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Long-term effects of empathy training in surgery residents: a one year follow-up study

Margot Phillips, Aine Lorie, John Kelley, Stacy Gray, Helen Riess


Objectives: This study is a 1-year follow-up investigation of the retention of the knowledge, attitudes and skills acquired after empathy training.

Methods: Eight otolaryngology residents completed 5 assessment measures before and after empathy training and at 1-year. They attended a 90-minute focus group assessing clinical usefulness of the training, attitudes and factors that affect empathy.

Results: Qualitative analysis revealed a positive response to the training and application of skills to clinical practices. Quantitative analyses suggest improvement in empathy after training was maintained at 1-year follow-up (p = 0.05). Knowledge of the neurobiology and physiology of empathy remained significantly greater than before the training (p = 0.007). 

Conclusions: Qualitative data indicate that the training program was well-received and helpful and follow-up focus groups provided physicians with opportunities for self-reflection and support from peers. 

Quantitative analysis demonstrated that improvement in self-reported empathy and objective knowledge of the neurobiology of emotions persist at 1-year follow-up. Accordingly, we recommend that empathy training and follow-up booster sessions become a standard component of residency training.


Burnout, communication skills, emotional engagement, emotional wellbeing, empathy, empathy training, idealism, improved clinical outcomes, long term effects, patient satisfaction, person-centered medicine, professionalism, sociocultural barriers, surgery

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Hojat, M., Mangione, S., Nasca, T.J., Rattner, S., Erdmann, J.B., Gonnella, J.S. & Magee, M. (2004). An empirical study of decline in empathy in medical school. Medical education 38 (9) 934-941.

Hojat, M., Vergare, M.J., Maxwell, K., Brainard, G., Herrine, S.K., Isenberg, G.A., Veloski, J. & Gonnella, J.S. (2009). The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Academic Medicine 84 (9) 1182-1191.

Bellini, L.M., Baime, M. & Shea, J.A. (2002). Variation of Mood and Empathy During Internship. Journal of the American Medical Association 287 (23) 3143-3146.

Bellini, L.M. & Shea, J.A. (2005). Mood change and empathy decline persist during three years of internal medicine training. Academic Medicine 80 (2) 164-167.

Nunes, P., Williams, S., Sa, B. & Stevenson, K. (2011). A study of empathy decline in students from five health disciplines during their first year of training. International Journal of Medical Education 2, 12-17.

Krasner, M.S., Epstein, R.M., Beckman, H., Suchman, A.L., Chapman, B., Mooney, C.J. & Quill, T.E. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. Journal of the American Medical Association 302 (12) 1284-1293.

Shanafelt, T.D., Bradley, K.A., Wipf, J.E. & Back, A.L. (2002). Burnout and self-reported patient care in an internal medicine residency program. Annals of Internal Medicine 136 (5) 358-367.

Hickson, G.B., Federspiel, C.F., Pichert, J.W., Miller, C.S., Gauld-Jaeger, J. & Bost, P. (2002). Patient complaints and malpractice risk. Journal of the American Medical Association.287 (22) 2951-2957.

Virshup BB, Oppenberg AA, Coleman MM. Strategic risk management: reducing malpractice claims through more effective patient-doctor communication. American journal of medical quality : the official journal of the American College of Medical Quality. Jul-Aug 1999;14(4):153-159.

Riess, H., Kelley, J.M., Bailey, R., Konowitz, P. & Gray, S.T. (2011). Improving Empathy and Relational Skills in Otolaryngology Residents: A Pilot Study. Otolaryngology - Head and Neck Surgery 144 (1) 120-122.

Mercer, S.W., Maxwell, M., Heaney, D. & Watt, G.C.M. (2004). The consultation and relational empathy (CARE) measure: Development and preliminary validation and reliability of an empathy-based consultation process measure. Family Practice 21 (6) 699-705.

Hemmerdinger, J., Stoddart, S. & Lilford, R. (2007). A systematic review of tests of empathy in medicine. BMC Medical Education 7 (1) 24.

Hojat, M., Mangione, S., Nasca, T.J., Cohen, M.J.M., Gonnella, J.S., Erdmann, J.B., Veloski, J. & Magee, M. (2001). The Jefferson Scale of Physician Empathy: Development and preliminary psychometric data. Educational and Psychological Measurement 61 (2) 349-365.

Mehrabian, A. & Epstein, N. (1972). A measure of emotional empathy. Journal of Personality 40 (4) 525-543.

Ekman, P. (2004). Emotions revealed: Recognizing faces and feelings to improve communication and emotional life. New York: Holt, Henry & Company.

Strauss, A.L. (1987). Qualitative analysis for social scientists. New York: Cambridge University Press.

Glaser, B.G. (1992). Basics of Grounded Theory Analysis: Emergence Vs. Forcing. Mill Valley CA: Sociology Press.

Hafferty, F.W. & Franks, R. (1994). The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine 69 (11) 861-871.

Flores, G. (2000). Culture and the patient-physician relationship: achieving cultural competency in health care. Journal of Pediatrics 136 (1) 14-23.

Betancourt, J.R. (2003). Cross-cultural medical education: conceptual approaches and frameworks for evaluation. Academic Medicine 78 (6) 560-569.

Schouten, B.C. & Meeuwesen, L. (2006). Cultural differences in medical communication: a review of the literature. Patient Education and Counseling 64 (1-3) 21-34.

Rosen, J., Spatz, E.S., Gaaserud, A.M., Abramovitch, H., Weinreb, B., Wenger, N.S. & Margolis, C.Z. (2004). A new approach to developing cross-cultural communication skills. Medical Teacher 26 (2) 126-132.

De Maesschalck, S., Deveugele, M. & Willems, S. (2011). Language, culture and emotions: exploring ethnic minority patients' emotional expressions in primary healthcare consultations. Patient Education and Counseling 84 (3) 406-412.

Cundiff, N.L. & Komarraju, M. (2008). Gender differences in ethnocultural empathy and attitudes toward men and women in authority. Journal of Leadership & Organizational Studies 15 (1) 5-15.

Magalhaes, E., Salgueira, A., Costa, P. & Costa, M. (2011). Empathy in senior year and first year medical students: a cross-sectional study. BMC Medical Education 11 (1) 52.



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