Improving empathy of physicians through guided reflective writing

Anita D. Misra-Hebert1, J. Harry Isaacson2, Martin Kohn2, Alan L. Hull2, Mohammadreza Hojat3, Klara K. Papp4 and Leonard Calabrese2

1Louis Stokes Cleveland Veterans Affairs Medical Center, USA

2Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, USA

3Department of Psychiatry and Human Behavior, Center for Research in Medical Education and Healthcare, Jefferson Medical College, USA

4State University of New York Downstate College of Medicine, USA

Submitted: 03/10/2011; Accepted: 06/04/2012; Published: 09/04/2012

Int J Med Educ. 2012; 3:71-77; doi: 10.5116/ijme.4f7e.e332

© 2012 Anita D. Misra-Hebert et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0

Objectives: This study was designed to explore how guided reflective writing could evoke empathy and reflection in a group of practicing physicians.

Methods: Total participants recruited included 40 staff physicians at Cleveland Clinic, a tertiary care academic medical center. Twenty physicians (intervention group) were assigned to participate in a 6-session faculty development program introducing narrative medicine and engaging in guided reflective writing. Ten physicians (comparison group 1) received the assigned course reading materials but did not participate in the course sessions. Ten physicians (comparison group 2) neither received the reading materials nor participated in the sessions. Qualitative analysis of the physicians' reflective writings was performed to identify major themes. The Jefferson Scale of Empathy was administered three times during the course.

Results: Qualitative analysis of physicians' writings showed themes of both compassionate solidarity and detached concern. Exploration of negative emotions occurred more frequently than positive ones. The most common writing style was case presentation. A total of 36 staff physicians completed the Jefferson Scale of Empathy. Results of statistical analysis suggested an improvement in empathy in the intervention group at the end of the course (p < 0 .05).

Conclusions: These results suggest a faculty development program using guided narrative writing can promote reflection and may enhance empathy among practicing physicians. These findings should encourage medical educators to design additional strategies for enhancing reflection and empathic behavior in trainees and specifically practicing physicians who can role model these behaviors to achieve the ultimate goal of improving the quality of patient care.