Dr. Beth Lown, an internist at Mt. Auburn Medical Center in Cambridge and medical director of the Boston-based Schwartz Center for Compassionate Healthcare, said that one pitfall of the survey is that students and residents are rating themselves, when ultimately empathy may be best judged by the patient.
In one study at Boston University, students interacted with actors portraying patients. Observers rated third-year students as more empathic than second-year students, which may indicate a difference between how students feel and how they act, Chen said.
“Students may select when to turn on their empathy switch and when not. This guy is coming in with a fractured foot and really wants to get out of here. He doesn’t require [empathy], whereas the homeless guy may need a little more understanding because he’s disenfranchised,’’ Chen said. It may be “they are full of empathy but they select when to use it.’’
Wang echoed this point, saying students learn how to be “efficient with their empathy’’ over time. “I’ve done a lot of cancer rotations. A hand on the shoulder or handing a patient a tissue can really help.’’
Chen, who is assistant dean of student affairs at the medical school, helps direct the internal medicine rotation that all medical students complete. He requires third-year medical students to attend weekly reflection groups to talk about difficult experiences in the hospital, such as a patient dying and coping with conflicting feelings of wanting to both talk to and avoid the family, or feeling nothing at all. He hopes these discussions will lead to greater empathy.
Hojat said a number of interventions can increase empathy in students and residents, including an experiment he calls the aging game. Students participate in a play during which they wear earplugs and dirty glasses to simulate how difficult it can be for the elderly to hear and see. But the impact wears off after a month or two, and Hojat is trying to figure out how to make the effect longer-lasting.
“Students come in with a lot of idealism,’’ Lown said. “They want to be of help and service. And then something starts to happen when they are exposed to clinical care. We need better curriculum and education on how to manage those feelings.’’
Liz Kowalczyk can be reached at email@example.com.