How do medical students without formal training in empathy development, understand and express empathy in the context of patient care?

Empathy is an essential element of physician-patient communication. The association between a physician and a patient largely depends on the physician’s ability to empathise with or be receptive to the patient’s emotional state. [1] A physician’s empathy is associated with better diagnostic and clinical outcomes, higher patient satisfaction, better therapeutic compliance and lesser incidences of malpractice complaints. [1-5] Empathy has been diversely defined in the medical education literature. [6] Some researchers describe empathy as an emotion,[7] some as a cognitive attribute,[8] and others consider it a personality attribute. [9] Furthermore, some authors have proposed a two-dimensional framework of empathy, including cognitive and affective components,[10] and others believe that empathy has three dimensions: cognitive, affective or emotional and action components. [11] Some researchers describe empathy by including four dimensions: emotive, cognitive, moral and behavioural. [12] There are researchers who claim that ‘clinical empathy is a complex, multidimensional construct including understanding the patient, reflecting your understanding, checking whether you understand the patient right, and acting upon that understanding in a therapeutic way’. [13] The diverse definitions of empathy share the fact that it is an ability to understand other persons’ thoughts and feelings; however, these definitions differ widely on ‘the ability to share those feelings’. [14] Although empathy is attracting more consideration in the medical field, the knowledge about medical students’ perspectives on their understanding and behavioural expressions of empathy with patients is not well developed. [3,4] Moreover, many studies have confirmed an empathy erosion in medical students during their undergraduate education. [4,15-19] Therefore, investigating medical students’ perspectives on various aspects of empathy is paramount to improving medical education and healthcare standards. Unfortunately, the exploratory studies considering students’ views are limited, and quantitative studies employing self-administered questionnaires have not furnished a profound conceptualisation of the beliefs and experiences of students regarding empathy in the context of patient care. Therefore, the rationale for this research was to gain a conceptualisation of empathy and its expressions from medical students’ perspectives. The study was carried out at a medical school in Mauritius. Formal training to enhance empathy development in medical students does not form part of the medical curriculum. Therefore, the study intended to explore how medical students with no formal training in empathy development: (i) understand the nature of empathy; (ii) value empathy in patient care; and (iii) express empathy in diverse situations. Background. Empathy is a crucial component of clinical practice and professionalism. Quantitative studies have reported empathy erosion in medical students. However, studies investigating medical students’ perspectives on their understanding and behavioural expressions of empathy with patients are limited. Objective. To explore medical students’ perspectives on the nature, significance and expressions of empathy during their undergraduate training. Methods. The study used a qualitative phenomenological approach. Twenty-five (out of 45) medical students were invited to participate. Semi-structured online interviews were conducted to elicit experiential details from participants. The recorded interviews were transcribed verbatim, and data were analysed using Braun and Clarke’s thematic analysis method. Results. Students described their beliefs and understanding of empathy and reflected on the process of empathising with patients. Most students defined empathy as having four interrelated and overlapping dimensions: cognitive, affective, behavioural and moral. In addition, they believed that empathising with patients was a bidirectional relational process, necessitating empathic inclination, adequate time, a non-judgemental approach and effective communication and listening skills. Conclusion. Empathy is more than a personal attribute; it is a multifaceted, dynamic and bidirectional relational process. Adequate time, support, stress management strategies, formal training and encouragement from experienced teachers are crucial elements to fostering genuine or deep empathy in medical students. Furthermore, students should be trained in developing emotional regulation and maintaining an appropriate balance between professional detachment and empathic connections.