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. 2020 May 13;30(2):955-964.
doi: 10.1007/s40670-020-00979-0. eCollection 2020 Jun.

'I'm sorry to hear that'-Empathy and Empathic Dissonance: the Perspectives of PA Students

William F Laughey  1 , Megan E L Brown  1 , Gabrielle M Finn  1
Affiliations

'I'm sorry to hear that'-Empathy and Empathic Dissonance: the Perspectives of PA Students

William F Laughey et al. Med Sci Educ. .

Abstract

Context: Our understanding of clinical empathy could be enhanced through qualitative research-research currently under-represented in the field. Physician associates within the UK undergo an intensive 2-year postgraduate medical education. As a new group of health professionals, they represent a fresh pair of eyes through which to examine clinical empathy, its nature and teaching.

Methods: Working with a constructivist paradigm, utilising grounded theory methodology, researchers studied 19 purposively sampled physician associate students in two UK medical schools. One-to-one semi-structured interviews were transcribed verbatim. Data were analysed using a grounded theory approach.

Results: The global themes were the pathways to empathy, empathy modifiers and empathic dissonance a novel term to describe the discomfort students experience when pressurised into making empathic statements they don't sincerely feel. Students preferred using non-verbal over verbal expressions of empathy. A conceptual model is proposed. The more substantial empathic pathway, affective empathy, involves input from the heart. An alternative empathy, more constrained, comes from the head: cognitive empathy was considered a solution to time pressure and emotional burden. Formal teaching establishes empathic dissonance, a problem which stems from over-reliance on the empathic statement as the means to deliver clinical empathy.

Conclusions: This study furthers our understanding of the construct and teaching of empathy. It identifies empathic barriers, especially time pressure. It proposes a novel concept-empathic dissonance-a concept that challenges medical educationalists to reframe future empathy teaching.

Keywords: Communication; Education; Empathy; Physician associate.

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Conflict of interest statement

Conflict of InterestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Empathy: heart and head—a conceptual model. A number of limiting factors reduce heart (affective) empathy to head (cognitive) empathy, including lack of time, difficulty relating to a patient or thinking their problem is trivial. Cognitive empathy is also seen as a solution to the emotional burden that affective empathy can bring. Cognitive empathy is associated with empathic dissonance, making empathic statements when no real empathy is felt—current teaching and assessment is fueling the problem of empathic dissonance
See this image and copyright information in PMC

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