Empatia (parte I): contribuições para a abordagem centrada na pessoa / Empathy (part I): contributions to a person-centered approach / Empatía (parte I): contribuciones a un enfoque centrado en la persona

Introdução: Este artigo explora o tema da empatia na relação médico-paciente. Objetivo: Contribuir para o aperfeiçoamento das habilidades de comunicação clínica ao revisar o entendimento e a aplicação da empatia na prática clínica. Métodos: Trata-se de uma revisão não sistemática dos principais livros utilizados na comunicação clínica sobre o tema da empatia. O recorte metodológico compreendeu as seguintes etapas: (1) amostra intencional da literatura; (2) coleta e leitura de dados ­ i.e., extração de fragmentos dos textos; (3) análise do conteúdo, com o foco na definição, importância e instrumentalização para a aplicação prática; (4) seleção e síntese, para facilitar a compreensão e a contextualização sobre o tema; e (5) comparação e ponderação do conteúdo selecionado. Resultados: A abrangência com que a empatia foi trabalhada na literatura selecionada resultou em três níveis de densidade empática: baixa, moderada e alta. Assim, a baixa densidade empática limitou-se mais à definição e importância do tema; a densidade moderada incorporou algum exemplo de como aplicar a empatia, porém de forma fragmentada; e a alta densidade empática abordou o tema de modo mais completo, facilitando a instrumentalização na prática clínica. Há concordância na literatura analisada de que a prática da empatia reflete-se na melhoria do cuidado médico, entretanto seu exercício permanece no campo racional. Ao exemplificar a aplicação prática da empatia, os autores sugerem que o médico adote uma postura isenta de julgamentos, ao mesmo tempo que propõem um exercício imaginativo, de adivinhação dos sentimentos/emoções do paciente. Apesar de os autores de alta densidade empática compreenderem a importância das emoções e nomeá-las no processo, percebe-se a necessidade de um desdobramento e aprofundamento a partir desse ponto. Conclusões: Por se tratar de um assunto complexo, com vários matizes, a empatia é abordada de diferentes formas na literatura selecionada. Isso evidencia sua riqueza e originalidade, ao mesmo tempo que apresenta lacunas para sua aplicação na prática clínica.

Introduction: This article explores the theme of empathy in the doctor-patient relationship. Objective: To contribute to the improvement of clinical communication skills by reviewing the understanding and application of empathy in clinical practice. Methods: A non-systematic review of the main books used in clinical communication on the topic of empathy. The methodological approach consisted in the following steps: (1) An intentional sample of the literature; (2) Data collection and reading, i.e., extracting fragments from texts; (3) Content analysis, focusing on definition, importance and instrumentalization for practical application; (4) Selection and synthesis to facilitate understanding and contextualization on the topic; and (5) Comparison and ponderance of the selected content. Results: The scope within which empathy was worked on in the selected literature resulted in three levels of empathic density: low, moderate, and high. Thus, low empathic density was limited to definition and importance; moderate density incorporated some examples of how to apply empathy in a fragmented way; high empathic density addressed the topic more fully, facilitating instrumentation in clinical practice. There is agreement in the literature analyzed that the practice of empathy reflects on the improvement of medical care. However, its exercise remains in the rational field. By exemplifying the practical application of empathy, the authors suggest that the physician adopt a non-judgmental posture, while proposing an imaginative exercise of guessing the patient's feelings/emotions. Although high-density empathy authors understand the importance of emotions and name them in the process, there is a need for an unfolding and deepening from this point on. Conclusions: Empathy is a complex subject with several nuances and is approached in different ways in the selected literature. This evidences its richness and originality, at the same time that it presents gaps for the application of empathy in clinical practice.

Introducción: Este artículo explora el tema de la empatía en la relación médico-paciente. Objetivo: contribuir a la mejora de las habilidades de comunicación clínica mediante la revisión de la comprensión y aplicación de la empatía en la práctica clínica. Método: se trata de una revisión no sistemática de los principales libros utilizados en comunicación clínica sobre el tema de la empatía. El enfoque metodológico comprendió los siguientes pasos: (1) Una muestra intencional de la literatura; (2) Recopilación y lectura de datos, es decir, extracción de fragmentos de textos; (3) Análisis de contenido, centrándose en definición, importancia e instrumentalización para la aplicación práctica; (4) Selección y síntesis para facilitar la comprensión y contextualización sobre el tema; y (5) Comparación y ponderación del contenido seleccionado. Resultados: el alcance con el que se trabajó la empatía en la literatura seleccionada tuvo como resultado tres niveles de densidad empática: baja, moderada y alta. Así, la baja densidad empática se limitaba más a la definición y la importancia; densidad moderada, incorporó algún ejemplo de cómo aplicar la empatía, pero de manera fragmentada; alta densidad empática se acercó del tema de manera más completa, facilitando la instrumentación en la práctica clínica. Existe acuerdo en la literatura analizada en que la práctica de la empatía se refleja en la mejora de la atención médica. Sin embargo, su ejercicio queda en el campo racional. Al ejemplificar la aplicación práctica de la empatía, los autores sugieren que el médico adopte una postura no crítica, al tiempo que propone un ejercicio imaginativo de adivinar los sentimientos/emociones del paciente. Si bien los autores de alta densidad empática entienden la importancia de las emociones y las nombran en el proceso, existe la necesidad de un desdoblamiento y profundización a partir de este punto. Conclusiones: Por tratarse de un tema complejo y con varios matices, la empatía es abordada de diferentes maneras en la literatura seleccionada. Esto evidencia su riqueza y originalidad, al mismo tiempo que presenta vacíos para la aplicación de la empatía en la práctica clínica.

A systematic review of aggression and empathy / Una revisión sistemática de la agresión y la empatía

Abstract The evidence on the relationships between aggression and empathy is unclear in the literature. A recent meta- analysis indicated that associations are limited, while repeated research in recent years has reported both positive and negative correlations. This systematic review seeks to establish the current evidence on different studies that have been conducted on the relationships between proactive and reactive aggressive behavior and empathy, from the cognitive and affective subdomains, in adolescents, youth and young adults. Method: Systematic review according to PRISMA guidelines. Results: 8 articles were found that met the inclusion and exclusion criteria described and discrepancies between the associations of the two variables addressed are reported. Conclusion: there seems to be a certain degree of acceptance of the inhibitory role of empathy against aggression, particularly that of affective empathy. No conclusive results were found for cognitive empathy with the different types of aggression.

Resumen La evidencia sobre las relaciones entre la agresión y la empatía no están claras en la literatura. Un metaanálisis reciente indicó que las asociaciones son limitadas, mientras que reiteradas investigaciones de los últimos años han reportado correlaciones positivas y negativas. Esta revisión sistemática busca establecer la evidencia actual sobre diferentes estudios que se han llevado a cabo sobre las relaciones entre la conducta agresiva de tipo proactivo y reactivo y la empatía, desde los subdominios cognitivo y afectivo, en adolescentes, jóvenes y adultos jóvenes. Método: Revisión sistemática de acuerdo con las directrices PRISMA. Resultados: se encontraron 8 artículos que cumplían los criterios de inclusión y exclusión descritos y se reportan las discrepancias entre las asociaciones de las dos variables abordadas. Conclusión: parece haber cierto grado aceptación en el papel inhibidor de la empatía frente a la agresión, de manera relevante el de la empatía afectiva. No se encontraron resultados concluyentes de la empatía cognitiva con los diferentes tipos de agresión.

Caracterización psicométrica y distribución empática entre las áreas académicas en estudiantes de enfermería / Psychometric Characterization and Empathic Distribution between Academic Areas in Nursing Students

Resumen Objetivo: El objetivo del estudio es caracterizar psicométricamente los datos de empatía y sus dimensiones, así como determinar la distribución empática entre las áreas académicas en el proceso de formación de estudiantes de pregrado de enfermería. Métodos: Este es un estudio comparativo, no experimental y transversal. La muestra estudiada fue de 365 estudiantes de enfermería de ambos sexos pertenecientes a la Facultad de Enfermería de la Universidad Veracruzana, México. El total de la población fue de 425 estudiantes y la muestra constituyó el 85,88% del total de estudiantes (mayo a julio de 2022). Se estudiaron las propiedades psicométricas de la escala de Empatía para Profesionales de la Salud, versión estudiantes (fiabilidad, validez de constructo e invarianza del modelo). Para describir y comparar los grupos se utilizaron estadísticos descriptivos, análisis de varianza y gráficos de las medias con barras que representaban el intervalo de confianza al 95%. Resultados: La medida de empatía alcanza coeficientes de fiabilidad satisfactorios y presenta adecuados indicadores de validez de constructo, resultando una medida invariante según área académica y sexo. Se encontró la existencia de déficits en algunas de las dimensiones de empatía. Conclusión: El análisis psicométrico (modelo de dimensiones subyacentes e invarianza), previa a la estimación de los parámetros de la empatía, constituye una necesitad metodológica que garantiza teóricamente la estimación de los niveles de empatía y de la comparación entre grupos. La distribución de los niveles de empatía entre las áreas académicas se caracterizó por un déficit en las dimensiones cuidado con compasión y "caminar en los zapatos del paciente".

Abstract Aim: The objective of the study is to psychometrically characterize the empathy data and its dimensions, as well as to determine the empathic distribution among the academic areas in the process of training undergraduate nursing students. Methods: This is a comparative, non-experimental, cross-sectional study. The studied sample consisted of 365 nursing students of both sexes belonging to the Faculty of Nursing of the Universidad Veracruzana, México. The total population was 425 students and the sample constituted 85.88% of the total number of students (May to July 2022). The psychometric properties of the Empathy Scale for Health Professionals, student version (reliability, construct validity, and model invariance) were studied. To describe and compare the groups, descriptive statistics, analysis of variance, and graphs of the means with bars -representing the 95% confidence interval- were used. Results: The empathy measure reaches satisfactory reliability coefficients and it presents adequate indicators of construct validity indicators, resulting in an invariant measure according to academic area and sex. The existence of deficits in some of the dimensions of empathy was found. Conclusion: The psychometric analysis (model of underlying dimensions and invariance), prior to the estimation of the empathy parameters, constitutes a methodological necessity that theoretically guarantees the estimation of the empathy levels and the comparison between groups. The distribution of empathy levels between academic areas was characterized by a deficit in the dimensions of compassionate care and "walking in the patient's shoes".

Estudio factorial exploratorio de empatía en docentes de una facultad de odontología / Exploratory Factorial Study of Empathy in Teachers of a Faculty of Dentistry

Resumen Objetivo: Explorar las dimensiones latentes presentes en los 20 ítems del constructo empatía, medido en docentes de una facultad de Odontología. Metodología: Docentes de odontología, pertenecientes a la Facultad de Odontología de la Universidad Andrés Bello, sede Santiago, constituida por 145 profesores de ambos sexos, en los cuales participaron el 88,27%. El instrumento aplicado es la Escala de Empatía de Jefferson para Profesionales de la Salud. La conformación del modelo de medida de la empatía se realizó mediante el análisis factorial exploratorio. El nivel de significación empleado fue de α<0,005. Resultados: Los resultados generales indican que los niveles de empatía son adecuados. Es posible establecer un modelo de tres factores. Dentro de la dimensión Cuidado Compasivo, perteneciente a la Empatía Emocional, se encuentra un ítem (14), el cual presentó una carga factorial significativa con Toma de Perspectiva con el paciente que pertenece a la Empatía Cognitiva. Conclusiones: Se establece un modelo tridimensional de la empatía en docentes de pregrado con el paciente. Los ítems de cada una de las dimensiones se correlacionaron entre sí, en concordancia con el modelo original de la empatía. Estos hallazgos deben ser corroborados por un análisis factorial confirmatorio.

Abstract Objective: To explore the latent dimensions, present in the 20 items of the empathy construct, measured in teachers of a dental school. Methodology: Dental teachers belonging to the Faculty of Dentistry of the Andrés Bello University, Santiago, consisting of 145 teachers of both sexes, in which 88.27% participated. The instrument applied was the Jefferson Empathy Scale for Health Professionals. Compliance with the model and the measurement of empathy levels was verified by means of exploratory factor analysis. The empathy measurement model was built using exploratory factor analysis. The level of significance used was α<0.005. Results: The overall results indicate that empathy levels are adequate. A three-factor model can be established. Within the Compassionate Care dimension, belonging to Emotional Empathy there is one item (14), which presented a significant correlation with Perspective Taking with the patient belonging to Cognitive Empathy. Conclusions: A three-dimensional model of empathy in undergraduate teachers with the patient is established. The items of each of the dimensions correlated with each other in agreement with the original model of empathy. These findings should be corroborated by a confirmatory factor analysis.

Effectiveness of different strategies to teach empathy among medical students: A randomized controlled study.

OBJECTIVES: To explore the effectiveness of two educational strategies for teaching empathy to medical students, focusing on their skills and on the theoretical knowledge and self-perception of empathy by patients, professors, and observers. METHODS: This is a randomized controlled study. Clerkship students were divided into two groups: an active group - Role Play and Reflection Group(RRG), and a more traditional group - Lecture Presentation Group(LPG). They were assessed pre- and post-intervention using the Jefferson Empathy Scale(JSPE), ESWIM Empathy Scale, CARE, empathic skills through simulated patient encounters, and a theoretical knowledge test. RESULTS: A total of 169 students were included. The RRG had higher scores (d=0.81) and greater gains (d=0.82) in empathic skills than the LPG. However, there were no significant differences in knowledge or other scales. Upon assessing skill acquisition (Post-Pre gains), there was a significant increase in both groups for all outcomes, except for JSPE in the LPG group and ESWIM for both groups. CONCLUSION: Medical empathy can be taught, and active learning methodologies can lead to better outcomes, especially on the ability to provide empathic care. PRACTICE IMPLICATIONS: These findings reinforce existing literature and helps medical schools make informed decisions regarding their teaching methodologies. TRIAL REGISTRY: https://ensaiosclinicos.gov.br/rg/RBR-8rwx89c.

Levels of Empathy in Students and Professors with Patients in a Faculty of Dentistry.

BACKGROUND: Empathy is an attribute that plays an essential role in the dentist-patient therapeutic relationship, clinical care, and treatment adherence, along with providing other benefits. The main objective of this research was to establish the validity, reliability, and invariance of the Jefferson Scale of Empathy and then characterize the empathy levels of students and teachers at a dental school. MATERIALS AND METHODS: An observational and cross-sectional study analyzed a sample of undergraduate students and professors from the Universidad Andrés Bello Faculty of Dentistry (Chile) (n = 1727 and n = 267, respectively). The Empathy Scale for Health Professionals (HP) and the same scale for students (HPS) were applied. RESULTS: The Jefferson Empathy Scale presents adequate psychometric properties. The empathy measure has adequate reliability and construct validity, confirming a fit of the three-factor empathy model to the data. The measurement is invariant within the university campus, the sex of the student, and between teacher and student. Teachers present greater empathy than students except in the Perspective Adoption dimension. CONCLUSIONS: The Jefferson Empathy Scale is reliable, valid, and invariant among Chilean dental students and professors. Students do not differ from their professors in the cognitive component of empathy, but they present a lower score in the affective component and global empathy. It is inferred that students can develop the affective component of empathy in their interactions with their professors, increasing their overall empathy. Understanding and fostering empathy in dental students and professors can significantly improve patient care and treatment adherence and increase patient and dentist satisfaction.

Comunicando o incomunicável? Mulheres com endometriose, assimetrias e limites da empatia / Communicating the incommunicable? Women with endometriosis, asymmetries and limits of empathy / ¿Comunicar lo incomunicable? Mujeres con endometriosis, asimetrías y límites de la empatía

Neste artigo, analisamos o documentário Endometriose: uma vida moldada pela dor, material que tem como objetivo "mostrar, tirar da invisibilidade e dar voz" a mulheres que vivem com intensa dor crônica causada pela doença que dá título à obra. Discutiremos, preliminarmente, as dificuldades e potencialidades do testemunho da dor física, a partir de reflexões de Scarry, Sontag e Bourke. Em seguida, abordaremos três fatores de caráter histórico-social que podem ajudar a explicar o silenciamento da experiência das pacientes: os limites da compaixão médica, especialmente relacionados a questões de gênero, classe e raça; a construção da ideia do corpo feminino como inerentemente patológico e as complexidades na relação médico-paciente em sua interseção com o gênero. Por fim, no último tópico do trabalho, trataremos dos esforços das mulheres com endometriose no sentido de tornar sua dor inteligível e modular que resposta desejam receber de seus interlocutores.

In this essay, we analyze the documentary Endometriosis: a life shaped by pain, a material that aims to "show, remove from invisibility and give voice" to women who live with intense chronic pain caused by endometriosis. We will preliminarily discuss the difficulties and potentialities of witnessing physical pain, based on the work of Scarry, Sontag and Bourke. Next, we will address three socio-historical factors that can help explain the silencing of patients' experiences: first, the limits of medical compassion, especially related to issues of gender, class and race; second, the construction of the idea of the female body as inherently pathological; third, the complexities in the doctor-patient relationship as it intersects with gender. Finally, in the last topic of the work, we will examine the efforts of endometriosis patients to make their pain intelligible and modulate the response they want to receive from their interlocutors.

En este artículo analizamos el documental Endometriosis: una vida marcada por el dolor, material que pretende "mostrar, sacar de la invisibilidad y dar voz" a mujeres que viven con intensos dolores crónicos provocados por la endometriosis. Discutiremos preliminarmente las dificultades y potencialidades de presenciar el dolor físico, a partir del pensamiento de Scarry, Sontag y Bourke. A continuación, abordaremos tres factores histórico-sociales que pueden ayudar a explicar el silenciamiento de las experiencias de los pacientes: primero, los límites de la compasión médica, especialmente relacionados con cuestiones de género, clase y raza; segundo, la construcción de la idea del cuerpo femenino como inherentemente patológico; tercero, las complejidades de la relación médico-paciente en su intersección con el género. Finalmente, en el último tema del trabajo, discutiremos los esfuerzos de las pacientes con endometriosis por hacer inteligible su dolor y modular la respuesta que quieren recibir de sus interlocutores.

Resilience as a Modulating Factor of Empathy in Medical Students

Introduction: Empathy is a complex and multidimensional attribute. Attempts have been made to explain empathic behavior based on other variables. Empirical evidence shows that empathy could be the product of the influence of several factors. One of these factors could be resilience. There is still no developed theory and consistent empirical evidence demonstrating that empathy depends on resilience. Objective: The aim of this study is to determine if resilience can predict empathic behavior. Methodology: This study is non-experimental and ex post facto with a cross-sectional design. Variables. Dependent: Empathy; Independent: Resilience. Population: Medical students belonging to the Faculty of Health Sciences of the Universidad Autónoma de Santa Ana (UNASA), Santa Ana, El Salvador (N=579). The sample (n=465) consisted of students (both sexes). Convenience sampling. Jefferson Scale of Empathy for Healthcare Professionals, student version (JSE-HPS). Trait Resilience Scale (EEA). A Structural Equation Modelling (SEM) model was used. Additionally, the Comparative Fit Index (CFI) (>0.95), Tucker-Lewis Index (TLI) (>0.95), Root Mean Square Error of Approximation (RMSEA) (<0.08), and Standardized Root Mean Square (SRMR) (<0.08), Confirmatory Factor Analysis (CFA) were employed. The significance level employed was α < 0.05. Results: All these results show that both measurement models (empathy and resilience) are adequately represented and are suitable for the structural model. Discussion: Individual resilience is a variable that can predict empathic behavior in medical students belonging to a Faculty of Health Sciences. The results constitute indirect empirical evidence that it is possible to define empathy as a dependent variable and resilience as an independent variable.

Introducción: La empatía es un atributo complejo y multidimensional. Se han realizado intentos para explicar el comportamiento empático basado en otras variables. La evidencia empírica muestra que la empatía podría ser el producto de la influencia de varios factores. Uno de estos factores podría ser la resiliencia. Aún no existe una teoría desarrollada y evidencia empírica consistente que demuestre que la empatía depende de la resiliencia. Objetivo: El objetivo de este estudio es determinar si la resiliencia puede predecir el comportamiento empático. Metodología: Este estudio es no experimental y ex post facto con un diseño transversal. Variables. Dependiente: Empatía; Independiente: Resiliencia. Población: Estudiantes de medicina pertenecientes a la Facultad de Ciencias de la Salud de la Universidad Autónoma de Santa Ana (UNASA), Santa Ana, El Salvador (N=579). La muestra (n=465) consistió en estudiantes (ambos sexos). Muestreo por conveniencia. Escala de Empatía de Jefferson para Profesionales de la Salud, versión estudiantil (JSE-HPS). Escala de Resiliencia de Rasgo (EEA). Se utilizó un modelo de Modelado de Ecuaciones Estructurales (SEM). Además, se emplearon el Índice de Ajuste Comparativo (CFI) (>0.95), Índice de Tucker-Lewis (TLI) (>0.95), Error Cuadrático Medio de Aproximación (RMSEA) (<0.08) y Error Cuadrático Medio Estandarizado (SRMR) (<0.08), Análisis Factorial Confirmatorio (CFA). El nivel de significancia empleado fue α < 0.05. Resultados: Estos resultados muestran que ambos modelos de medición (empatía y resiliencia) están adecuadamente representados y son adecuados para el modelo estructural. Discusión: Los resultados constituyen evidencia empírica indirecta de que es posible definir la empatía como una variable dependiente y la resiliencia como una variable independiente.

Subjective body-related experiences, and perception of the interventions and empathy of the healthcare team in adolescents with overweight. / Vivencias subjetivas relativas al cuerpo, percepción respecto a las intervenciones y empatía del equipo de salud en adolescentes con exceso de peso.

Introduction. Overweight adolescents are confronted daily with stereotypes that condition their body image, self-esteem, and mood. Objectives. To describe, in adolescents with overweight, the subjective experiences related to the body in daily life and their perceptions regarding the interventions and empathy of the health team. Population and methods. Descriptive study with qualitative approach. Semi-structured interviews were conducted with adolescents aged 11 to 18 years with selfreported mass index (BMI) ≥ 26 and referring to medical or nutritional follow-up for overweight, attended at the Adolescence Service of a hospital in the Autonomous City of Buenos Aires, between October 1, 2021, and May 31, 2022. Results. Twenty adolescents were evaluated, with a median age of 13.5 years, most of them from female sex (16/20). All reported body dissatisfaction from an early age (median age: 10 years old). They mention difficulty dressing due to the lack of different sizes; they even limit sports practice. They suffered weight- related body humiliation at school, in the family, or public (15/20). They perceived weight control in a dual way: weight loss was the primary stimulus for treatment, but its centrality in the consultations generated discomfort. The leading causes of therapeutic abandonment were the impossibility of temporarily sustaining the recommendations and the lack of weight loss. The treating team was willing to listen to the patients but needed to understand their daily experiences, physical, material, esthetic, social conditioning, beliefs, and perceptions. Conclusion. The adolescents included in this study perceived specific interventions of the healthcare team as beneficial, with empathic deficiencies.

Introducción. Adolescentes con exceso de peso confrontan a diario con estereotipos que condicionan su imagen corporal, autoestima y ánimo. Objetivos. Describir, en adolescentes con exceso de peso, las vivencias subjetivas relativas al cuerpo en la vida diaria y sus percepciones respecto a las intervenciones y empatía del equipo de salud. Población y métodos. Estudio descriptivo con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a adolescentes entre 11 y 18 años con índice de masa corporal (IMC) ≥ 26 autorreferenciado y/o que refirieran seguimiento médico o nutricional por exceso de peso, asistidos en el Servicio de Adolescencia de un hospital de la Ciudad Autónoma de Buenos Aires, entre el 1 de octubre de 2021 y el 31 de mayo de 2022. Resultados. Se evaluaron 20 adolescentes, con mediana de edad de 13,5 años, mayoritariamente de sexo femenino (16/20). La totalidad refirió insatisfacción corporal desde edades tempranas (edad mediana: 10 años). Mencionan dificultad para vestirse por falta de talles; limitan incluso la práctica deportiva. Padecieron humillación corporal relacionada con el peso en la escuela, la familia o la vía pública (15/20). Percibieron el control de peso de manera dual: su descenso fue el principal estímulo del tratamiento, pero su centralidad en las consultas generó malestar. Las principales causas de abandono terapéutico fueron la imposibilidad de sostener temporalmente las recomendaciones y la falta de descenso de peso. Se percibió del equipo tratante buena predisposición y escucha, pero cierta incomprensión sobre las vivencias cotidianas, condicionamientos físicos, materiales, estéticos, sociales, de sus creencias y percepciones. Conclusión. Percibieron beneficiosas ciertas intervenciones del equipo de salud, con falencias empáticas.

Is there an association among spirituality, resilience and empathy in medical students?

BACKGROUND: Spirituality has religious and nonreligious dimensions and is often linked to well-being, positive emotions, connection and meaning in life. Both empathy and resilience are important in medical training and future professional practice since they are considered core skills related to professionalism and patient care. Our study aimed to understand the relationships among spirituality, resilience, and empathy in medical students. We also aimed to determine whether there are differences by gender and between medical students in different years of a medical program. METHODS: Medical students (n = 1370) of the first to fourth years of a six-year medical program, from six medical schools, completed questionnaires to assess empathy (Jefferson Empathy Scale and Davis Multidimensional Interpersonal Reactivity Scale) and resilience (Wagnild & Young Scale) and to rate their spirituality. RESULTS: Medical students with high spirituality showed higher scores for both resilience and empathy (p < 0.001). In addition, we observed higher levels of both spirituality and empathy, but not resilience, in female medical students than in male medical students. In contrast, we did not detect significant differences in spirituality, empathy, or resilience between students in different years of medical school. CONCLUSION: Medical students with high levels of spirituality have also higher scores for both empathy and resilience. Spirituality, empathy and resilience have similar values for students in different years of a medical program.

Videojuegos y empatía. Del contenido violento a la actitud empática / Video games and empathy. From violent content to empathetic attitude

Resumen Objetivo: Comprender la relación entre el uso de videojuegos según su nivel de violencia y la disposición empática en la adolescencia. Método: Enfoque cuantitativo de diseño no experimental, de corte transversal y de alcance descriptivo-correlacional. La recolección de datos se llevó a cabo a través de un cuestionario ad hoc que exploró los factores que componen al uso de videojuegos (α=0,951), y la escala Índice de Reactividad Interpersonal que evaluó las cuatro dimensiones de empatía (α=0,745). La muestra quedó conformada por n=400 adolescentes de 12 a 18 años de edad, 55,2 % hombres y 44,8 % mujeres. Se utilizó un muestro probabilístico aleatorio simple. Resultados: La prueba H de Kruskal-Wallis determinó que el uso de videojuegos excesivamente violentos es un factor que genera diferencias estadísticamente (+18; p-valor= 0,001) en una dimensión de la empatía (Malestar Personal, MP), siendo mayor en quienes actualmente juegan estos juegos. Discusiones: MP es un constructo que, en altos niveles, marca una tendencia a evitar a las personas que están pasando por situaciones adversas, relacionándose negativamente con el comportamiento prosocial y el altruismo. En la investigación, los adolescentes que más juegan videojuegos +18 son quienes presentan una menor disposición empática, lo cual es congruente con otras investigaciones, donde se encontró que el uso de videojuegos violentos (UVV) redujo los niveles de empatía en niños y adolescentes, prediciendo una mayor frecuencia de conductas violentas. Así mismo, estudios regionales sugieren que el UVV aumenta los niveles de ira y agresividad, a la par que reduce la empatía.

Abstract Objective: To understand the relationship between the use of video games according to their level of violence and empathic disposition in adolescence. Method: Quantitative approach of non-experimental design, cross-sectional and descriptive-correlational scope. Data collection was carried out through an ad hoc questionnaire that explored the factors that make up the use of video games (α=0,951), and the Interpersonal Reactivity Index scale that evaluated the four dimensions of empathy (α=0,745). The sample consisted of n=400 adolescents aged 12 to 18 years, 55,2 % male and 44,8 % female. A simple random probability sample was used. Results: The Kruskal-Wallis H-test determined that the use of excessively violent video games is a factor that generates statistically significant differences (+18; p-value = 0,001) in one dimension of empathy (Personal Malaise, PM), being higher in those who currently play these games. Discussion: PM is a construct that, at high levels, marks a tendency to avoid people who are going through adverse situations, being negatively related to prosocial behavior and altruism. In the research, adolescents who play more video games +18 are those who present a lower empathic disposition, which is congruent with other research, where it was found that the use of violent video games (VVG) reduced the levels of empathy in children and adolescents, predicting a higher frequency of violent behaviors. Likewise, regional studies suggest that VVG increases levels of anger and aggression, while reducing empathy.

Physicians' attention to patients' communication cues can improve patient satisfaction with care and perception of physicians' empathy.

BACKGROUND: The pathway that links good communication skills and better health outcomes is still unclear. However, it is known that the way that physicians and patients communicate with each other has direct consequences on more "proximal outcomes", such as perceptions of physician empathy and patient satisfaction. However, which specific communication skills lead to those patient outcomes is still unknown. In this study, the authors aimed to analyze which specific patient and physician communication skills are correlated to patients' satisfaction with care and patient-perceived physician empathy. METHODS: The authors classified and quantified verbal and nonverbal communication of second-year internal medicine residents and their patients through video recordings of their consultations. Patients also rated their satisfaction with care and the physician's empathy for them. RESULTS: Using a linear regression model, the authors identified that patients' and physicians' expressions of disapproval, physicians' disruptions, and patients' use of content questions negatively correlated to patients' satisfaction and patient-perceived physician empathy. Conversely, patient affective behaviors and the physician's provision of advice/suggestion were positively correlated to at least one of the patient-measured outcomes. CONCLUSION: Our findings point to the importance of physicians' attentiveness to patients' communication cues. Training physicians to interpret those cues could help develop more satisfactory and empathic therapeutic relationships.

Clinical empathy in a medium and high-risk Brazilian unit.

BACKGROUND: Clinical empathy is an essential part of healthcare, and patient-centered care models require clinical empathy to be established. Despite this, little is known about its measurement in the neonatal scenario. RESEARCH AIM: To measure clinical empathy in health professionals who work with medium and high-risk neonates and build a construct of this empathy. RESEARCH DESIGN: Single-center survey study. PARTICIPANTS AND RESEARCH CONTEXT: The Jefferson Scale of Empathy for Health Professionals questionnaire was applied to health professionals who work in an intensive care unit and a medium-risk unit, in Brazil. Analysis was done using descriptive statistics and a factor analysis model, to build the construct of empathy. Overall empathy was calculated, and the domains' punctuations were analyzed and compared to the maximum punctuation possible. The study followed the STROBE checklist. ETHICAL CONSIDERATIONS: This study was approved by the Research Ethics Committee of the institution. All participants signed the informed consent form. Participants' confidentiality and anonymity were protected. FINDINGS: Median empathy was 117 (IQR 113-124). The domain of Walking in the Patient's Shoes had lower scores and represented 77.6% of the maximum punctuation possible. The factor analysis included three factors named Understanding, Experiences, and Treatment, and Emotional Relationships, explaining 64.3% of the overall variance. The domain Walking in the Patient's Shoes was not included in the model. CONCLUSIONS: In this scenario, clinical empathy should improve. There is a need to improve the domain of Walking in the Patient's Shoes, in this case, the neonate, and provide more empathic care to them.

Empatía con el paciente en médicos especialistas que trabajan en un Hospital de Cuenca (Ecuador) / Empathy with the Patient in Medical Specialists Working in a Hospital in Cuenca ­ Ecuador / Empatia com o paciente em médicos especialistas que trabalham em um hospital em Cuenca, Equador

ntroducción: la empatía es uno de los componentes de la estructura de la humanización en la atención de los pacientes. Los médicos especialistas deben tener mucha empatía. El objetivo del artículo es des-cribir los índices de empatía en médicos que trabajan en un hospital de alta complejidad y explorar si existen diferencias entre las especialidades estudiadas. Métodos: se accedió a una muestra por conve-niencia de 237 médicos que representa el 53.55 % del total poblacional (n = 443). La empatía se midió con la Escala de Empatía para Profesionales de la Salud (hp), junto con análisis factorial confirmatorio y análisis multigrupo (para examinar la invarianza del modelo entre los sexos) y análisis de confia-bilidad (α de Cronbach, coeficiente de correlación intraclase y ω de McDonald). Resultados: la espe-cialidad de pediatría tuvo los mayores índices de empatía general y en las dimensiones "cuidado con compasión" y "caminando en los zapatos del paciente", no así en la dimensión "toma de perspectiva", donde es semejante a las especialidades de anestesiología, medicina crítica y terapia intensiva, y gine-cología. Conclusión: los valores de la empatía y los valores en las subescalas "cuidado con compasión" y "caminando en los zapatos del paciente" fueron (en valores absolutos, pero no estadísticos) mayores en la especialidad de pediatría. En la subescala "toma de perspectiva", las especialidades de pediatría, anestesiología, cirugía y clínica se observaron puntuaciones prácticamente iguales. Se requieren otros estudios que permita arribar a una explicación que permita entender por qué algunas especialidades tienen valores de empatía mayores que otras

Introduction: Empathy is one of the components of the structure of humanization in patient care. Medical specialists must have high levels of empathy. Objective: The aim of this paper is to describe the levels of empathy in doctors working in a highly complex hospital and to explore whether there are differ-ences between the specialties studied. Methods: A convenience sample of 237 physicians representing 53.55% of the total population (n = 443) was accessed. Empathy was measured using the Empathy Scale for Health Professionals (hp). Confirmatory factor analysis and multigroup analysis were performed to examine the invariance of the model between the sexes and reliability analyzes (Cronbach's α, intraclass correlation coefficient and McDonald's ω). Results: The specialty of pediatrics had the highest levels in general empathy and in the Compassionate Care and Walking in Patient Shoes subscales, but not in the Perspective Taking subescale where it presents levels similar to the specialties of anesthesiology, critical medicine and intensive care. and gynecology. Conclusions: The empathy values and the values in the compassionate care and "Walking in the patient's shoes" subscales were (in absolute values, but not sta-tistically) higher in the Pediatrics specialty. In the subscale Perspective Taking, Pediatrics, Anesthesiology, Surgery, and Clinic, practically the same scores were observed. Other studies are required to arrive at an explanation that allows us to understand why some specialties have higher empathy values than others.

Introdução: a empatia é um dos componentes da estrutura de humanização no atendimento ao paciente. Os médicos especialistas devem ter altos níveis de empatia. Objetivo: o objetivo deste artigo é descre-ver os níveis de empatia em médicos que trabalham em um hospital de alta complexidade e explorar se há diferenças entre as especialidades estudadas. Materiais e métodos: foi acessada uma amostra de conveniência de 237 médicos, representando 53,55% da população total (n = 443). A empatia foi medida usando a Escala de Empatia para Profissionais de Saúde. A análise fatorial confirmatória e a análise mul-tigrupo foram realizadas (para examinar a invariância do modelo entre os sexos) e a análise de confia-bilidade (α de Cronbach, coeficiente de correlação intraclasse e ω de McDonald). Resultados: a pediatria apresentou os níveis mais altos de empatia geral e nas dimensões "cuidado compassivo" e "estar no lugar do paciente", mas não na dimensão "tomada de perspectiva", em que os níveis foram semelhantes aos da anestesiologia, da medicina crítica e da terapia intensiva, e da ginecologia. Conclusões: os valores de empatia e os valores das subescalas "cuidado compassivo" e "estar no lugar do paciente" foram (em valo-res absolutos, mas não estatisticamente) mais altos na especialidade de pediatria. Na subescala "tomada de perspectiva", as especialidades de pediatria, anestesiologia, cirurgia e clínica tiveram pontuações quase iguais. São necessários mais estudos para explicar por que algumas especialidades têm valores de empatia mais altos do que outras

Cooperative behavior in adolescents: a contribution of empathy and emotional regulation?

Aim: This study aims to identify different levels of empathy and emotional regulation along adolescent years and their relationship with cooperative behavior. Methods: Eighty healthy males were divided into four age groups: 20 Early Adolescents, 20 Middle Adolescents, 20 Late Adolescents and 20 Adults. Participants responded to empathic and emotional regulation scales, then were assigned to an unknown partner to perform the prisoner's dilemma paradigm. Results: The statistical analyses allowed to distinguish the groups on the basis of the components making up the two scales: scores on the Perspective Taking component were higher for Adults and Late Adolescents participants than for Middle Adolescents and Early Adolescents groups (p < 0.05); scores on the Personal Distress component were higher for Early Adolescents group than for Late Adolescents and Middle Adolescents groups (p < 0.05); scores on the Difficulties engaging in goal directed behavior component were higher for Middle Adolescents and Early Adolescents groups than for Adults group (p < 0.05). We observed differences between groups (p < 0.001) with higher number of cooperation responses in Adults compared to Middle Adolescents (p < 0.05) and Early Adolescents groups (p < 0.001). Discussion: These findings suggest that the cooperative behavior changes during the different stages of adolescence seem to be related to the development of empathy and emotional regulation components.

Empathy bodyssence: temporal dynamics of sensorimotor and physiological responses and the subjective experience in synchrony with the other's suffering.

Background: Empathy is foundational in our intersubjective interactions, connecting with others across bodily, emotional, and cognitive dimensions. Previous evidence suggests that observing individuals in painful situations elicits whole bodily responses, unveiling the interdependence of the body and empathy. Although the role of the body has been extensively described, the temporal structure of bodily responses and its association with the comprehension of subjective experiences remain unclear. Objective: Building upon the enactive approach, our study introduces and examines "bodyssence," a neologism formed from "body" and "essence." Our primary goal is to analyze the temporal dynamics, physiological, and phenomenological elements in synchrony with the experiences of sportspersons suffering physical accidents. Methods: Using the empirical 5E approach, a refinement of Varela's neurophenomenological program, we integrated both objective third-person measurements (postural sway, electrodermal response, and heart rate) and first-person descriptions (phenomenological data). Thirty-five participants watched videos of sportspersons experiencing physical accidents during extreme sports practice, as well as neutral videos, while standing on a force platform and wearing electrodermal and heart electrodes. Subsequently, micro-phenomenological interviews were conducted. Results: Bodyssence is composed of three distinct temporal dynamics. Forefeel marks the commencement phase, encapsulating the body's pre-reflective consciousness as participants anticipate impending physical accidents involving extreme sportspersons, manifested through minimal postural movement and high heart rate. Fullfeel, capturing the zenith of empathetic engagement, is defined by profound negative emotions, and significant bodily and kinesthetic sensations, with this stage notably featuring an increase in postural movement alongside a reduction in heart rate. In the Reliefeel phase, participants report a decrease in emotional intensity, feeling a sense of relief, as their postural control starts to reach a state of equilibrium, and heart rate remaining low. Throughout these phases, the level of electrodermal activity consistently remains high. Conclusion: This study through an enactive approach elucidates the temporal attunement of bodily experience to the pain experienced by others. The integration of both first and third-person perspectives through an empirical 5E approach reveals the intricate nature of bodyssence, offering an innovative approach to understanding the dynamic nature of empathy.

Empathic attitude of dental students from a peruvian public University associated with reading Habit: a regression analysis / Actitud empática de los estudiantes de odontología de una Universidad pública peruana asociado al hábito de lectura: un análisis de regresión

Abstract The present study aims to identify the empathic attitude of dental students from a Peruvian public university, about their reading habits, as well as the level of studies and other sociodemographic variables. 226 first-, fourth-, and sixth-year students registered in the academic year 2022 were enrolled in the study. The Jefferson Empathy scale, which included 20 items, was used with a Likert scale ranging from 1 to 7, i.e., from totally disagree to totally agree. A file containing questions about the sociodemographic data registry was prepared together with the Jefferson Empathy questionnaire. It was found that the profile of the students was mainly feminine, and the average age was 22 years; they came from Lima. They had the habit of reading and a little more than half of the group did not participate in sports activities. The "adequate" level of empathy was the highest (51.77%). By dichotomizing the response variable, it was found that adequate empathy was related to the habit of reading, especially reading dental books. Dental students from this public university mostly have an adequate level of empathy; it is independent of the sociodemographic variables but is related to reading habits.

Resumen En el presente estudio se planteó identificar la actitud empática de los estudiantes de odontología de una universidad pública peruana en relación al hábito de lectura así como al nivel de estudios y variables sociodemográficas. Se consideró a 226 estudiantes de primero, cuarto y sexto año matriculados en el año académico 2022. Se utilizó la escala de empatía de Jefferson que consta de 20 ítems, y cuyas categorías de respuesta val del 1 al 7 que significa totalmente en desacuerdo a totalmente de acuerdo. Se elaboró una ficha que además contenía una primera parte para llenar de acuerdo a sus datos sociodemográficos. Se encontró que el perfil de los estudiantes perteneció al sexo femenino, con una media de 22 años, procedían de Lima, presentaban el hábito de lectura y un poco más de la mitad del grupo no realizan actividades deportivas. El nivel de empatía adecuado fue el más alto (51.77%). Al dicotomizar la variable respuesta se encontro que la empatía adecuada estuvo relacionada con el hábito de lectura y con la lectura de libros de odontología. Se concluye que los estudiantes de odontología de esta universidad pública tienen mayormente nivel de empatía adecuado y que es independiente de las variables sociodemográficas pero se encuentra relacionado a los hábitos de lectura.

La prosocialidad: estrategia de educación integral frente a la violencia / Prosocial behavior: A comprehensive education strategy to tackle violence / Prosocialidade: uma estratégia de educação integrante contra a violencia

Resumen (analítico) En Colombia no existen estudios consolidados que muestren la existencia de conductas prosociales y menos indicadores que reflejen cómo estas conductas pueden influir en la reducción de los comportamientos agresivos. Lo que sí se sabe por estudios previos es que las conductas de naturaleza altruista parecen incompatibles con la agresividad. El artículo recoge los resultados de una investigación que describe las conductas prosociales de los niños de este contexto. El estudio de tipo transversal se realizó con 587 niños entre los 9 y 12 años. Los resultados evidencian niveles elevados de prosocialidad y diferencias significativas a favor de las niñas en casi todas las dimensiones evaluadas. Con la presencia de estos comportamientos se puede inferir que la prosocialidad representa un activo muy importante para prevenir manifestaciones agresivas en las escuelas.

Abstract (analytical) In Colombia there are no consolidated studies that evidence the existence of prosocial behavior. There are very few indicators that measure how these behaviors can help reduce levels of aggression and violence. What is known from previous studies is that altruistic behaviors seem incompatible with aggression. This article summarizes the results of an investigation that describes the prosocial behaviors of children in the Colombian context. A cross-sectional study was carried out with 587 children between 9 and 12 years of age. The results show high levels of prosocial behavior among girls and significant differences among members of this gender group in almost all of the dimensions that were evaluated. Based on these results, it can be inferred that prosocial behavior represents a very important asset that helps prevent acts of aggression in schools.

Resumo (analítico) Na Colômbia, não existem estudos consolidados que mostrem a existência de comportamentos pró-sociais e poucos indicadores que reflitam como esses comportamentos podem influenciar na redução de comportamentos agressivos. O que se sabe de estudos anteriores é que comportamentos de natureza altruísta parecem incompatíveis com a agressividade. O artigo recolhe os resultados de uma investigação que descreve os comportamentos pró-sociais de crianças neste contexto. O estudo transversal foi realizado com 587 crianças entre 9 e 12 anos de idade. Os resultados mostram altos níveis de pró-socialidade e diferenças significativas a favor das meninas em quase todas as dimensões avaliadas. Com a presença desses comportamentos, pode-se inferir que a pró-socialidade representa um recurso muito importante para prevenir manifestações agressivas nas escolas.

Significado de cuidar niños con parálisis cerebral / Meanings of caring for children with cerebral palsy / Significado de cuidar crianças com paralisia cerebral

Resumen (analítico) Existe insuficiente evidencia acerca de lo que significa ser cuidador de niños o niñas con parálisis cerebral en Colombia. Nuestra investigación se aborda desde un enfoque hermenéutico, utilizando el método de la teoría fundamentada, con 13 entrevistas semiestructuradas a adultos cuidadores de niños y niñas con parálisis cerebral. Emergen cuatro categorías: amor incondicional, cuidando como mujer, atravesando el duelo e interminable lucha por los derechos del menor. Se concluye que existe una decidida forma de afrontamiento de las cuidadoras, pues están dispuestas a renunciar a sus propias vidas, a sus relaciones personales y sociales, a sufrir un constante duelo, a aprender nuevas formas de cuidar y transformar sus hogares, hasta luchar por la atención digna de sus hijos. El amor sin condiciones les permite reconocerse como mujeres cuidadoras únicas.

Abstract (analytical) There is insufficient evidence regarding meanings developed by caregivers of children with Cerebral Palsy in Colombia. The methodology involved adopting a hermeneutic approach, which was combined with the grounded theory method. A total of 13 semi-structured interviews were conducted with adult caregivers of children with cerebral palsy. Following an analysis of the results, four categories emerged: unconditional love; caring as a woman; experiencing grief; and the endless fight for their child's rights. It was concluded that the caregivers of children with Cerebral Palsy have developed determined coping skills. This is because they are willing to give up their own lives, sacrifice their personal and social relationships, experience constant grief and learn new ways of caring and transforming their homes in their struggle to provide dignified care for their children. Unconditional love allows these caregivers to recognize themselves as unique caring women.

Resumo (analítico) Não há evidências suficientes sobre o que significa ser cuidador de crianças com paralisia cerebral na Colômbia. Pesquisa abordada a partir de uma abordagem hermenêutica, utilizando como método da teoria fundamentada, com 13 entrevistas semiestruturadas com adultos cuidadores de crianças com paralisia cerebral. Emergem quatro categorias: amor incondicional, cuidado como mulher, vivência do luto e luta incessante pelos direitos da criança. Conclui-se que existe uma determinada forma de enfrentamento para os cuidadores, pois estão dispostos a abdicar de sua própria vida, de suas relações pessoais e sociais, a sofrer lutos constantes, a aprender novas formas de cuidar e transformar seus lares, a lutar por cuidado digno de seus filhos. O amor incondicional permite que elas se reconheçam como mulheres únicas e carinhosas.