Empathy is an important quality for medical doctors and highly valued by patients(1). The term describes distinct, cognitive, affective, and behavioural interpersonal reactions including various forms of perspective taking, empathic concern, personal distress, and other congruent emotional and behavioural responses(2). In the context of patient care, empathy is described as a predominantly cognitive attribute involving an understanding of patients’ experiences, concerns and perspectives, and communicating this, rather than sharing patient feelings(3).
The ability of doctors to empathise: to recognise, relate to and understand another’s emotional situation is important to patients(4). Physicians’ empathy has a significant impact on patients’ reporting of symptoms(5), disease outcomes(6), and patient satisfaction and compliance(4). In the present era of patient-centred care, empathy is a key component of a doctors’ professionalism. Producing graduates with a high degree of empathy should be the goal of all medical educators(7).
Despite this, in recent years a lack of empathy among doctors and decline in communication and emotional support from healthcare professionals has been reported(8, 9). There are few Nepal-based studies of student empathy, however, one study found lower empathy scores among Nepali final year medical students than those in developed countries(10). From elsewhere in South Asia: India, Pakistan and Bangladesh, in recent years, there have been several reports on the assessment of empathy in medical students(11–13). These studies point out low levels of empathy and also stress the need to inculcate empathy by means of a formal curriculum.
The question of whether empathy can be taught is much debated, but there is general indication that empathy may be subject to positive change with a range of interventional strategies(14). For many years the lack of educational experiences have been identified as a contributor to low empathy amongst medical students(15). Indeed, traditional medical education often contributes to the problem as students’ empathy and compassion decline during their training(16, 17). Empathy has been shown to increase following different interventions emphasising empathy through: integrating early patient contact with communication and interaction teaching(18), patient narrative and creative arts, writing, drama, and experiential learning(19).
Medical Humanities explores human experiences through the media of arts, literature, drama, music, film and philosophy(20). Medical Humanities courses have been designed and implemented within medical curricula, partially to address the problem of low empathy amongst students(18, 19, 21, 22). Many medical schools across the world have incorporated medical humanities in their undergraduate curricula(23), although these vary greatly in their content. Student empathy has been shown to increase following Medical Humanities teaching(24, 25) and it is likely that Medical Humanities teaching will result in more compassionate doctors(26, 27) although there is currently no evidence to support this(23). Patients, who are the potential beneficiaries of such interventions, have positive views of medical humanities courses(21).
Patan Academy of Health Sciences aims to produce “technically competent, caring and socially responsible physicians who: believe in compassion, love, respect, fairness and excellence, and communicate well with patients, family and colleagues”(28). In 2018 PAHS commenced a new 16-hours-long medical humanities course within the introductory block for first year medical students(29). The medical humanities course explores diverse topics including: social injustice, compassion, death and dying, disability, doctor-patient relationship and the elderly. The course employs various media such as: art, photography, literature, film and poetry. Stimulus material is provided and students engaged in active learning through small group discussion, presentations, poster design and drama(29). Students undertake a disability exposure: inhabiting the roles of carers and physically disabled people, they visit the local area. After the activity students reflect on their experience. At the end of the course students produce individual written reflections and group dramas, exploring their experiences and learning. Medical Humanities teaching is relatively new to Nepal. In other South Asian countries, the idea of introducing Medical Humanities in the medical curriculum has both been pondered on and tried(30–33).
It is important to evaluate the impact of educational interventions, particularly in new contexts. Evaluation can facilitate the development of outcome-based education and provide evidence to support the expansion of medical humanities education within medical schools in South Asia(34). PAHS’ Medical Humanities course is positively perceived by learners who found it enjoyable and interesting, and believed it made them think differently and helped them to understand a doctors’ role in caring; they also felt that it would make them better doctors(29). However, there has been no evaluation of the course’s impact on student empathy.
There is one Nepal-based study measuring the effect of a medical humanities course on empathy, using the Interpersonal Reactivity Index (IRI), which showed an increase in the perspective taking component of empathy but was unclear on the overall score impact(35). There have been no studies in Nepal or South Asia, evaluating student empathy before and after a medical humanities course using the Jefferson Scale of physician empathy.
This study evaluates the empathy levels of a first year cohort of medical students, before and after undertaking a Medical Humanities course. This is a part of a longitudinal cohort study, comparing these students’ empathy scores at different points in their undergraduate training.