The integrated curriculum and student empathy: a longitudinal multi-cohort analysis.

Research has demonstrated erosion of empathy in students during medical education. Particularly, U.S. studies have demonstrated empathy declines during clinical training in the third and fourth year of traditional medical programs. Yet, studies conducted outside the U.S. have not confirmed this trend. Timing and extent of patient interactions have been identified as empathy-protective factors. The need to examine empathy within different learning contexts has been noted, as has the need for longitudinal and time-series research designs to analyze trajectories. Between fall 2010 and spring 2019, we assessed empathy longitudinally among six student cohorts (N = 493) at a U.S. medical school, where patient interaction occurs early and throughout an integrated curriculum. Empathy levels of students in each cohort were assessed at five time points utilizing the Jefferson Scale of Physician Empathy-Student version. We hypothesized empathy levels will not degrade by program end, and trajectories will not show patterns of decline in Years Three and Four. Analysis of Variance (ANOVA) and Linear Mixed Model (LMM) analyses were used to analyze differences at baseline and changes in empathy trajectories. ANOVA analyses revealed statistically significant differences at baseline by class cohort (F(5, 487) = [23.28], p < 0.001). LMM analyses indicated empathy was either significantly higher or not different at the end of the program (F(19, 1676) = [13.97], p < 0.001). Empathy trajectories varied among cohorts; yet, none resulted in an overall empathy decline by the end of the program. Findings demonstrate empathy in U.S. medical students can be unchanged or higher by the end of medical education. Outcomes are consistent with reports of non-declining medical student empathy outside the U.S. and support the notion of context-specificity. Results further support recent research, suggesting decreases in empathy during training can stabilize or increase by program end. These findings have important implications for future empathy research context and design considerations, as well as program planning.

Rapid Transition to a Virtual Multiple Mini-Interview Admissions Process: A New Medical School's Experience During the COVID-19 Pandemic.

PROBLEM: The University of Houston College of Medicine (UH COM) began its first admissions cycle after receiving preliminary accreditation in February 2020. With the advent of remote learning in response to the COVID-19 pandemic, the school moved its admissions process, including multiple mini-interview (MMI), from an in-person to online format in mid-March 2020. APPROACH: The UH COM selected Zoom as the video conferencing platform for its virtual admissions process, including MMI. On each interview day (3-4 hours), 14-16 applicants joined administrators, faculty, and staff in a virtual meeting room. Applicants were divided into 2 groups: one viewed short presentations about the school, curriculum, and departments, while the other participated in 7 MMI stations (one-on-one interactions with interviewers) via virtual breakout rooms; the groups then switched. The MMI stations were the same as those used in-person in early March. Applicants were able to ask questions at multiple points during the day. Technical support was provided for participants with connectivity issues or unfamiliar with Zoom. OUTCOMES: Of the 180 applicants interviewed in March-April 2020, 134 (74%) participated in the virtual process and 46 (26%) in the on-site process. Twenty-five (83%) of the 30 members of the inaugural class of 2024 interviewed virtually. Advantages of the virtual format included ease of access for faculty and more flexibility and less expense for applicants. Challenges included the need for applicants to decide whether to accept an offer of admission from a new school without visiting and missed opportunities for faculty to have relatively unstructured interactions with applicants. NEXT STEPS: This virtual admissions process was a feasible alternative for the inaugural class but is not sustainable. UH COM plans to leverage lessons learned to refine the virtual format for use in future admissions cycles, even when in-person interviews are possible.

Timing of Hospice Referral: Assessing Satisfaction While the Patient Receives Hospice Services.

Generally, satisfaction with timing of hospice referral was measured in mortality follow back surveys of patients who died in hospice. In contrast in this study, investigators assessed timing of the hospice referral in patients/families enrolled in hospice for a minimum of two weeks. About 1/3 of patients/families identified it would have been easier if they started hospice earlier. Barriers to early hospice access were associated primarily with access to the healthcare system.