PERSPECTIVE INSTRUCTIONS TO INCREASE STUDENT EMPATHY IN MEDICAL DECISION MAKING

Purpose:

The purpose of this study was to pilot test perspective taking instructions as a potential medical education tool to increase student empathy and reduce cognitive biases in medical decision-making. Perspective taking instructions are an established empathy induction tool in non-medical basic research contexts, in which they have been demonstrated to increase empathic emotions and decrease forms of social cognitive bias in helpers.

Method:

Perspective taking instructions were adapted for a clinician-patient encounter to be piloted via web-based software. The procedure was pretested on a sample of physicians and refined in response to their feedback.

Eighteen fourth year medical students participated in the pilot test.  Each was randomly assigned to receive imagine-self (n = 7), imagine-other (n = 4), or objective (n = 7) perspective instructions.  The students then read a patient case of a middle-aged female patient who described ongoing symptoms of chronic pain and fatigue. Dependent measures included students’ empathic feelings for the patient, and the degrees to which students believed the patient’s condition to be attributable to (a) psychological and (b) physiological causes. Students were also assessed for trait empathy levels.

Result:

One-way analysis of variance with planned contrast coefficients replicated prior findings that the imagine-other perspective led to greater levels of empathic concern for the patient than the imagine-self, t(16) = 1.95, p = .03.  In addition, both the imagine-other perspective (b = .523, p = .007) and trait perspective taking (b = .521, p = .006) were retained as significant predictors of experienced empathic concern in a stepwise multiple regression analysis that included trait measures of empathy, F(2, 17) = 10.87, p = .001, R² = .592, R² = .592, adjusted R² = .54. 

Also consistent with prior research, students assigned to perspective take (either imagine-self or imagine-other) placed greater weight on physiological relative to psychological factors as causes of the patient’s complaint, t(16) = 2.36, p =.03, 95% CI [.21, 3.90], compared to objective students.  

Conclusion:

These initial data support the translational potential of perspective taking instructions for medical education curricula to help students maintain empathic functioning in clinical contexts, and to minimize cognitive biases that could detract from medical decision making.