A closer look into empathy among medical students: The career eulogy as a lens

Background Empathy is widely considered to be key to being an effective physician. The measurement of empathy is important to those designing medical education. The majority of the literature on empathy is based on survey scales that ask the learner to express their degree of agreement with a series of statements. We have previously studied and published an entirely projective measure that we term a career eulogy. Methods We had 65 students based at a regional rural medical school campus complete measures of a career eulogy (CE) and the Jefferson Scale of Empathy (JSE) over their four years in medical school. We then calculated weighted correlations between these two instruments. We also asked students to rank 10 factors that they thought affected student responses about empathy. Results We found a significant moderate correlation of JSE score with mentions of compassion on the CE (r = 0.414, p= 0.001). We also found that women scored higher on both instruments. The only factor showing consensus among students was that the general outlook on life was the most likely factor explaining student empathy responses. Conclusions Mentions in the compassion category on the CE appear to be measuring a concept very similar to empathy on the JSE. Students expressed that factors affecting their responses about empathy are very individual and that only interventions to change the general outlook on life may affect these measures of empathy. Having used the CE for the last five years, we find it to be a brief, very useful exercise both for measurement of empathy and as a group facilitation method in our professional identity curriculum. We welcome others to use our CE instrument in larger and more diverse groups to determine its true value in both measuring empathy and facilitating group process

A Career Eulogy Reflective Exercise: A View into Early Professional Identity Formation

Beginning medical students have a very early idea of what their physician identity will be. Providing a brief structured opportunity to reflect on the end of their career can be an important first step in identity formation. A reflective exercise was used in the summer prior to beginning medical school as each class of students at a regional rural medical school began a summer prematriculation program from 2015-2019. Students wrote what they wished to be said about them at the end of their career using a “Career Eulogy.” Identifiers were removed and narratives were coded into recurring text clusters by the authors. The students, on an anonymous evaluation, strongly agreed that the exercise facilitated the accomplishment of the program goals. Reflections from 42 entering medical students indicated a preference to be remembered for compassion, passion, quality, and patient relationships. Men more frequently mentioned family and enjoying life, and women more frequently mentioned patient relationships. Rural students included quality and being a teacher of medical students more frequently, and those with a physician parent included passion and community more frequently. Those who later chose family medicine as a specialty more often included references to enjoying life and family. This reflective exercise provided useful insight into early professional identity formation among these medical students and served to encourage group discussion. It could be used with larger, more diverse groups to determine its value and clarify true differences among the demographic and specialty choice patterns. This exercise could also be used annually for each student, providing a longitudinal view of identity formation

Keeping Rural Medical Students Connected to their Roots: A “Home for the Holidays” Immersion Experience

Keeping Rural Medical Students Connected to their Roots: A “Home for the Holidays” Immersion Experience Abstract Introduction Preclinical medical students with an initial affinity for rural practice often experience urban disruption during training. Longer summer rural immersion experiences have been shown to be somewhat effective in keeping rural students connected to their rural roots. Some students cannot adapt their schedules to these longer experiences. In response, a brief practice experience near home during the winter break of the academic year was established. Methods Nineteen detailed rural practice assessments were completed by preclinical medical students during school years 2009-2014 and essays and anonymous evaluations of the experience were analyzed. Results All students reported the four components of the experience increased understanding of rural medicine and all but 2 reported it was relevant to their career objectives. These two, at this early stage in training, decided rural practice was not for them and subsequently chose sub-specialty training. Six of the 12 (50%) who have completed medical school chose a family medicine residency. The themes in the essay portion included insights into rural lifestyle, returning home, health system organization issues, and patient expectations and traditions. Conclusions Initial experience with a “home for the holidays” approach for rural immersion of rural medical students was successful in reconnecting these students to their roots, and 17/19 (90%) reported their intention to choose rural practice

Do medical residents with rural upbringing show less decline in empathy during training? A report from a rural family medicine residency

Abstract Purpose Our focus in this study was to determine if demographic variables, including specifically rural upbringing, showed any association with a measure of empathy among family medicine residents at a rural site. Methods We surveyed 40 residents annually using the Jefferson Scale of Empathy (JSE) from 2016 to 2020 and compared scores between residents with rural vs urban hometowns. The response rate was 98/99 (99%) of completed survey opportunities. Findings There was no significant difference in JSE scores of rural vs urban residents at baseline, and both groups showed a decline after the PG-1 year. However, the rural-raised residents showed a significantly different rebound after the PG-2 and PG-3 year, with the urban-raised residents actually showing a slight continuing decline (p=.023 and p=.033). Conclusion These preliminary findings among family medicine residents at a rural site suggest that rural background residents might regain empathy better than urban background residents during the course of their training. Further study should validate our findings and address possible explanations, including the importance of cultural concordance with the patient population served. This and other hypotheses will be explored in further studies with focus groups and other contemporaneous measures

Rural Medical Student Opinions About Rural Practice: Does Choice of College Make a Difference?

Purpose While many programs assume medical students who attended rural colleges are more likely to practice in smaller towns later, there are few studies to support this assumption. This study examines aspects of medical students’ opinions about rural living and rural practice based on where they attended college. Method Students with rural upbringing were identified and administered a previously published rural health opinion survey. The opinion survey was administered across three academic years, from 2015 to 2017, and included a total of three scales and nine subscales for analysis. Factor analysis was used to identify the nine subscales. Results Respondents who attended small town colleges tended to have much stronger opinions about the positive aspects of small town living. Small town college attendees also had stronger positive opinions regarding rural practice than their larger college counterparts. Discussion These preliminary data indicate considering a medical school applicants’ choice of college may provide insight into their opinions about future rural practice. Additional research is needed to collect a larger dataset to examine the association of college choice with opinions about rural practice

Keeping Rural Medical Students Connected to their Roots: A “Home for the Holidays” Immersion Experience

Introduction Preclinical medical students with an initial affinity for rural practice often experience urban disruption during training. Longer summer rural immersion experiences have been shown to be somewhat effective in keeping rural students connected to their rural roots. Some students cannot adapt their schedules to these longer experiences. In response, a brief practice experience near home during the winter break of the academic year was established. Methods Nineteen detailed rural practice assessments were completed by preclinical medical students during school years 2009-2014 and essays and anonymous evaluations of the experience were analyzed. Results All students reported the four components of the experience increased understanding of rural medicine and all but 2 reported it was relevant to their career objectives. These two, at this early stage in training, decided rural practice was not for them and subsequently chose sub-specialty training. Six of the 12 (50%) who have completed medical school chose a family medicine residency. The themes in the essay portion included insights into rural lifestyle, returning home, health system organization issues, and patient expectations and traditions. Conclusions Initial experience with a “home for the holidays” approach for rural immersion of rural medical students was successful in reconnecting these students to their roots, and 17/19 (90%) reported their intention to choose rural practice

Why Medical Students Choose Rural Clinical Campuses For Training: A Report From Two Campuses At Opposite Ends Of The Commonwealth

Introduction Although US medical schools have increased their enrollment by about 30%, most of the increase has occurred in urban areas. The affinity model proposes that rural training of a rural student will more likely result in a rural physician, but the exact role of these rural campuses is unclear. Do they solidify and reinforce a pre-existing career plan, do they create social and marital ties that make the transition to rural medicine easier, or could they be replaced with a briefer and more efficient rural rotation? We administered a questionnaire to students attending two different two year rural clinical campuses in the same state in order to explore their opinions regarding the advantages of a rural campus. Methods Two different rural M3-M4 year clinical campuses, affiliated with different medical schools in the same state, administered surveys to 70 medical students across all four years of medical school. Both schools selectively recruit rural students to the rural campuses, and require a campus decision at admission. Both schools require students to attend their first two years at an urban campus, and transfer to the rural campus for clinical education. Questions addressed student opinions on rural campus location, recommendations from others regarding attendance, campus atmosphere and social life, teaching methods and involvement in patient care. Comparisons were analyzed using the non-parametric Mann Whitney U test. Results The top five reasons students chose a rural campus included three aspects of rural training and two features of being rural. There were small differences between the two campuses regarding the importance of more procedures during training and more outdoor activities, the opportunity to study with friends, and strength of local leadership, reflecting differences in the practice setting and the environment of the two campuses. Differences were also noted between upper-level and lower-level students regarding the importance of studying with friends, and the chances of meeting a future spouse. Finally, very rural students (30 miles from urban area) were less concerned with availability of scholarships, and lack of fine dining, but viewed the opportunity to study with friends more favorably. Conclusions This study adds to the published literature by surveying students at multiple rural campuses by year of training. There were many more similarities than differences, but there were differences between the two campuses, and there were also differences as the students progressed in their training, and differences between very rural students and other students attending the campus. Rural campuses provide both clinical and social support for students contemplating rural practice. Results of the survey indicate both are of importance to the students as well, with quality of training the most important factor

Rural Medical Student Opinions About Rural Practice: Does Choice of College Make a Difference?

Purpose While many programs assume medical students who attended rural colleges are more likely to practice in smaller towns later, there are few studies to support this assumption. This study examines aspects of medical students’ opinions about rural living and rural practice based on where they attended college. Method Students with rural upbringing were identified and administered a previously published rural health opinion survey. The opinion survey was administered across three academic years, from 2015 to 2017, and included a total of three scales and nine subscales for analysis. Factor analysis was used to identify the nine subscales. Results Respondents who attended small town colleges tended to have much stronger opinions about the positive aspects of small town living. Small town college attendees also had stronger positive opinions regarding rural practice than their larger college counterparts. Discussion These preliminary data indicate considering a medical school applicants’ choice of college may provide insight into their opinions about future rural practice. Additional research is needed to collect a larger dataset to examine the association of college choice with opinions about rural practice

Changes In Rural Affinity Among Rural Medical Students As They Experience Education In An Urban Setting

Abstract Introduction The maldistribution of physicians in the United States has led to a shortage of healthcare providers in rural areas and rural patients being underserved. A physician’s connections to rural settings, including upbringing and medical training, often influence the decision to practice in rural areas. This study examines opinions from medical students who participated in a regional rural campus track, which includes summer immersion programs, rural-focused sessions, and clinical rotations. The authors hypothesized that Rural Track students experience urban disruption, and their opinions about rural living and practice would become increasingly less positive over time while students lived at the urban campus for preclinical coursework. Materials and Methods The Rural Health Opinion Survey (RHOS), a previously published measure of opinions concerning living and practicing in rural areas, was administered to students at one public medical school located in Louisville, Kentucky. Factor analysis was performed on each of the three sections of the survey (items related to rural living, patients in rural areas, and physicians in rural areas), and composite subscale scores were calculated for each student. The first phase of this large longitudinal study reported here uses t-tests to compare pre- and post-test scores for 36 students in the Rural Track program. Scores of M1/M2 students who were based at the urban campus were also compared to M3/M4 students who had returned to the rural campus. Results Ninety-two percent (36/39) of Rural Track students completed both pre- and post-surveys, and of these respondents, 89% percent (32/36) grew up in a hometown with fewer than 30,000 people. Overall scores were not significantly different between Rural Track M1/M2 in the urban setting and the Rural Track M3/M4 students based at the rural campus. M3/M4 students showed a differential positive opinion over time of rural comfortable living that approached significance and agreed less that the rural physician workload is heavier. M1/M2 students expressed more positive opinions over time about availability of quality service. Both groups showed strong agreement over time that rural patients are more motivated. Discussion Our hypothesis that Rural Track students on the urban campus would show increasingly less positive opinions about rural health and practice was not supported. Students may not have experienced urban disruption because of the Rural Track curriculum elements, and/or time in the urban environment may have reinforced rural affinity by providing new perspective on the positive aspects of rural settings. Further research and efforts are necessary to identify critical points of reconnection for medical students and to support rural affinity within medical school curriculum. Upcoming research efforts will address the overall hypothesis that Rural Track students’ continued connection to rural settings generates more positive opinions about rural living and practice as compared to opinions from students with rural backgrounds who spend all four years of medical school in the urban setting

Changes In Rural Affinity Among Rural Medical Students As They Experience Education In An Urb

Abstract Introduction The maldistribution of physicians in the United States has led to a shortage of healthcare providers in rural areas and rural patients being underserved. A physician’s connections to rural settings, including upbringing and medical training, often influence the decision to practice in rural areas. This study examines opinions from medical students who participated in a regional rural campus track, which includes summer immersion programs, rural-focused sessions, and clinical rotations. The authors hypothesized that Rural Track students experience urban disruption, and their opinions about rural living and practice would become increasingly less positive over time while students lived at the urban campus for preclinical coursework. Materials and Methods The Rural Health Opinion Survey (RHOS), a previously published measure of opinions concerning living and practicing in rural areas, was administered to students at one public medical school located in Louisville, Kentucky. Factor analysis was performed on each of the three sections of the survey (items related to rural living, patients in rural areas, and physicians in rural areas), and composite subscale scores were calculated for each student. The first phase of this large longitudinal study reported here uses t-tests to compare pre- and post-test scores for 36 students in the Rural Track program. Scores of M1/M2 students who were based at the urban campus were also compared to M3/M4 students who had returned to the rural campus. Results Ninety-two percent (36/39) of Rural Track students completed both pre- and post-surveys, and of these respondents, 89% percent (32/36) grew up in a hometown with fewer than 30,000 people. Overall scores were not significantly different between Rural Track M1/M2 in the urban setting and the Rural Track M3/M4 students based at the rural campus. M3/M4 students showed a differential positive opinion over time of rural comfortable living that approached significance and agreed less that the rural physician workload is heavier. M1/M2 students expressed more positive opinions over time about availability of quality service. Both groups showed strong agreement over time that rural patients are more motivated. Discussion Our hypothesis that Rural Track students on the urban campus would show increasingly less positive opinions about rural health and practice was not supported. Students may not have experienced urban disruption because of the Rural Track curriculum elements, and/or time in the urban environment may have reinforced rural affinity by providing new perspective on the positive aspects of rural settings. Further research and efforts are necessary to identify critical points of reconnection for medical students and to support rural affinity within medical school curriculum. Upcoming research efforts will address the overall hypothesis that Rural Track students’ continued connection to rural settings generates more positive opinions about rural living and practice as compared to opinions from students with rural backgrounds who spend all four years of medical school in the urban setting