Does medical students' personality have an impact on their intention to show empathic behavior?

Several studies have demonstrated a correlation between specific personal traits and empathy. However, it is not clear if persons with certain personality traits lack the intent to show empathic behavior or if other factors independent of their intent are affecting their empathic behavior. To answer this question, we asked 132 medical students to fill out questionnaires evaluating the General Intention to Show Empathic Behavior (GISEB) and the five personality traits measured by NEO Five-Factor Inventory (NEO-FFI). Additionally, we evaluated the influence of other factors, such as age, gender, curricular progress (second versus fourth year), and preferred specialization after graduation. We performed a Pearson's correlation and a regression analysis. Results indicate that the five personality traits and gender have little influence on the General Intention (GISEB), only extraversion (r = .221, 95% CI [.013-.394], p = .027), and agreeableness (r = .229, 95% CI [.021-.428], p = .022) correlated with the intention. The only predictor for General Intention (GISEB) was curricular progress (ß = - .27, p < .05), showing a decrease of General Intention to Show Empathic Behavior from second to fourth year of university (U = 1203.5, p = .002). A further finding indicates that gender and personality influence the students' wish of specialization after graduation: Agreeableness (F(12, 53) = 2.376, p = .016) impacted the preferred specialization. Our study demonstrated that medical students' personality might not notably impact the intention to show empathic behavior. Further research is needed to investigate moderating effects.

Standardized patients in psychiatry - the best way to learn clinical skills?

BACKGROUND: Standardized patients (SP) have been successfully utilized in medical education to train students' communication skills. At the Medical University of Vienna communication training with SPs in psychiatry is a mandatory part of the curriculum. In the training, the SP plays the role of four different patients suffering from depression/suicidal tendencies, somatoform disorder, anxiety disorder, or borderline disorder while the student attempts to gather the patient's medical history. Both the instructor and SP then give the student constructive feedback afterwards. METHOD: The aim of the study was to evaluate the quality of the SP's roleplay and feedback, using a self-created questionnaire. Additionally, we wanted to gauge the differences between the students' and teachers' evaluations of the SP's role playing performance and feedback. RESULTS: The questionnaire was completed by 529 students and 29 teachers who attended the training. Overall, both students and teachers evaluated the SPs' performance and feedback very well. In comparison to the responses given by the teachers, more students reported that the "SP overacted" while fewer students believed that the "SP could be a real patient". The feedback given by the SP was evaluated similarly by students and teachers, suggesting that students are able to recognize the quality of constructive feedback. Furthermore, the SP's quality of roleplaying was evaluated as the poorest while playing the psychiatric disorder "depression/suicidal tendencies." CONCLUSIONS: Our study showed that students and teachers appreciate SPs' competence of role play and of giving feedback. However, further studies should be performed to figure out why both students and teachers alike evaluated the played psychiatric disorder "depression/suicidal tendencies" to be the worst.

Transference and countertransference: A review.

Originally a psychodynamic concept, the therapeutic relationship (also therapeutic alliance, helping alliance or simply alliance) has become a pan-theoretical model for the professional relationship between a therapist and his or her client (Kivlighan, 1995). With the development of this concept in the latter half of the 20th century, psychotherapeutic theory and practice saw a paradigm shift away from strict adherence to technique with little room for responsive, individual behavior from the therapist and toward the "authentic" human relationship at the core of therapy. This meant that more consideration was given to the idea of mutual influence from patient and therapist to the success of therapy (Safran & Muran, 2006). This article aims to provide a comprehensive overview of the complex and shifting research on the therapeutic relationship to promote a greater understanding of the concept.

Empathy in Psychoanalysis and Medical Education - what can we learn from each other?

BACKGROUND: Several research areas, including medical education (ME), focus on empathy as an important topic in interpersonal relationships. This focus is central to the use of communication skills related to empathy and even more crucial to provide information in a way that makes patients feel more involved in the treatment process. Psychoanalysis (PA) provides its initial concept of empathy based on affective aspects including findings from neuroscience and brain research. Enhancing cooperation between ME and PA can help to integrate both aspects of empathy into a longitudinal training program. DISCUSSION: The condition of psychoanalytic empathy definitions is the understanding of unconscious processes. It is important to primarily attend especially the dominant affects towards the patient before interpreting his or her behaviour, since in explaining the emerging affects, the analyst has to empathize with the patient to understand the (unconscious) reasons for its behaviour. A strong consideration of nonverbal communication, clinical perceptions, intuitive interaction, contagion-like processes and their implementation and empowerment in medical and therapeutic curricula is one way of beneficially using interdisciplinary approaches to yield empathy in clinical interaction. CONCLUSION: Established methods of PA, like training of containment, reflective functioning, affective holding and giving meaningful interpretations in accordance with countertransferential and transferential aspects may help to put a focus on the clinican-patient-interaction and the preservation of the physicians' (mental) health. In consequence of the discussion of various training methods that take the theoretical and practical concepts of empathy into account, we aim for an implementation of the named methods in the medical curricula.

Dimensions of Activity in Countertransference and Therapist Reactions: Therapist Reactions During Sessions with Depressed Patients.

OBJECTIVES: This paper presents the interaction structure between the therapist's countertransference and the patient's affect based on identified dimensions of how therapists feel and react during sessions with depressed patients. METHODS: 639 sessions were audio-recorded and rated by trained raters. These recordings were obtained from the Munich Psychotherapy Study and analyzed with the PQS, the AREQ, and the TRQ/CTQ. RESULTS: Seven components with good to excellent internal consistency (Cronbach α = .745-.902) were found and labeled Hostile Feelings, Positive, Disengaged, Overwhelmed and Encroaching Feelings concerning countertransference and therapists' emotional reaction, while the therapist's behavior was scored on separate dimensions. The middle and final sessions reveal significant correlations between a patient's positive affect experience and positive countertransference. CONCLUSIONS: The confirmed pattern implies not only that a positive affect is related to a positive countertransference reaction, but also that a positive countertransference entails a positive affect. The fact that this pattern could be accounted for only during the middle and the last sessions indicate that the working alliance is not fully established at the beginning of the treatment.

Psychiatrists' emotional reactions: Useful for precise diagnosis in adolescence?

Therapist response (countertransference) can be defined as the range of emotions a clinician experiences when interacting with a patient. Previous research has shown that this reaction plays an important role in the establishment of the therapeutic relationship, and that certain psychiatric disorders are systematically related to strong countertransference reactions in clinicians. For this study, 30 videotaped sessions were retrospectively analyzed by one observer using the Therapist Response Questionnaire (TRQ). The authors aimed to investigate the differences in therapist response between an adolescent case group consisting of 19 patients diagnosed with a cluster B personality disorder (PD), and a control group composed of 11 adolescents diagnosed with anorexia nervosa. The PD group scored significantly higher on the hostile/mistreated, helpless/inadequate, disengaged and overwhelmed/disorganized factors. This study adds evidence to the preexisting empirical literature on therapist response in regard to personality disorders and emphasizes the continuing need for recognition of countertransference across all psychotherapy orientations.

Transcendence, religion and spirituality in medicine: Medical students' point of view.

To explore how medical students-the doctors of tomorrow-reflect upon meeting the spiritual needs of their patients, and whether they have reflected on their own religious or spiritual beliefs, or not. The study also investigates to what extent the students feel comfortable with addressing spiritual issues in their patient care, and whether they feel this is beyond their role as medical doctors.A self-administered questionnaire was developed. The survey was administered in teaching classes at the medical university of Vienna. One thousand four hundred (836 women and 564 men) students responded, laying the foundation for a thorough statistical analysis.59.5% of the students had reflected on their own belief concepts, 21.9% consider themselves religious, and 20.1% see themselves as spiritual individuals. 75.6% of the students agreed with the statement that religious conviction/spirituality might have an effect on how cancer patients cope. 85.9% would consider talking with their patients about religious/spiritual issues if patients wish to do so. 86.3% would involve chaplains if they feel it is necessary.The results of this study suggest that future doctors want to see the patient in a wider scope than the bio-psycho-social one, by including the meta-dimension of transcendence.

Significance of gender in the attitude towards doctor-patient communication in medical students and physicians.

BACKGROUND: Gender-specific differences in the attitudes towards doctor-patient communication among medical students and physicians were assessed. METHODS: A total of 150 medical students and 51 physicians from different departments took part in the study. The association, attitude and experiences regarding doctor-patient communication were assessed with a series of tools and questionnaires. RESULTS: Female doctors and students tended to describe the doctor-patient communication with positive attributes, such as "helpful", "sentimental", "voluble", "sociable", "gentle", "yielding" and "peaceful". Male students and physicians, on the other hand, described doctor-patient communication as "overbearing", "robust" and "inhibited". The most frequent associations females had with the term doctor-patient communication were "empathy", "confidence", "openess", while the most frequent association of the male colleagues was "medical history". Female doctors reported speaking about the psychosocial situation of the patient significantly more often and believed in higher patient satisfaction by sharing more information. Furthermore, they reported having longer conversations with a more equal partnership than their male colleagues. Compared to male students, female students were willing to take part in training their communication skills more often and had more interest in research about doctor-patient communication. Male medical students reported self-doubt during conversations with female patients, while one third of the male physicians talked about "the power over the patient". CONCLUSIONS: This study indicates a gender-dependent communication style influenced by stereotypes. At the establishment of communication training these differences should be taken into account, especially to strengthen male communication skills and improve their attitudes.