Empathy as an important clinical skill. Copious literature, no attempt to review it here SP program embedded in first two years of the Clinical Medicine Course: Used ACIR now MIRS to teach and evaluate Interpersonal Interviewing and communication skills. Change made because MIRS has the reliability characteristics of the ACIR and better validity given the constructs of patient centered care developed in the late 20 th century One new item on the MIRS is empathy. Defined as RC Smith does with the NURS mnemonic. Students now taught with a specific set of strategies for expressing empathy. The assessment in the Fall of year 2 of medical school was a constant. It focused on focused history and physical of a knee/hip pain and the review of systems for patients with a vague complaint.
 The interviewer uses supportive comments regarding the patient’s emotions. The interviewer uses NURS or other specific techniques for demonstrating empathy.  The interviewer is neutral, neither overly positive nor negative in demonstrating empathy.  No empathy is demonstrated. The interviewer uses a negative emphasis or openly criticizes the patient.
Subjects were 2 nd year students who did a clinical skills assessment as part of the Clinical Medicine course in the Fall of the second year The assessment included three cases a focused h&p of knee pain, and two vague complaints weight loss and fatigue and weight gain and fatigue where there was the expectation that the student would do a complete review of systems. Each student has 25 minutes for each case and has feedback about the content and process of the encounter from the SP after each case. MIRS was scored by each SP trained to 80% agreement actual in this assessment was 87% Empathy was the outcome measure Four years of data
2006: MIRS newly introduced and explained, no prior experience with the empathy item; tape review 2007, 2008: lecture at the beginning of year 1 and 5 clinical skills assessments where empathy was scored and feedback may have been given; tape review 2009: added an empathy assignment to the 07, and 08
Pair review; bookmark video write down empathy statements that could have been included Reflect on empathy in own life
Modest and significant improvement with each intervention. Limitations: one school, one curriculum, no random assignment; no long term follow-up Encouraging to see improvement with interventions.
Tracking of Medical Students Empathy Skills with a Curriculum Change Carol A. Pfeiffer, Ph.D. University of Connecticut School of Medicine
Rationale <ul><li>Empathy a critical skill for clinicians </li></ul><ul><li>Shift in measurement strategy from ACIR to MIRS in order to teach and evaluate patient centered care more effectively </li></ul><ul><li>Better definition of empathy item using RC Smith’s “NURS” model: Name, Understand, Respect Support </li></ul><ul><li>Used consistent measures of clinical skills for tracking the skill (SP cases) </li></ul>
MIRS Empathy Item <ul><li> The interviewer uses supportive comments regarding the patient’s emotions. The interviewer uses NURS or other specific techniques for demonstrating empathy. </li></ul><ul><li> The interviewer is neutral, neither overly positive nor negative in demonstrating empathy. </li></ul><ul><li> No empathy is demonstrated. The interviewer uses a negative emphasis or openly criticizes the patient. </li></ul>
Methods <ul><li>Subjects were the second year medical students in November of 2006-2009 </li></ul><ul><li>Measure: Three cases of focused history and physical exam: Knee pain, weight loss and fatigue and weight gain and fatigue. MIRS scored by the SP for each encounter (trained to inter-rater agreement >80%) actual 87% </li></ul><ul><li>MIRS item Empathy measured on a 1 – 5 Likert scale with 5 as the best score </li></ul><ul><li>Scores tracked for four years </li></ul>
Intervention <ul><li>In 2006 we attempted to improve our students’ ability to express empathy by describing it more fully as part of our communications skills training. The students in that class had an introductory lecture about to the MIRS two months before the CSA, but little practice with it </li></ul><ul><li>In 2007 and 2008 the students had over a year of practice with the MIRS in lecture and 5 prior clinical skills assessments </li></ul><ul><li>In 2009 we added a video review assignment focusing on empathy to the curriculum </li></ul>
Empathy Assignment <ul><li>Working in pairs review your videos and bookmark three places where you could have responded with empathy and did not. Write down some statements you can make in the future in a similar situation, using the NURS model. </li></ul><ul><li>Life and medicine both offer many opportunities for empathy. Describe one empathic moment from your own life, either within or outside of the practice of medicine. </li></ul>
Analysis <ul><li>MIRS measured on a 1-5 scale with 5 as the best </li></ul><ul><li>A one way analysis of variance was used to calculate the significance of the change following the interventions. </li></ul>
One Way ANOVA: p<0.00 .5 4.2 83 2009 .6 4.0 79 2008 .6 4.0 77 2007 .7 3.8 84 2006 SD Mean N Year
Conclusions <ul><li>Empathy scores did improve modestly and significantly with the introduction of the new measure of interpersonal and interviewing skills and then again with the addition of a specific assignment focused on empathy </li></ul><ul><li>The study was done at only one school with a particular curriculum focus and measurement strategies. </li></ul><ul><li>No long term follow-up as yet </li></ul>