Empathy in Psychoanalysis and Medical Education - what can we learn from each other?

BACKGROUND: Several research areas, including medical education (ME), focus on empathy as an important topic in interpersonal relationships. This focus is central to the use of communication skills related to empathy and even more crucial to provide information in a way that makes patients feel more involved in the treatment process. Psychoanalysis (PA) provides its initial concept of empathy based on affective aspects including findings from neuroscience and brain research. Enhancing cooperation between ME and PA can help to integrate both aspects of empathy into a longitudinal training program. DISCUSSION: The condition of psychoanalytic empathy definitions is the understanding of unconscious processes. It is important to primarily attend especially the dominant affects towards the patient before interpreting his or her behaviour, since in explaining the emerging affects, the analyst has to empathize with the patient to understand the (unconscious) reasons for its behaviour. A strong consideration of nonverbal communication, clinical perceptions, intuitive interaction, contagion-like processes and their implementation and empowerment in medical and therapeutic curricula is one way of beneficially using interdisciplinary approaches to yield empathy in clinical interaction. CONCLUSION: Established methods of PA, like training of containment, reflective functioning, affective holding and giving meaningful interpretations in accordance with countertransferential and transferential aspects may help to put a focus on the clinican-patient-interaction and the preservation of the physicians' (mental) health. In consequence of the discussion of various training methods that take the theoretical and practical concepts of empathy into account, we aim for an implementation of the named methods in the medical curricula.

Reflections on empathy in medical education: What can we learn from social neurosciences?

The role of empathy in human social interaction has been examined in several research fields, including medical education (ME) and social neuroscience (SN). SN yields insights into empathy based on neurobiological processes, and such information may also be relevant to ME. In this reflection article, the authors first critically review current definitions and concepts of empathy in ME and link them to recent SN findings. In the light of recent evidence from SN, research in ME regarding the positive and negative effects of empathy for physicians and patients is discussed, as well as the question whether (future) physicians differ from the general population with regard to empathic skills. Commonly used SN paradigms and ME approaches to assess empathy are contrasted, a joint approach is advocated, and implications for further interdisciplinary studies are outlined. Finally, the authors delineate the contribution of SN to the question of whether empathy is teachable, and argue that SN findings represent a potential for new ME training approaches. In conclusion, the authors discuss how the incorporation of perspectives on empathy from different research areas would benefit ME, and suggest the translation and integration of such findings into ME research approaches.

Practical clinical skills assessment for a cohort of 680 2nd year human medicine students. Is it feasible?

In clinical skills training objective structured clinical examinations (OSCEs) are the method of choice to foster learning. Hence, implementing them is challenging and expensive. Thus it is investigated how an alternative procedure that keeps OSCE's essential elements, but assigns less stations to each student, works in terms of validity and justifiability.Data of n = 694 students, each taking five tasks drawn semi-randomized out of a pool of 26 tasks, strictly aligned with learning objectives, are analyzed. Despite unsurprisingly low overall reliability, a justifiable pass/fail decision is possible for 480 students (69 %). The remaining group (n = 210, 30 %) is indeed larger than with longer OSCEs, and would need ongoing assessment. The tasks' psychometric quality contributes to exams construct validity. Resource preserving short practical skills assessment is educationally valid and feasible with MedUniVienna's human medicine cohorts of n = 680.

Rising to the challenge: cross-cultural adaptation and psychometric evaluation of the adapted German version of the Jefferson Scale of Physician Empathy for Students (JSPE-S).

Assessment of students' attitudes towards physicians' empathy is essential in medical education and in practice because empathy is vital in physician-patient communication. To cross-culturally adapt the Jefferson Scale of Physician Empathy (S-version, JSPE-S) into a German version, examine its psychometric properties in comparison to the original US version (psychometric equivalence), and to compare the level of attitude towards empathy to the original US version and to other cultural adaptations. The German version was administered to the 2010 2nd year medical students cohort at the Medical University of Vienna, Austria (n = 516). Item-total score correlations were all positive. Reliability was high (Cronbach's alpha = .82); a 6-7 weeks test-retest correlation for a subsample was .45. In an explanatory factor analysis, a four-factor solution emerged and is akin to published results of the original JSPE-S. This study provides an example of successful cross-cultural adaptation of an assessment instrument. The German adaptation of the JSPE at hand will pave the way for future international research regarding the concept of empathy and its outcomes.

Twelve tips for designing and implementing a structured rater training in OSCEs.

BACKGROUND: Observation, rating, and grading are parts of the routine of the faculty when in contact with medical students. Most interestingly, there is a dearth of proper instructions on rater training for objective structured clinical examinations (OSCEs) in medical education literature. AIMS: We assembled 12 tips for implementing a structured rater training program. To highlight these tips, we provided examples of our implementation of rater training for an OSCE in 2009. METHODS: We developed a tailored rater training program by compiling information from medical education and other related research disciplines. RESULTS: The structured rater training at hand proved feasible, and the acceptance rate of this training by examiners was high.

Status Quo of Progress Testing in Veterinary Medical Education and Lessons Learned.

Progress testing is an assessment tool for longitudinal measurement of increase in knowledge of a specific group, e.g., students, which is well-known in medical education. This article gives an overview of progress testing in veterinary education with a focus on the progress test of the German-speaking countries. The "progress test veterinary medicine" (PTT) was developed in 2013 as part of a project by the Competence Centre for E-Learning, Didactics and Educational Research in Veterinary Medicine-a project cooperation of all German-speaking institutes for veterinary medicine in Germany, Austria, and Switzerland. After the end of the project, the PTT was still continued at six locations, at each of the five German schools for veterinary medicine and additionally in Austria. Further changes to the PTT platform and the analysis were carried out to optimize the PTT for continuing to offer the test from 2017 to 2019. The PTT is an interdisciplinary, formative electronic online test. It is taken annually and is composed of 136 multiple-choice single best answer questions. In addition, a "don't know" option is given. The content of the PTT refers to the day 1 competencies described by the European Association of Establishments for Veterinary Education. The platform Q-Exam® Institutions (IQuL GmbH, Bergisch Gladbach, Germany) is used for creating and administrating the PTT questions, the review processes and organizing of the online question database. After compiling the test by means of a blueprint, the PTT file is made available at every location. After the last PTT in 2018, the link to an evaluation was sent to the students from four out of these six partner Universities. The 450 analyzed questionnaires showed that the students mainly use the PTT to compare their individual results with those of fellow students in the respective semester. To conclude our study, a checklist with our main findings for implementing progress testing was created.

Feedback in medical education - a workshop report with practical examples and recommendations.

Background: As a teaching method, feedback is an integral part of medical education. However, there is a lack of a uniform theoretical basis or generally recognized guidelines for its specific design. Against this background, the aim of this article is to discuss conceptual considerations and empirical findings regarding feedback using various practical examples. Procedure and conceptual considerations: Building on the results of a workshop of the Committee for Communicative and Social Competences of the Society for Medical Education (GMA), this article first explains central conceptual considerations and empirical results on the topic of feedback. A particular focus is on various variables that influence the effect of feedback. This includes the feedback source, the frequency of feedback, starting points of feedback, the connection between feedback and reflection as well as the motivation and meta-cognitive skills of the feedback recipient. Practical examples: The implementation of feedback in practice is illustrated using eight examples from the field of medical and dental education. They stem from various settings and the focus is on formative oral feedback. It will become evident that the focus is more on the givers of feedback than the recipients of feedback. Instructions for recipients of feedback on how to reflect on it is still the exception. Discussion: Many of the relevant aspects for the effect of feedback described in the literature are already taken into account in the practical examples discussed. In conclusion, seven recommendations are made for implementing feedback in practice.

Teaching parasitology in a modular veterinary curriculum - The Vienna experience.

In a changing world with rapidly evolving new technologies, even in the "sheltered world" of teachers and lecturers at universities, we are challenged by new developments. As diversification is increasing in many aspects of our professional life, there is also a need to employ new ways of teaching, learning and assessments in veterinary curricula, taking into account the increasing numbers of students and limited teaching resources. The "classical" Austrian veterinary curriculum, with a series of consecutive lectures followed by practical courses in the different disciplines, separated from each other in the curricular time table and by annual examinations, has been a long-standing concept for teaching in the past. However, when veterinary practitioners and graduates where asked to judge the adequacy of undergraduate training for their professional skills and knowledge, several major shortcomings were revealed. The most commonly mentioned point was a lack of first-day competencies. As a consequence, the Vetmeduni Vienna developed a new veterinary curriculum implemented in 2014-2015. This curriculum covers 12 semesters and includes a "Diploma" (degree) thesis and several externships; graduates are eligible to practice in all branches of veterinary medicine. We abandoned the classical discipline-based teaching, established a modular, mostly organ-based system, and focus on student-centred and competency-based learning and teaching with defined learning outcomes and first-day skills. We also include training of scientific, managerial and communication skills in the curriculum. What does this mean for parasitology? We do not teach this subject in a closed lecture, but rather in a modular style, starting in the first year with the taxonomy and basic morphology of the animal kingdom, proceeding to parasite biology of the major groups in the second year, to the diagnostic and clinical training in practicals in the third year as well as joint lectures, seminars and conversatories in the organ- and species-based clinical training in years 3-6. Examinations are organised in different test formats, aligned to a list of skills and diseases. Quality assurance is a formal process and implemented at different levels. The ultimate aim of undergraduate teaching is to provide students with defined professional competencies and promoting life-long learning.

Publication activity in medical education research: A descriptive analysis of submissions to the GMS Zeitschrift für Medizinische Ausbildung in 2007-2015.

Objectives: The significance of medical education research has increased internationally. In this context we investigated whether, and if so, how the quantity and quality of scientific papers reviewed and/or published by the GMS Zeitschrift für Medizinische Ausbildung (GMS Z Med Ausbild) changed. Methods: The quantity and ratio of original papers, project reports and reviews submitted to or published in the GMS Z Med Ausbild were analysed. Published scientific articles were investigated in regard to the quality features "study type" and "mode of data collection" as well as the background (university affiliation) of the last authors. The citation frequency within the first five years after PubMed listing was compared to the one of BMC Medical Education in the corresponding period. Results: The number of submitted scientific manuscripts increased steadily. Most of the submissions and publications are original papers. For publications explorative studies and prospective data collection are most common. A shift over time is not observed. 16% of the published works come from one and 36% from four of the in total 39 universities represented by the last authors. The development of the citation frequency of articles published in GMS Z Med Ausbild is similar to that of BMC Medical Education. Conclusion: The rising number of submissions indicates an increasing significance of medical education research in German-speaking countries. The development of the number of citations reflects the growing appreciation of GMS Z Med Ausbild also indicated by the increasing number of online accesses. Our findings that study type and mode of data collection did not change has to be interpreted with caution since among other things choice and correct application of adequate methods are crucial regarding a scientific work's quality, too. These aspects, however, were not investigated in this paper.

[An experiment for testing the psychometric equivalence of the non verbal instruction of the adaptive intelligence diagnosticum]. / Sprachfreie Administration von Intelligenztests nicht ohne Aquivalenzprüfung-- am Beispiel des AID 2.

The Adaptive Intelligence Diagnosticum's manual additionally offers an optional non verbal instruction for seven of the fourteen subtests. There has, however, been no empirical evidence with regard to the psychometric equivalence of the tests with both versions of instruction. Therefore, an experiment was carried out. A total of 120 children (aged 6-8 years) were randomized into control (verbal instruction) and experimental groups (non verbal instruction). In the one subtest "Competence in Realism" nearly 50 percent of the children could not understand the relevant non verbal instruction. However, when only those children who did understand the non verbal instruction of a subtest are taken into account, no significant difference is observed, neither with respect to the mean of the scores nor to their standard deviation. In this respect, the test of equivalence has insofar been successful.

Significance of gender in the attitude towards doctor-patient communication in medical students and physicians.

BACKGROUND: Gender-specific differences in the attitudes towards doctor-patient communication among medical students and physicians were assessed. METHODS: A total of 150 medical students and 51 physicians from different departments took part in the study. The association, attitude and experiences regarding doctor-patient communication were assessed with a series of tools and questionnaires. RESULTS: Female doctors and students tended to describe the doctor-patient communication with positive attributes, such as "helpful", "sentimental", "voluble", "sociable", "gentle", "yielding" and "peaceful". Male students and physicians, on the other hand, described doctor-patient communication as "overbearing", "robust" and "inhibited". The most frequent associations females had with the term doctor-patient communication were "empathy", "confidence", "openess", while the most frequent association of the male colleagues was "medical history". Female doctors reported speaking about the psychosocial situation of the patient significantly more often and believed in higher patient satisfaction by sharing more information. Furthermore, they reported having longer conversations with a more equal partnership than their male colleagues. Compared to male students, female students were willing to take part in training their communication skills more often and had more interest in research about doctor-patient communication. Male medical students reported self-doubt during conversations with female patients, while one third of the male physicians talked about "the power over the patient". CONCLUSIONS: This study indicates a gender-dependent communication style influenced by stereotypes. At the establishment of communication training these differences should be taken into account, especially to strengthen male communication skills and improve their attitudes.

Desire and reality--teaching and assessing communicative competencies in undergraduate medical education in German-speaking Europe--a survey.

OBJECTIVES: Increasingly, communicative competencies are becoming a permanent feature of training and assessment in German-speaking medical schools (n=43; Germany, Austria, Switzerland - "D-A-CH"). In support of further curricular development of communicative competencies, the survey by the "Communicative and Social Competencies" (KusK) committee of the German Society for Medical Education (GMA) systematically appraises the scope of and form in which teaching and assessment take place. METHODS: The iterative online questionnaire, developed in cooperation with KusK, comprises 70 questions regarding instruction (n=14), assessment (n=48), local conditions (n=5), with three fields for further remarks. Per location, two to three individuals who were familiar with the respective institute's curriculum were invited to take part in the survey. RESULTS: Thirty-nine medical schools (40 degree programmes) took part in the survey. Communicative competencies are taught in all of the programmes. Ten degree programmes have a longitudinal curriculum for communicative competencies; 25 programmes offer this in part. Sixteen of the 40 programmes use the Basler Consensus Statement for orientation. In over 80% of the degree programmes, communicative competencies are taught in the second and third year of studies. Almost all of the programmes work with simulated patients (n=38) and feedback (n=37). Exams are exclusively summative (n=11), exclusively formative (n=3), or both summative and formative (n=16) and usually take place in the fifth or sixth year of studies (n=22 and n=20). Apart from written examinations (n=15) and presentations (n=9), practical examinations are primarily administered (OSCE, n=31); WPA (n=8), usually with self-developed scales (OSCE, n=19). With regards to the examiners' training and the manner of results-reporting to the students, there is a high variance. CONCLUSIONS: Instruction in communicative competencies has been implemented at all 39 of the participating medical schools. For the most part, communicative competencies instruction in the D-A-C-H region takes place in small groups and is tested using the OSCE. The challenges for further curricular development lie in the expansion of feedback, the critical evaluation of appropriate assessment strategies, and in the quality assurance of exams.