficient development of effective teaching and assessment of triadic consultations.

Effects of geomorphology, habitat, and spatial location on fish assemblages in a watershed in Ohio, USA.

In this paper, we evaluate relationships between in-stream habitat, water chemistry, spatial distribution within a predominantly agricultural Midwestern watershed and geomorphic features and fish assemblage attributes and abundances. Our specific objectives were to: (1) identify and quantify key environmental variables at reach and system wide (watershed) scales; and (2) evaluate the relative influence of those environmental factors in structuring and explaining fish assemblage attributes at reach scales to help prioritize stream monitoring efforts and better incorporate all factors that influence aquatic biology in watershed management programs. The original combined data set consisted of 31 variables measured at 32 sites, which was reduced to 9 variables through correlation and linear regression analysis: stream order, percent wooded riparian zone, drainage area, in-stream cover quality, substrate quality, gradient, cross-sectional area, width of the flood prone area, and average substrate size. Canonical correspondence analysis (CCA) and variance partitioning were used to relate environmental variables to fish species abundance and assemblage attributes. Fish assemblages and abundances were explained best by stream size, gradient, substrate size and quality, and percent wooded riparian zone. Further data are needed to investigate why water chemistry variables had insignificant relationships with IBI scores. Results suggest that more quantifiable variables and consideration of spatial location of a stream reach within a watershed system should be standard data incorporated into stream monitoring programs to identify impairments that, while biologically limiting, are not fully captured or elucidated using current bioassessment methods.

Exploring life with a long-term condition using asynchronous online communication.

OBJECTIVE: We describe the development and evaluation of a novel programme that uses an online patient portal system to provide medical students with early and authentic experience of patient interaction. METHODS: Focus group discussions were held with students, tutors and patients who had taken part in the first year of the programme. RESULTS: The programme provided an opportunity for early patient interaction in a safe environment. Students were able to practice communication skills learnt elsewhere in the course as well as identifying some of the different skills required for asynchronous online interactions. The approach gave opportunities to develop understanding of aspects of life with a long-term condition. CONCLUSION: Using an online patient portal system to interact with a patient enabled students to develop and apply their communication skills in a safe environment and gain a holistic view of a patient's experience. PRACTICE IMPLICATIONS: Medical students need to be equipped with the skills needed to communicate electronically with patients. Current medical curricula currently focus on more traditional models of the consultation. Further research is needed to establish best practice in this rapidly growing area.

Using Optical Tweezers Combined with Total Internal Reflection Microscopy to Study Interactions Between the ER and Golgi in Plant Cells.

Optical tweezers have been used to trap and micromanipulate several biological specimens ranging from DNA, macromolecules, organelles to single celled organisms. Using a combination of the refraction and scattering of laser light from a focused laser beam, refractile objects are physically captured and can be moved within the surrounding media. The technique is routinely used to determine biophysical properties such as the forces exerted by motor proteins. Here, we describe how optical tweezers combined with total internal reflection fluorescence (TIRF) microscopy can be used to assess physical interactions between organelles, more specifically the ER and Golgi bodies in plant cells.

Complete Genome Sequences of Paenibacillus larvae Phages BN12, Dragolir, Kiel007, Leyra, Likha, Pagassa, PBL1c, and Tadhana.

We present here the complete genomes of eight phages that infect Paenibacillus larvae, the causative agent of American foulbrood in honeybees. Phage PBL1c was originally isolated in 1984 from a P. larvae lysogen, while the remaining phages were isolated in 2014 from bee debris, honeycomb, and lysogens from three states in the USA.

Complete Genome Sequences of 18 Paenibacillus larvae Phages from the Western United States.

We present here the complete genomes of 18 phages that infect Paenibacillus larvae, the causative agent of American foulbrood in honeybees. The phages were isolated between 2014 and 2016 as part of an undergraduate phage discovery course at Brigham Young University. The phages were isolated primarily from bee debris and lysogens.

Genome Sequences of Five Additional Brevibacillus laterosporus Bacteriophages.

Brevibacillus laterosporus has been isolated from many different environments, including beehives, and produces compounds that are toxic to many organisms. Five B. laterosporus phages have been isolated previously. Here, we announce five additional phages that infect this bacterium, including the first B. laterosporus siphoviruses to be discovered.