Challenging the myth of the attrition of empathy in paediatrics residents

• Published in: Medical education Vol. 54; no. 1; pp. 82 - 87
• Main Authors: Rawal, Surabhi, Strahlendorf, Caron, Nimmon, Laura
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-01-2020
• Subjects: Curricula; Descriptive research; Medical education; Pediatrics
• ISSN: 0308-0110; 1365-2923
• DOI: 10.1111/medu.13877

Context
Empathy is vital to the physician–patient relationship. It promotes patient compliance and increases treatment efficacy. Studies evaluating the loss of empathy as residents advance through training curricula have generated inconsistent claims. Those considering diverse resident populations have supported a decline, whereas the few studies focused on paediatrics note stable empathy scores during training, which, indeed, exceed those of the general population. To better understand the issue as it pertains to paediatrics trainees, this study aimed to explore the state, and map a trajectory, of empathy in paediatrics residents, to identify factors influencing the learning and retention of empathy.
Methods
This qualitative descriptive study was conducted at an urban children's hospital in Canada. A total of 10 participants were recruited for semi‐structured interviews via a purposeful sampling strategy. The institutional research ethics board approved the project.
Results
Senior residents (R3 and R4) reported increased empathy, attributable to greater knowledge regarding paediatric illnesses, according them a fuller sense of the impact on families. Challenges to sustained empathy correlated with published literature: time constraints, compassion fatigue and burnout with poor coping, and the hidden curriculum. Empathy was learned from peers, preceptors and other health care providers. Resident resilience, borne out of personal adversity, was protective against the loss of empathy. Residents advocated for increased autonomy and responsibility for patient care, and increased exposure to longitudinal care, including the patient's social context and home life, to increase resident empathy.
Conclusions
Curriculum development committees could consider the inclusion of these encounters and experiences in residency training, although similar descriptive research in other specialty contexts would be needed to refine understanding.
We commonly criticize medical educational for how it extinguishes empathy in its trainees. Rawal et al. offer data suggesting reality may be more nuanced as pediatrics residents were seen to hold overlapping interpretations of empathy, acknowledge its value, and thoughtfully strive to practice it.