Assessing patient experience of the tenets of osteopathic medicine.

CONTEXT: Previous studies document that both osteopathic physicians and third-party observers identify an approach to the patient that is consistent with the philosophy and tenets of osteopathic medicine, often without investigating whether patients identify or are satisfied with it. Osteopathic physicians and the medical education community understand the distinctiveness of an osteopathic approach to the patient. Understanding the outcomes of an osteopathic approach to patient care includes confirming whether patients experience the tenets of osteopathic medicine in physician visits and, if so, how it relates to their experience of physician empathy and satisfaction with the visit. OBJECTIVES: The objectives of this study were to assess patient experience of the tenets of osteopathic medicine, physician empathy, and satisfaction with the visit and to compare the results for patients who saw DOs with those who saw MD physicians. METHODS: More than 2000 patients at four outpatient clinic facilities were surveyed after a clinical visit on 22 prompts regarding their experiences of physician behaviors, physician empathy, and their own satisfaction with the encounter. Adult patients who were treated by an osteopathic or allopathic physician for a nonemergency encounter and who were not pregnant were included in the analysis. Survey results for 1,330 patient-physician encounters were analyzed utilizing linear regression models comparing constructs representing patient experiences of the tenets of osteopathic medicine (Tenets), physician empathy (Physician Empathy), satisfaction (Satisfaction) with the encounter, as well as additional demographic and encounter variables. RESULTS: Approximately 23.8 % of patients approached during the study period completed a survey (n=2,793), and among those, 54.7 % of patients who consented to the study and who saw a physician provider (n=1,330/2,431) were included. Significant (p≤0.01), positive associations among patient experiences of Satisfaction with the visit and Physician Empathy were observed among those who saw both DO and MD physicians. Patients experienced the Tenets during encounters with both DO and MD physicians, but linear regression showed that their experience of the Tenets was significantly (p≤0.01) and positively explained by their experience of Physician Empathy (ß=0.332, p=0.00, se=0.052) and Satisfaction with the visit (ß=0.209, p=0.01, se=0.081) only when the physician was a DO. CONCLUSIONS: Patients identified physician behaviors consistent with the Tenets and positively associated their experiences of Physician Empathy and Satisfaction with the visit regardless of physician training background. Patient experience of the Tenets significantly explained their experiences of Physician Empathy and Satisfaction after visits with a DO but not after visits with an MD.

Clinical Preceptors' Perceptions of Empathy: The Empathy in Osteopathic Training and Education (EMOTE) Study.

CONTEXT: Physician empathy influences rapport with patients and improves outcomes, but it is not well understood as an outcome of osteopathic medical education. OBJECTIVE: To determine how clerkship preceptors at Touro University College of Osteopathic Medicine-CA (TUCOM) in Vallejo define empathy and how they compare observed empathetic behavior of TUCOM students with that of other medical students. METHODS: Cross-sectional data were obtained from a survey of TUCOM clinical preceptors comparing TUCOM students with other medical students on 10 behaviors. Results were analyzed with a 2-tailed z test of proportional difference at the 95% confidence level. RESULTS: Of 650 preceptors contacted, 177 responded and were included in the final analysis (27%). Survey item reliability was high (Cronbach α=0.96). A majority of preceptors (59% to 71%) considered TUCOM students "similar" to other medical students for each behavior. A majority of preceptors (107 [60%]) shared a definition of empathy with one another and with the National Board of Osteopathic Medical Examiners and the American Association of Colleges of Osteopathic Medicine. Approximately 39% of preceptors rated TUCOM students "better" or "advanced" for "displays of empathy" compared with approximately 30% of preceptors who rated students as better or advanced across all 10 behaviors. Preceptors who shared a definition of empathy rated TUCOM students as better or advanced at a significantly higher rate for "displays of empathy" (z=1.982, P<.05) compared with preceptors who did not share a definition (n=70). Osteopathic preceptors (n=67) rated TUCOM students significantly higher on "displays of empathy" (z=2.82, P<.05) and "clear and effective communication to patients, families and co-workers" (z=2.83, P<.01) than did allopathic preceptors. No significant differences were found based on number of years as a preceptor or on the combination of types of students the preceptor taught. CONCLUSION: Most clinical preceptors shared a definition of empathy, and they were able to observe and rate displays of it in clerkship students. Preceptors rated TUCOM students more favorably than other students they taught for displays of empathy.

Correlation Between Standardize Patients' Perceptions of Osteopathic Medical Students and Students' Self-Rated Empathy.

CONTEXT: The use of standardized patients (SPs) promotes and enhances interpersonal skill sets of medical students and provides a critical opportunity for students to display their relational competence during simulated patient encounters. OBJECTIVE: To investigate whether SPs' ratings of osteopathic medical students' empathy and interpersonal skills correlate with students' self-rated empathy. METHODS: The study used a cross-sectional quantitative design. After SP encounters, first-, second-, and third-year osteopathic medical students self-rated empathy using the Jefferson Scale of Empathy medical student version. Standardized patients also assessed students' empathy using the Jefferson Scale of Patient Perceptions of Physician Empathy and interpersonal skills using the Professionalism Assessment Ratings Scale. RESULTS: Of 780 first-, second-, and third-year students, 717 students returned the survey (91.9%). In total, 383 students were women (53.4%) and 334 were men (46.6%). Of 717 SP encounters, SPs returned surveys for 648 encounters (90.3%). Ratings from SPs regarding their perceptions of osteopathic medical students' empathetic abilities and interpersonal skills did not correlate with students' self-rated empathy scores. Second- and third-year students were perceived by SPs as having better-developed empathetic and interpersonal skill sets when compared with first-year students. Results of SPs' ratings indicated that the higher the interpersonal skills, the higher the SP-perceived empathy for students across all years (r=0.66; P<.001). CONCLUSION: Students' self-rated empathy did not correlate with SP-perceived empathy. However, the findings validated that students' core relational competencies increase as they progress through medical school.

Effect of Medical Education on Empathy in Osteopathic Medical Students.

CONTEXT: Empathy is an integral component of the patient-physician relationship and involves a cognitive ability to connect with others in a meaningful fashion. Multiple longitudinal studies have shown that self-reported allopathic medical student empathy declines significantly during year 3. However, to date, only 4 cross-sectional studies have been published on osteopathic medical students' empathy. Whereas studies of allopathic medical students reported a decline in empathy, similar results were not found in osteopathic studies. OBJECTIVE: To investigate (1) self-reported empathy through years 1 to 3 of osteopathic medical students and (2) whether empathy declines during year 3. DESIGN: Design included cross-sectional and test-retest data collection. SETTING: Private osteopathic medical school in the Northeast region of the United States. PARTICIPANTS: Osteopathic medical students. MAIN OUTCOME MEASURE: The Jefferson Scale of Empathy medical student version. RESULTS: Respondents (N=717) included 383 women (53%) and 334 men (47%). When empathy levels were examined by demographics, the only significant finding was that women reported significantly higher empathy levels than men (112.3 vs 109.3; P<.001). Cross-sectional results indicate that mean empathy levels were significantly lower for third-year students at the end of the year (108.7) compared with first- and second-year students at the beginning of the year (111.3 and 112.4, respectively; P<.05). Test-retest analyses of year 3 indicated significantly lower empathy levels from the beginning to the end of the academic year (111.2 and 108.7, respectively; P<.05). CONCLUSION: Osteopathic medical students' empathy declined significantly during year 3, which is consistent with the findings from allopathic samples but differs from findings from osteopathic samples. More research is needed to build the data on osteopathic medical student samples and to achieve a better understanding of changes in empathy in osteopathic and allopathic medical students.