Empathy as related to gender, age, race and ethnicity, academic background and career interest: A nationwide study of osteopathic medical students in the United States.

CONTEXT: Research on associations between medical student empathy and demographics, academic background and career interest is limited, lacks representative samples and suffers from single institutional features. This study was designed to fill the gap by examining associations between empathy in patient care, and gender, age, race and ethnicity, academic background and career interest in nationwide, multi-institutional samples of medical students in the United States and to provide more definitive answers regarding the aforementioned associations, with more confidence in the internal and external validity of the findings. METHODS: Four nationwide samples participated in this study (n = 10 751). Samples 1, 2, 3 and 4 included 3616 first-year, 2764 second-year, 2413 third-year and 1958 fourth-year students who completed a web-based survey at the end of the 2017-2018 academic year. The survey included questions on demographics, academic background and career interest, the Jefferson Scale of Empathy, and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire to control for the effect of 'good impression' response bias. RESULTS: Statistically significant and practically important associations were found between empathy scores and gender (in favour of women), race and ethnicity (in favour of African-American and Hispanic/Latino/Spanish), academic background (in favour of 'Social and Behavioural Sciences' and 'Arts and Humanities' in Samples 1 and 2) and career interest (in favour of 'People-Oriented' and 'Psychiatry' specialties). CONCLUSIONS: Special features of this study (eg, nationwide representative samples, use of a validated instrument for measuring empathy in patient care, statistical control for the effect of 'good impression' response bias, and consistency of findings in different samples from multiple institutions) provide more definitive answers to the issue of correlates of empathy in medical students and increase our confidence in the validity, reliability and generalisability of the results. Findings have implications for career counselling and targeting students who need more guidance to enhance their empathic orientation.

Does Empathy Decline in the Clinical Phase of Medical Education? A Nationwide, Multi-Institutional, Cross-Sectional Study of Students at DO-Granting Medical Schools.

PURPOSE: To examine differences in students' empathy in different years of medical school in a nationwide study of students of U.S. DO-granting medical schools. METHOD: Participants in this cross-sectional study included 10,751 students enrolled in 41 of 48 campuses of DO-granting medical schools in the United States (3,616 first-year, 2,764 second-year, 2,413 third-year, and 1,958 fourth-year students). They completed a web-based survey at the end of the 2017-2018 academic year that included the Jefferson Scale of Empathy and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire for measuring "good impression" response bias. Comparisons were made on empathy scores among students in different years of medical school using analysis of covariance, controlling for the effect of "good impression" response bias. Also, comparisons were made with preexisting data from students of U.S. MD-granting medical schools. RESULTS: A statistically significant decline in empathy scores was observed when comparing students in the preclinical (years 1 and 2) and the clinical (years 3 and 4) phases of medical school (P < .001); however, the magnitude of the decline was negligible (effect size =0.13). Comparison of findings with MD students showed that while the pattern of empathy decline was similar, the magnitude of the decline was less pronounced in DO students. CONCLUSIONS: Differences in DO-granting and MD-granting medical education systems, such as emphasis on provision of holistic care, hands-on approaches to diagnosis and treatment, and patient-centered care, provide plausible explanations for disparity in the magnitude of empathy decline in DO compared with MD students. More research is needed to examine changes in empathy in longitudinal study and explore reasons for changes to avert erosion of empathy in medical school.

2019 United States Osteopathic Medical Regulatory Summit: Consensus, Recommendations, and Next Steps in Defining Osteopathic Distinctiveness.

BACKGROUND: Osteopathic distinctiveness is a result of professional education, identity formation, training, credentialing, and qualifications. With the advancement of a single graduate medical education (GME) accreditation system and the continued growth of the osteopathic medical profession, osteopathic distinctiveness and professional identity are seen as lacking clarity and pose a challenge. SUMMIT: To achieve consensus on a succinct definition of osteopathic distinctiveness and to identify steps to more clearly define and advance that distinctiveness, particularly in professional self-regulation, a representative group of osteopathic medical students, residents, physicians, and members of the licensing, GME, and undergraduate medical education (UME) communities convened the 2019 United States Osteopathic Medical Regulatory Summit in February 2019. Key features of osteopathic distinctiveness were discussed. Growth in the profession; changes in health care delivery, technology, and demographics within the profession and patient communities; and associated challenges and opportunities for osteopathic medical practice and patients were considered. CONSENSUS: Osteopathic medicine is a distinctive practice that brings unique, added value to patients, the public, and the health care community at large. A universal definition and common understanding of that distinctiveness is lacking. Efforts to unify messaging that defines osteopathic distinctiveness, to align the distinctive elements of osteopathic medical education and professional self-regulation across a continuum, and to advance research on care and educational program outcomes are critical to the future of the osteopathic medical profession. RECOMMENDATIONS: (1) Convene a task force of groups represented at the Summit to develop a succinct and consistent message defining osteopathic distinctiveness. (2) Demonstrate uniqueness of the profession through research demonstrating efficacy of care and patient outcomes, adding to the public good. (3) Harmonize GME and UME by beginning to align entrustable professional activities with UME milestones. (4) Convene representatives from osteopathic specialty colleges and certification boards to define curricular elements across GME, certification, and osteopathic continuous certification. (5) Build on the Project in Osteopathic Medical Education and Empathy study.

Empathy in Medicine National Norms for the Jefferson Scale of Empathy: A Nationwide Project in Osteopathic Medical Education and Empathy (POMEE).

CONTEXT: National norms are necessary to assess individual scores from validated instruments. Before undertaking this study, no national norms were available on empathy scores. The Project in Osteopathic Medical Education and Empathy (POMEE) provided a unique opportunity to develop the first national norms for medical students. OBJECTIVE: To develop national norms for the assessments of osteopathic medical students' empathy scores on the broadly used and well-validated Jefferson Scale of Empathy (JSE) at all levels of osteopathic medical school education. METHODS: Participants were students from 41 of 48 participating campuses of osteopathic medical schools. Students were invited to complete a web-based survey, which included the JSE, in the 2017-2018 academic year. RESULTS: A total of 16,149 completed surveys were used to create national norm tables. Three national norm tables were developed for first-year matriculants and for students in preclinical (years 1 and 2) and clinical (years 3 and 4) phases of medical school. The norm tables allow any raw score on the JSE for male and female osteopathic medical students from matriculation to graduation to be converted to a percentile rank to assess an individual's score against national data. CONCLUSIONS: National norms developed in this project, for men and women and at different levels of medical school education, can not only be used for the assessment of student's individual scores on the JSE, but can also serve as a supplementary measure for admissions to medical school and postgraduate medical education programs.

Navigating Tumultuous Change in the Medical Profession: The Coalition for Physician Accountability.

Collaboration among the national organizations responsible for self-regulation in medicine in the United States is critical, as achieving the quadruple aim of enhancing the patient experience and improving population health while lowering costs and improving the work life of clinicians and staff is becoming more challenging. The leaders of the national organizations responsible for accreditation, assessment, licensure, and certification recognize this and have come together as the Coalition for Physician Accountability. The coalition, which meets twice per year, was created in 2011 as a discursive space for group discussion and action related to advancing health care, promoting professional accountability, and improving the education, training, and assessment of physicians. The coalition offers a useful avenue for members to seek common ground and develop constructive, thoughtful solutions to common challenges. Its members have endorsed consensus statements about current topics relevant to health care regulation, advanced innovation in medical school curricula, encouraged a plan for single graduate medical education accreditation for physicians holding MD and DO degrees, supported interprofessional education, championed opioid epidemic mitigation strategies, and supported initiatives responsive to physician workforce shortages, including the Interstate Medical Licensure Compact, an expedited pathway by which eligible physicians may be licensed to practice in multiple jurisdictions.

The Jefferson Scale of Empathy: a nationwide study of measurement properties, underlying components, latent variable structure, and national norms in medical students.

The Jefferson Scale of Empathy (JSE) is a broadly used instrument developed to measure empathy in the context of health professions education and patient care. Evidence in support of psychometrics of the JSE has been reported in health professions students and practitioners with the exception of osteopathic medical students. This study was designed to examine measurement properties, underlying components, and latent variable structure of the JSE in a nationwide sample of first-year matriculants at U.S. colleges of osteopathic medicine, and to develop a national norm table for the assessment of JSE scores. A web-based survey was administered at the beginning of the 2017-2018 academic year which included the JSE, a scale to detect "good impression" responses, and demographic/background information. Usable surveys were received from 6009 students enrolled in 41 college campuses (median response rate = 92%). The JSE mean score and standard deviation for the sample were 116.54 and 10.85, respectively. Item-total score correlations were positive and statistically significant (p < 0.01), and Cronbach α = 0.82. Significant gender differences were observed on the JSE scores in favor of women. Also, significant differences were found on item scores between top and bottom third scorers on the JSE. Three factors of Perspective Taking, Compassionate Care, and Walking in Patient's Shoes emerged in an exploratory factor analysis by using half of the sample. Results of confirmatory factor analysis with another half of the sample confirmed the 3-factor model. We also developed a national norm table which is the first to assess students' JSE scores against national data.

A new pathway for medical education.

Physician education in the United States must change to meet the primary care needs of a rapidly transforming health care delivery system. Yet medical schools continue to produce a disproportionate number of hospital-based specialists through a high-cost, time-intensive educational model. In response, the American Osteopathic Association and the American Association of Colleges of Osteopathic Medicine established a blue-ribbon commission to recommend changes needed to prepare primary care physicians for the evolving system. The commission recommends that medical schools, in collaboration with their graduate medical education partners, create a new education model that is based on achievement of competencies without a prescribed number of months of study and incorporates the knowledge and skills needed for a twenty-first-century primary care practice. The course of study would occur within a longitudinal clinical training environment that allows for seamless transition from medical school through residency training.

Student vaccination requirements of U.S. health professional schools: a survey.

BACKGROUND: Unvaccinated health care personnel are at increased risk for transmitting vaccine-preventable diseases to their patients. The Advisory Committee on Immunization Practices (ACIP) recommends that health care personnel, including students, receive measles, mumps, rubella, hepatitis B, varicella, influenza, and pertussis vaccines. Prematriculation vaccination requirements of health professional schools represent an early opportunity to ensure that health care personnel receive recommended vaccines. OBJECTIVE: To examine prematriculation vaccination requirements and related policies at selected health professional schools in the United States and compare requirements with current ACIP recommendations. DESIGN: Cross-sectional study using an Internet-based survey. SETTING: Medical and baccalaureate nursing schools in the United States and its territories. PARTICIPANTS: Deans of accredited medical schools granting MD (n = 130) and DO (n = 26) degrees and of baccalaureate nursing programs (n = 603). MEASUREMENTS: Proportion of MD-granting and DO-granting schools and baccalaureate nursing programs that require that entering students receive vaccines recommended by the ACIP for health care personnel. RESULTS: 563 schools (75%) responded. More than 90% of all school types required measles, mumps, rubella, and hepatitis B vaccines for entering students; varicella vaccination also was commonly required. Tetanus, diphtheria, and acellular pertussis vaccination was required by 66%, 70%, and 75% of nursing, MD-granting, and DO-granting schools, respectively. Nursing and DO-granting schools (31% and 45%, respectively) were less likely than MD-granting schools (78%) to offer students influenza vaccines free of charge. LIMITATIONS: Estimates were conservative, because schools that reported that they did not require proof of immunity for a given vaccine were considered not to require that vaccine. Estimates also were restricted to schools that train physicians and nurses. CONCLUSION: The majority of schools now require most ACIP-recommended vaccines for students. Medical and nursing schools should adopt policies on student vaccination and serologic testing that conform to ACIP recommendations and should encourage annual influenza vaccination by offering influenza vaccination to students at no cost. PRIMARY FUNDING SOURCE: None.

Using the Clinical Prevention and Population Health Curriculum Framework to encourage curricular change.

The Healthy People Curriculum Task Force was established in 2002 to encourage implementation of Healthy People 2010 Objective 1.7: "To increase the proportion of schools of medicine, schools of nursing and health professional training schools whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention." In 2004, the Task Force published a Clinical Prevention and Population Health Curriculum Framework ("Framework") to help each profession assess and develop more robust approaches to this content in their training. During the 6 years since the publication of the Framework, the Task Force members introduced and disseminated it to constituents, facilitated its implementation at member schools, integrated it into initiatives that would influence training across schools, and adapted and applied the Framework to meet the data needs of the Healthy People 2010 Objective 1.7. The Framework has been incorporated into initiatives that help promote curricular change, such as accreditation standards and national board examination content, and efforts to disseminate the experiences of peers, expert recommendations, and activities to monitor and update curricular content. The publication of the revised Framework and the release of Healthy People 2020 (and the associated Education for Health Framework) provide an opportunity to review the efforts of the health professions groups to advance the kind of curricular change recommended in Healthy People 2010 and Healthy People 2020 and to appreciate the many strategies required to influence health professions curricula.

The roles of healthcare professionals in implementing clinical prevention and population health.

Across the health disciplines, clinical prevention and population health activities increasingly are recognized as integral to the practice of their professions. Most of the major clinical health professions organizations have begun incorporating clinical prevention and population health activities and services into educational curricula, the accreditation process, and training to affect clinical practice. Students in each health profession need to understand the roles played by those in other health professions. This understanding is a prerequisite for better communication and collaboration among the professions and for accomplishing the educational objectives included in Healthy People 2020 and organized using the Education for Health framework. To help accomplish these goals, this article summarizes each health profession's contributions to the field of prevention and population health, explains how the profession contributes to interprofessional education or practice, reviews specific challenges faced in the provision of these types of services, and highlights future opportunities to expand the provision of these services. Several general themes emerge from a review of the different health professions' contributions to this area. First, having well-trained prevention and population health professionals outside of the traditional public health field is important because prevention and population health activities occur in almost all healthcare settings. Second, because health professionals work in interprofessional teams in the clinical setting, training and educating all health professionals within interprofessional models would be prudent. Third, in order to expand services, reimbursement for health promotion counseling, preventive medicine, and disease management assistance needs to be appropriate for each of the professions.

The challenges of primary care and innovative responses in osteopathic education.

Numerous reports predict U.S. primary care physician shortages, with deficits of 20,000-46,000 doctors projected by 2020-25. Doctors of osteopathic medicine (DOs) could help fill some of the gap alongside their medical doctor (MD) colleagues. Many osteopathic schools have undertaken initiatives to reinvigorate primary care career choices among students. This paper describes these developments, and it highlights as examples early-stage innovations at Lake Erie College of Osteopathic Medicine and A.T. Still University School of Osteopathic Medicine in Arizona. It will be several years before the changes can be assessed. The final outcome awaits coordinated national design changes in primary care support and training and in health care coverage.

The status and future of osteopathic medical education in the United States.

Osteopathic medical education (OME) developed during the 20th century into a separate system of training U.S. physicians. Doctors of osteopathic medicine (DOs) were educated in osteopathic medical colleges and residencies in osteopathic hospitals, took separate specialty and licensure examinations, and generally practiced in separate clinical environments from those of MDs. Founded more than 110 years ago in the United States to train osteopaths as an alternative to MD training of that time, by midcentury schools of osteopathy became schools of osteopathic medicine with the adoption of public health and biomedical principles, and osteopaths became osteopathic physicians, achieving full practice rights throughout the country. By 2000 there were 19 osteopathic medical schools, 42,000 practitioners, and a parallel system of osteopathic graduate medical education specialty training. Recently, OME's academic and clinical training environment has changed. Heightened accreditation requirements, curriculum innovations, competency-based standards, evidence-based training, increased research on osteopathic manipulative medicine (a distinctive aspect of OME), and new and expanding colleges have occurred (nine new osteopathic campuses developed between 2000 and 2008 and a 30% increase in the first-year osteopathic medical student class). During recent decades, a movement away from osteopathic medicine's traditionally primary-care-focused and separate training/practice system has occurred. Nearly all osteopathic hospitals closed or were integrated into allopathic hospital systems, student clinical training expanded into venues with MD education programs, fewer DO graduates pursued traditional primary care training, 60% entered training programs of the Accreditation Council for Graduate Medical Education, and DO and MD specialty practice integration became widespread. These developments have triggered a reassessment process for OME and professional organizational leadership.