A recent report by doctors from the University College Cork (UCC), in Ireland, has revealed that the results, which medical students receive in the empathy section of Ireland’s Health Professions Admission Test (HPAT), are not consistent with students’ own self-reported empathy levels.

The test, which is designed to make medical education more accessible to aspiring doctors, evaluates student’s emotional intelligence to ensure they are able to communicate with patients in stressful and difficult situations.

One of the authors of the report, Dr Donnchadh O’Sullivan, wrote that the HPAT should be updated to include an interview or “situational judgement testing” to better appraise potential student’s empathy levels.

The study, which was published in the British Medical Open Journal in August, was conducted during the 2014/15 academic year at UCC. Involving a total of 290 students, it discusses how ‘empathy’ is regarded as one of the most important skills required by the profession.

“Our study doesn’t say the HPAT is useless. It’s just saying that we didn’t find a correlation between the HPAT scores and empathy levels,” asserted Dr O’Sullivan. “From the get-go in medicine we’re taught the most important trait we need is to be kind. It’s essential for getting on with other people and getting on with the patient,” he explained.

According to recent studies, patients whose doctors listen to them and demonstrate an understanding of their concerns comply more with those doctors’ orders – and, are more satisfied with their treatment, as well as enjoying better health.
According to recent studies, patients whose doctors listen to them and demonstrate an understanding of their concerns comply more with those doctors’ orders – and, are more satisfied with their treatment, as well as enjoying better health.

The importance of empathy in medicine

Looking back at the healthcare setting today, it almost appears that the trait of empathy is somehow not widely practised. Most medical students begin their medical practice with much empathy and genuine love—a real desire to help other people. However, in medical school, they learn to mask their feelings, or worse, to deny them.

In a healthcare setting, empathy has been shown to improve the doctor-patient relationship in several ways. In addition, clinical empathy also increases patient satisfaction. According to the Centre for Medical Humanities, Compassionate Care and Bioethics at Stoney Brook University in the US – studies have shown that patients who feel they were treated compassionately by their doctor are more satisfied with their care.

There are also better patient outcomes; including improved patient management of long-term conditions (such as diabetes, pain and anxiety) and better adherence to prescribed treatments and lifestyle recommendations. Patients, when spoken to kindly, tend to comprehend medical information better, as well.

As surprising as it may sound, research has found that doctors who are compassionate make fewer medical errors; and therefore, diagnose better. This could be the reason that compassionate doctors face fewer malpractice claims. Considering that there are modules in medical schools that teach students to develop empathetic skills – one may ask, is there a need for such an entrance test?

Reasons that such a test may be unnecessary

Perhaps the greatest argument against an empathy test is that numerous studies over the years have proven that medical student’s empathy changes over the course of their degrees, most predominantly, decreasing as students become increasing de-sensitised. Continuous empathy classes for the duration of the degree will most likely be more beneficial.

Secondly, as the empathy test is an entrance exam, it is very possible that less-empathetic candidates are taught to give the right answers – empathy by rote learning. Interviews have mostly been stopped because they were criticised for being too open to bias. And, while the standardised approach may be fairer, it might be less useful.

In addition to that, a study performed by researchers from the Department of Public Health and Epidemiology at the University of Birmingham found that existing methods of testing empathy are not sufficiently reliable or valid as a selection method. The study was a review of literature commenting on empathy tests for medical students.

Validity of the CARE Measure

According to the Birmingham study there may be an empathy test that could work. Called the Consultation and Relational Empathy (CARE) Measure, it was developed by the Departments of General Practice in Glasgow and Edinburgh Universities.

Known as a second person measure, the CARE Measure is a 10-minute long questionnaire that measures empathy in the scenario of a ‘one-on-one’ consultation between a clinician and their patient. After having been subjected to psychometric evaluation, it is considered useful. MIMS

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