GP trainees’ conceptual structure of empathy: a qualitative study

Problem

Empathy is important for building a relationship of trust with patients and influences treatment results and patient satisfaction. Despite the importance, clinical empathy has been thought to decrease with the increase of clinical experience. It is suggested that students’ and residents’ empathy do not decrease quantitatively but change qualitatively as they go through clinical experience. Though, it hasn’t been clear how specialty trainees perceive empathy. General practitioners recognise empathy as an essential concept to deal with wide and complicated health problems. Therefore, we aimed to identify how specialty trainees in general practice (GP trainees) perceive empathy.

Approach

We recruited eight GP trainees, and had two focus groups in 2017, one personal interview and one additional interview in 2018. Participants were recruited through convenience sampling. Four ST1 (Specialty Training 1) trainees, one ST2 trainee and three ST4 trainees were all recruited from the department of general medicine of a university in Japan. The transcripts of the discussions were analysed using a qualitative data analysis method called “Steps for Coding and Theorization”. We used Morse’s classification (1992) as a framework to analyse the development of GP trainees’ empathy. The Ethical Committee of Nagoya University Graduate School of Medicine approved the study (approval number 2017-0294-2).

Findings

GP trainees thought empathy indispensable for building a good relationship of trust with patients (Moral). They empathized with patients objectively based on clinical experiences such as conversations with past patients and advice from senior doctors on how to communicate with patients (Cognitive). If GP trainees have patient experiences or experience life events such as pregnancy or giving birth to a child, they empathized with patients subjectively (Emotional). These cognitive and emotional empathy were expressed for patients immediately (Behavioral). However, GP trainees’ fatigue and distress of management to patients with MUS (Medically Unexplained Symptoms) made GP trainees lose emotional empathy and inhibit to show behavioral empathy.

Consequences

We found that GP trainees improved cognitive empathy by getting used to “Reflective Practice” based on clinical experiences, and improved emotional empathy by their own patient experiences because of the “Wounded Healer” effect. We also found that GP trainees’ empathy was negatively affected by MUS management. The possible reason was because GP trainees had not enough experience to patients with MUS, they were frustrated by their own skeptical perspectives to patients’ serious MUS conditions. The conceptual structure of GP trainees’ empathy revealed in this research would be applicable not only to education of empathy for GP trainees but also to stress management encountered by GP trainees. Limitations of this research were that we asked specific GP trainees to participate in this research and the expression of behavioral empathy was not recognized by others.