Longitudinal Integrated Clerkships, empathy and patient centredness: A prospective cohort study

Ethical erosion literature describes medical students’ patient centredness and empathy declines through their clinical years of training. Longitudinal Integrated Clerkships (LICs), an alternate clinical educational design, have been hypothesised to reduce ethical erosion. The authors aimed to measure change in medical students’ patient centredness and empathy at an institution with the largest LIC worldwide. Two whole LIC cohorts (LIC1 and LIC2) were invited to complete a questionnaire, which included patient centredness and empathy scales. Students completed the questionnaire at the start and end of each academic year. Block-rotation students (Non-LIC) were a comparator cohort. Complete cases data were analysed. 22 Non-LIC, 66 LIC1 and 33 LIC2 students responded. Non-LIC students experienced a significant decline in empathy ([start] 113.14 vs. [end] 102.68, <i>p</i>&lt;.001). Empathy did not significantly decline in the LIC cohorts. Patient centredness in LIC1 and LIC2 grew and reduced in the Non-LIC cohort, however, these changes were not statistically significant. This study supports the hypothesis LICs may reduce ethical erosion when compared to block-rotation placements. The results provide evidence that ethical erosion occurs in students who have completed block-rotation placements. This is the first study of UK-based medical students measuring empathy and patient centredness following completion of an LIC.

伦理侵蚀相关研究文献表明，医学生的以患者为中心照护（patient centredness）能力与共情（empathy）能力会在其临床培训阶段逐步下降。纵向整合临床实习（Longitudinal Integrated Clerkships，LICs）作为一种替代性临床教育模式，被学界假设可减缓伦理侵蚀现象。本研究旨在对全球规模最大的LICs教学基地内的医学生进行追踪，以测量其以患者为中心照护能力与共情能力的变化情况。研究邀请了两届完整的LICs队列（LIC1与LIC2）完成一份包含以患者为中心照护量表与共情量表的调查问卷，所有学生均在每学年的期初与期末完成该问卷。采用分段轮转实习（block-rotation）模式的学生（Non-LIC）作为对照队列。本研究对有效完成全部调研流程的受试者数据进行了统计分析。最终共有22名非LIC组（Non-LIC）学生、66名LIC1组学生与33名LIC2组学生完成调研并提供有效数据。非LIC组学生的共情能力出现显著下降（期初得分113.14与期末得分102.68，*p* < 0.001）。而LIC组队列学生的共情能力未出现显著下降。LIC1与LIC2组学生的以患者为中心照护能力呈上升趋势，而非LIC组则呈下降趋势，但上述变化均未达到统计学显著性水平。本研究结果支持前述假设：相较于分段轮转实习模式，LICs可有效减缓医学生的伦理侵蚀现象。本研究结果同时证实，完成分段轮转实习的医学生确实会出现伦理侵蚀现象。本研究是全球首个针对英国医学生，在完成LICs教学后测量其共情能力与以患者为中心照护能力的学术研究。