title: Clinical practice and self-awareness as determinants of empathy in undergraduate education: a qualitative short survey at three medical schools in Germany.
abstract: OBJECTIVE
  Physician empathy constitutes an outcome-relevant aim of medical education. Yet, the factors promoting and inhibiting physician empathy have not yet been extensively researched, especially in Germany. In this study, we explored German medical students' views of the factors promoting and inhibiting their empathy and how their experiences were related to their curricula.
  
  
  METHODS
  A qualitative short survey was conducted at three medical schools: Bochum University, the University of Cologne and Witten/Herdecke University. Students were invited to complete an anonymous written questionnaire comprised of open-ended questions inquiring about the educational content of and situations during their medical education that positively or negatively impacted their empathy. Data were analyzed through qualitative content analysis according to the methods of Green and Thorogood.
  
  
  RESULTS
  A total of 115 students participated in the survey. Respondents reported that practice-based education involving patient contact and teaching with reference to clinical practice and the patient's perspective improved their empathy, while a lack of these inhibited it. Students' internal reactions to patients, such as liking or disliking a patient, prejudice and other attitudes, were also considered to influence their empathy. Although each of the three schools takes a different approach to teaching interpersonal skills, no relevant differences were found in their students' responses concerning the possible determinants of empathy.
  
  
  CONCLUSIONS
  Providing more training in practice and more contact with patients may be effective ways of promoting student empathy. Students need support in establishing therapeutic relationships with patients and in dealing with their own feelings and attitudes. Such support could be provided in the form of reflective practice training in order to promote self-awareness. More research is needed to evaluate these hypothetical conclusions.
authors.affiliation: Witten/Herdecke University, Faculty of Health, School of Medicine, Institute for Integrative Medicine, Integrated Curriculum for Anthroposophic Medicine, Witten, Germany ; Augusta-Kranken-Anstalt, Medizinische Kliniken, Bochum, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ahrweiler
authors.affiliation: Witten/Herdecke University, Faculty of Health, School of Medicine, Institute for Integrative Medicine, Integrated Curriculum for Anthroposophic Medicine, Witten, Germany ; Gemeinschaftskrankenhaus Herdecke, Department of Internal Medicine, Clinical Education Ward for Integrative Medicine, Herdecke, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Scheffer
authors.affiliation: Witten/Herdecke University, Faculty of Health, School of Medicine, Institute for Integrative Medicine, Integrated Curriculum for Anthroposophic Medicine, Witten, Germany.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Roling
authors.affiliation: University of Haifa, Faculty of Social Welfare & Health Sciences, Department of Nursing, Haifa, Isarael.
authors.forename: Hadass
authors.initials: H
authors.lastname: Goldblatt
authors.affiliation: Universitätsklinikum Erlangen, Gesellschaft für Berufliche Fortbildung, Forschung und Entwicklung e.V. an der Medizinischen Klinik 1, Erlangen, Germany.
authors.forename: Eckhart G
authors.initials: EG
authors.lastname: Hahn
authors.affiliation: Witten/Herdecke University, Faculty of Health, Witten, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Neumann
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001364:Awareness; D003142:Communication; D004504:Education, Medical, Undergraduate; D004645:Empathy; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012577:Schools, Medical; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: empathy; medical students; practice-based learning; self-awareness; undergraduate medical education