Self Funded - Evidence-based empathy education and training

Supervisor

• Professor Jeremy Howick (Jh815@leicester.ac.uk)

Project description

We are pleased to offer a PhD opportunity for a self funded applicant to study for a PhD in collaboration with The Stoneygate Centre for Empathic Healthcare.

Project highlights

• Work with internationally recognized dynamic team who are putting empathy at the core of medical education and healthcare training.
• Conduct ground-breaking research on the effects and impact of empathy on patients and healthcare practitioners.
• A range of methods are required including evidence synthesis, qualitative studies, longitudinal studies, and implementation science (the candidate will not have to do all of these).

Background

Empathic healthcare improves patient quality of life satisfaction with their care while reducing their pain.[1] Higher levels of practitioner empathy are also associated with lower mortality among diabetic patients.[2] Empathy can also reduce practitioner burnout.[3, 4] The 2022 Ockenden and Kirkup Reports into the avoidable infant and maternal deaths at the Shrewsbury and Telford Hospitals NHS Trust both cite lack of empathy as one of the causes of the tragedies.[7, 8] Seven years previously, the Francis report into the Mid Staffordshire NHS Foundation Trust concluded that a contributing cause of the hundreds of unnecessary deaths was a lack of empathy.[9] Unsurprisingly, the General Medical Council (GMC) in the UK, which sets the standards for medical student education, holds empathy to be a core value.[10]

Despite its importance, the extent to which patients report that their practitioners are empathic varies widely,[13] and medical student empathy appears to decline throughout medical school.[14] The problem with empathy decline has been reported to persist into post-graduate medicine.

To address the twin problems with lower-than-desirable levels empathy, the new Stoneygate Centre for Empathic Healthcare are developing and implementing five curriculum streams into the Leicester Medical School Curriculum and into postgraduate training:

1. Creating an empathic “hidden curriculum” (through near to peer support, role modelling, etc.). 
2. Patient (stories) during the teaching of pathophysiology. 
3. Empathic, evidence-based communication skills training. 
4. “Walk a mile in your shoes,” where we provide students and healthcare professionals experiences such having them spend the night in the ER.
5. Self-empathy (or wellbeing)

We also have a growing creative health curriculum stream that teaches students and healthcare professionals to write or creatively express themselves.

Aims

To develop, deliver, and evaluate research-based educational interventions, related to the above themes, that promote empathy among medical students and healthcare professionals.

Methods

We use an evidence-based approach for all our curriculum interventions that involve:

• systematic reviews to identify best existing practice;
• qualitative research to refine curriculum plans; and
• rigorous evaluation (where feasible, with controlled trials) of curriculum interventions.

We are committed to achieving and demonstrating impact of our work within the medical school and wider NHS setting; this requires rigorous (usually, mixed methods) implementation science.

Anticipated outputs and impact

The Stoneygate Centre for Empathic Healthcare has connections with medical schools and professional bodies within the UK and abroad, so this doctoral research will have a measurable and important positive impact on both patients and practitioners. Under the directorship of Professor Jeremy Howick, the doctoral student will produce multiple publications each year.

References

1. Howick, J., et al., Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. Journal of the Royal Society of Medicine, 2018. 111(7): p. 240-252.
2. Dambha-Miller, H., et al., Association Between Primary Care Practitioner Empathy and Risk of Cardiovascular Events and All-Cause Mortality Among Patients With Type 2 Diabetes: A Population-Based Prospective Cohort Study. Ann Fam Med, 2019. 17(4): p. 311-318.
3. Thirioux, B., F. Birault, and N. Jaafari, Empathy Is a Protective Factor of Burnout in Physicians: New Neuro-Phenomenological Hypotheses Regarding Empathy and Sympathy in Care Relationship. Front Psychol, 2016. 7: p. 763.
4. Gleichgerrcht, E. and J. Decety, Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PLoS One, 2013. 8(4): p. e61526.
5. Moore, P.J., N.E. Adler, and P.A. Robertson, Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. West J Med, 2000. 173(4): p. 244-50.
6. Street, R.L., Jr., et al., How Communication "Failed" or "Saved the Day": Counterfactual Accounts of Medical Errors. J Patient Exp, 2020. 7(6): p. 1247-1254.
7. Ockenden, D., Ockendend Report: Findings, Conclusions and Essential Actions From the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust. 2022, House of Commons: London.
8. Kirkup, B., Maternity and neonatal services in East Kent: 'Reading the signals' report. 2022, GOV.UK.
9. Francis, R., Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: executive summary 2013, GOV.UK.
10. GMC. Our Strategy 2021-25. 2021  [cited 2023 26/7/23].
11. Decety, J. and J.M. Cowell, Friends or Foes: Is Empathy Necessary for Moral Behavior? Perspect Psychol Sci, 2014. 9(5): p. 525-37.
12. Albuquerque, A. and J. Howick, The moral role of clinical empathy in patient healthcare. Int J Fam Commun Med, 2023. 7(1): p. 11-14.
13. Howick, J., et al., How empathic is your healthcare practitioner? A systematic review and meta-analysis of patient surveys. BMC Med Educ, 2017. 17(1): p. 136.
14. Ponnamperuma, G., S.P. Yeo, and D.D. Samarasekera, Is empathy change in medical school geo-socioculturally influenced? Med Educ, 2019. 53(7): p. 655-665.
15. Hafferty, F.W. and R. Franks, The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med, 1994. 69(11): p. 861-71.
16. Lempp, H. and C. Seale, The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching. Bmj, 2004. 329(7469): p. 770-3.
17. Howick, J., et al., Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies. BMC Med Educ, 2023. 23(1): p. 270.