Non-academic factors influencing the development of empathy in undergraduate nursing students: a cross-sectional study.

BACKGROUND: Empathy is described as a core competence of nursing. There is abundant research evidence supporting that empathy varies according to personal characteristics and targeted training. The aim of this study was to characterize non-academic factors (personal and environmental) influencing the development of empathy in undergraduate nursing studies who are not receiving a targeted training in empathetic abilities in their nursing schools. METHODS: A cross-sectional study was performed in the three nursing schools located in Cusco city, Peru (two private and one public). The Jefferson Scales of Empathy, Attitudes toward Physician-Nurse Collaboration, and Lifelong Learning, the Emotional Loneliness Scale for Adults, and the Scale of Life Satisfaction, were applied as the main measures. Also, information regarding gender, nursing school, and age, were collected. After psychometric properties were assessed, all measures were used in the development of a multivariate regression model to characterize factors of influence in empathy. RESULTS: In a sample composed by 700 undergraduate nursing students (72 males and 628 females), a multivariate linear regression model was created. This model explained the 53% of variance of empathy and fitted all conditions necessary for inference estimations. Teamwork abilities, loneliness, age, sex, subjective well-being, and nursing school, appeared as factors influencing the development of empathy in patients' care. CONCLUSIONS: Findings have indicated that, in absence of a targeted training, individual characteristics and characteristics associated with social and family environments play an important role of influence in the development of empathy in nursing students. These findings are also in consonance with others previously reported in different cultural settings including high-, middle- and low-income countries.

[Empathy, inter-professional collaboration, and lifelong medical learning in Spanish and Latin-American physicians-in-training who start their postgraduate training in hospitals in Spain. Preliminary outcomes]. / Empatía, habilidades de colaboración interprofesional y aprendizaje médico permanente en residentes españoles y latinoamericanos que inician los programas de formación médica especializada en España. Resultados preliminares.

OBJECTIVE: To identify similarities and differences in empathy, abilities toward inter-professional collaboration, and lifelong medical learning, between Spanish and Latin-American physicians-in-training who start their posgraduate training in teaching hospitals in Spain. DESIGN: Observational study using self-administered questionnaires. SETTINGS: Five teaching hospitals in the province of Barcelona, Spain. PARTICIPANTS: Spanish and Latin-American physicians-in-training who started their first year of post-graduate medical training. MAIN MEASUREMENTS: Empathy was measured using the Jefferson scale of empathy. Abilities for inter-professional collaboration were measured using the Jefferson scale attitudes towards nurse-physician collaboration. Learning was measured using the Jefferson scale of medical lifelong learning scale. RESULTS: From a sample of 156 physicians-in-training, 110 from Spain and 40 from Latin America, the Spanish group showed the highest empathy (p<.05). On the other hand, Latin-American physicians had the highest scores in lifelong learning abilities (p<.001). A positive relationship was found between empathy and inter-professional collaboration for the whole sample (r=+0.34; p<.05). CONCLUSIONS: These results confirm previous preliminary data and underline the positive influence of empathy in the development of inter-professional collaboration abilities. In Latin-American physicians who start posgraduate training programs, lifelong learning abilities have a positive influence on the development of other professional competencies.

[Medical empathy of physicians-in-training who are enrolled in professional training programs. A comparative intercultural study in Spain]. / Empatía médica en médicos que realizan el programa de formación médica especializada. Estudio comparativo intercultural en España.

OBJECTIVE: To characterise some of the environmental factors that are sensitive to cultural influence, and are involved in the development of medical empathy in Spanish and Latin American physicians-in-training. DESIGN: Cross-sectional study using questionnaires. SETTING: Primary care and specialized medicine centres of the Healthcare System of La Rioja, Logroño, Spain. PARTICIPANTS: Physicians-in-training MAIN MEASUREMENTS: : Empathy was measured using the Jefferson Scale of Physician Empathy, version for healthcare professionals (JSE-HP). Socio-demographic, academic, and professional background information was collected. RESULTS: A total of 104 residents (67 from Spain and 32 from Latin America) answered and returned the questionnairess. The JSE-HP showed adequate psychometric properties. The empathy mean score of Spanish group was higher than that of the Latin American group (P=.01). Differences in the development of empathy were associated with: the development of professional models (P<.001), the positive encounter with other professionals (P=.001), and with a continuing medical education (P=.008). CONCLUSIONS: Some factors involved in the development of empathy that are sensitive to cultural influence have been characterised. The development of future research areas is suggested.

Empathy and Occupational Health and Well-Being in Ecuadorian Physicians Working with COVID-19 Patients: A Mixed-Method Study.

Approximately one out of ten COVID-19 cases in Ecuador was a physician. It has been reported that this situation has led to a serious detriment of physicians' health and well-being. This study aimed to (i) identify predictors of emotional exhaustion, somatization, and work alienation in Ecuadorian physicians working with COVID-19 patients and (ii) explore the pandemic impact on doctor-patient relationships and on empathy. In 79 Ecuadorian physicians (45 women) who worked with COVID-19 patients, two separate multiple regression models explained the following: 73% of the variability of emotional exhaustion was based on somatization, work alienation, working sector, and passing through a symptomatic infection (p < 0.001), and 56% of the variability of somatization was based on gender and emotional exhaustion (p < 0.001), respectively. Furthermore, intention to leave the profession was more frequent among physicians with greater work alienation (p = 0.003). On the contrary, more empathic physicians never considered leaving their profession during the COVID-19 pandemic (p = 0.03). In physicians' verbatim, cognitive empathy appeared associated to a positive change in doctor-patient relationships. On the contrary, having an overwhelming emotional empathy appeared associated to a negative change in doctor-patient relationships. These findings characterize differences in how physicians cope while working in the frontline of the pandemic.

Change in demand for health-related undergraduate studies in Spain during 2015-2021: a temporal series study.

Introduction: The expansion of higher education is a worldwide phenomenon. To our knowledge, there are no studies analyzing the trends in demands of enrollment in health-related studies in Spain. Therefore, the objective was to analyze the change in demand (the number of requests for enrollment divided by the number of offered places) for undergraduate health-related studies in Spain during the period 2015-2021 as well as compare the change by region in the pre (2015-2019) and pandemic (2020-2021) period. Methods: This is an observational (ecological type) study with temporal series analyses using data from public (non-for-profit) higher education institutions from the Integrated University Information System. For the analysis by region, we calculated the demand of all twelve undergraduate health-related degrees and the percentages of change between both periods using the Wilcoxon test. The Joinpoint Regression program was used to analyze the trends in demand for each degree during the 7-year period. Results: Significant (p < 0.001) increases in demand during the pandemic period were observed in all regions. During the pandemic, medicine, biomedicine, nursing, odontology and pharmacy presented a higher demand in comparison with data collected before the pandemic started. In contrast, this pattern was not confirmed in the following cases: physiotherapy, occupational therapy, podiatry, psychology, social work, human nutrition and dietetics. By regions, Navarra, Asturias, and La Rioja presented the most drastic changes. In regions with the biggest number of universities, such as Catalonia, Andalusia and Madrid, the change observed was smaller.

Role of Empathy and Lifelong Learning Abilities in Physicians and Nurses Who Work in Direct Contact with Patients in Adverse Working Conditions.

Empathy and lifelong learning are two professional competencies that depend on the four principles of professionalism: humanism, altruism, excellence, and accountability. In occupational health, there is evidence that empathy prevents work distress. However, in the case of lifelong learning, the evidence is still scarce. In addition, recent studies suggest that the development of lifelong learning varies in physicians and nurses and that it is sensitive to the influence of cultural stereotypes associated with professional roles. This study was performed with the purpose of determining the specific role that empathy and lifelong learning play in the reduction in occupational stress. This study included a sample composed by 40 physicians and 40 nurses with high dedication to clinical work in ambulatory consultations from a public healthcare institution in Paraguay. Somatization, exhaustion, and work alienation, described as indicators of occupational stress, were used as dependent variables, whereas empathy, lifelong learning, gender, discipline, professional experience, civil status, and family burden were used as potential predictors. Three multiple regression models explained 32% of the variability of somatization based on a linear relationship with empathy, lifelong learning, and civil status; 73% of the variability of exhaustion based on a linear relationship with empathy, somatization, work alienation, and discipline; and 62% of the variability of work alienation based on a linear relationship with lifelong learning, exhaustion, and discipline. These findings indicate that empathy and lifelong learning play important roles in the prevention of work distress in physicians and nurses. However, this role varies by discipline.

Burnout in International Medical Students: Characterization of Professionalism and Loneliness as Predictive Factors of Burnout.

BACKGROUND: Burnout is a common mental problem in medical students. For those who are following medical studies abroad there is a higher risk of suffering this syndrome, due to the combination of academic stress and the stress derived from their new living situation. This study was performed with the purpose of testing the following hypothesis: in medical students enrolled in medical programs abroad, abilities associated with professionalism and family support play a protective role in the prevention of suffering burnout. METHODS: A cross-sectional study was performed in the Faculty of Medicine of the University of Zagreb, where a fully English medical program is offered. The general version of the Maslach Burnout Inventory (MBI-GS) was used as a dependent variable, while Jefferson Scales of empathy, teamwork, and physician lifelong learning and the Social and Emotional Loneliness Scale for Adults were used as predictive variables. In addition, information related to sex, country of birth, native language, age, academic achievement, and living situation were collected in a socio-demographic form. Linear regression models were applied to identify predictors of burnout. RESULTS: In a sample composed of 188 medical students (38 Croatians and 144 foreigners from 28 countries), 18% of the global score in the MBI-GS was explained by lifelong learning and family loneliness. A separate analysis for each domain of the MBI-GS allowed the creation of three models: the first model explained 19% of the variance of the "exhaustion" domain by "country of birth", "living with parents", "academic year", and "cynicism"; a second model explained 24% of the variance of the "cynicism" domain by "academic year", "empathy", "lifelong learning", and "exhaustion"; and finally, a third model explained 24% of the variance of the "professional efficacy" domain by "lifelong learning", "family loneliness", and "cynicism". All obtained models presented an effect size between medium and large, as well as matching the required conditions for statistical inference. CONCLUSIONS: These findings confirm the important role that family plays as a source of support for medical students. Empathy and lifelong learning, two specific elements of medical professionalism, appear as protective factors in the prevention of burnout in international students.

[Empathy and loneliness in the context of healthcare professions: a scoping review]. / Empatía y soledad en el contexto de las profesiones sanitarias: artículo de revisión.

Social and communication skills play an important role in the relationship between healthcare professionals and their patients. In this field, it is plausible that clinical empathy and loneliness play an important role of influence. However, the knowledge about this roll is still scarce. The main purpose of this review was to collect findings reported on this matter in students and healthcare professionals. The review included: articles published in English or Spanish during the last fifty years that were indexed in MedLine or SCOPUS, with students or health professionals as participants, and where empathy and loneliness had been used as main measures. Eleven articles, published between 1986 and 2020, that met the abovementioned criteria were included in the analysis. From them, eight corresponded to observational studies and three to interventional studies. Eight studies included students and the other three included healthcare professionals in their study samples. A negative correlation between empathy and loneliness was found in four studies. Furthermore, loneliness in the family environment was described as a negative predictor of empathy towards patients. Training programs in empathic skills and group accompaniment proved not only effective in the improvement of empathy in students, but also in the reduction of loneliness. These findings confirm a close relationship between clinical empathy and loneliness. They also show that the improvement in empathic skills not only has a positive effect on the professional ethical behavior towards patients, but it also helps improving the professional's well-being by reducing loneliness.

Characterization of Factors Predicting a Favorable Opinion of Research Applications Submitted for an Ethical Review Process.

Introduction: In Spain, biomedical research applications must receive a positive ethical opinion from Research Ethics Committees (RECs) before being executed. There is limited information on how to optimize the ethical review process to reduce delays. This study was performed to characterize variables predicting favorable opinions at the first ethical review performed by a REC. Material and Methods: The study assessed all research applications revised by a REC in 2019-2020. Data was extracted from REC's database of La Rioja, Spain. Variables collected covered three areas: (i) principal investigator's profile; (ii) study design; and (iii) ethical review process. A model based on multiple logistic regression analysis was created to identify variables explaining favorable opinions in first rounds of ethical review processes. Results: The sample included 125 applications (41 submitted in 2019, and 84 in 2020). At the first review, nine (7%) applications were rejected, 56 (45%) were approved, and the remaining 60 (48%) required at least two reviews prior to approval. When comparing both years, a 2-fold increase in the number of applications submitted, and a difference in the ratio of applications with a favorable vs. non-favorable opinion were observed. Furthermore, a model predicted 71% of probability of obtaining a favorable opinion in the first ethical review. Three variables appeared as being explanatory: if the principal investigator is either the group leader or the department's head (OR = 17.39; p < 0.001), and if the informed consent (OR = 11.79; p = 0.01), and methods and procedures (OR = 34.15; p < 0.001) are well done. Conclusions: These findings confirm an increase in the number of submissions and a difference in the ratio of applications approved by year. Findings observed also confirm deficiencies in "informed consent" and in "methods and procedures" are the two main causes of delay for favorable ethical opinions. Additionally, findings highlight the need that group leaders and heads of departments should be more involved in guiding and supervising their research teams, especially when research applications are led by less experienced researchers. Based on these findings, it is suggested that an adequate mentoring and targeted training in research could derive in more robust research applications and in smoother ethical review processes.

Inter-Professional Collaboration and Occupational Well-Being of Physicians Who Work in Adverse Working Conditions.

Inter-professional collaboration, empathy and lifelong learning, components of medical professionalism, have been associated with occupational well-being in physicians. However, it is not clear whether this role persists in adverse working conditions. This study was performed to assess whether this is the case. These three abilities, and the self-perception of somatization, exhaustion and work alienation, were measured in a sample of 60 physicians working in a hospital declared to be in an institutional emergency. A multiple regression model explained 40% of the variability of exhaustion, with a large effect size (Cohen's-f2 = 0.64), based on a linear relationship with teamwork (p = 0.01), and more dedication to academic (p < 0.001) and management activities (p < 0.003). Neither somatization nor alienation were predicted by empathy or lifelong learning abilities. Somatization, exhaustion, or alienation scores either explained empathy, inter-professional collaboration or lifelong learning scores. These findings indicate that, in adverse working environments, physicians with a greater sense of inter-professional collaboration or performing multi-task activities are more exposed to suffering exhaustion.

Empathy Enhancement Based on a Semiotics Training Program: A Longitudinal Study in Peruvian Medical Students.

BACKGROUND: Empathy, as a core element of medical professionalism, is part of leadership in medicine. This attribute, predominantly cognitive, involves understanding and communication capacity. Empathy can be enhanced with courses on medical semiotics. It appears adequate to apply this enhancement in the early stages of professional training. Based on this, this study was performed with the purpose of demonstrating the positive effect that an academic course on medical semiotics has on the development of empathy in medical students. METHODS: A quasi-experimental study was conducted in one School of Medicine in Peru, where medical students had to attend a 17-week course on medical semiotics as part of their regular training. The sample, composed by 269 students, included two cohorts of third-year medical students. As main measures, the Jefferson Scales of Empathy (JSE), inter-professional collaboration (JSAPNC), and lifelong learning (JeffSPLL), were used. In addition, students' scores evaluating theoretical and practical aspects of the course were collected once the course was finished. Pre- and post-tests were administered in week 1 and in week 17. Analyses compared measures in both moments and in time. Inter-professional collaboration and lifelong learning scores and empathy scores were used as discriminant and convergent validity measures of students' course scores, respectively. RESULTS: Gender differences on empathy appeared, but only at the beginning. In the entire sample, empathy enhancement was confirmed in time (p < 0.001), with a large effect size (r = 0.45). This effect was also observed in both gender groups, separately. On the contrary, no changes appeared in inter-professional collaboration and in lifelong learning abilities in time. In addition, a positive correlation was observed among empathy, inter-professional collaboration and lifelong learning abilities at the beginning and at the end, confirming that the improvement observed was specific for empathy and explained by the educational intervention assessed. CONCLUSION: These findings bring empiric evidence supporting the positive effect that training in medical semiotics has on empathy. In addition, these findings highlight some gender differences in the development of empathy in medical students.

Positive Impact of Professionalism on the Perception of Global Well-Being: A Study in Healthcare Professionals Starting Their First Working Experience in Peruvian Rural Areas.

Introduction: In Peru, recently graduated physicians and nurses who are willing to start working in the public healthcare system, first have to work in their newly acquired profession in the programme denominated "Servicio Rural Urbano y Marginal de Salud" (SERUMS). The SERUMS programme is a 1-year contract in rural areas of the country. The aim of this study was to confirm the following hypothesis: the development of abilities associated to professionalism has a positive effect on the perception of global well-being in the professionals beginning SERUMS. Material and methods: In the study two cohorts of medical and nursing professionals that started SERUMS in 2017 and 2019 were included. The perception of global well-being and general health condition were measured with the Scale of Life Satisfaction (SWLS) and the General Health Questionnaire (GHQ-28), respectively. Professionalism was measured using Jefferson's scales of empathy (JSE), teamwork (JSAPNC), and lifelong learning (JeffSPLL). An analysis in phases using the R language was applied to develop a multiple regression model that would explain the lineal relationship between the global perception of well-being and the studied variables. Results: The study sample included 303 professionals (108 men and 195 women) with a mean age of 26 years, ranging from 22 to 39 years (SD = 4). Based on their profession, 230 were medical doctors and 67 were nurses. The multiple regression model evidenced that age (p < 0.001), social dysfunction (p < 0.001), severe depression (p < 0.001), and inter-professional collaborative work abilities (p < 0.001) explain 38% of the variability in the global perception of well-being. Moreover, a second model explained 44% of the variability in the inter-professional collaborative work abilities based on a lineal relationship with empathy (p < 0.001), lifelong learning (p < 0.001), and future professional orientation (p = 0.01). Both models complied with the necessary conditions for statistic inference and showed large effect sizes. Conclusions: These findings confirm that professionalism has an important role in improving the global well-being of the professionals initiating SERUMS. This influence is direct in the case of inter-professional collaborative work, whereas it is indirect in the case of empathy and lifelong learning.

Family Loneliness: Its Effects in the Development of Empathy, Teamwork and Lifelong Learning Abilities in Medical Students.

CONTEXT: Family offers an important source of social support where individuals acquire social abilities that are necessary to create positive human relationships. This influence has been discussed by different sociological and psychological theories along the life span of individuals. In medicine, empathy, teamwork, and lifelong learning have been described as specific elements of professionalism that have special importance in the interaction with patients and in physicians' well-being at the workplace. This study was performed with the aim of demonstrating the following hypothesis: In the absence of specific training in empathy and teamwork and lifelong learning abilities, their development in medical students is associated with the students' perception of loneliness from their family environment. METHODS: A cross-sectional study was performed in the only two medical schools of Cusco (Peru), one private and the other public. Jefferson Scales of Empathy, Teamwork, and Lifelong Learning were used as the main measures. Mother-son and father-son relationships and family loneliness were measured to characterize the family environment. In addition, information related to sex, medical school, academic achievements, and place of origin were collected to control possible biases. Comparative, correlation, and multiple regression analyses were performed among the variables studied. RESULTS: In a sample of 818 medical students, differences by school appeared in empathy, teamwork, lifelong learning, and family loneliness. In addition, family loneliness showed an inverse correlation with empathy, teamwork, and learning measures. While having a positive relationship with the mother was associated with a greater development of empathy and learning abilities in the entire sample, a similar effect was observed in father-son relationships, but only in the private medical school group. Finally, in the public medical group, a multiple regression model explained 43% of the variability of empathy based on a lineal relationship with teamwork (p < 0.001), lifelong learning (p < 0.001), and family loneliness (p < 0.001). CONCLUSION: These findings confirm how family loneliness is detrimental to the development of medical professionalism. Also, they support the important role that the family, and especially parents, plays in the development of empathy, teamwork, and abilities in medical students. Finally, these findings highlighted important differences among students enrolled in public and private medical schools.

Factors Related to the Differential Development of Inter-Professional Collaboration Abilities in Medicine and Nursing Students.

Introduction: For physicians and nurses, teamwork involves a set of communication and social skills, and specific training in interdisciplinary work in order to be able to work together cooperatively, sharing responsibilities, solving problems, and making decisions to carry out actions centered on patients' care. Recent studies demonstrate that in the absence of targeted interdisciplinary educational programs, the development of teamwork abilities is sensitive to the influence of the dominant work environment. The purpose of this study was to characterize the role that environmental and individual factors play in the development of teamwork in environments with a dominant hierarchical work model. Methods: Questionnaires were distributed to 1,880 undergraduate students (980 medicine students and 900 nursing students) from three universities of Cusco city (Peru). The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration was used as the main variable. The Jefferson Scales of Empathy and Lifelong Learning, the Social and Emotional Loneliness Scale for Adults, the Scale of Life Satisfaction, sex, discipline, age, and academic semester were used as explanatory variables. After calculating internal reliability and normality of the main measures, descriptive, comparative, and correlation analyses were performed to determine variables influencing the teamwork score. Results: A total of 1,518 (81%) surveys were returned fully completed. Adequate reliability was confirmed in all instruments. In the sample, nursing students showed greater inter-professional collaborative abilities than medicine students (p < 0.001). This attitudinal gap was higher in advanced semesters. A three-way ANOVA indicated differences in teamwork were associated with discipline (p < 0.001), sex (p < 0.01), and university (p < 0.001). However, main effects were associated only with discipline (η p2 = 0.14). Teamwork showed an inverse correlation with loneliness (ρ = -0.28; p < 0.001) and a positive correlation with empathy (ρ = + 0.49; p < 0.001) and lifelong learning (ρ = + 0.48; p < 0.001). Teamwork positively correlated with life satisfaction only in the medicine student group (ρ = + 0.15; p < 0.001). Conclusion: These findings bring new evidence to support the main effect that social environments, in the absence of targeted interdisciplinary educational programs, play in the development of teamwork.

Improvement of Inter-Professional Collaborative Work Abilities in Mexican Medical and Nursing Students: A Longitudinal Study.

Background: Inter-professional and interpersonal relationships in collaborative work environments can prove to be critical elements in healthcare practice. When implementers fail to understand the importance of a collaborative perspective, this can lead to communication problems which ultimately harm the users. Objectives: To improve the inter-professional collaborative work skills of Mexican students in their first year of medical and nursing degrees through the use of a training program geared toward development of interpersonal skills and interdisciplinary work. Methods: The sample was composed of 162 students (62 males and 99 females) from the School of Healthcare Sciences of the Autonomous University of Coahuila, Mexico. The main measures used were the Jefferson Scale of Empathy (JSE); the Jefferson Scale of Attitudes toward Inter-Professional Collaborative Work between Medical and Nursing Professionals (JSAPNC); and the Jefferson Scale of Lifelong Learning (JeffSPLL). The entire sample was divided into two groups (experimental and control groups). Both groups attended an extra-curricular program using a coaching methodology. In the first case the topic focused on attitudes toward inter-professional collaborative work. In the second case, the program focused on addiction. Both programs ran for 4 months. Psychometric instruments were applied at the beginning and at the end of both programs. After analyzing the reliability of the instruments, an ANOVA test was performed. Results: The control group of medical students showed a deterioration in the development of collaborative work skills (p < 0.01), whereas in the experimental group this deterioration was not present. In the experimental group of nursing students, a significant increase in the development of collaborative work skills (p < 0.05) was observed. The differences were clearly due to the professional area of study (p < 0.001). Conclusion: There are differences in collaborative work skill development among different professional areas. These differences can be reduced through the implementation of a program aimed at developing collaborative work and interpersonal skills in the early stages of training.

Role of a Semiotics-Based Curriculum in Empathy Enhancement: A Longitudinal Study in Three Dominican Medical Schools.

Background: Empathy in the context of patient care is defined as a predominantly cognitive attribute that involves an understanding of the patient's experiences, concerns, and perspectives, combined with a capacity to communicate this understanding and an intention to help. In medical education, it is recognized that empathy can be improved by interventional approaches. In this sense, a semiotic-based curriculum could be an important didactic tool for improving medical empathy. The main purpose of this study was to determine if in medical schools where a semiotic-based curriculum is offered, the empathetic orientation of medical students improves as a consequence of the acquisition and development of students' communication skills that are required in clinician-patient encounters. Design: This quasi-experimental study was conducted in three medical schools of the Dominican Republic that offer three different medical curricula: (i) a theoretical and practical semiotic-based curriculum; (ii) a theoretical semiotic-based curriculum; and (iii) a curriculum without semiotic courses. The Jefferson scale of empathy was administered in two different moments to students enrolled in pre-clinical cycles of those institutions. Data was subjected to comparative statistical analysis and logistic regression analysis. Results: The study included 165 students (55 male and 110 female). Comparison analysis showed statistically significant differences in the development of empathy among groups (p < 0.001). Logistic regression confirmed that gender, age, and a semiotic-based curriculum contributed toward the enhancement of empathy. Conclusion: These findings demonstrate the importance of medical semiotics as a didactic teaching method for improving beginners' empathetic orientation in patients' care.

Professionalism and Occupational Well-Being: Similarities and Differences Among Latin American Health Professionals.

Context: Empathy, teamwork, and lifelong learning are described as key elements of professionalism. The first recipients of their benefits are professionals themselves. Paradoxically, scarce studies have reported association between professionalism and occupational well-being. The main purpose of this study was to characterize the influence that empathy, teamwork, and lifelong learning, play in the occupational well-being of physicians and nurses working in Latin American healthcare institutions. Materials and Methods: The Jefferson Scale of Empathy, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, the Jefferson Scale of Physicians Lifelong Learning, and the Scale of Collateral Effects (somatization, exhaustion, and work alienation), were administered to 522 physicians and nurses working in institutions of Mexico, Colombia, Ecuador, and Argentina. Internal reliability was calculated. Gender and discipline were used as explanatory variables in comparison analysis. Two-way analysis of variance was performed to examine differences due to the main effects of the gender, and discipline, and to determine possible combined effects. Correlation analysis was performed to measure associations between collateral effects and age, and between collateral effects and professionalism. Results: A total of 353 (68%) surveys were returned fully completed. Adequate reliability was confirmed in all instruments. No differences were found among countries for collateral effects. Correlation analysis confirmed in physicians an inverse association between empathy and collateral effects (P = -0.16; p < 0.05), and between collateral effects and lifelong learning (P = -0.18; p < 0.01). In nurses, this association was confirmed only for empathy (P = -0.19; p < 0.05). Important differences in the development of professionalism and in its effects on occupational well-being appeared associated to inter-professional collaboration and work roles. An inverse correlation between age and collateral effects was confirmed in physicians (P = -0.22; p < 0.001) and in nurses (P = -28; p < 0.001). Comparison by gender confirmed higher somatization in women physicians and nurses than in men groups (p < 0.001). On the other hand, comparison by discipline confirmed higher exhaustion and alienation in physicians than in nurses (p < 0.01). Conclusion: The findings support the importance that empathy, teamwork, and lifelong learning have in practitioners' health and welfare, and the role that cultural behaviors, associated to work professional models and social stereotypes, play in the interaction between professionalism and occupational well-being.