Senior Residents’ Conceptual Structure of Empathy: A Qualitative Study

Problem

Showing empathy is an essential skill for physicians. It influences patients’ outcomes, and conveying empathy to patients is also important in encouraging them to disclose their concerns. But in spite of the importance, prior studies demonstrate a longitudinal decrease in empathy during residency. To these findings, Aomatsu (2013) found a qualitative change in students’ and residents’ empathy as they go through clinical experience. To continue this study, we identified senior residents’ conceptual structures of empathy.

Approach

In 2017, we conducted a qualitative study with two focus group discussions in which three and four senior residents participated separately. Recruitment of study participants was done through convenience sampling. They were all recruited from the department of general medicine of a university in Japan. The transcripts of the focus group discussions were analysed using a qualitative data analysis method called “Steps for Coding and Theorization” (SCAT). We used Morse’s classification (1992) as a framework to analyse the development of senior residents’ empathy. The classification is described as: (1) emotive: The ability to subjectively experience and share in another’s psychological state and emotions; (2) moral: An internal altruistic force that motivates the practice of empathy; (3) cognitive: The intellectual ability to identify and understand another’s emotions and perspective from an objective stance and (4) behavioural: Communicative response to convey understanding of another’s perspective.

Findings

Senior residents thought that it was indispensable to show empathy for gaining patients’ trust (moral). To accomplish this, they shared their emotions with patients (emotive) and even when they couldn’t, they expressed empathy (behavioral) according to their evaluation of patients’ physical and mental health status (cognitive). Medical training enhanced senior residents’ cognitive empathy. Non-occupational experiences like marriage and childbirth enhanced emotive empathy.

Consequences

As they get older, senior residents go through new life experiences. For example, having a child gave them the point of view of a mother. These non-occupational experiences seemed to enhance their emotional part of empathy. On the other hand, occupational experiences like watching the consultation of a good role model, or remembering past patients they have examined themselves before, seemed to enhance the cognitive part of empathy. A limitation of the study is that it uses data collected from a convenience sample from a single university. Overall, this study suggests that senior residents have a qualitatively different conception of empathy compared to residents and medical students. We hope that a better understanding of these differences contributes to future postgraduate education.