Personality traits are associated with cognitive empathy in medical students but not with its evolution and interventions to improve it.

OBJECTIVE: Cognitive empathy might decrease during medical school. Factors associated with its evolution remain poorly understood, as well as whether such factors could moderate the effect of an intervention to preserve cognitive empathy. The aim was to explore the associations between personality traits and both cognitive empathy at baseline and its changes at follow-up. The possible effect of an intervention depended upon personality traits was also examined. METHODS: The cohort consisted of fourth year medical students and the associations between personality traits, using the Short Big Five Inventory, and cognitive empathy changes at 3-month, using the Jefferson Scale of Empathy-Student version (JSE-S), were examined. A randomization in two groups (Balint groups versus no intervention) allowed examining whether the effect of the intervention depended upon personality traits. Linear regressions were adjusted for gender, anticipated specialty choice, parental education, living status, financial insecurity, randomization group and baseline JSE-S. RESULTS: The cohort included 311 participants from October 2015 to December 2016 at Paris Diderot and Paris Descartes University. At follow-up, there was a JSE-S total score increase of 1.22(SD:9.10) in the intervention group, compared to a decrease of 1.64(SD:10.74) in the other group. Baseline JSE-S was positively associated with Extraversion and Conscientiousness and negatively with Neuroticism. In contrast, we found no associations between baseline personality traits and JSE-S change. There were no interactions between personality traits and randomization group. CONCLUSION: Although personality might be linked with cognitive empathy, medical students may benefit from strategies designed for improving cognitive empathy regardless of their personality.

[Caring for those who care for us]. / Prendre soin de ceux qui nous soignent.

The AAPML is a French association offering support for health professionals and private practice doctors suffering from stress via a helpline. It provides information and training for health professionals and takes into account their engagement in the workplace.

Promoting empathy among medical students: A two-site randomized controlled study.

OBJECTIVE: To assess the effects of Balint groups on empathy measured by the Consultation And Relational Empathy Measure (CARE) scale rated by standardized patients during objective structured clinical examination and self-rated Jefferson's School Empathy Scale - Medical Student (JSPE-MS©) among fourth-year medical students. METHODS: A two-site randomized controlled trial were planned, from October 2015 to December 2015 at Paris Diderot and Paris Descartes University, France. Eligible students were fourth-year students who gave their consent to participate. Participants were allocated in equal proportion to the intervention group or to the control group. Participants in the intervention group received a training of 7 sessions of 1.5-hour Balint groups, over 3months. The main outcomes were CARE and the JSPE-MS© scores at follow-up. RESULTS: Data from 299 out of 352 randomized participants were analyzed: 155 in the intervention group and 144 in the control group, with no differences in baseline measures. There was no significant difference in CARE score at follow-up between the two groups (P=0.49). The intervention group displayed significantly higher JSPE-MS© score at follow-up than the control group [Mean (SD): 111.9 (10.6) versus 107.7 (12.7), P=0.002]. The JSPE-MS© score increased from baseline to follow-up in the intervention group, whereas it decreased in the control group [1.5 (9.1) versus -1.8 (10.8), P=0.006]. CONCLUSIONS: Balint groups may contribute to promote clinical empathy among medical students. TRIAL REGISTRATION: NCT02681380.

'Intern life': a longitudinal study of burnout, empathy, and coping strategies used by French GPs in training.

BACKGROUND: More than half of French medical GP trainees (GPTs) suffer from burnout. AIM: To define and follow the evolution of risk factors, such as empathy and coping strategies, associated with burnout in this population. DESIGN & SETTING: Prospective longitudinal study involving volunteers of 577 Parisian university GPTs in 2012. METHOD: Self-reported anonymous online questionnaires were sent three times every 6 months to all participants. Stress was measured using the Intern-Life scale and burnout using the Maslach Inventory, and anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS). Sociodemographic, professional, and personal data, including coping strategies and measures of empathy were also collected. RESULTS: In total 343 questionnaires were fully completed at baseline (T0): 304 were usable at baseline, 169 were usable at 6 months (T1) and 174 at 1 year (T2). Stress rates decreased sharply between T1 (scores 42.96) and T2 (17.08), while scores for burnout remained relatively stable: more than 13% of GPTs had high scores in all three dimensions of burnout. Depersonalisation increased from 61% (T1) to 66% (T2). One hundred and four paired samples were analysed between T0 and T1, and between T1 and T2. Emotion-centred coping was associated with emotional exhaustion (P<0.05), while professional support reduced it. Experiences of aggression increased depersonalisation (P<0.05). Social support, problem-centred coping, perspective-taking empathy, and professional support improved the sense of personal accomplishment (P<0.05). CONCLUSION: Tools to help GPTs are available but are underused. More training in doctor-patient relationships and understanding of medical hidden curricula are necessary to decrease burnout among GPTs and improve their wellbeing and patient care.

[Disagreements between GP trainees and their seniors. Management and impacts on the hidden curriculum. Qualitative study of 37 situations in Paris]. / Désaccords entre internes de médecine générale et seniors sur les soins aux patients. Gestion et impacts sur le hidden curriculum. Étude qualitative de 37 situations en Île-de-France.

INTEREST OF THE WORK: Disagreements and conflicts have a negative impact on the satisfaction and the performances of working team members. Young doctors in training are part of the health care team. The management of the disagreements with which they are confronted is a part of their professionalization process. OBJECTIVE: To clarify and analyze the disagreements between GP trainees and their seniors in patients care and their consequences in doctor curriculum. METHODS: Qualitative descriptive study. Five focus groups including a total of 25 Parisian trainees were performed to explore situations of disagreements with their seniors about patients care. Phenomenical analysis was performed by two researchers. RESULTS: Thirty-seven situations were reported. A number of potential sources of conflicts were highlighted. Factors that can transform a disagreement into an insoluble conflict were identified. The consequences of these disagreements on the quality of care and their impact on the empowerment of trainees were analysed. Number of disagreements related patients facing end of life. Specificities of emergency contexts and ambulatory practice were underlined. The role of the hierarchical link in the genesis and the development of the conflicts was confirmed. The personality of the trainee, his conception of responsibility, the exchange of knowledge, the "commercial" aspects of doctors practice can be at the origin of conflicts. PERSPECTIVES: The disagreements can play a positive role in trainees empowerment. A training in the management of anticipated or known conflicts can usefully clarify and optimize the hidden curriculum of the medical students towards professionalism.

[Becoming doctor: Highlight the hidden curriculum. Medical error as an example]. / Devenir médecin : éclairer le hidden curriculum. L'exemple de l'erreur médicale.

Medical culture is both individual and collective. It is also implicit, hidden (hidden curriculum) and binding.It spreads and builds from the beginning of the training.It strongly impacts the personalities and professional care practices. Awareness of its existence and identification of its main lines are the first steps for fruitful research.

Burnout among French GPs in training: a cross-sectional study.

BACKGROUND: French GPs in training have an important role in making hospitals function and are the future workforce, however burnout among this group is not uncommon. AIM: To assess burnout among French trainees. DESIGN AND SETTING: Descriptive, epidemiological, transverse cross-sectional study in France. METHOD: All 6309 French trainees attending a meeting to choose their next 6-month placement (March 2011), were invited to complete a written questionnaire including the Maslach Burnout Inventory, items about their health, and how they felt about medical internship. RESULTS: A total of 4050 anonymous questionnaires were analysed (response rate: 64.2%). The percentage of trainees with high levels of emotional exhaustion was 16.0%, 33.8% had a high score for depersonalisation, and 38.9% had a high score for low personal accomplishment. A total of 41.9% had no high score at all and 6.5% (n = 283) presented three high scores. Notable associations were found between burnout and workload, lack of acknowledgement for trainees' work, working in accident and emergency departments, and lack of time devoted to private life. CONCLUSION: This is the first French national survey about burnout in French GP trainees. It confirms the findings of previous French regional studies, which showed an increased rate of depersonalisation but decreased rates of emotional exhaustion. Trainees play an important role in the French health system: they represent tomorrow's doctors, so these results are worrying for the French public-health system. They imply a need for action by doctors, professional bodies, and healthcare organisations. A few preventive measures could be tested, such as creating an employment contract for trainees, helping trainees to assume responsibilities step by step, and putting more thought into training in outpatient clinics.

Medical errors reported by French general practitioners in training: results of a survey and individual interviews.

CONTEXT: French interns in general practice are, like all medical students, exposed to medical errors during their training. OBJECTIVE: To measure the professional and personal impact of medical errors on French general practitioner (GP) trainees. DESIGN, SETTING AND PARTICIPANTS: Quantitative and qualitative study of medical errors and GP trainees enrolled at Paris Diderot University. METHOD: An online anonymous questionnaire was sent to all GP trainees at Paris Diderot University and recorded semi-structured interviews were conducted with 10 volunteers. RESULTS: 70 of the 392 (18%) interns contacted replied to the questionnaire and 10 semi-structured interviews were then conducted. 97% of the participants had already made a medical error. Even with the extreme, conservative assumption that non-respondents would have reported no errors, the prevalence of self-reported medical errors in the whole sample would still have been 17%. 64% said they were at least strongly affected by their error and 74% made constructive changes to their work after the error. The interns revealed that the emotional impact of their errors were great with feelings such as guilt that could remain for more than 2 years after the event. 33% would have liked to talk more about the circumstances of their error with their superior. Most interns suggest more training on medical errors and more open-minded discussion when the error actually happens rather than formal training at the university. CONCLUSION: Medical errors remain a sensitive subject that is not broached enough in our university but interns need to talk about their experiences with their peers to improve risk management and prevent the recurrence of new errors.