The primary focus of the study was to determine whether coursework in the medical humanities would ameliorate students’ loss of and failure to develop empathy, a problem known to be common during medical education.
Methods
Students were offered an elective course in the Medical Humanities for academic credit. The Jefferson Scale of Empathy Student Version (JSE-S) was administered at the beginning and end of an academic year in which humanities courses were offered. Changes in JSE-S scores among students who studied Medical Humanities were compared with changes in student who did not take any humanities coursework.
Results
Medical humanities coursework correlated with superior empathy outcomes among the medical students. Of students not enrolled in humanities courses, 71% declined or failed to increase in JSE-S score over the academic year. Of those who took humanities coursework, 46% declined or failed to increase in JSE-S scores. The difference was statistically significant (P = .03). The medical humanities curriculum correlated with favorable empathy outcomes as measured by the JSE-S.
Conclusions
Elective medical humanities coursework correlated with improved empathy score outcomes in a group of US medical students. This may reflect a direct effect of the humanities coursework. Alternately, students’ elective choice to take medical humanities coursework may be a marker for students with a propensity to favorable empathy outcomes.
This study aimed to determine whether, compared with the usual decline in empathy among medical students, coursework in the humanities was associated with a desirable increase in a measure of medical student empathy.
Empathy among physicians is valued by society, patients, and families.1 In addition to being an intrinsic professional value, greater physician empathy also correlates with better clinical outcomes.2, 3 Students with lower empathy scores tend to be averse to uncertainty, and these students also are known to choose specialty training away from direct patient care.4 Deficient empathy also is related to professional burnout in practicing physicians.4,5
Empathy is known to decline, rather than grow, during medical education.6, 7 Surveys of patients have found that distressing numbers of patients say that their physicians lack sufficient empathy and compassion.8 If empathy and compassion are desired outcomes in medical education, research is needed to design curricula that preserve or improve students’ empathy.
Medical humanities have been proposed as an activity that might improve empathy in medical students by fostering skills such as the interpretation of narratives and the ability to manage situations where there is no single correct answer.5, 9 Humanities coursework for medical students has been shown to improve some clinical skills. For example, time spent viewing fine art is associated with improved observational skills in physical diagnosis.10,11, 12 Recent data suggest that reading literary fiction enhances “theory of mind,” a cognitive capacity that enables persons to understand the mental state of others, a skill that engenders empathetic clinical relationships.13
Some neuropsychologic research exists regarding the mechanisms by which literature and humanities may influence empathy,14, 15 but few prior data sets examine the impact of humanities studies on medical student empathy. The few data that exist are conflicting. By using the Jefferson Scale of Empathy Student Version (JSE-S), Rosenthal and colleagues16 found that a mandatory multicomponent “Humanism and Professionalism” course was associated with preserved empathy scores, but those data did not compare students in the course with students without such an experience. Yang and Yang17 found that a 4-hour experience with interpreting paintings did not influence medical students’ scores on the JSE-S and called for further experimental investigations. Potash et al18 compared a group of students who made art with a group of students who experienced a “problem-solving” workshop; empathy declined in both groups, without a statistical difference in outcome.
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-Jeremy Graham, DO, MA, Lauren M. Benson, MD, Judy Swanson, MD, Darryl Potyk, MD, Kenn Daratha, PhD, Ken Roberts, PhD
This article originally appeared in the December 2016 issue of The American Journal of Medicine.
