JMIR Publications

ABSTRACT

Background:

Expressing empathy builds trust with patients, increases patient satisfaction and is associated with better health outcomes. Research shows expressing empathy and compassion to patients improves patient adherence to medications, decreases patient anxiety and decreases the number of malpractice lawsuits. Yet, there is a dearth of research on teaching empathy to pre-medical students. Stanford Medicine’s Clinical Science, Technology and Medicine Summer Internship (also called SASI) is a two-week, collaborative medical internship for high school and undergraduate students that aims to inspire students to pursue careers in healthcare as compassionate providers. The summer 2020 program was adapted to accomplish these objectives in a fully remote environment due to the COVID-19 global pandemic.

Objective:

This study measured the change in participants’ empathy and competencies in clinical and communication skills before and after program participation.

Methods:

Forty-one participants completed the Core Track (CT) only and thirty-nine participants completed the Core + Research Track (RT) of this program. Participants in both tracks received instruction in selected clinical skills and interacted directly with patients to improve interviewing skills and gain empathy. RT participants received additional instruction in research methodology. All participants completed online pre-and post-surveys about knowledge and skills assessment (KSA). Participant empathy was assessed using the validated Consultation and Relational Empathy (CARE) measure. A subset of participants completed optional focus groups to discuss empathy. Pre-and post- KSA and CARE measure scores were compared using paired t-tests and a linear regression model. Open-ended focus group answers were thematically analyzed.

Results:

Participants in both tracks demonstrated significant improvement in empathy after the two-week virtual online course (p = 0.007 in CT; p < 0.001 in RT). These results remained significant when controlled for gender and age. Lower pre-test score was associated with a greater change in empathy. Participants in both tracks demonstrated significant improvement in KSA questions related to surgical skills (CT: p < 0.001; RT: p < 0.001), epinephrine pen usage (CT: p < 0.001; RT: p < 0.001), x-ray image interpretation (CT: p < 0.001; RT: p < 0.001), and synthesizing information to problem solve (CT: p < 0.001; RT: p = 0.051). CT participants also showed significant improvement in health communication skills (p = 0.001). Qualitative analysis yielded three themes: empathy as action, empathy as a mindset, and empathy in designing healthcare systems.

Conclusions:

Summer internships that introduce high school and undergraduate students to the field of healthcare through hands-on interaction and patient involvement may be an effective way to develop measurable empathy skills when combined with clinical skills training and mentorship. Notably, these increases were measured in a program administered via a virtual learning environment.