Assessing institutional empathy in medical settings
DOI:
https://doi.org/10.1558/japl.31861Keywords:
assessment, clinical skills, empathy, prosody, simulation, standardisation, superdiversityAbstract
The use of role-play in standardised medical assessments raises many problems, particularly around the measurement of interpersonal skills such as 'empathy'. Research on the use of simulations has tended to focus on quantified, psychometric assessments of their reliability and validity. However, communication, which often forms a central part of the assessment in medical simulations, is a difficult matter to address through this post hoc analytic method. A sociolinguistic approach to analysing real recordings of simulated medical assessments allows greater insight into communication and interpersonal skills. We use our research on medical licensing exams to illustrate some of the current questions about the examining of such skills through understanding the fine-grained detail of talk. Drawing on Goffman to critique simulated relationships and on Gumperz to analyse the role of differences in communicative style, and based on microanalysis of video-recorded role-players and candidates, we argue that the focus on interpersonal skills in standardised assessments amplifies the problem of using simulated empathy and requires additional interactional work. This focus on interpersonal skills in such assessments can lead to inequalities, since an unfair weight may be put upon candidates trained overseas. The paper concludes that the debate on 'language' in such exams and their standardisation in superdiverse societies needs to be reset.
CC-BY - This work is licensed under https://creativecommons.org/licenses/by/4.0/
References
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Howie J., Heaney, D. and Maxwell, M. (2004) Quality, core values and the general practice consultation: Issues of definition, measurement and delivery. Family Practice 21 (4): 458–468. https://doi.org/10.1093/fampra/cmh419
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Khan, K. Z., Ramachandran, S., Gaunt, K. and Pushkar, P. (2013) The objective structured clinical examination (OSCE): Association of Medical Education in Europe (AMEE) Guide No. 81. Part I: An historical and theoretical perspective. Medical Teacher 35 (9): e1437–e1446. https://doi.org/10.3109/0142159X.2013.818634
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Schumacher, E. F. (1973) Small is Beautiful. London: Blond and Briggs.
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Balint, M. (1970) Quality, core values and the general practice consultation: Issues of definition, measurement and delivery. Family Practice 21 (4): 458–468.
Bleakley, A. (2003) ‘Good’ and ‘poor’ communication in an OSCE: Education or training? Medical Education 37 (3): 186–187. https://doi.org/10.1046/j.1365-2923.2003.01423.x
Blommaert, J. and Rampton, B. (2016) Language and superdiversity. In K. Arnaut, J. Blommaert, B. Rampton and M. Spotti (eds) Language and Superdiversity, 21–48. London: Routledge.
Bonvicini, K., Perlin, M., Bylund, C., Carroll, G., Rouse, R. and Goldstein, M. (2009) Impact of communication training on physician expression of empathy in patient encounters. Patient Education and Counseling 75 (1): 3–10. https://doi.org/10.1016/j.pec.2008.09.007
Boulet, J. R., Smee, S. M., Dillon, G. F. and Gimpel J. R. (2009) The use of standardized patient assessments for certification and licensure decisions. Simulation in Healthcare 4 (1): 35–42. https://doi.org/10.1097/SIH.0b013e318182fc6c
Bouma, H. (2008) Is empathy necessary for the practice of ‘good’ medicine? Open Ethics Journal 2: 1–12. https://doi.org/10.2174/1874761200802010001
Bourdieu, P. (1977) Outline of a Theory of Practice. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511812507
Bradley, P. (2006) The history of simulation in medical education and possible future directions. Medical Education 40 (3): 254–262. https://doi.org/10.1111/j.1365-2929.2006.02394.x
Brannick, M. T., Erol-Korkmaz, H. T. and Prewett, M. (2011) A systematic review of the reliability of objective structured clinical examination scores. Medical Education 45 (12): 1181–1189. https://doi.org/10.1111/j.1365-2923.2011.04075.x
Brown, B., Crawford, P. and Carter, R. (2006) Evidence-Based Health Communication. Milton Keynes: Open University Press.
Burawoy, M. (1998) The extended case method. Sociological Theory 16 (1): 4–33. https://doi.org/10.1111/0735-2751.00040
Campion, P., Foulkes, J., Neighbour, R. and Tate, P. (2002) Patient-centredness in the MRCGP video examination: Analysis of a large cohort. British Medical Journal 325 (7366): 691–692. https://doi.org/10.1136/bmj.325.7366.691
Cleland, J. A., Abe, K. and Rethans, J-J. (2009) The use of simulated patients in medical education: Association for Medical Education in Europe (AMEE) Guide No 42. Medical Teacher 31 (6): 477–486. https://doi.org/10.1080/01421590903002821
Copland, F., Shaw, S. and Snell, J. (2015) Linguistic Ethnography: Interdisciplinary Explorations. Basingstoke, UK: Palgrave Macmillan. https://doi.org/10.4135/9781473910607.n2
De la Croix, A. and Skelton, J. (2009) The reality of role-play: Interruptions and amount of talk in simulated consultations. Medical Education 43 (7): 695–703. https://doi.org/10.1111/j.1365-2923.2009.03392.x
De la Croix, A. and Skelton, J. (2013) The simulation game: An analysis of interactions between students and simulated patients. Medical Education 47 (1): 49–58. https://doi.org/10.1111/medu.12064
ELAN (2017) [Computer software, Version 5.0.0-beta]. Nijmegen: Max Planck Institute for Psycholinguistics. Available online: https://tla.mpi.nl/tools/tla-tools/elan/
Erickson, F. and Schultz, G. (1982) The Counselor as Gatekeeper. New York: Academic Press.
First, L. R., Chaudhry, H. J. and Melnick, D. E. (2013) Quality, cost, and value of clinical skills assessment. New England Journal of Medicine 368 (10): 963–964. https://doi.org/10.1056/NEJMc1301008
Fraser, S. and Greenhalgh, T. (2001) Coping with complexity: Educating for capability. British Medical Journal 323 (7316): 799–803. https://doi.org/10.1136/bmj.323.7316.799
Goffman, E. (1959) The Presentation of Self in Everyday Life. New York: Doubleday.
Goffman, E. (1974) Frame Analysis: An Essay on the Organization of Experience. Cambridge, MA: Harvard University Press.
Goffman, E. (2005) Interaction Ritual: Essays in Face-to-Face Behavior. London: Aldine Transaction Publishers.
Greenhalgh, T. (2014) Future-proofing relationship-based care: A priority for general practice. British Journal of General Practice 64 (628): 580. https://doi.org/10.3399/bjgp14X682357
Grugulis, I. and Vincent, S. (2009) Whose skill is it anyway? ‘Soft skills’ and polarization. Work, Employment and Society 23 (4): 597–615. https://doi.org/10.1177/0950017009344862
Gumperz, J. (1982) Discourse Strategies. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511611834
Halpern, J. (2003) What is clinical empathy? Journal of General Internal Medicine 18 (8): 670–674. https://doi.org/10.1046/j.1525-1497.2003.21017.x
Hoekje, B. (2011) International medical graduate in U.S. higher education: An overview of issues for ESP and applied linguistics. In B. Hoekje and S. Tipton (eds) English Language and the Medical Profession: Instructing and Assessing the Communication Skills of International Physicians, 3–20. Bingley, UK: Emerald Publishing.
Hojat, M., Mangione, S., Nasca, T. J., Rattner, S., Erdmann, J. B., Gonnella, J. S. and Magee, M. (2004) An empirical study of decline in empathy in medical school. Medical Education 38 (9): 934–941. https://doi.org/10.1111/j.1365-2929.2004.01911.x
Howie J., Heaney, D. and Maxwell, M. (2004) Quality, core values and the general practice consultation: Issues of definition, measurement and delivery. Family Practice 21 (4): 458–468. https://doi.org/10.1093/fampra/cmh419
Iedema, R., Jorm, C., Braithwaite, J., Travaglia, J. and Lum, M. (2006) A root cause analysis of clinical error: Confronting the disjunction between formal rules and situated clinical activity. Social Science and Medicine 63 (5): 1201–1212. https://doi.org/10.1016/j.socscimed.2006.03.035
Jamison, L. (2014) The Empathy Exams: Essays. Minneapolis, MI: Graywolf Press.
Khan, K. Z., Ramachandran, S., Gaunt, K. and Pushkar, P. (2013) The objective structured clinical examination (OSCE): Association of Medical Education in Europe (AMEE) Guide No. 81. Part I: An historical and theoretical perspective. Medical Teacher 35 (9): e1437–e1446. https://doi.org/10.3109/0142159X.2013.818634
Konijin, E. (2000) Acting Emotions: Shaping Emotions on Stage. Amsterdam: Amsterdam University Press. https://doi.org/10.5117/9789053564448
Korkiakangas, T, Weldon, S-M., Bezemer, J. and Kneebone, R. (2015) Video-supported simulation for interactions in the operating theatre (ViSIOT). Clinical Simulation in Nursing 11 (4): 203–207. https://doi.org/10.1016/j.ecns.2015.01.006
Kurtz, S., Silverman, J. and Draper, J. (1998) Teaching and Learning Communication Skills in Medicine. Abingdon, UK: Radcliffe Medical Press.
Larson, E. B. and Yao, X. (2005) Clinical empathy as emotional labor in the patient–physician relationship. Journal of the American Medical Association 293 (9): 1100–1106. https://doi.org/10.1001/jama.293.9.1100
Lievens, F. and Sackett, P. R. (2012) The validity of interpersonal skills assessment via situational judgment tests for predicting academic success and job performance. Journal of Applied Psychology 97 (2): 460–468. https://doi.org/10.1037/a0025741
MacWhinney, B. (2000) The CHILDES Project: Tools for Analyzing Talk (3rd edition). Mahwah, NJ: Lawrence Erlbaum Associates.
Malhotra, A., Gregory, I., Darvill, E., Goble E., Pryce-Roberts, A., Lundberg, K., Konradsen, S. and Hafstad, H. (2009) Mind the gap: Learners’ perspectives on what they learn in communication compared to how they and others behave in the real world. Patient Education and Counseling 76 (3): 385–390. https://doi.org/10.1016/j.pec.2009.07.024
Marshall, R. and Bleakley, A. (2009) The death of Hector: Pity in Homer, empathy in medical education. Medical Humanities 35 (1): 7–12. https://doi.org/10.1136/jmh.2008.001081
McManus, I. C., Elder, A. T and Dacre, J. (2013) Investigating possible ethnicity and sex bias in clinical examiners: An analysis of data from the Membership of the Royal College of Physicians (MRCP(UK)) PACES and nPACES examinations. BioMedCentral Medical Education 13: 103. https://doi.org/10.1186/1472-6920-13-103
Mitchell, J. (1983) Case and situational analysis. Sociological Review 31 (2): 187–211. https://doi.org/10.1111/j.1467-954X.1983.tb00387.x
Neighbour, R. (1987) The Inner Consultation – How to Develop an Effective and Intuitive Consulting Style. Lancaster, UK: Kluwer Academic Press.
Niements, N. (2013) From role-playing to role-taking: Interpreter’s role(s) in healthcare. In C. Schäffner, Y. Fowler and K. Kredens (eds) Interpreting in a Changing Landscape: Selected Papers from Critical Link, 305–319. Amsterdam: John Benjamins.
O’Grady, C. and Candlin, C. N. (2013) Engendering trust in a multiparty consultation involving an adolescent patient In C. N. Candlin and J. Crichton (eds) Discourses of Trust, 52–69. Basingstoke, UK: Palgrave Macmillan.
Pedersen, R. (2009) Empirical research on empathy in medicine: Critical review. Patient Education and Counseling 76 (3): 307–322. https://doi.org/10.1016/j.pec.2009.06.012
Roberts, C., Atkins, S. and Hawthorne, K. (2014) Performance Features in Clinical Skills Assessment: Linguistic and Cultural Factors in the Membership Exam in the Royal College of General Practitioners. London: King’s College London with the University of Nottingham.
Roberts, C. and Sarangi, S. (2003) Uptake of discourse research in interprofessional settings: Reporting from medical consultancy. Applied Linguistics 24 (3): 338–359. https://doi.org/10.1093/applin/24.3.338
Roberts, C., Wass, V., Jones, R., Sarangi, S. and Gillett, A. (2003) A discourse analysis study of ‘good’ and ‘poor’ communication in an OSCE: A proposed new framework for teaching students. Medical Education 37 (3): 192–201. https://doi.org/10.1046/j.1365-2923.2003.01443.x
Rubin, D. L., Healy, P., Gardiner, T., Zath, R. C. and Moore, C. P. (1997) Nonnative physicians as message sources: Effects of accent and ethnicity on patients: Responses to AIDS prevention counseling. Health Communication 9 (4): 351–368. https://doi.org/10.1207/s15327027hc0904_4
Schumacher, E. F. (1973) Small is Beautiful. London: Blond and Briggs.
Seale, C., Butler, C., Hutchby, I., Kinnersley, P. and Rollnick, S. (2007) Negotiating frame ambiguity: A study of simulated encounters in medical education. Communication and Medicine 4 (2): 177–187. https://doi.org/10.1515/CAM.2007.021
Skelton, J. R. (2005) Everything you were afraid to ask about communication skills. British Journal of General Practice 55 (510): 40–46.
Smajdor, A., Stöckl, A. and Salter, C. (2011) The limits of empathy: Problems in medical education and practice. British Medical Journal of Medical Ethics 37 (6): 325. https://doi.org/10.1136/jme.2010.039628
Small, M. L. (2009) ‘How many cases do I need?’ On science and the logic of case selection in field-based research. Ethnography 10 (1): 5–38. https://doi.org/10.1177/
1466138108099586
Stepien, K. and Baernstein, A. (2006) Educating for empathy: A review. Journal of General Internal Medicine 21 (5): 524–530. https://doi.org/10.1111/j.1525-1497.2006.00443.x
Stewart, M. (2001) Towards a global definition of patient-centred care. British Medical Journal 322 (7284): 444–445. https://doi.org/10.1136/bmj.322.7284.444
Suchman, A. L., Markakis, K., Beckman, H. B. and Frankel, R. (1997) A model of empathic communication in the medical interview. Journal of the American Medical Association 277 (8): 678–682. https://doi.org/10.1001/jama.1997.03540320082047
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Published
2018-12-31
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Articles
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Equinox Publishing Ltd.
How to Cite
Atkins, S., & Roberts, C. (2018). Assessing institutional empathy in medical settings. Journal of Applied Linguistics and Professional Practice, 13(1-3), 11-33. https://doi.org/10.1558/japl.31861
