How does medical education affect empathy and compassion in medical students? A meta-ethnography: BEME Guide No. 57

Background: Empathy and compassion are important in healthcare delivery, and are necessary qualities in medical students. Aims: To explore medical students', patients' and educators' perceptions of what affects empathy and the expression of compassion; and to address gaps in knowledge, attitudes and skills on how education affects empathy and the expression of compassion in medical students. Methods: The seven steps by Noblit and Hare were used for this meta-ethnography. Databases were searched for studies in English, published from 2007 to 2017 with outcomes of empathy and compassion. Key themes and concepts were identified, and accounts from the studies were used to build interpretations. Findings: Thirty-three qualitative studies were included and four main themes were derived: seeing the patient as a person; appreciating the elements of empathy and compassion; navigating in the training environment; and being guided by ideals. Interactions between the patient, the medical student and training environment which affect the development of empathy and compassion are illustrated in a conceptual model. Conclusions: This meta-ethnography extends our understanding of how medical education affects the expression of empathy and compassion in medical students. The results provide important considerations for medical educators and faculty developers in further developing and improving medical curricula.背景：共情与关怀在医疗服务中至关重要，亦是医学生必备的职业素养。 研究目的：探讨医学生、患者与教育工作者对影响共情与关怀表达的因素的认知，并弥补当前在「教育如何影响医学生共情与关怀表达」相关知识、态度与技能方面的认知缺口。 研究方法：本研究采用Noblit与Hare提出的七步法开展元民族学（meta-ethnography）研究。检索2007年至2017年间发表的英文文献，筛选以共情与关怀为研究结局的相关研究。通过识别核心主题与概念，结合各研究的阐述内容构建解读框架。 研究结果：本研究共纳入33项质性研究，提炼出四大核心主题：将患者视为完整的个体、认知共情与关怀的构成要素、适应培训环境、以职业理想为指引。研究构建了概念模型，阐明了患者、医学生与培训环境三者间的交互作用如何影响医学生共情与关怀能力的发展。 研究结论：本项元民族学研究深化了我们对医学教育如何影响医学生共情与关怀表达的认知。研究结果可为医学教育工作者与师资发展人员进一步优化与完善医学课程体系提供重要参考依据。